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HomeMy WebLinkAboutEHPR-9-10-7294.TIF HIS IS NOT A PERMIT Case # EHPR -9 -10 -7294 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services I842 sM Environmental Health Plan Review - OSWP IMPROVEMENT - AUTH CONST - NEW WELL NAME TO APPEAR ON PERMIT Tina Connor Oeu., Pin to be. SITE ADDRESS: itikga LAVON AV, Catawba, NC Pin#: 378002567014 NAME of SUBDIVISION: Lot # Section/Bloch/P naseu PROPERTY SIZE: Square Feet Acres 4.11 DIRECTIONS: 10E/ MURRAY'S MILL RD/ LEFT CENTER CHURCH RD/ GO 1/2 MILE TALK & LET ONTO LOWARENCE RD/ LOT ON RIGHT / RT LAVON AV/ NEXT TO HOUSE #5562 APPLICANT OWNER CONTRACTOR Tina Connor Tina Connor 5562 Lavon AV 5562 Lavon AV Catawba NC 28609 Catawba NC 28609 PRIMARY CONTACT: Contractor APPLICATION FOR: New Construction DIM EXISTING STRUCTURE: EXISTING FACILITY TYPE: N/A NUMBER OF EXISTING BEDROOMS: SEWER TYPE: Septic Tank EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: WELL TYPE: Public water is * *NOT ** available for this property. PUBLIC WATER TYPE AVAILABLE: DESCRIBE WORK: SINGLE FAMILY MODULAR DWELLING PROPERTY EASEMENTS: NONE • PROPOSED CONSTRUCTION ju.) 1'( N PRIMARY RESIDENCE NEW RESIDENCE? RESIDENCE? New Residence N_SS tCr ' # OF NEW BEDROOMS: 3 # OF STRUCTURE OCCUPANTS: 2 � _ PROJECT DESC: SINGLE FAMILY MODULAR } t om PROJECT DIMENSION: 28 X 52 BASEMENT? No BASEMENT FIXTURES? No APPLICATION FOR WELL CONSTRUCTION /ABANDONMENT /REPAIR PROPOSED WELL TYPE: ABANDONMENT TYPE: WELL REPAI REQUESTED? I understand that this is a formal application fora 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. e y re resentation by you of house or structure location should conform to applicable setbacks. e: — lz - / Signature of Applicant or Age An Environmental Health Specialist will contact you within 2 wor ng days of application date. If you need further information or assistance pleas: call 828 - 466 -7291 AREA1 09/13/10 12:46 �A CATAWBA COUNTY Case # EHPR -9 -10 -7294 � i ,! � a G Pu blic Health Department Subdivision D -n 've� �0 's PO Environmental Box 389, 100 -A Health Southwest ti Blvd NeRewtoni v , NC 28658 Lot# 184 w PIN# 378002567014 Applicant/Owner Tina Connor, 5562 Lavon AV, Catawba NC 28609 Site Address: 5562 LAVON AV, Catawba, NC Property Size: SF 4_11 ACRES Directions: 10E/ MURRAY'S MILL RD/ LEFT CENTER CHURCH RD/ GO 1/2 MILE TALK & LET ONTO LOWARENCE RD/ LOT ON RIGHT / RT LAVON AV/ NEXT TO HOUSE #5562 Minimum Setbacks FEE NAME DATE AMOUNT BALANCE DUE Front 30 Side 15 Authorization to Construct Fee (New /Expansion) Fee 09/13/2010 $150.00 $0.00 Rear 30 Improvement Permit Fee 09/13/2010 $150.00 $0.00 Side St Well Permit & Inspection Fee 09/13/2010 $300.00 $0.00 Max Hght TOTAL FEES $600.00 $0.00 CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 1 09/13/10 12:46 THIS IS NOT A PERMIT wl_s # 1 1 CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services IP F AC i._ S. f. Rpr. S.T. Exp. Exist. S. T. I!_ Well Permit fl Replacement Well . Narne to Ay ear on Permit: 774/4 /'.,� at r 2. Permit Re ,nested B Business Phone: W... /t7 Address:; /a 65 / ltd/ 70 Gt/ .._ /1tl4/7/r (, p?F-(3 Phone: g _Le ymo 3. Property Owner: / / AM 6 il/i/OK Business Phone: Address: ' / /WO ti 4 C,t 4iA 6 07 eF60 Home Phone: 4. Name of Subdivision: Lot #: Section /Block /Phase : Property Address: Directions to Property: ' 7- i fi i ,dy i o d 10 j,7-, i. if 4.),(7 o 7)- /W&Ar/lf•/ted . 