HomeMy WebLinkAboutEHPR-3-11-9965.TIF �1$ THIS IS NOT A PERMIT Case # EHPR-3-1 1-9965
C �� CATAWBA COUNTY HEALTH DEPARTMENT
c� ''C Plan Review Application for Environmental Services
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Environmental Health Plan Review - OSWP
(�J15z-d a�'d IMPROVEMENT
r�(�,�.1 �p�s �lo�� �� NAME TO APPEAR ON PERMIT
Denver Eller
SITE ADDRESS: 1211 KIRKWOOD ST, H1CkOry, NC Pin#: 2770045�1608
NAME of SUBDIVISION: Lot # Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 1.24
DIRECTIONS: OLD SHELBY RD/ RT ON MT OLIVE FAITH RD/ LFT ON KIRKWOOD/ HOME AT VERY END
APPxYCANT OWNER CONTRACTOR
/llenver Eller � T�enver Eller '
1 1211 KIRKWOOD ST � 1211 KIRKWOOD ST
HICKORY NC 28603 HICKORY NC 28603 '
' 828-322-1909 82&322-1909
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PRIMARY CON ACT: Owner -- APPLICATION FOR: New Construction
DIM EXISTING STRUCTURE: 25 x 56 EXISTING FACILITY TYPE: Mobile Home
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 ""NOT*` available for this property.
PUBLIC WATER TYPE AVAILABLE: N/A
DESCRIBE WORK: 12 x 16 Storage Building - no Electrical
DESCRIPTION OF double wide brown black shutters
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPERTY EASEMENTS: none
PROPOSED CONSTRUCTION
ACCESSORY STRUCTURES
DESCRIPTION: 12 x 16 Wood Shingle Roof Building
# OF NEW BEDROOMS: STRUCTURE DIMENSIONS: 12 x 16 ACC DWELLING? No
PLUMBING? No # OF STRUCTURE OCCUPANTS:
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 nor�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
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Minimum Setbacks Front: 30 Side: 10 Rear: 5 Side St: Max Height:
03/24/ 11 09:43