HomeMy WebLinkAboutEHPR-5-11-10756.TIF Environmental Health Additional Fee Collection Notice
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The following additional fees as checked below must be coliected prior to further
action by our department
� Repair Permit Application
� Permit revision (re-draw) �
I� Well Permit
Cr Authorization to Construct (system upgrades, etc)
� Other (please explain below) '
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.��' THIS IS NOT A PERMIT Case # EHPR-5-11-10756
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e �� � CATAWBA COUNTY HEALTH DEPARTMENT
c� ,�''C Plan Review Application for Environmental Services
1842 5M Environmental I�ealth Plan Review - OSWP
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NAME TO APPEAR ON PERMIT
CHRISTOPHER BEINER
s�Te a��RESS: 1412 LANCER DR, Hickory, NC Pir�: 370006289885
NAME of SUBDIVISION: MOUNTAIN VIEW ESTATES PH 2 Lot # 32 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.349
DIRECTIONS: HWY 321 / RIVER RD EXIT/ RIVER RD / ZION CHURCH / RT BETHEL CHURCH / 2ND RT LANCE DR /
STH HOUSE ON RIGHT
APPLICANT OWNER CONTRACTOR
CHRISTOPHER BEINER CHRISTOPHER BEINER
1412 LANCER DR 1412 LANCER DR
HICKORY NC 28602 HICKORY NC 28602
828-330-0065 82&330-0065
PRIMARY CONTACT: Owner APPLICATION FOR: New Construction
DIM EXISTING STRUCTURE: 40 X 26 EXISTING FACILITY TYPE: H use�-
NUMBER OF EXISTING BEDROOMS: 2 SEWER TYPE. e tic Tank
NUMBER OF EXISTING OCCUPANTS: 5 EXISTING WATER SUPPLY IN USE: Community Well
CALCULATED DESIGN FLOW:
Public water is "`NOT** available for this property.
PUBLIC WATER TYPE AVAILABLE:
DESCRIBE WORK: 24 FT ROUND ABOVE GROUND POOL
DESCRIPTION OF SINGLE FAMILY DWELLING
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPERTY EASE NONE
PROPOSED COPISTRUCTION
ACCESSORY STRUCTURES
DESCRIPTION: PVT ABOVE GROUND POOL
# OF NEW BEDROOMS: 0 STRUCTURE DIMENSIONS: 24 FT RO[JND ACC DWELLING? No
PLUMBING? No NONE # OF STRUCTURE OCCUPANTS: 0
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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WIIIB9i1111111 SetbBCkS: Front: Side: Rear: Side St: Max Height:
OS/OS/11 12:49