44//`-t {. cj4 GAvto<M).6"o /if/ XI. ?th f /0 42 a iMg) of � /r h'vof/ d dt Nsx r ro 33 5. Propert!' Size: Square Feet Acres Date Platted /Recorded 6. TYPE OF FACILITY: r House Mobile Home Dimension of Structure E Bedrooms* *Any room that will be in nded for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications. The num r of bedrooms will be confirmed by rooms identified on the house plans as a bedroom at the time of building permit issuance. This may prevent the eed for system size increase in the future. Basement: c Yes ()\ No Water Using Fixtures in Basement: - Yes I No No. in Family: Whirlpool Tub: Yes y\No Galion Capacity: MULTIPLE FAMILY RESIDENCES: Units ' Total Number of Bedrooms ___3 DAY CARE: Number of Children j RESTAURANT: Seats ' Square Feet Dming Area Square Feet Food Stand /Meat Market Floor Space TYPE OF BUSINESS: No of. Employees 1st 2nd 3rd [ — OTHER : (Specify) 7. Do you anticipate any additions to Facility? ( Yes ` ND If so describe I 8. Has any grading, removal, or addition of sbil been done to this property? r, ` Yes NNo If so describe 9. Are there easements /right -of -ways recorded on this property? Yes f-. No 10. Is a public water supply available on or adjacent to the above property? Yes "" Check type that is available: r.. Conmun;ty Weft i - Semi - public Well 7 Cou y /City/Township water line 11. Well Type Applying For: iX Individual Well Community Well I Semi-public Well __.. Irrigation Well .... Geothermal Well 12. Monitorin j Well Request:: Yes No 4 of Wells: Name of Site: I understand that this a forma! application for a well permi!. Improvement Permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba Cout,ty Heaith Department employees to go on this property for evaluation purposes. I certify the above information to he correct and understand that an Improvement Permit issued as a result of this information is transferable 9 may be el +gible for eon expiring, datE!, but ma., bE r evo'<ed if this . nformation, site plans or intended use changes for the proposed facility. A Well perm . t and Authorization to Construct issued by t!rh depa:.ment 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 set backs. *''IF A PERMIT HAS TO BE REDESIGNED AND /OR RETRPP r MADE To THE- PROPERTY, THERE IS AN ADDITION L CHARGE. ** i Date: 0 Signature of Owner or Agent: . , i . Gi rj)( Print Form • Acknowledgement Certificate for Funulr Subdivision I act-:ro'wledge that this plat umas approved under the provisions of a Family Subdivision as defined in Tabl Catawba County unified Development Ordinance for the purpose for a family member to homestead on th certified to be any further subdividino of any of these parcels beyond a Fancily Subdivision shall require road improveme accordance with the Catawba County Unified Development OrsuiNXW /r.)