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Home My WebLink AboutEHPR-12-09-3091.TIF ~A OG THIS IS NOT A PERMIT Case # EHPR-12-09-3091 s~o® CATAWBA COUNTY HEALTH DEPARTMENT v _ P„o Plan Review Application for Environmental Services 1842 sM Environmental Health Plan Review - OSWP IMPROVEMENT APPLICANT OWNER - T; CONTRAGTOR7 Lee Setzer Lee.Setze- 5156 NNC Hwy 16 '5156 N NC Hwy 16 Claremont NC 2861'0 Claremont NC 28610- NAME TO APPEAR ON PERMIT Lee Setzer Pin#: 375415631766 SITE ADDRESS: 5198 N NC 16 HWY, Claremont, NC DIRECTIONS: 16 N, RIGHT ON OXFORD SCHOOL RD, RIGHT ON 1 ST PAVED ROAD, NO SIGN, 350 FEET PROPERTY ON RIGHT NAME of SUBDIVISION: LEE A SETZER Lot # 2 Sect ion/Block/Phase PROPERTY SIZE: Square Feet Acres .75 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 50 X 80 Bedrooms 3 Basement: Yes Water Using Fixtures in Basement:No No. in Family 3 Whirlpool Tub : -'.Gal.-Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.001'' Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area 1 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: NO Has any grading, removal, or addition of soitlieen done to this property? i; If so. describe NO Are there easements/right-of-ways recorded on this property?";NO 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 issuedpand 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 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 30 FEE NAME DATE AMOUNT Irnprove Went Permif'Fee "d 12%1172009. " $150:00 r~ 1 7.77 Side 15 Rear 30 TOTAL FEES $150.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 12/11/09 10:51 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit F6 Authorization to Construct El Septic Repair El Septic Expansion ❑ Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit i-66, A. 2. Permit Requested By Business Phone Address Home Phone Z8-15~ 6 3. Property Owner t_.f-e-- A : S~fZcf Business Phone -3 Address P. )\J(- 1j, 14"'u Home Phone 41.1 4. Name of Subdivision Lot Section/Block/Phase Property Address Directions to Property: 1 j o t o 4P 60 tjx ~e rd Sc. ve / ! oa d~ 7 41 -t-4 ~_r\ l ;-n 1-i A. t o ~ c,Uri foa 9 (o ti 0 4e v.-1- . P^e.PLr i. o-n, ri 5. Property Size: Square Feet Acres , 7.5 Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Strijeture VJC 1 _ D Bedrooms* *Anv roam the ii vv III b, int~n~l~,l I ,i sleeping at the.time of construction ,,r 1(,1 ruuir-,conslcJeratton shoul,i be lwtA as bedioon1 1n~i o„uni~,i vn;all ~Ihl,lIion;: i1unibei ol.bzdrooiiis bedroom it tl~c tim lImIliiti,>u:~n~~ CIu~ m3} p~Cvei t~th, 11,~J 1('1 t~ni SIZE in the luture Basement: yes no Water Using Fixtures in Basement: ye /nT No. in Family 3 Whirlpool Tub ye 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 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. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE." Date Signature of Owner or Agent _e, ` Q~\\\ N + 99YYY cD o ~ Z 6 O~ L L 1 /2A rebar 3 $wP 0 3 " rebar N Ln .0 2 ~oclz) ~Areso~ z 0 112' rebar 180.00' co V- 84'5356 "W o{ v- N o cis cp j v- N .o~ o, cry cy o 0 N 87°23'38"W 409.61 ' 1 " pipe Charles A. Hortsoe Deed: 2033-296 Plat Book 40; Page 181 Jolly W. Woody A C0~ CATAWBA COUNTY, NC v 100-A South West Blvd PLAN RECEIPT Newton, NC 28658- V (828)465-8399 Frlday, December 11, 2009 U 184 Z sM w,%vw.catawbacountync.gov Plan Case: EHPR-12-09-3091 Invoice Number: INV-12-09-257948 Environmental Health Plan Review Invoice Date: 12/11/2009 Fee Name Fee Amount Improvement Permit Fee Flxed $150:O0I Total Fees Due: $150.00 PAYMENTS Date Pay Type Check Number Amount Paid Change X12/11/2009 Cheeck.. 11544 $150:00 $0.00' Total Paid: $150.00 Total Due: $0.00 plan receipt 17'k 13d fd-a02f-1'Iti l -978c-c55iiec9 h55a; rpt 12/11/2009 10:50