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HomeMy WebLinkAboutEHPR-11-09-2899.TIF ~~A C THIS IS NOT A PERMIT Case # EHPR-I 1-09-2899 a CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services Environmental Health Plan Review - OSWP 1784 2 Sh, IMPROVEMENT - AUTH CONST -NEW WELL APPLICANT OWNER CONTRACTOR JASON SAIN JASON SAIN PAINT MASTERS AND COMPANY, INC 2372 SETTLEMYRE BRIDGE RD 2372 SETTLEMYRE BRIDGE RD MAIDEN NC 28650 NEWTON NC 28658 NEWTON NC 28658 828-428-2204 BARRY_HARBINSON@HOTMAIL.COM NAME TO APPEAR ON PERMIT JASON SAIN Pin#: 3721 19605573 SITE ADDRESS: 2372 SETTLEMYRE BRIDGE RD, NEWTON. NC DIRECTIONS: RADIO STATION RD/ RT ON STARTOWN CONOVER RD/ LT ON SETTLEMYRE BRIDGE RD/ LOT ON RT/ SMALL ROAD UP TO LOT / THERE IS A NO TRESPRESSING SIGN NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 10.14 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms 5 Basement: No Water Using Fixtures in Basement: No. in Family 6 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 Ist 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 Are there easements/right-of-ways recorded on this property? N/A 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 nor 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: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 wo ing ays 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 30 FEE NAME DATE AMOUNT Side 15 Authorization to Construct Fee (New/. 11/24/2009 $275.00 Rear 30 Improvement Permit Fee 11/24/2009 $150.00 Max Hght Well Pen-nit & Inspection Fee 11/24/2009 $300.00 TOTAL FEES $725.00 *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 1 1 /24/09 16:12 Catawba County, North Carolina This mop prochtct eras prepared from the Catawba Conow. At C. Geographic hrfornunion Svstem- N Cotam'ha Comdr has made suhstantiol effn'is 10 ensmc• the acCUroCr of location caul lahchog informrnion ccomained an this map. Catem bo Coonh' promotes (111d; ecommends the independent verification ofcan' clalo cmNoined nn this map prochtct by fhe user. The Cotnnt' ofCatawha, its emplovee.s, agents and personnel disclaim, and shall no to held liable fit om and cd done{qcs, loss or hahilm, whethc r direct. mclirect nr copse uentiul which prise u' n .cc• ram ap product or the use thereof ln' app person or ell/Ill. Legend Selected Parcel Number: 3721-19-60-5573 I inch = 100 feet Prepared for: l tt u Ga \ V . 1f.14A. 5573 / a THIS IS NOT A LEGAL DOCUMENT T IV 11y' November 24, 2009 03:42 Pill CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3721-19-60-5573 Name: SAIN JASON RONALD Name2: SAIN LISA BANDY Address:' 3920 DEAL RD Address2: City: CLAREMONT State: NC Zip: 28610-9773 Account: 159744169 Calc Acreage: 10.14 Tax Map: LRK: 904065 Deed Book: 2916 Deed Page: 0701 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: Street Name: SETTLEMYRE BRIDGE RD Site Zip: 28658 Township: NEWTON Fire Code: HICKORY RURAL City Code: COUNTY State Road: Total Bldgs Value: Land Value: $47,700 Total Value: $47,700 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 92 Watershed: Watershed Split: Voter Precinct: P40 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: STARTOWN Middle School: MAIDEN High School: MAIDEN School Split: NO P&Z Case Number: Census Tract 2010: Census Block 2010: Small Area Plan: STARTOWN Agricultural District: Printed: Tuesday, November 24, 2009 03:46 PM THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit Authorization to Constru t-© Septic Repair ❑ Septic Expansion ❑ Existing Tank Check ❑ New Well Permit Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit J PS o N SA-I tJ 2. Permit Requested By Irk PA-i&-r PtksT~.S 4 c::~, x-Aj c- Business Phone 31 Z-1P ZZz Address 357-0 D/ yp'T pa /vE /ylf~/JEn~ /YL Zklo S~U Home Phone 3. Property Owner y /?'5o ro 6A4/Vu Business Phone Address Hom Phone 4. Name of Subdivision of Secti n/B oc Phase Property Address Directions to Property: 14a7-a wN ?a BX-i e- /2j Ua a 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure vX ~U Bedrooms* *Any room that will be`intended for sleeping at the time of construction or for future consideration should be noted is a bedroom and counted on all applications. `fhe 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 need for system size increase in the future. Basement: ye ~io Water Using Fixtures in Basement: ye No. in Family Whirlpool Tub yes 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 1 st 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 o If so, describe: 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 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 THE PROPERTY THERE IS AN ADDITIONAL CHARGE" Date 1-2,Y d Signature of Owner or Agent