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HomeMy WebLinkAboutEHPR-03-2016-23387.TIF BA THIS IS NOT A PERMIT Case # EHPR-03-2016-23387 ict-' part G 1-4 Kuala a CATAWBA COUNTY HEALTH DEPARTMENT v\. ;'°�' % PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r 2842 sM Environmental Health Plan Review - OSWP p •I' -D 0 IMPROVEMENT- AUTH CONST- EXPANSION •l t a+ Owner RUSSELL HEDRICK, 4155 SECTION HOUSE RD, HICKORY NC 28601 C:80353043I5 NAME TO APPEAR ON PERMIT Russell Hedrick SITE ADDRESS: 1750 33RD ST NE, HICKORY NC 28601 PIN # 372315644742 NAME of SUBDIVISION: RUSSELL ERNEST HEDRICK Lot# 1 Section/Block PROPERTY SIZE: Square Feet 44,866.80 Acres 1.03 DIRECTIONS: Springs Rd to 25th Ave NE, Turn onto 33rd St NE, drive to the end of 33rd St NE, Right on Concrete Driveway PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Public Water DESCRIBE WORK: *Putting a new Barn on the property beside him. Property is zoned for Agricultural use. New Barn 50x80 -will have a sink, toilet, shower- Requires an additional 240 gallons/day *Existing system's drain field is now cut off of the property & will need to be brought into compliance by a change in property line or septic easement. SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF House EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 94x53 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Barn w/sink, toilet, shower 50x80 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-chapplicaticn 03/14/2016 11:07 Page 1 or4 .e•• CATAWBA COUNTY Case EHPR-03-2016-23387 if • Y. ®� Public Health Department Subdivision Yi t RUSSELL ERNEST HEDRICK Q ; q �,, Environmental Health Division PIN# 372315644742 ''� PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 79t s� NAME ON PERMIT: ( RUSSELL HEDRICK),4155 SECTION HOUSE RD, HICKORY NC 28601 ( Russell Hedrick) Site Address: 1750 33RD ST NE, HICKORY NC 28601 Property Size: Square Feet 44,866.80 Acres 1.03 Directions: Springs Rd to 25th Ave NE,Turn onto 33rd St NE, drive to the end of 33rd St NE, Right on Concrete Driveway Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws ar d- •es unders1;, •• t a •lely responsible for the proper identification and Vla—beling of all property lines and corners and making the site ac es • - so at a cow••'•e - + e - .rte can •e performed Date: 3--( r 1 (Q Signature of Applicant or Agent ,_ // An Environmental Health Specialist will contact you,C in 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 Y il @n M-k.:;7a fz 1: ri F g i 3 In me n ii FEENAEJ ist t M m * . . : Ei DATE w +rFEE 4MOUNTaw Authorization to Construct Fee (New/Expansion) 03/14/2016 $300.00 Fee Improvement Permit Fee ,�S• i , g 03/14/2016 $150.00 tigiB" ?TOAE EEES4 I t s a f P RID` M-x r 3 1 450 4 "t5tlt, o tatat . . ti rai ti a'a Poiitli4 tnnigNi S wk « ` " i, gio, FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 03/14/2016 11:07 Page 2 of 4 CATAwBA THIS IS NOT A PERMIT courTY vv � aa� CATAWBA COUNTY HEALTH DEPARTMENT tl Application for Environmental Services Page 1 Improvement Permit Authorization to Construct n Septic Repair r Septic Malfunction r Septic Expansion .New Well Permit n Replacement Well n Well Abandonment Well Repair n Existing System Inspection (Pre-Approval Required) n Application is for New Construction n Existing Facility n * Property Address I�S) ��(1 5-t-- /()(i Subdivision (1)•64)1P/04•6 -r'vior I-riCiAory .it/C c:9€.62(51 Lot# Acres Section/Block/Phase Driving Directions to Property $V(j✓lt Id. �fj �G Jf✓t U✓r'}'o 3S r s 1 ✓I/f dr il.).