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Home My WebLink AboutEHPR-10-09-2285.TIF THIS IS NOT A PERMIT # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check k]---llew Well Permit ❑ Rep~l-,acement Well E] Well Abandonment El 1. Name to Appear on Permit ;ti"K/ ' 4 , 4 IQ - 2. Permit Requested By Business Phone S2f1- 3/6 Address 2 -S4 671f-e- /I IV_ 15 - J~ a Home Phone ?--2-<,L11 i 73, 3. Property Owner r' Business Phone Address 5.0 .51 Home Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address _ Directions to Prope> x- S 5. Property Size: Square Feet Acres y~ Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure Bedrooms* 3 *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 buildingpermit issuance. This may prevent the need for system size increase in the future. Basement: yes ~o Water Using Fixtures in.elt: ye /no No. in Family Whirlpool Tub ye no Gallon Capacity MULTIPLE FAMILY RESIDENCES: Uni s Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square Feet Dining Area -Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions t Facility? Yes /No If so, describe: ~iE;1 8. Has any grading, removal, or addition of soil been done to this pro e ? Y4/ No,) If so, describe: 9. Are there easements/right-of-ways recorded on this property . Yes/ ~O- 10. Is a public water supply available on or adjacent to the above erty Yes No Check type that is available: [ ] Community well [ ] Semi-public well [ ounty/City/Township water line **If No, a Well Permit must be issued with the Septic Permit.** 11. Well Type Applying For: [ ] Individual well [ ] Community well [ ] Semi-Public well I understand that this is a formal application for a well permit, Improvement Pen-nit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is valid for 5 years or may be non-expiring under certain specified conditions. Improvement Permits and Well Permits are transferable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE OPERTY, THERE IS A TI AL CHARGE" Date Signature of Owner or Agent ss~' Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geographic Information System. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this map product by the user. The County of Catawba, its employees, agents and personnel disclaim, and shalt 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 product or the use thereof by any person or entity. Legend Selected Parcel Number: 3714-06-39-2441 1 inch = 60 feet Prepared for: ,i LTI -3'6 3 3 O p 5 O F' 2500 o0 D454 ' N 4 r 24\4 ~o 00 P 11 ~ 22a 3 3 x 7 1 i (p 67' Qi G~'•`~_ 1. y ~ =r,;:-----"" 4343 85 45.00 311 THIS IS NOT A LEGAL DOCUMENT Thursday, October 22, 2009 03:18 PM Y RESIDENTIAL APPLICATION FOR ZONING / GRADING PERMITS Hickory Office (828) 323-7410 (A City of Hickory application becomes a permit upon approval Cowity Zoning Office (828) 465-8380 Hickory Fax (828) 323-7474 by a City of Hickory Zoning Administrator.) County Zoning Fax (828) 465-8484 Ifproposed land disturbance is 1 ACRE or MORE, applicant must obtain Erosion & Sedimentation Control Plan approval from Catawba County, Erosion 8c Sediment Control. (828-465-8161) Parcel Identification No. . 77~--/Z\ 3 Date Project 911 Address: 22,~ /v The building or land was previously used for: Proposed use or change to this building or land: to r/O/V ~j Applican //yln4/y -1 le ~ It -Z ~T Applicant's telephone No. Applicant's Address: Applicant's Fax: A plicant's Email 3i173 Property Owner:,t--4, 6#1 G ~ /J T, . Owner's Tellee hone No.:C~~ Owner's Address: ZV ALL BUSINESSES OPERATING IN THE CITY LIMITS T HAVE A PRIVILEGE LICENSE This Permit is performance-orl5 . Property owner is resp s' 1 f r taking any additional measures not shown on the approved plan to prevent er o and offsite sedimentation. ` Applicant's Signat C a Date / _ ZZ FOR OFFI AL USE ONLY ZONING CENSUS TRACT 40t Front Setback Size of Lot Approved PD Side Street Setback Lot of Record Approved Minor PD Side Setback Use Permitted Elevation Certificate Required Rear Setback Flood Plain - - Maximum Height 40 Watershed _ 123 4 Protected Critical Other (Describe): Zoning/Grading Permit Approved: Date: ko i Zoning Administrator Conditions of Approval: Zoning/GratAing Permit Disapproved: Date: Zoning Administrator Reasons For Disapproval: Rev031909 Received By: Date EHPR-10-09-2285 TRACKING INFORMATION Date Calls 10-26-09 1st Contact - Discussion Only 10-27-09 Site Ready to be Flagged 10-27-09 Site Flagged 10-27-09 Site Ready to be Evaluated 10-27-09 Site Evaluated Approved for Issuance Other Date Comments/Field Notes y,A G CATAWBA COUNTY Case # EPHR-10-09-2285 Subdivision Public Health Department t Environmental Health Division Section/B1/Ph/Lot# PO Box 389, 100A Southwest Blvd, Newton NC 28658 PIN# 1,84 2 sr+ (828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200 Applicant/Owner Jimmie White Jr. Site Address: 4220 1 St NE Hickory Property Size: Directions: EXISTING SYSTEM INSPECTION REPORT Site/System Diagram 1'3 14bil ~sr Type of Facility : House 7 Mobile Home I-1 #Bedrooms 3 Business n Specify Other Specify Proposed Additions/Accessory Structure: Sunroom Approved ❑ Not Approved ® Reason Proposed sunrooln location is overtop of existing drainfeild Evidence of System Malfunction : YES ❑ NO ® System Type/Description 2a- bed 10-27-09 AUTHORIZED STATE AGENT DATE NOT FOR LOAN ~A7PPR7~O~7VA7-L ~7 7~ r777~r7~ 1.17ECK p ,,7 C--.\Documems and Settings\jenghsh\Loca1 Settings\Temporary Internet 7~ 1'tleS\Content.OutT look\1 rOJVV9G6\EXIS1G TA~71V11 2205.Uocx