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HomeMy WebLinkAboutEHPR-11-09-2820.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 Abandonme~~ I . Name to Appear on Permit 7 !X--f 9 e -J 2. Permit Requested By Business Phone D Z z 6 c?/r- Address Home Phone 3. Property Owner Business Phone 4y c- c-/ i .2 s % S --v Home Phone Address 4. Name of Subdivision Lot # Section/Block/Phase Property Address Directio to Property: (f S 7-;,` - • T o ~P T .l 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House _ Mobile Home Dimension of Structure Bedrooms* *Any room that %vill 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 identifiied on ho plans as a bedroom at the time of building permit issuance. This may prevent the need for systcllz ease in the future. Basement: yes/no Water Using Fixt asement: yes/no No. in Family Whirlpool Tub yes/no Gallon Ca MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats quare Feet Dining Area -Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINES Number of Employees 1st 2nd 3rd OTHER: (S 7. Do y.Qw nticipate any additions to Facility? Yes / No so, describe: 8. Has an radingreef val or addition of soil b;en don to this prope ? No If so, describe: /L o / `0' 2 f 5G. -r r^_ 9. Are there easements/right-of-ways recorded on this property? Yes / No 10. Is a public ater supply available on or adjacent to the above property? Yes ( No Check type that is av ' mmunity well [ ] Semi-public well [ ] County/City/Township water line **If No, a Well Permit must be issued with t e mit.** It. Well Type Applying For: [ ] Individual well [ ] Commune 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, ERE IS AN ADDITIONAL CHARGE." Date Z D ^~q Signature of Owner or Agen C_ /LI. 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 J4 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: 3702-19-60-7856 1 inch = 100 feet Prepared for: 00 951 15 356.9) ~ GIF E F~lC`g tP, C-_, \ r 3 55A `O © - \ w had 'i t 117 co C 5.5 1.30A 0,~~ THIS IS NOT A LEGAL DOCUMENT q q b Friday, November 20, 2009 09:45 AM } CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3702-19-60-7856 Name: MYERS + CO LTD DBA S + M BUILDERS Name2: Address: 4314 SECREST SHORTCUT RD Address2: City: MONROE State: NC Zip: 28110-9255 Account: 49323850 Calc Acreage: 3.55 Tax Map: 092H 01001 LRK: 43283 Deed Book: 1203 Deed Page: 0141 Subdivision Name: Subdivision Block: Lots: COMMON AREA Plat Book: 17 Plat Page: 49 Building Number: 220 Street Name: 14TH AV SE Site Zip: 28602 Township: HICKORY Fire Code: City Code: HICKORY State Road: Total Bldgs Value: Land Value: Total Value: Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 86 Watershed: Watershed Split: Voter Precinct: P4 E911 District: HICKORY Zoning: PD-H-R-5 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: SOUTHWEST Middle School: GRANDVIEW High School: HICKORY School Split: NO P&Z Case Number: Census Tract 2010: 011102 Census Block 2010: 1029 Small Area Plan: Agricultural District: