HomeMy WebLinkAboutEHPR-6-11-11173.TIF .�� � THIS IS NOT A PERMIT Case # EHPR-6-1 1-1 1 173
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�' y CATAWBA COUNTY HEALTH DEPARTMENT
V , y� ''C Plan Review Application for Environmental Services
1g�2 sM Environmental Health Plan Review - Septic Malfunction
I ►1 �'Ji S�cl �.pz,� SEPTIC MALFUNCTION
NAME TO APPEAR ON PERMIT
BINH THAI NGUYEN
S�Te A��Ress: 1157 HIDDEN CREEK CIR, Hickory, NC Pirr�: 371009050334
NAME of SUBDIVISION:HIDDEN CREEK ESTATES Lot # 23 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.349
DIRECTIONS: HWY 10 W TO BYPASS N 321 EXIT RIVER RD RIGHT ON RIVER RD RIGHT HIDDEN CREEK HOUSE ON
RIGHT AFTER CURVE
APPLICANT OWNER CONTRACTOR
BINH THAI NGUYEN BINH THAI NGUYEN
1157 HIDDEN CREEK CIR 1157 HIDDEN CREEK CIR
HICKORY NC 28602 HICKORY NC 28602
828-322-3009 82&322-3009
PRIMARY CONTACT: Owner APPLICATION FOR: Existing Structure
DIM EXISTING STRUCTURE: 30X50 EXISTING FACILITY TYPE: House
NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: tic Tank
NUMBER OF EXISTING OCCUPANTS: 6 EXISTING WATER SUPPLY IN US : Public Water\
CALCULATED DESIGN FLOW: 360
Public water IS available for this property.
PUBLIC WATER TYPE AVAILABLE: County/City/Township Water
DESCRIBE WORK: SYSTEM FAILING, SEWAGE ON GROUND OUTSIDE
DESCRIPTION OF HOUSE
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPOSED FUTURE ADDITIONS N
OR IMPROVEMENTS:
PROPERTY EASEMENTS: N
PROPOSED CONSTRUCTION
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 ca11828-466-7291
AREA2
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Minimum Setbaeks Front: Side: Rear: Side St: Max Height:
FEE NAME DATE AMOUNT BALANCE DUE
Authorization to Construct (Repair) Fee 06/06/2011 $300.00 $0.00
TOTAL FEES $300.00 $0.00
06/15/l 1 15:56