� -1-0> end, 0P 7D61 ✓c f- OWN CovICte+e- c4 NAME TO APPEAR ON PERMIT? Owner n Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name Rusc 11 RJ'ic1.t Address (5 Ga S C c:93 • Phone 803 - 30- l{3i5- Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT?9wner ❑ Applicant n Contractor Description of Existing Structures on Site S in e • 'I Y 5 .4J NIN #of Bedrooms *t 3 Structuretimensions _ 'dot-Occupants 5 Basement Ej Yes n No Basement Fixtures n Yes n No _ The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes 181 No Does the site contain any jurisdictional wetlands? fz3 Yes ❑ No Does the site contain any existing wastewater systems? ❑ Yes No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes % No Is the site subject to approval by any other public agency? ❑ Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use n Individual Well n Community Well n Semi-Public Well &County/City/Township Water Line Is a public water supply available? ** PCI. Yes ❑ No If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other ❑ Any CATAVY BA THIS IS NOT A PERMIT , co Iry ... CATAWBA COUNTY HEALTH DEPARTMENT ,, ,,,,n, Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence n New Residence 7 Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement n Yes ❑ No Basement Fixtures Yes n No ikAccessory Structure(s) Describe Tirrrt O$JJ_ Frifyl #of New Bedrooms *t if applicable 0 Structure Dimensions SO Xr # of Occupants 0 Accessory Dwelling n Yes R. No `, Plumbing E Yes ❑ No Describe Plumbing Needed r,-p xil a64rumm _ f,i1c ><oi/c11 ShoLL -A n Multi-Family Residence# Units #Bedrooms per Unit*t Total # Bedrooms *t Structure Dimensions n Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church#of Seats Kitchen n Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well n Community Well Abandonment Type n Drilled n Bored ❑ Dug n Unknown Well Repair Requested n Yes n No Describe Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on-site staff. *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications. The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. t If structure is plumbed but no bedrooms, calculated design flow is required. ** If No, a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for(5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site Ai accessible so that a complete site evaluation ca. : performed. / / Signature of Owner or Agen _ Date P I I (1 rr11 II t Printed Name of Owner or Agent 055-€ i I E t- d i1 c Catawba County Environmental Health , / ^6_ ; -, ), / tilli 662 J J et' Apt 1 °ry 173) a- ry lg'- 4°4) �3 4Uive 060 ° ,ah 0 100 y 60 ,„, _co r,„,, 0 06., . a f .m.p is ., a ` / / / a & 1I * y>. ` ir. 7 O N a O 3 $ / o, -- S ry a a / a / o Parcel: 372315644742, 1750 33RD ST NE 1in=80ft HICKORY, 28601 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct, indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 