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�$ THIS IS NOT A PER114IT Case # EHPR-S-t I-10883
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�" � � GATAWBA COUNI�Y HEAL'I`H DEPART�v1ENT
:� '�: °°" plan R.eview Applica�ion for-EnviranmentaJ Serviees
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'�� Environmental Health Plan Revie�v - OS'S'�'P
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� L t� �i 5P� ChG s 1MPROVEf�9ENT --
� ' NAMF 70 APPEAR ON PERM
SHANE 1aND DANA VUILSOf�
SITE AQDRESS HUDSON CHAPEL P�ll, CATAWBA, NC P��: 470�03136958
NAME of SUBDIVISION: -/ Lot N ( SectionlBloc}✓Phasc
PROPERTY SfZE: Square Feet Acres 18.SG9
DIRECTIONS: HIGHWAY 1Q E- TURN RIGHT ONTO HUDSON CHAPEL RD - PROPERTY UN RIGHT CORNER OF
HUDSON CHAPEL RD AND BROWN CHAPEL RD '
APPLICAIYT OWNER CONTRAGTOR
SHANE AiVD DANA WTLSON LAKE LUXURY H03v1ES L[.0
8823 DOG LEG RD PO BOX 3792 '
SHERRILLS FORD NC 2867r � MOORESV(LLE NC 28 i 17-3792
(82�478-7389
PRfMARY CONTACT: Appficant APPLtCATION FOR: ltiew Construction
DIM EXISTING STRUCTURE: NONE EXISTING FACILITY TYPE: N/A
NUMBER OF EXISTING BEDRQOMS: SEWER TYPE; Septic'Fank
NUMBER OF EXISTING OCCUPANTS: � EXISTING WATER SUPPLY IN USE: Privatc Well
CALCULATED DESIGN FLOW: 48Q
P�blic water is `''NOT°' available for this property.
PUBLlC WATER TYPE AVAILABLE: N/A
DESCRIBE WORK: LOOKING TO BUY PROPERTY AND WANT[NG SOIL ?'EST
DESCRIP710N OF �p{�t�
E�(15T1N6 STRUCTl1RES
ON SITE (1F ANI�
PROPOSED FUTt�RE ADDITIONS ;_gEDROQM H�ME
OR IMPROVEMEIJTS:
PRQPERTY EASEMEAITS: NO
PROPOSED CONSTRUCTIaN
PRIMARY RESlQFS10E
NEW RESIDENCE? New R' xice
# OF NEW BEDROOMS: 4 # OF STRUCTURE OCCtlP�+NTS:
PROJECT DESC; H�1t�fESITB
PRO.lECT DIAAEW : SO x 50
BASEMENT7 BASEMENTFIXTURES? No
I understand that this is a[ormal application for a well permit, Improvernenl permit or Authorizatfon to Construct a ground absorption sewage dispasal
system to -sen�e the above descr+bed facility an this property artd avthorize Catawba County �-leakh Deparfment erttpfoyees to go on this property for
evaluation putposss. { certify tfie above information to be correct and undet5tand that an fmprovement Permit issued as a resulf of this information rs
trartsfsrabte and may be etigibte fura non-expinrtg date, trut may be revoked if this information, site plans or Intended use changes for the proposed
facllity. A VJell Permif and Authorization tu Construct issued by this department is valid for (5} five years from the date issued and is not transferabte.
Note: You must obtain Zoning Approval prior to locacing a home or structure on this property. Any representation b ou of house or
struc cc ! ti�n should conform to applicable se�backs.
Ul J
Date; Signature of Applicant or Agent �! , �
An EnvironmentaI Health Specialist wiil contact you within 2 working days of appli atio date.
lf you need further infocmation ,or.assistance please ca11.828-466-7241
AJl�AI
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I 06/02J11 (d:48
�
�qP. CATAWBA COUNTY Case # EHPR-5-1 1-10883
� � Public Health Departmcnt
4
a Environmental Heal[h Division - Plan Review Subdivision
�_ `� PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 1 - 0 � 1
�a 2 s� PIN# 470103136958
ApplicanUOwner SHANE AND DANA WILSON, 8823 DOG LEG RD, SHERRILLS FORD NC 28673-
Site Address: HUDSON CHAPEL RD, CATAWBA, NC
Property Size: SF 18.5�i9 ACRES
� Directions: HIGHWAY ]0 E- TURN RIGHT ONTO HUDSON CHAPEL RD - PROPERTY ON RIGHT CORNER OF HUDSON
CHAPEL RD AND BROWN CHAPEL RD
Minimum Setbacks Front: 80 Side: 15 Rear: 30 Side St: Max Height:
FEE NAME DATE AMOUNT BALANCE DUE
Improvement Permit Fee OS/13/2011 $150.00 $0.00
TOTAL FEES $150.00 $0.00
CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
I
O6/02/ I I l 0:48
Environmental Health Additional Fee Collection Notice
The following additional fees as checked below must be collected prior to further
action by our department
� Repair Permit Application
� Permit revision (re-draw)
� Well Permit
� Authorization to Construct (system upgrades, etc) .
� Other (please explain below)
1�C�ni� �/�us�1" S;c � vis-e� � � nv s
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EHS �"�� S Date