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Home My WebLink AboutEHPR-12-09-2967.TIF THIS IS NOT A PERMIT Case # EHPR-12-09-2967 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - OSWP IMPROVEMENT - AUTH CONST APPLICANT n`V NER CONTRACTOR STAN KOZERSKI STAN KOZERSKI 3736 CALDWELL RD 3736 CALDWELL RD NEWTON NC 28658 NEWTON NC 28658 828-291-6862 828-291-6862 trs 11758@yahoo.com trs] 1758@yahoo.com NAME TO APPEAR ON PERMIT STAN KOZERSKI Pin#: 366802699133 SITE ADDRESS: 3736 CALDWELL RD, Newton, NC DIRECTIONS: HWY 16 S/ LT ON CALDWELL/ LOT ON LT/ SHARED DRIVEWAY ON NEIGHBORS LOT/ DRIVEWAY BETWEEN BRICK HOUSE & DW MOH NAME of SUBDIVISION: N/A Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.5 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home X Dimension of Structure Z1~ x-7 (o Bedrooms 4 Basement: No Water Using Fixtures in Basement: No. in Family 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 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 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: /.2 2 r 9 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 1 (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[. 12/02/2009 $275.00 Rear 30 Improvement Permit Fee 12/02/2009 $150.00 Max Hght $425.00 TOTAL FEES *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 12/02/09 14:34 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT A lication for Environme tal Services Improvement Permit Authorization to Construct Septic Repair ❑ Septic Expansion ❑ Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ n Well Abandonment ❑ I. Name to Appear on Permit 2. Permit Requested By Business Phon Address Home Phone 3. Property Owner S ~rs~ /<O Z:C--S'4' VCC_-3 \'-\t4k Q i W, Business Phone(pa o?q/ Address CO(Y1 Hope Phone - 4. Name of Subdivision Lot # Section/Block/Phase Property Address 11 zu C- Directions to Property: 1+7 r) A S - La-V- l 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure fib' 76 Bedrooms* *Any room that will 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 confiirtned b_v 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: yes Water Using Fixtures in Basement: yes( No. in Family ir 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 I st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Ye /No l• / If so, describe: f~wa ~~~M S' ~p o Win., a o 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? es No 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 [ ] 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 applicati n for a w 11 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 1Z - Signature of Owner or Agent ~s 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 oflocation and labeling information contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this map product by the user. The County of Catawba, its enplovees, 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 ftom this map product or the use thereof by any person at, entity. Legend Selected Parcel Number: 3668-02-69-9133 1 inch = 60 feet Cj Prepared for: 42.25 0350 10 ~ - , C) (306) r rf'. d' Z ~~~~"u4 "fie p' ,r 840' ,Plat 32-17 1 0 k 4 2, THIS IS NOT A LEGAL DOCUMENT _ Wednesday, December 02, 2009 12:58 PM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3668-02-69-9133 Name:. KOZERSKI STAN Name2: Address: 603 COVERT AVE Address2: City: NEW HYDE PARK State: NY Zip: 11040-5440 Account: 156807000 Calc Acreage: 0.5 Tax Map: 002 K 04008 LRK: 1563 Deed Book: 2856 Deed Page: 1309 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 3736 Street Name: CALDWELL RD Site Zip: 28658 Township: CALDWELL Fire Code: BANDY'S City Code: COUNTY State Road: Total Bldgs Value: $26,000 Land Value: $6,800 Total Value: $32,800 Year Built: 1979 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 122 Watershed: WS-II Protected Area Watershed Split: NO Voter Precinct: P1 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: BALLS CREEK Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011400 Census Block 2010: 4018 Small Area Plan: BALLS CREEK Agricultural District: Printed: Wednesday, December 02, 2009 12:58 PM