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Home My WebLink AboutEHPR-3-10-4479.TIF g'A C THIS IS NOT A PERMIT Case # EHPR-3-10-4479 y CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 sM Environmental Health Plan Review - OSWP IMPROVEMENT- AUTH CONST APPLICANT OWNER CONTRACTOR Hickory Hollow LLC Hickory Hollow LLC 211 Fairway DR 211 Fairway DR Fayetteville NC 28305 Fayetteville NC 28305 (828)348-4230 (828)348-4230 NAME TO APPEAR ON PERMIT Hickory Hollow LLC Pin#: 376003235936 SITE ADDRESS: 3325 FORK CREEK LN, Claremont, NC DIRECTIONS: FROM INTERSECTION OF HWY 10 & BETHANY CHURCH RD/ LEFT INTO SHADY VALLEY / RT ON HANOVER & STAY STRAIGHT TO FORK CREEK LANE NAME of SUBDIVISION: COUNTRY VALLEY PH 2 MAP 1 1 Lot # 39 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.379 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home X Dimension of Structure 28 X 52 Bedrooms 3 Basement: No Water Using Fixtures in Basement:No 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 Ist 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? NONE Type of Water Supply: Individual Well Community Well X 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 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 stricture on this property. An representation by you of house or structure location shoU/4 co nform to applicable setbacks. Date: ~Ql 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/Expansion) Fee 03/22/2010 $150.00 Rear 30 Improvement Permit Fee 03/22/2010 $150.00 Max Hght TOTAL FEES $300.00 *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 03/22/10 16:36 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT A lication for Environment -I Services Improvement Permit ` Authorization to Construct Septic Repair El Septic Expansion El Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment E] 1. Name to Appear on Permit c'o~%•s o~~r1 i 4c o w 1- t.._C- 2. Permit Requested By Trwo••S Business Phone Sig 31F ~a34 Address oJ\ e Home Phone Business Phone 3. Property Owner o \ UP) Address Lo'-Ae_ ome Phone Section/Block/Phase 4. Name of Subdivision yN $P Lot # Property Address Coeek_ Directions to Property: QAJt0 S lc +uT r\ o 0 ~ a^<_4 t s*ro„ -10 t7o~ r-'_ o-AQ.. 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure K 5 2--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 permit is uance. This may prevent the need for system size increase in the future. Basement: yes/ Water Using Fixtures in Basement: yes/ o 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) 7. Do you anticipate any additions to Facility? Yes 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 o 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~1 PEERRTY, THERE IS AN ADDITIONAL CHARGE." Date 31aa"laol o Signature of Owner or Agent Catawba County, North Carolina FN This mop product war prepared j om the Calnrba Comnv, VC. Geographic h jormalion Simem. Catawba Coun(v has made substantial efforts io ensure the occuracv ojlocation and laheling illfiarmation contained on This map. Calmrha Comity pronlales c117d recommends the independent rerijicatinn ofom, dales contained on this map product by the user. The County of Cotmrba, ils emplapces, agents and personnel disclaim, cmd shall not be hell liable for any and all damages, loss or liabilily, whether direct, indirect or cansegaemticil which arises or map arise from This nap product or the use dtereof by miv person or emits. Legend Selected Parcel Numbcr: 3760-03-23-5936 1 inch = 60 feet Prepared for 130 14 ti cri 06 00 cr.-, 12 W 5194 P T 0 4183 316:92- lat65-186 - 07 60.07 115 115. . 130 at 57 186 P I LN. pC 165-.02 l 5- 125.05 0110 3996 . co; 00 38 . -P 172 4 0 T 33 r 125 TFIIS IS NOT A LEGAL, DOCUMENT Monday, March 22, 2010 03:58 PNI CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3760-03-23-5936 Name: HICKORY HOLLOW LLC Name2: Address: 211 FAIRWAY DR Address2: City: FAYETTEVILLE State: NC Zip: 28305-5571 Account: 159745324 Calc Acreage: 0.38 Tax Map: LRK: 301837 Deed Book: 2929 Deed Page: 0290 Subdivision Name: COUNTRY VALLEY PH 2 MAP 11 Subdivision Block: A Lots: 39 Plat Book: 65 Plat Page: 186 Building Number: 3325 Street Name: FORK CREEK LN Site Zip: 28610 Township: CATAWBA Fire Code: CLAREMONT RURAL City Code: COUNTY State Road: Total Bldgs Value: Land Value: $9,300 Total Value: $9,300 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 122 Watershed: WS-IV Protected Area Watershed Split: NO Voter Precinct: P5 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: DWMH-O,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: RIVER BEND High School: BUNKER HILL School Split: NO P&Z Case Number: Census Tract 2010: 011400 Census Block 2010: 2032 Small Area Plan: BALLS CREEK Agricultural District: Printed: Monday, March 22, 2010 03:58 PM ~A CD CATAWBA COUNTY, NC i00-A South West Blvd PLAN INVOICE Newton, NC 28658- 0®~~ (828)465-8399 Monday, March 22, 2010 4► 1842 SM www.catawbacountync.gov Plan Case: EHPR-3-10-4479 Invoice Number: INV-3-10-260667 Environmental Health Plan Review Invoice Date: 03/22/2010 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Authorization to Construct Fee Adjustable $150.00 (New/Expansion) Fee Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/22/2010 Credit Card -1 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 plan invoice :308 17=IUc~-f4cd-l~al-3da_'s-51 1 fDc:761.7;.ipt 03/22/2010 16:36