HomeMy WebLinkAboutEHPR-3-11-9813.TIF �' � THIS IS NOT A PERMIT Case # EHPR -3 -11 -9813
CATAWBA COUNTY HEALTH DEPARTMENT
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1 JB & JANE R CADWALLADER
SITE ADDRESS: 2039 TRAVIS RD SE, Conover, NC Pin#: 375117111282
NAME of SUBDIVISION: Lot # Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 3.829
DIRECTIONS: HWY 321 TOWARD CONOVER RIGHT ON 20TH ST RIGHT ON BURRIS RD LEFT ON TRAVIS RD 2ND
HOUSE ON LEFT CHAIN LINKED FENCE IN FRONT
APPLICANT OWNER CONTRACTOR
JB & JANE R CADWALLADER JB & JANE R CADWALLADER
2039 TRAVIS RD SE 2039 TRAVIS RD SE
CONOVER NC 28613 CONOVER NC 28613
828 - 464 -1192 828 -464 -1192
PRIMARY CONTACT: Owner APPLICATION FOR: Existing Structure
DIM EXISTING STRUCTURE: 68X48 EXISTING FACILITY TYPE: House
NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANTS: 2 EXISTING WATER SUPPLY IN USE: Private Well
CALCULATED DESIGN FLOW:
Public water IS available for this property.
PUBLIC WATER TYPE AVAILABLE: County/City/Township Water
DESCRIBE WORK: OLD BORED WELL NOW HAS GROUND WATER RUNNING INTO IT AND WOULD LIKE A NEW
WELL
DESCRIPTION OF HOUSE
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPOSED FUTURE ADDITIONS NONE
OR IMPROVEMENTS:
PROPERTY EASEMENTS: NONE
PROPOSED CONSTRUCTION
APPLIC TION FOR WELL CONSTRUCTION /ABANDONMENT /REPAIR
PROPOSED WELL TYPE: I ndividual Well ABANDONMENT TYPE:
WELL REPAI REQUESTED S_
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.
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
AREA2
(Minimum Setbacks: Front: Side: Rear: Side St: Max Height:
03/16/11 08:43
,gi CATAWBA COUNTY Case # EHPR -3 -11 -9813
: 2 Public Health Department Subdivision
Environmental Health Division - Plan Review
"I" 0 PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Lot#
/8.2 sm PIN# 375117111282
Applicant/Owner JB & JANE R CADWALLADER, 2039 SE TRAVIS RD, CONOVER NC 28613
Site Address: 2039 TRAVIS RD SE, Conover, NC
Property Size: SF 3.829 ACRES
Directions: HWY 321 TOWARD CONOVER RIGHT ON 20TH ST RIGHT ON BURRIS RD LEFT ON TRAVIS RD 2ND HOUSE ON
LEFT CHAIN LINKED FENCE IN FRONT
FEE NAME DATE AMOUNT BALANCE DUE
Well Permit & Inspection Fee 03/14/2011 $300.00 $0.00
TOTAL FEES $300.00 $0.00
CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
03/16/11 08:43