03/14/2016 Di cf(r WM (652 o r 1, • \ / 60 0 173} 8 0 e p y Q ry 79.23? T Ng o 0 700 et., J'J 320 I/ 27 111 20 so co o •1754 7 O p' 50 l ph. h o �' a (30 ^oo I q.. Parcel ID: 37231 5644742 ,o LRK/REID: 56406 ' / "' I I750 33RD ST NE / mp i HICKORY,28601 / ,: j HEDRICK RUSSELL E / , Zoning District- HICKORY Zoning: R-1 r i Zoning Overlays: NONE Iiii / ^- 01 Parcel Report �.i List all owners l / A-, n Deed History Report-. --, I Assessment Report / ,1�^�/ \ google binv �u»�- : .._.USIBUi '.. &Gak€ h i+flWLmi°, .. -ex:. . .... '-. .,... ,.-.,,,.. (♦ak `W.S k c� I s1 VIc htoji3aIn 5, nt. , ID; lit Pei mqe,cld S hove(.> o 3pd del MC oent Ives st be Likrnh,`1,5 Of Fij)n5 inh) eyiSI;, b(O,,t3kf ,Ath c ua— ta_, S ft/Cktn iti i5 QrroS prvpe/ 1-9 lGll- l 1 ne. NUC Foie Comb at- jfl&pe"ier WIe Aso r or c� lb m r ac t, �:�LcLue d At 4 e,,�gt Parcel Report Page 1 of 1 Parcel Report - Catawba County NC • Parcel Information: Owner Information: Parcel ID: 372315644742 Owner: HEDRICK RUSSELL E Parcel Address: 1750 33RD ST NE Owner2: City: HICKORY, 28601 Address: 4155 SECTION HOUSE ROAD LRK(REID): 56406 Address2: Deed Book/Page: 3167/1554 City: HICKORY Subdivision: RUSSELL ERNEST HEDRICK State/Zip: NC 28601-9394 Lots/Block: 1/ Last Sale: School Information: Plat Sale: ge: 72/74 School District: COUNTY Legal: LOT 1 PLAT 72-74 Elementary School: WEBB A MURRAY Middle School: ARNDT Calculated Acreage: 1.030 Tax Map: 165H 07050 High School: ST STEPHENS Township: HICKORY School Map State Road#: 1576 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: ST STEPHENS Zoningl: R-1 Building(s) Value: $114,200 Zoning2: Land Value: $14,500 Zoning3: Assessed Total Value: $128,700 Zoning Overlay: Year Built/Remodeled: 1962/ Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710372300J Building Details 2010 Census Block: 2029 WaterShed: 2010 Census Tract: 010303 Voter Precinct: P28 Agricultural District: PROXIMITY Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/repan product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2015, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=372315644742&typ=P 3/14/2016 _o f H �p \ CATAWBA COUNTY 0 0 Cate y ,o• •, OP-10-2012-031660 Mil -44 Public Health Department - • Subdivision < o ^ Environmental Health Division e p—� r - PINd 372315644742 ° PO Box 389 r G., 100-A Southwest Blvd,Newton,NC 28658 " " r E y O LOT# -. 0 Ls A 1-1 NAME ON PERMIT: COOL PARK PUMPING INC, 1535 VICTORIAN HILLS CIR, CONOVER NC 28613 Site Address: 1750 33RD ST NE, HICKORY NC 28601 Property Size: Square Feet 17,424.00 Acres 0.4 Directions: SPRINGS RD TO 27TH ST PL NE LEFT ONTO 19TH AV NE RIGHT ONTO 33RD ST NE Catawba County Health Department Operation Permit System Type: IIIG - OTHER NON-CONV TRENCH SYSTEMS (In accordance with Table Va) 0 Description: 25% REDUCTION 9) Types V and VI systems expire in 5 years. Owner must contact health department 6 months prior to exiration for permit renewal. System Installation Comments: PERMIT CONDITIONS: 1. All maintenance, monitoring, and performance requirements shall be in accordance with 15A NCAC 18.1900, Rule .1961 2. Operation & Maintenance Specifics: Yes No X Subsurface system operator required? If yes, see attached sheet for additional operation conditions, maintenance and reporting. This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and All conditions of the Improvement Permit and Construction Authorization. Kelly Isenhour#1099 09/26/2012 SYSTEM INSTALLER INSTALLATION DATE Megen McBride 10/01/2012 AUTHORIZED STATE AGENT DATE OF OPERATION PERMIT ISSUANCE Form F E9-chpermit 10/022012 10:56 Page I of6 OP 3I1)t;06-2oQ.