HomeMy WebLinkAboutEHPR-4-11-10572.TIF � THIS IS NOT A PERMIT Case # EHPR-4-11-10572
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H y CATAWBA COUNTY HEALTH DEPARTMENT
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WILLIAM VANDERWESTEN
SlTE ADDRESS: 3364 PLATEAU RD Newton, NC Pir,�: 269802585634
NAME of SUBDIVISION: Lot # 2 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 1.019
DIRECTIONS: HWY 10 E TO 127- PLATEAU RD ON LEFT, TURN ON PLATEAU RD APPROX 1/4 MILE ON LEFT.
PPLICANT WNER CONTRACTOR
WILLIAM VANDERWESTEN WILLIAM VANDERWESTE
1207 21ST AV NE APT E 1207 21ST AV NE APT E
HICKORY NC 28601- HICKORY NC 28601-
8284235204 8284235204
PRIMARY CONTACT: Owner APPLICATION FOR: Existing Structure
DIM EXISTING STRUCTURE: 20X70 EXISTING FACILITY TYPE: Mobile Home
NUMBER OF EXISTING BEDROOMS: 4 SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANTS: 5 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: BUILT A POOL AND NOW NEEDING A PERMIT
DESCRIPTION OF DOUBLE WIDE MOBILE HOME
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPOSED FUTURE ADDITIONS NONE
OR IMPROVEMENTS:
PROPERTY EAS EMENTS: PRIVATE EASEMENT
PROPOSED CONSTRUCTION
ACCESSORY STRUCTURES
DESCRIPTION: ROUND POOL
# OF NEW BEDROOMS: STRUCTURE DIMENSIONS: 26 FT ROUND POOL ACC DWELLING?
PLUMBING? # 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 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
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Minimum Setbacks Front: 80 Side: 10 Rear: 10 Side St: Max Height:
04/25/11 15:18