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$ Cpl THIS IS NOT A PERMIT Case # EHPR-2-10-3875
CATAWBA COUNTY I-TE-ALTH DEPARTMENT
U : ^C Plan Review Application for Environmental Services
1842 sM Environmental Health Plan Review - OSWP
V~v V IMPROVEMENT - AUTF/ CONST
APPLICANT OWNER CONTRACTOR
CASSIE NANTZ JONATHAN ELDER
3063 HODGES ST 4668 CRYSTAL ST
CONNELLY SPRINGS NC 28612- CLAREMONT NC 28610-8618
(828)234-9929
NAME TO APPEAR ON PERMIT CASSIE NANTZ Pin#: 364810471485
SITE ADDRESS: 1400 PRISON CAMP RD, Newton, NC
DIRECTIONS: 321 S LEFT ON PRISON CAMP, HOUSE ON LEFT APROX 1/2 MILE
NAME of SUBDIVISION: Lot # PT 3 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.879 Date Platted/Recorded
TYPE OF FACILITY: House Mobile Home X Dimension of Structure 28X48 Bedrooms 3
Basement: No Water Using Fixtures in Basement:No No. in Family 2
Whirlpool Tub : Gal. Capacity:
MULTIPLE FAMILY RESIDENCE: Units 0.00 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: NO
Has any grading, removal, or addition of soil been done to this property?
If so, describe NO
Are there easements/right-of-ways recorded on this property? DUKE P
Type of Water Supply: Individual Well Community Well Municipal X 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 norrexpiring 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 represntationbyou of house or structure
location should conform to applicable setbacks. 7
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 I
(FOR OFFICE USE ONLY)
Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A
Minimum Setbacks
Front 80 FEE NAME DATE AMOUNT
Side 15 Authorization to Construct Fee~(New[03/03/2010 $150.00
Rear 30 Improvement Permit Fee 02/15/2010' $150.60
Max Hght $300.00
TOTAL FEES
*If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge
03/03/10 16:47
~g'A Cp CATAWBA COUNTY, NC
100-A South West Blvd PLAN RECEIPT
Newton, NC 28658-
0 (828)465-8399 Wednesday, March 3, 2010
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jg 4 Z sM www.catawbacountync.gov
Plan Case: EHPR-2-10-3875 Invoice Number: INV-3-10-260048
Environmental Health Plan Review Invoice Date: 03/03/2010
Site Address: 1400 PRISON CAMP RD, Newton, NC
APPLICANT OWNER
CASSIE NANTZ JONATHAN ELDER
3063 HODGES ST 4668 CRYSTAL ST
CONNELLY SPRINGS NC 28612- CLAREMONT NC 28610-8618
(828)234-9929
Fee Name Fee Amount
Authorization to Construct Fee Adjustable $150.00
(New/Expansion) Fee
Total Fees Due: $150.00
PAYMENTS
Date Pay Type Check Number Amount Paid Change
03/03/2010 Cash -1 $150.00 $0.00
Total Paid: $150.00
Payer: ALLEN WILLIAMS
Total Due: $0.00
plan receipt ; 0744351 c-805-=4420-a23a-3b I afi36b3daf'}.1-p1 03/03/2010 16:47