-15$77 1-60 334 sl. N E S S ^ 41 II%1IZ \DiI I"', y r1—VSCA41004 101.irks-1416i. I ew( ¶4 -t�nw t$\ 4( q R(h Gra # }}off uses r6i i c N1ev-}er. 0 to. ITanK r 3 bed -- hoost. 4 33r.1 5. NE CATAWBA COUNTY Case# AUTH-06-2012-029085 �� Y Public Health Department Subdivision < . °o<. Y Environmental Health Division PIN# 278220916924 �.'` PO Box 389, 100-Aa Southwest Blvd.Newton.NC 28658 LOT# NAME ON PERMIT: COOL PARK PUMPING INC, 1535 VICTORIAN HILLS CIR, CONOVER NC 28613 Site Address: 1750 33RD ST NE, HICKORY NC 28601 Property Size: Square Feet 17,424.00 Acres 0.4 Directions: SPRINGS RD TO 27TH ST PL NE LEFT ONTO 19TH AV NE RIGHT ONTO 33RD ST NE Authorization to Construct Permit Authorization to Construct Wastewater System (Required for Building Permitl * See site plan and number of additional attachments( ). Proposed Wastewater System: 25% REDUCTION Wastewater Flow 360 9P d Type: IIIG - OTHER NON-CONY TRENCH SYSTEMS Soil LTAR: 0.3 g.p.d./ft2 Permit Category: Repairs Type of Facility: Primary Residence - house Basement? Yes Basement Plumbing? No Bedrooms: 3 Wastewater System Requirements Tank Size: Existing Tank Unknown Size Pump Tank gal Grease Trap gal Dosing Volume gal Pump Specs: GPM @ TDH Pressure Head ft Draw Down in Drainfield: Total Area: 900 sq ft Total Length: 300 ft Maximum Trench Depth 28 in Aggregate Depth in Trench Width 3 ft Minimum Soil Cover 12 in Minimum Trench Separation 9 ft on center Number of Drain Lines 3 Distribution: Serial Pre Treatment: NONE Additional Specifications: Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains, is not approved, and may result in failure to approve the initial system installation, or the suspension/revocation of existing permits. >>>>> DO NOT INSTALL SYSTEM UNDER WET CONDITIONS <<<<< Proposed Repair System Class: Proposed System: Distribution Type:: Soil LIAR: g.p.d.tft2 L9-ehpemut 06/28/2012 10:10 Page I of 8 ryz' • CATAW'BACOUNTY Case II AUTH-06-2012-029085 :fa , Public Health Department Subdivision 4 x>e>f Environmental Health Division PIN# 278220916924 �s'v°' PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# NAME ON PERMIT: COOL PARK PUMPING INC, 1535 VICTORIAN HILLS CIR, CONOVER NC 28613 Site Address: 1750 33RD ST NE, HICKORY NC 28601 Property Size: Square Feet 17,424.00 Acres 0.4 Directions: SPRINGS RD TO 27TH ST PL NE LEFT ONTO 19TH AV NE RIGHT ONTO 33RD ST NE The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This • Authorization to Construct Permit is subject to revocation if the site plan, plat or the intended use changes,or if site conditions are altered. The Authorization to Construct Permit is not affected by a change in ownership of the property. This permit was issued in • compliance with the provisions of the North Carolina 'Laws and Rules for Sewage Treatment and Disposal Systems' (15A NCAC 18A .1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given orriod of time Megen McBride 06/28/2012 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 06/27/2017 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. 