/43' • . , t ,L),7,)trt ./ i 'c III Owner /Subdivider Date this the day 'fats Page Public Plat Declaration Ail roaos this succ'vIs o are hereby aeciarea public: The maintenance c,f alt streets ar.o'oaos n ibe;s s 1, 1( ne the , espy ' S'L 't' (1( rl o Pe. (i O 4` r 7 R - a "(. S'1ai• ix (', ' �5I i -Fay; y. • -'i -et ; „ , .;'4 lards r}` chi ^ 1 Or1 1 ' , d ^? {�c(?a`'n1t?h` •: ' ar SGirct( ,.` i:ti'(t•:r )1 , - i :hp i Oh a 1-1.:41 1p 1-1.:41 rat .,C.� 314 iP+ b) Owner /Subdivider Date Thomas Earl Yount CD 1 o Pbk 27 Pg 64 N Control 1 m Stone /fencecorner S 87 "59'12" E 392 87' _r i - 314" IPflbolt " " Reference _ ---_ yNiHiams Dbk 3036. Pg 1618 3, Pg. 44 iD Parcel No 3780 -02 -56 -7014 7 Pg 68 f ° Lot 1 o M 2.16 acres w 94268.14 sq ft I 0518 "Rebar S 87'59'12" E 324 90' --- • ; o 0 518 "Reba c j in Z Lot 2 o 5562 Lavon Ave Roosevelt E. Abernethy 2.29 acres a Dbk. 870• Pg 238 99559.20 sq ft Control SepticTank /app 5 co "' Axle well! g © gy p "' s i G? `r o P /, is , C, p r ung 30 Roadway C ° ''� N 54' 40'12 E I (° % O , 52 51' © e /8 "Reba i f ,co I si, G,dk � c? 5l8 "Rebar Hewitt r iye�a/ I RAN Info I '9. 398 .. o I T Id Bearino Distance • • co -, I L1 S 20 ° 31'40" W 46 37' ' n L2 S 83 °25'00" E 144 66' I -' _ ©_ l (°;:...2:01.140'325i)?.. L3 S 83''25'00" E 114 90' `r Ll r 5 88 "Reb /8 " Rebar L4 S 20 "44'03" E 8 78' o l 5 S 07"16'49" WW 37 201 , f --- - - -- - - - -- - 15040' L'..;)- o ° ' - - 1 TY veer -A- �D .o...a. N 83 °2 5'00" W O.ap _ a _ �eVO - _ BY Ne.,:, -4 - u u,, R ,•.,_ pp - - n A.�%e. " _ - Existin New 45 R/W S' - ED So r•. -tat c..oa � � .4 - - , 3 - an In. rw�t1...% - _ie.w INi!KOr F f- lou/itt Z N P - '7 7- , `�� _ �A�d1tiQ nat • Catawba County, North Carolina N This map product was prepared from the Catawba County, NC, Geographic Information System. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information A contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this snap product by the user. The County of Catawba, its employees, agents and personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 3780 -02 -56 -7014 1 inch = 100 feet Prepared for: .;..,�. ... ``Y' `5.;!1 400 -- -.,..- U\TSJ ; Cr 318.8 - '..,., ` -- •`M1`�,,,,,,.. ` ' F.n. 0.Y - ` , �` t \ t w... a : ,. -,. ..., \ --... „..., ,, C „....,,, 1 1 / v o '63 , y t. 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O < - - S y r _ � �o = = s w - O� _ Cn - r • 3 N m .g - m ° o N p a 3- a m a ns � a ' V co 73 - -- N N 171) ` I ' � O o r -moo $ °3 - ° ,.. -,0 - ° I D " % • �g'A CMG CA COUNTY, NC ��' �� I00 A South West Blvd Newton, NC 28658- PLAN RECEIPT U \ ��� (828)465 - 8399 Monday, September 13, 2010 - $ 42 sM www.catawbacountync.gov Plan Case: EHPR -9 -10 -7294 Invoice Number: INV -9 -10- 266905 Environmental Health Plan Review Invoice Date: 09/13/2010 Site Address: 5562 LAVON AV, Catawba, NC APPLICANT OWNER Tina Connor Tina Connor 5562 Lavon AV 5562 Lavon AV Catawba NC 28609 Catawba NC 28609 Fee Name Fee Amount Authorization to Construct Fee Adjustable $150.00 (New /Expansion) Fee Well Permit & Inspection Fee Fixed $300.00 Improvement Permit Fee Fixed $150.00 Total Fees Due: $600.00 PAYMENTS PAYER: CMH HOMES, INC. CMH HOMES, INC. Date Pay Type Check Number Amount Paid Chang( 09/13/2010 Check 3994066 $600.00 $0.00 Total Paid: $600.00 Total Due: $0.00 plantcccipt( 3- 1t15(1llc- a4la- icOd- b5 6b( rpt 09/13/2010 12:45