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Home My WebLink AboutEHPR-11-09-2615.TIF THIS IS NOT A PERMIT Case # EHPR-1 1-09-2615 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services Ig~2 SM Environmental Health Plan Review - OSWP EXS_SYSTEM APPLICANT OWNER CONTRACTOR HENRIETTA HUFFMAN HENRIETTA HUFFMAN 7183 RH RD 7183 RH RD HICKORY NC 28602 HICKORY NC 28602 NAME TO APPEAR ON PERMIT HENRIETTA HUFFMAN Pin#: 277002881546 SITE ADDRESS: 7183 RH RD, Hickory, NC DIRECTIONS: OLD SHELBY RD - TURN RIGHT ONTO HENRY RIVER RD - TURN LEFT ONTO RH RD - 2ND ON LEFT NAME of SUBDIVISION: HENRIETTA HUFFMAN Lot # I Section/Block/Phase PROPERTY SIZE: Square Feet Acres 6.77 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 30 X 38 Bedrooms 3 Basement: No Water Using Fixtures in Basement:No No. in Family 2 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.00 Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: NO Has any grading, removal, or addition of soil been done to this property? If so, describe NO Are there easements/right-of-ways recorded on this property? NO Type of Water Supply: Individual Well X Community Well Municipal 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: //-//)-09 Signature of Applicant or Agent t/y" 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 FEE NAME DATE AMOUNT Side Existing Tank Check Fee 11/10/2009 $80.00 Rear TOTAL FEES $80.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 11/10/09 11:00 THIS IS NOT A PERMIT wLS # CHjfd ~1 ZS CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair El Septic Expansion F] Existing Tank Check 0 New Well Permit E] Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Per it A-1 2. Permit Requested By Gw _ r 11i114 Q c 7 Business Phone A114 Address 71k2 , IC14 - 1711e'ko -V ?,f - "GL Home Phone JeZr-325/ 4033 3. Property Owner /7 i t _ '9:~i Business Phone w /t Address Z 1 LH / ee-le0 L -4Z Home Phone KL+'-32`/ Ya 4. Name of Subdivision 1_1"i c D _ car r ec. Lot # / Section/Block/Phase Property Address 71P'3 1i? /V mi~& k& e; Directions to Property: Z ~/Q K,1 7Z' A--.c /T el-lill ZZW 5. Property Size: Square Feet X Acres (k-77 Date Platted/Recorded 27 C f 6. TYPE OF FACILITY: House X Mobile Home Dimension of Structure 30 X.3 V Bedrooms- 3 "Any robin that will be intended for sleepin`, at the time of construction or for future consideration should be noted as a bedroom and counted on alI 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 heed for system size increase in the future. Basement: yes,no 1 Water Using Fixtures in Basement: yesc No. in Family 2- Whirlpool Tub yes no Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units A/14 Total Number of Bedrooms ~-4 DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area,, 7*uare Feet Food stand/Meat Market Floor Space 4/4- TYPE OF BUSINESS: A14 Number of Employees 1 st _,G~ 2nd /V'~+ 3rd IV,4- OTHER: (Specify) A 7. Do you anticipate any additions to Facility? Yes / If so, describe: A- 8. Has any grading, removal, or addition of soil been done to this property? Yes / 1 If so, describe: 4'r4_ 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 property? Yes / hI Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/City/Township water line **If No, a Well Pen-nit 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 TAfO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE" Date /D 0f Signature of Owner or Agent'YJ 1,rtaA_4 Q Dn/ Gg A Cp CATAWBA COUNTY, NC I00-A South West Blvd PLAN RECEIPT Newton, NC 28658- 0 (828)465-8399 Tuesday, November 10, 2009 18 42 sM www.catawbacountync.gov Plan Case: EHPR-11-09-2615 Invoice Number: INV-11-09-257134 Environmental Health Plan Review Invoice Date: 11/10/2009 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 11/10/2009 Check 8520 $80.00 $0.00 Total Paid: $80.00 Total Due: $0.00 :m r«ei~t;637jcfx~-Z'&)-=4019-1)806-1du11 jU')TR'; 8; ipt 11/10/2009 11:00