1:9-ehpermit 06/28/2012 10.10 Page 2 of 8 A(,-Rejair Ulf- 6 -20(2- 15t'T7 1750 33rd S+ NE Hrckay ii 7-c is Ok -b \SG .4i1i exis-liAtI cepkic, IG4 so twat a5 ►-is i4aci- I Skyuckurail Sound Tf it is o-Wer ,s`c-, Cn rromis Inuit a new j c'5ul 414. I*skal1 re I a Crier `ir Oa \ 4• 1);5tohti`etV 66k And WRAC( TiDO Ott- u 1 3b0 fR• DV 2550 P-taut-ilC/n -On co'^iovr. 1 n ZhS� rE" SAtucA-oas, 15f1- fvor" V,ser cvls, SDI, from ,� S�s�e.rh M�� �- 5 {l� -f r W cr \ s, �o k cm,- proper limes, a y well, 1��. {�or� � � � -k oo IAA cx qe, y4r, CuA, o✓ -ail\ oVev sides- once ins t a. 206.3• C `" U M 4— W Task 1 3 be�roa^ how j 1 0 I 0 33r4 SI. iiE I,4' DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES • Shod—41— DIVISION OF FNVIRONN.ENIAL HEALTH PROPERTY ID t ON-SITE WASTEWATER SECTION COUNTY: SOUISLTE EVALUATION AppI�t��, _forON-SITE WASTEWATER STEM _ O 4 Laol Par{[ TurApin3 tic• APPLICATION DATE '' fl- {t•Alr21NL 1517 ADDRESS: .1 DATE EVAWATED; 2L-IL PROPOSED FACILTrY: PROPOSED DESIGN FLOW(.1949): 3L0 - PROPSLIYSize LOCATION OF STTE:-175° 37 • NE titter-my PROPERTY RECORDW WATER SUPPLY: 0 Pd;ate N Public a Well 0 SEcing U Other EVALUATION DEMO: 0 Auger Boxing B Pit U Cut . • TYPE OF WASTEWATER: ® Sewage U Indust:id Proms 0 Df:nd • Rik' '=L':i;i E3i[':=': ; _�iEi;':I ; ,r L • —'- — --' =__. -- --.,....._..._ .. :S6ITx11$I1�t)�:C1��__ ':-_:__; �_e :e;1:_.._ ._ � ';l .;: ei9' E: l ..........._....F-:_--.`:i` _.........-._. _ _�1'a'--1.- _tea:: . $EJ1ioxi Tr. _...:.::;; �,�:t �g :;'.f1Id1:':::. :_: ' _ 1ilf_- _s_�__:ita�_.-i�fr"•'s_v;?Je� 1�et'= - �2:}r PDSIIION! inrr L O U =t �„ tea- ,�7 _- _`'-•.:SLOP__&RE _..{ff?7:.::: ::_.: `� i_. ..._ _.t�at,_E_I�yT_,ti Y'.. .. .______._:___ °.. ,>- ,.. _ _ --=;- 0-4 SL. -r rtss. Vxe �} ND Gi-. sk.t - ¶r,ss. SfKp • 1 sure,small - yo p 3 ir(1vS«s of 9# • • • • • 2 • • 3 • • 4 DESCRIPTION SYSTEM REPAIR SYSTEM OMRFAACTPRR(.1946) 48k SITE CLASSIFICATION Available Spa(. 945) I"�� EVALUATED BY: ''C- 4O�'� Sytm rude) OTE R(S)PRESENT: 1LL. Site LIAR 0.3 COMMENTS: • 1r 11Tgnik 140v54- I 33ta Si. Ni; (tout t ASo1 drvesi) (Na hhSc4(e) s$A C( CATAWBA COUNTY h 100A SOUTHWEST BLVD Ida 14 NEWTON,NORTH CAROLINA 28658 RECEIPT ® PHONE: 828.465.8399 c.) `s v�®q ''C Monday, March 14, 2016 /842 sM www.catawbacountync.gov PAYOR: Hedrick, Russell PAYMENTS TRANSACTION NUMBER: TRC-637173-14-03-2016 PAYMENT DATE : 03/14/2016 PAYMENT TYPE: Check 1688 INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326113 Improvement Permit Fee $150.00 03;161326113 r eiS j f)4 ` %, 'A uttio'rilation,to,C'onstruct:Fee E, t= _ -3S300:00? (New/Expansion) Fee TOTAL PAYMENTS : $450.00 EHPR-03-2016-23387 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 1750 33RD ST NE, HICKORY NC 28601 Owner RUSSELL HEDRICK, 4155 SECTION HOUSE RD, HICKORY NC 28601 C:8035304315 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 03/14/2016 11:06 Page 1 of 1