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Home My WebLink AboutEHPR-11-09-2543.TIF THIS IS NOT 'A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment El I . Name to Appear on Permit 7)0 n u J eJ 5~,~~a~► 2. Permit Requested By Business Phone 7~~[ -Y9G-a 7.1 t Address l inq O q ~<aC,W+A)G 1J 019- ✓ _Sc ti r e % Home Phone 70q -GI-6-67fry 3. Property Owner Business Phone Address Home Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address I, Gg 1 L m r Directions to Property: r1 l /Y\,- ~Cl ~V~P r`r ~ 0 ~S I5~ ~ 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home t/ Dimension of Structure bO X 1i Bedrooms*- *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.iis .nce. This may `prevent the need for system size increase in the future. Basement: yes „o Water Using Fixtures in Basement: yes No. in Family ' Whirlpool Tub ye / o Gallon Capacity vv MULTIPLE FAMILY RESIDENCES: Units 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 to Facility? Yes No If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes 1o If so, describe: t/ 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 i 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 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 PROPERTY, THERE IS AN ADDITIONAL CHARGE." Date (/1 - 5 -0 7 Signature of Owner or Agent C'~-~ ~ j(; 'Z THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services r IP F- AC F- S.T. Rpr. S.T. Exp. r Exist. S. T. I- Well Permit F- Replacement Well 1. Name to Appear on Permit: 12 ~ c 2D A 2. Permit Requested BY: I er+~ct- %2- So 17-v0 Business Phone: 1 r ~ Address 1 I0 ~ K N OX r op V -Z- Home Phone: 3. Property Owner: T. Business Phone: Address f~3~ v&U ~-~0 i7 C49L'r ~HomePhone: -P~ ~ cry >c IZ D ► 3 ~ ~ ~r' ~ 4. Name of Subdivision: Lot Section/Block/Phase: Property Address: 65~ I ~+iQ ~s rya ago ~(o t i 5~(~ b Directions to Property: 0" OOu Q~, Le UJ ',0 ¢ i-1 {-p ~L.oc G O v P~v~.G t 5. Property Size: Square Feet F-Acres 7 1 Date Platted/Recorded 6. TYPE OF FACILITY: House (V/"Mobile Home Dimension of Structure 1N01-;e Bedrooms*F *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 the house plans as a bedroom at the time of building permit issuance. This may prevent the need for system size increase in the future. Basement: C~ Yes (F/No Water Using Fixtures in Basement: C' Yes C' No No. in Family: Whirlpool Tub: C' Yes 60 Gallon Capacity: MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square Feet Dining Area F Square Feet Food Stand/Meat Market Floor Space F TYPE OF BUSINESS: No. of Employees 1st F-2nd F- 3rd F-- OTHER : (Specify) 7. Do you anticipate any additions to Facility? n Yes C' No if so describe l~ ~vb Catawba County, North Carolina This mcrp produce wns pr'epcned from the Catawba Couniv, NC, Geographic b forrnatimr Svs/em. N Catawba Comav has mcrcle substantial efforts to easure the accrtrac>> of location and labeling info! malion conta}ned on Ibis map. Catawba County promotes and recommends the independent verification ofanr clala conloined on Ibis map produce by the user. I ere Comm! of Catmrba, ils employees, ggenls and personnel disclaim, and shall rrol be held liable f<n' am- and all damages, loss or liahilify, s+'ltether direct, indirect or consequential which arises or mw arise from this map product or (lie use !hereof bt' anv person or enlih'- legend Selected Parccl Number: 3696-07-59-=1466 1 inch = 60 feet Prepared for: r Dc) e5 fl o °(1 n o c.~ c LARGE G U L LY~,'/~ r 1, 91 o, 2498 7 T f Qi:o 90 \O tl r` 5394 l at 19-2 s/~o `J I•_ - _ p THIS IS NOT A LEGAL DOCUNIENT I'hutsday, November 05, 2009 11:52 Ai~1 A na ~ CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3696-07-59-4466 Name: KENT THOMAS EVERETTE LFI Name2: Address: 1535 VANCOUVER DR Address2: City: CHARLOTTE State: NC Zip: 28213-5413 Account: 37939150 Calc Acreage: 0.71 Tax Map: 016 X 02025 LRK: 16850 Deed Book: 1880 Deed Page: 1291 Subdivision Name: EMERALD ISLES UNRECORDED Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 6581 Street Name: EMERALD ISLE DR Site Zip: 28673 Township: MOUNTAIN CREEK Fire Code: SHERRILLS FORD City Code: COUNTY State Road: 1977 Total Bldgs Value: Land Value: $11,100 Total Value: $11,100 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 129 Watershed: WS-IV Critical Area Watershed Split: NO Voter Precinct: P31 E911 District: COUNTY Zoning: R-30 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: CRC-O,WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: SHERRILLS FORD Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011502 Census Block 2010: 3046 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Thursday, November 05, 2009 12:20 PM A C~ CATAWBA COUNTY, NC 100-A South West Blvd PLAN INVOICE F Newton, NC 28658- U 465-8399 Thursday, November 5 2009 184 sM www.catawbacountync.-ov Plan Case: EHPR-11-09-2543 Invoice Number: I NV-1 1-09-257037 Environmental Health Plan Review Invoice Date: 11/05/2009 Fee Name Fee Amount Existing Tank Check Fee Fixed $80.00 Total Fees Due: $80.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 11/05/2009 Check 1003 $80.00 $0.00 Total Paid: $80.00 Total Due: $0.00 p!;;r !ncn:: h--,,Id.3s-•I-i r-I1ca,' :h?'11, !d, 11/05/2009 12:25