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HomeMy WebLinkAboutEHPR-12-09-2984.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 Abandonment ❑ 1. Name to Appear on Permit " e, r-e ,a/ 15, 2. Permit Requested By Business Phone ,k,Z~ 3 L 0 75/y Address Home Phone 3. Property Owner- '64,i/ Business Phone Address L 777 A _~R Home Phone _2Y/ 3S"7 z. 4. Name of Subdivision Lot # Section/Block/Phase Property Address Directions to Property: 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure la Bedrooms*3 *Am/ room that will be intended for sleeping at the tune of construction or for future consideration should be noted as a bedroom and counted on all 1pp11cat1oiis. The number of bedrooms will be confinned by rooms identified on house plans as~a bedroom attlte tune of building permit issuance. This may prevent the need for system size . rcrease in the future. Basement:~ye uo Water Using Fixtures in Basement: ye no No. in Family _ 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 169 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 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. xxlF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE" l,7 Date 0,'c 3 ~l 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 contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this snap 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: 3699-02-77-3735 1 inch = 50 feet Prepared for: sr r _ ~ F< s 00 a 1.19A 73 5 Q) 8. N /1 ~ V 2 PO r F /f THIS IS NOT A LEGAL DOCUMENT Thursday, December 03, 2009 09:18 AM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3699-02-77-3735 Name: WILSON HAROLD MCREE Name2: WILSON SONJA D Address: PO BOX 442 Address2: City: CATAWBA State: NC Zip: 28609-0442 Account: 75571510 Calc Acreage: 1.19 Tax Map: 017 Y 01012A LRK: 18036 Deed Book: 1201 Deed Page: 0314 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 6777 Street Name: COMM SCOPE RD Site Zip: 28609 Township: CATAWBA Fire Code: BANDY'S City Code: COUNTY State Road: Total Bldgs Value: $158,400 Land Value: $11,000 Total Value: $169,400 Year Built: 1979 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 128 Watershed: WS-IV Protected Area Watershed Split: NO Voter Precinct: P21 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: CATAWBA Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011502 Census Block 2010: 1025 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Thursday, December 03, 2009 09:18 AM ~g'A Cn~ CATAWBA COUNTY, NC I00-A South West Blvd PLAN RECEIPT E-] Newton, NC 28658- 0 (828)465-8399 Thursday, December 3, 2009 184 Z sM www.catawbacountync.gov Plan Case: EHPR-12-09-2984 Invoice Number: INV-12-09-257696 Environmental Health Plan Review Invoice Date: 12/03/2009 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $300.00 Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 12/03/2009 Check 2628 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 planrcccipl;Idddch7R-43h2-1630-k5"-85a4dI0h0-IN! rpi 12/03/2009 09:30