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Home My WebLink AboutEHPR-3-10-4101.TIF ~$A C THIS IS NOT A PERMIT Case # EHPR-3-10-4101 CATAWBA COUNTY HEALTH DEPARTMENT V Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - OSWP IMPROVEMENT APPLICANT OWNER CONTRACTOR CALIN SERAZ AVERY ABERNETHY 5209 GLENWOOD PL CT 825 NW 3RD AV HICKORY NC 28602- HICKORY NC 28601-4806 (828)638-3771 NAME TO APPEAR ON PERMIT CALIN SERAZ Pin#: 268902798192 SITE ADDRESS: 1347 SHADOWFAX WYND, Hickory, NC DIRECTIONS: HWY 127 S - TURN RIGHT INTO DEERFIELD - TURN RIGHT ONTO SHADOWFAX WYND - PROPERTY ON LEFT NAME of SUBDIVISION: DEERFIELD 4 Lot # 49 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 1.07 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 51 X 51 Bedrooms 3 Basement: No Water Using Fixtures in Basement:No No. in Family 3 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 Ist 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? 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 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. s Date: D-3 -O(-~ D!O Signature of Applicant or Agent An Environmental Health Specialist will contact you withi rking days of application date. If you need further information or assistance eas call 828-466-7291 AREA2 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 30 FEE NAME DATE AMOUNT Side 15 Improvement Permit Fee 03/01/2010 $150.00 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 S60 charge 03/01/10 14:01 THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Ap lication for Environmental Services Improvement Permit Authorization to Construct El Septic Repair ❑ Septic Expansion El Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit Cflz /,V 6 • S~2A LQ& -Leg-L e-27 2tf 2. Permit Requested By CAL i/y 6. S-E'elq ? Business Phone Address 5--'09 GI_E-A) OQ,' FL CT, Ykr-O4 , NC o2860ck Home Phone Business Phone 3. Property Owner A/3E2~1'FTH y AVc'2T /74 kA_ Address V s 3'-'!' Awr /U W HICcOyz y AJC a060 / Home Phone / 4. Name of Subdivision D£E7R -FIEZ d { H4,cs 7 jy Lot # el'F cActai Phase I V Property Address 13y'7 SHr~dOW Ax W ivy 12e~-~ Directions to Property: - D 6ELIJ ~ J E-c A S 3 `v ' 1'QP ~~crti z7 ' X dD W rAx uvti d a f~ 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Y_ Mobile Home Dimension of Structure SI X 5-1 - 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 confirmed by rooms identified on house plans as a bedroom at the time of building pennit issuance. This may prevent the need for system size me ase in the future. Basement: yes6) Water Using Fixtures in Basement: yes/(Oi No. in Family Whirlpool Tub yes o 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) or\ 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 If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes tN' ~ 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: Nk1 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 PRO ERTY, THERE IS AN ADDITIONAL CHARGE.- Date 03 - 0/.-a0/'0 Signature of Owner or Agent 7/ V 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 ofany data contained on this map 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 anv person or entity. Legend Selected Parcel Number: 2689-02-79-8192 1 inch = 60 feet Prepared for: O i j 8321 o0 .5~ s 50 •o 1.14A •o 3'270 ° 51 f 4a€;t 49 1.23A Q0 X80• 0978 DO 52 0 4E 56 285 THIS IS NOT A LEGAL DOCUMENT Mon, March 01, 2010 01:29 PM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 2689-02-79-8192 Name: ABERNETHY AVERY MARK Name2: ABERNETHY GARY JAMES Address: 825 3RD AVE NW Address2: City: HICKORY State: NC Zip: 28601-4806 Account: 161179 Calc Acreage: 1.07 Tax Map: 002AB 01049 LRK: 90706 Deed Book: 1712 Deed Page: 0151 Subdivision Name: DEERFIELD 4 Subdivision Block: Lots: 49 Plat Book: 29 Plat Page: 13 Building Number: 1347 Street Name: SHADOWFAX WYND Site Zip: 28602 Township: BANDY'S Fire Code: MOUNTAIN VIEW City Code: COUNTY State Road: Total Bldgs Value: Land Value: $25,800 Total Value: $25,800 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 82 Watershed: WS-III Protected Area Watershed Split: NO Voter Precinct: P24 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: MOUNTAIN VIEW Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P&Z Case Number: Census Tract 2010: 011801 Census Block 2010: 1023 Small Area Plan: MOUNTAIN VIEW Agricultural District: Printed: Mon, March 01, 2010 01:30 PM 4'A Cpl CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT Newton, NC 28658- 0 (828)465-8399 Monday, March 1, 2010 184 2 sM www.catawbacountync.gov Plan Case: EHPR-3-10-4101 Invoice Number: INV-3-10-259952 Environmental Health Plan Review Invoice Date: 03/01/2010 Site Address: 1347 SHADOWFAX WYND, Hickory, NC APPLICANT OWNER CALIN SERAZ AVERY ABERNETHY 5209 GLENWOOD PL CT 825 NW 3RD AV HICKORY NC 28602- HICKORY NC 28601-4806 (828)63 8-3771 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Total Fees Due: $150.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/01/2010 Check 1690 $150.00 $0.00 Total Paid: $150.00 Payer: CAUN SERAZ Total Due: $0.00 plan receipt ; I a754cOR-414 1 -4923Q 147- 3611690 a7me! .rpt 03/01/2010 14:00