HomeMy WebLinkAboutEHPR-4-11-10648.TIF � � THIS IS NOT A PERMIT Case # EHPR-4-11-10648
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�" y CATAWBA COUNTY HEALTH DEPARTMENT
U ,�� ''C Plan Review Application for Environmental Services
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P,� �i NAME TO APPEAR ON PERMIT
� SOIVYA► LACKEY
SITE ADDRESS: 2129 KIRBY ST Claremont, NC Pir,�: 375517104336
NAME of SUBDIVISION: Lot # Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 2.75
DIRECTIONS: 16N/ BEFORE SPRINGS RD / LEFT KIRBY ST / HOUSE ON LEFT
APPLICANT OWNER CONTRACTOR
OAKWOOD HOMES #712 SONYA LACKEY
1265 HWY 70 5893 NC 16 HWY N
NEWTON NC 28658 CLAREMONT NC 28610
(828)4642662 82&310-3448
PRIMARY CONTACT: Applicant APPLICATION FOR: New Construction
DIM EXISTING STRUCTURE: 14 X 72 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:
DESCRIBE WORK: 2011 DW MOBILE HOME 28 X 44 MEETS APPEARANCE CRITERIA; MUST FACE FRONT OF
PROPERTY; MUST BE MASONRY UNDERPINNED; MUST HAVE 36 SQ.FT. DECK ON FRONT;
AND TONGUE MUST BE REMOVED OR SCREENED
DESCRIPTION OF SW MOBILE HOME
EXISTING STRUCTURES
ON SITE (IF ANY)
PR EASEMENTS: NONE
PROPOSED CONSTRUCTION
PRIMARY RESIDENCE
NEW RESIDENCE? New R ence
# OF NEW BEDROOMS: � # OF STRUCTURE OCCUPANTS: 2
PROJECT DESC: DW MOBILE HOME
PROJECT DIMENSION: 28 X 44
BASEMENT? No BASEMENTFIXTURES? No
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 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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04/28/11 1621