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Home My WebLink AboutEHPR-11-09-2667.TIF ~A THIS IS NOT A PERMIT Case # EHPR-11-09-2667 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 18 sM Environmental Health Plan Review - OSWP REPLACE-WELL FA- L "it , A - PI NT j0N'1'NER, CONTRACTOR JACOB CANIPL JACOB CANIPE - 1272 SAIN RD 1272 SAIN RD . HICKORY NC 28602 HICKORY NC 28602 " 828-381-4604 828-381-4604 NAME TO APPEAR ON PERMIT JACOB CANIPE Pir►#: 370013139828 SITE ADDRESS: 1272 SAIN RD, Hickory, NC DIRECTIONS: HWY 127 S - TURN LEFT ONTO ZION CHURCH RD - TURN RIGHT ONTO SAM RD - I MILE ON LEFT NAME of SUBDIVISION: Lot # 1 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.4 Date Platted/Recorded TYPE OF FACILITY: House " Mobile Home X Dimension of Structure 28 X 54 Bedrooms 3 Basement: No Water Using Fixtures in Basement:No No. in Family 2 t Whirlpool Tub : Gal., Capacity: MULTIPLE FAMILY RESIDENCE: Units I.00 ' i Total Number oC 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 soilbeen done to this property 8! 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: Q - a q Signature of Applicant or Agent An Environmental Health Specialist will contact you within 22 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 WellPermit& Gispetioii Fee ll/I`I%2009 $30.0:00 Rear 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 11/11/09 09:03 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit El Authorization to Construct El Septic Repair ❑ Septic Expansion ❑ Existing Tank Check ❑ New Well Permit ❑ Replacement Well ~ Well Abandonment ❑ 1. Naive to Appear on Permit 3c c-- o b CcZ n , 2. Permit Requested By " Business Phone Address t'1 o'l 0 in, Ch. (2 cl . ki e--k~~ Home Phone / - /noU 3. Property Owner ' o -.e. Business Phone Address k Home PhoneQgy 4. Name of Subdivision Lot # Section/Block/Phase Property Address r Directions to Property: R C/ 5. Property Size: Square Feet Acres i, Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home L/_ ,-Dimension of Structure ~-K k Lf _ Bedrooms* . ~Anv room th,it ill he intended loi sleeplw, :it the time of construction oll for I'utulL. con~1021*atI011 should be notcd '!.s a bedroom and k~unn[cd on 'al] aPPp lrcdtions. 'flit number of hcdt(; ms will be coirliumcd by.iuom'- identified ofi house plan, bedroom alt the time ol:building permit issuance ]_.'his ma; pi.`„nt the need for.system size iu cease iii the I'uture: Basement: yes Water Using Fixtures in Basement: yes/& No. in Family aZ Whirlpool Tub yes/no Gallon Capacity 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 / o 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 / o 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 [ ountylCitylTownship water line **If No, a Well Permit must be is 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 d 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 A contained on this map. Catawba County promotes and recommends the independent verification ofony 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: 3700-13-13-9828 1 inch = 60 feet Prepared for: CSC1. h~ 1 12 ~g p9 `96) LTI aal 1 O O 1 Ag g5 9828 oyo 1.09~A~ 0 0729 ~Z0, 0-1 N do THIS IS NOT A LEGAL DOCUMENT \ Wed, November 11, 2009 08:46 AM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3700-13-13-9828 Name: CANIPE JACOB LAWRENCE Name2: CANIPE CAROLYN H Address: 1298 SAINE RD Address2: City: HICKORY State: NC Zip: 28602-8108 Account: 10472010 Calc Acreage: 0.4 Tax Map: 173H 02031B LRK: 58860 Deed Book: 1223 Deed Page: 0059 Subdivision Name: Subdivision Block: Lots: 1 Plat Book: 26 Plat Page: 35 Building Number: 1272 Street Name: SAIN RD Site Zip: 28602 Township: HICKORY Fire Code: MOUNTAIN VIEW City Code: COUNTY State Road: 1133 Total Bldgs Value: Land Value: $8,400 Total Value: $8,400 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 81 Watershed: WS-III Protected Area Watershed Split: NO Voter Precinct: P23 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: ED-O,DWMH-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: MOUNTAIN VIEW Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P&Z Case Number: Census Tract 2010: 011801 Census Block 2010: 3004 Small Area Plan: MOUNTAIN VIEW Agricultural District: Printed: Wed, November 11, 2009 08:46 AM CATAWBA COUNTY, NC Ir 100-A South West Blvd P /r/ RECEIPT Newton, NC 28658- do/"'1 \1 I (828)465-8399 Wednesday, November 11, 2009 1 sM www.catawbacountync.gov Plan Case: EHPR-11-09-2667 Invoice Number: INV-11-09-257176 Environmental Health Plan Review Invoice Date: 11/11/2009 Fee Name Fee Amount Well. Permit & Inspection Fee Fixeci $300.00? Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 11/11/2009 Cash -1 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 planieccipt,9bh711?b-ht) 0-4c>:~93R~-eaa3f~;3J~5zi9;.ipt 11/11/2009 09:01