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Home My WebLink AboutEHPR-10-09-2321.TIF -A - THIS IS NOT A PERMIT Case # EHPR-10-09-2321 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 184 SM Environmental Health Plan Review - OSWP APPLICANT DOWNER - CONTR'ACTO/ i Ro,-'er Dale 'Ro er Dale I v. s 4. NC NC. 828-302-5965 828-302-5965 NAME TO APPEAR ON PERMIT Roger Dale Pin#: 372307598583 SITE ADDRESS: 2560 NE 31ST ST DR, Hickory, NC DIRECTIONS: SPRINGS RD GOING NORTH/ LT 21 ST LN NE/ LT 31 ST st dr ne/ 2ND HOUSE ON LEFT NAME of SUBDIVISION: RANDOM WOODS Lot # 3 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.379 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure _ Bedrooms 3 Basement: Yes Water Using Fixtures in Basement:Yes No. in Family Whirlpool Tub Gal Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.00j Total Number of Bedrooms DAYCARE: Number of Children t` 0.00 ' Square Feet Foodstand/Meat Market Floor Space RESTAURANT: Seats 0.00 Square Feet Dining Area TYPE OF BUSINESS: Number of Employees'. 0.00 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: Has any grading, removal, or addition of soil-been-done to this property? 3' If so, describe i Are there easements/right-of-ways recorded on this :property? Type of Water Supply: Individual Well Community Well Municipal X Semi-Public I understand that this is a formal application for a well permit, Improvement permit 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 transferable and may be eligible for a non-expiring date, but may be revoked if.this information, site plans or intended use changes for the proposed facility. A Well Permit and 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. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 0 FEE NAME" DATE AMOUNT Side 0 AuthorizaLiuil w onstrucl iRwair) FdO/23 200y $30C~.1Ju Rear 0 TOTAL FEES $300.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 10/26/09 09:25 ' THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair Septic Expansion El Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit O GE/2 D ),d l L 2. Permit Requested By 0 IA)ArC`(k Business Phone E.'R B--31)A Address .2-5-6 0 Y Home Phone ~S,;,S 3. Property Owner Business Phone Address Home Phone 4. Name of Subdivision &fi? A/ Q0 J 60000-5 -Lot # Section/Block/Phase Property Address sm8,601/ Directions to Property: IVC~ -r -:;4 41, _ 5 L27 I\/ / 2YP s6~ 5. Property Size: Square Feet Acres ,.3 Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure Be_drooms* Anv loom that will be inteiidc;l for slecpin'-, :11 the time of construction or toi future considct,mon ~Iw[ild be not(-'d as a _ bodroom and counted of all appiicatioiis. I l]c number ol'bedrooms :11 1) c'i Firmcd I-, room. iLlcniiIicd on h~~ii~: plans as a b Broom at he timeNoi bBaseme t imet'i , ucn This may prC evt tl ncc.l (or_ \ <t"111 'ire R IC e ,c in the llitur . m.. Deno Water Using Fixtures in Basement: yes no No. in Family_ Whirlpool Tub ye:mo Gallon Capacity MU TIPLE AMILY RESIDENCES: Units Total Number of Bedrooms DAY A" c: Number of Children RESTA RANT: Seats Square Feet Dining Area -Square Feet Food stand/Meat Market Floor Space TYP USINESS: Number of Employees Ist 2nd 3rd OT R: ( ecify) 7. Do you anticipate any additions to Facility? Yes / No If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes / No If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes / No 10. Is a public water supply available on or adjacent to the above property? Yes / No Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/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 Permit 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 Pen-nits 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 CREDESIGNED AND/OR RETRIPS MADE TO THE PR TY, THER IS AN ADDITIONAL CHARGE.** Date 20 / Signature of Owner or Agent 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 Countypromotes 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 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 product or the use thereof by any person or entity. Legend Selected Parcel Number: 3723-07-59-8583 I inch = 60 feet Prepared for: ,l 77671 t. rbN 1 - 61 ~rb0609/ 761 X583` ° 7662`' ,moo ~ 1 7 8424 79 7~ 7931 76s 97 ~7 \ x,6 o , 7 9357 X7- THIS IS NOT A LEGAL DOCUMENT Friday, October 23, 2009 04:38 PM CATAWBA COUNTY, NC 100-A South West Blvd 8658- PLAN INVOICE Newton, NC 28658 oar®' (828)465-8399 Friday, October 23, 2009 1g-4Z SM www.catawbacountync.gov Plan Case: EHPR-10-09-2321 Invoice Number: INV-10-09-256560 Environmental Health Plan Review Invoice Date: 10/23/2009 Fee Name Fee Amount to. Construct ~F~epair) Fee . AdjustablE S ;OO:UO_ Authorizatiori, Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change `10/2312009 Check 1021; $300.00" $0.00 Total Paid: $300.00 Total Due: $0.00 plan invoice;67c8e1bb= fda-toad-a~'lbi-79~0112COM211.1pt 10/23/2009 !6:47