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HomeMy WebLinkAboutEHPR-11-09-2800.TIF THIS IS NOT A PERMIT Case # EHPR-11-09-2800 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services Environmental Health Plan Review - OSWP 184 2 sM ABANDONMENT APPLICANT OWNER CONTRACTOR SHANE REAL Richard Tucker 1336 NW 6th ST NC Hickory NC 28601 (704)736-1720 NAME TO APPEAR ON PERMIT SHANE BEAL Pin#: 370310367762 SITE ADDRESS: 1336 NW 6TH ST, Hickory, NC DIRECTIONS: LR BLVD TOWARD HICKORY, LEFT ONTO 1ST AVE SE, RIGHT ONTO HWY 127, LEFT ONTO 16T1-I AVE NW, LEFT ONTO 6TH ST NW NAME of SUBDIVISION: Lot# Section/Block/Phase PROPERTY SIZE: Square Feet Acres 1.539 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension ot'Structure Bedrooms 2 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: 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 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: O 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 AREA 2 (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front FEE NAME DATE AMOUNT Side Rear TOTAL FEES Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 11/19/09 15:45 THIS IS NOT A PERMIT WI_S# CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services ❑ IP [7 AC M S.T. Rpr. 0 S.T. Exp. Exist. S. T. Well Permit Replacement Well 1. Name to Appear on Permit: ALYaAp.,-S4 Aoo,l~cNS FcQ: 2rcl-ll-~eo or-4c-12 P-GS)oe -VCC 2. Permit Requested By: M. SNn,NE 6&1&11 L Business Phone: '20Y-736- Address: F lf,71 acl,1z,, xc Fso52 Home Phone: -7ON"736' 3. Property Owner: ician,2 -CC4 Business Phone: Address: 133 L Sr w ,~/cK~y .vc 28G0~ Home Phone: 4. Name of Subdivision: Lot E Section/Block/Phase: Property Address: 33~ ~J lCv Directions to Pro erty: F F C- L E N o l /L (Z NY.vE D i.Uro E/icec2 y• ov o I ST Av E S 7o #A& 12-7 © 7N 70 A; AVE W t-- cA To G'`' 57. 4W 5. Property Size: Square Feet Acres Date Platted/Recorded 1 6. TYPE OF FACILITY: 10 House p Mobile Home Dimension of Structure Bedrooms* Basement: QYes `0 No Water Using Fixtures in Basement: 0 Yes )Q No No. in Family: Z Whirlpool Tub: QYes ONO Gallon Capacity: MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats a Square Feet Dining Area 1-7 Square Feet Food Stand/Meat Market Floor Space F TYPE OF BUSINESS: No. of Employees 1 st 2nd E-71 3rd E OTHER : (Specify) 7. Do you anticipate any additions to Facility? QYes ()No If so describe 8. Has any grading, removal, or addition of soil been done to this property? OYes XNo If so describe 9. Are there easements/right-of-ways recorded on this property? OYes 00 10. Is a public water supply available on or adjacent to the above property? w `es O No Check type that is available: ❑ Community Well ❑ Semi-public Well County/City/Township water line 11. Well Type Applying For: ❑ Individual Well ❑ Community Well ❑ Semi-public Well ❑ Irrigation Well ❑ Geothermal Well 12. Monitoring Well Request: 0Yes QNo # of Wells: Name of Site: I understand that this 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 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 set backs. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE.- Date: I Signature of Owner or Agent: Catawba County, North Carolina This map product was prepared fi am the Catawba County, NC, Geographic Information System. N Catawba County has made substantial efforts to ensure the accuracy of locution and labeling information contained on this map. Catawba County promotes and recononends the independent verification ofany 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 01' consequential which arises or may arise from this map product a• the use thereof by any person at, entity. Legend Selected Parcel Number: 3703-10-36-7762 1 inch = 80 feet Prepared for: 7052 -'9032- l~ ^ i CD 0 O N 0 230.00 181.00 411.00 J a- 5 o° ~0. 1.56A ~ 0 7897 co C) 144.60 - _ - - - t 149.60 158.70 0 rn /14 ° 1.54A 7762 co C 7 (446) (193) rr 152.83 M C?° 100.43 CC) t - ' 0 13 ~ -'6631 co 194 CO-_ 1 - - 0567 12 1.26A o N~ 7501 N 9522-' N r ? 149.97 342.60 ti THIS IS NOT A LEGAL DOCUMENT 442.80 Thursday, November 19, 2009 03:43 PM 11 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel IQ: ' 3703-10-36-7762 Name: TUCKER RICHARD JOHN Name2: TUCKER GAYE M Address: 1336 6TH ST NW Address2: City: HICKORY State: NC Zip: 28601-2410 Account: 70752500 Calc Acreage: 1.54 Tax Map: 077H 08002 LRK: 39290 Deed Book: 1434 Deed Page: 0311 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 1336 Street Name: 6TH ST NW Site Zip: 28601 Township: HICKORY Fire Code: City Code: HICKORY State Road: Total Bldgs Value: $126,700 Land Value: $71,600 Total Value: $198,300 Year Built: 1940 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 19 Watershed: WS-IV Protected Area Watershed Split: NO Voter Precinct: P36 E911 District: HICKORY Zoning: R-2 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: HICKORY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: HICKORY Elementary School: VIEWMONT Middle School: GRANDVIEW High School: HICKORY School Split: NO P&Z Case Number: Census Tract 2010: 010500 Census Block 2010: 2040 Small Area Plan: Agricultural District: Printed: Thursday, November 19, 2009 03:43 PM