HomeMy WebLinkAboutEHPR-3-10-4152 (2).TIF
S~~A C THIS IS NOT A PERMIT Case # EHPR-3-10=4152
CATAWBA COUNTY HEALTH DEPARTMENT
Plan Review Application for Environmental Services
1842 sM Environmental Health Plan Review - OSWP
ABANDONMENT
APPLICANT OWNER CONTRACTOR
HABITAT FOR HUMANITY OF CATAWBHABITAT FOR HUMANITY OF CATAWB
PO BOX 9475 PO BOX 9475
HICKORY NC 28603-9475 HICKORY NC 28603-9475
NAME TO APPEAR ON PERMIT HABITAT FOR HUMANITY OF CATAWBA VALLEY INC Pin#: 371007697450
SITE ADDRESS: 2790 ROBINSON RD, Newton, NC
DIRECTIONS: 2790 ROBINSON RD
NAME of SUBDIVISION: BLUE SKY ACRES Lot # COMMON Section[Block/Phase
PROPERTY SIZE: Square Feet Acres 3.22 Date Platted/Recorded
TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms 0
Basement: 0 Water Using Fixtures in Basement:0 No. in Family
Whirlpool Tub : Gal. Capacity:
MULTIPLE FAMILY RESIDENCE: Units 1.00 Total Number of Bedrooms
DAYCARE: Number of Children
RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space
TYPE OF BUSINESS: Number of Employees Ist 2nd 3rd
OTHER: (Specify)
Do you aniticipate any additions to Facility?
If so, describe:
Has any grading, removal, or addition of soil been done to this property?
If so, describe
Are there ease ments/right-of-ways recorded on this property? 0
Type of Water Supply: Individual Well Community Well Municipal Semi-Public
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 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. Any representation y you of house or structure
location should conform to applicable setbacks.
Date: 3 Signature of Applicant or Agent Z-4
in 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
ARERA2
(FOR OFFICE USE ONLY)
Zoning Approval: Yes No "Zoning Approval UDO Zoning Form A
Minimum Setbacks
Front FEE NAME DATE AMOUNT
Side
Rear TOTAL FEES
Max Hght
*If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge
03/03/10 12:43
THIS IS NOT A PERMIT WLS #
CATAWBA COUNTY HEALTH DEPARTMENT
Application for Environmental Services
Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑
Existing Tank Check ❑ New Well ell Permit ❑ Replacement Well ❑ Well Abandonment
I. Name to Appear on Permit (~P 14 G.~
2. Permit Requested By KQ- -l o &,r Business Phone Kk 6 t z S~2 S
Address ~o 1"3 ILf Is U, CL f f~- Horne Phone
3. Property Owner Business Phone
Address Home Phone
4. Name of Subdivision 13 (.re Sv► , < s Lot # Section/Block/Phase
Property Address ;-7710 ~b 'mss Q~ FA-
Directions to Property: tM Je..5 S ~.~kl. cs kd v-¢- N;)-e nod- r, R~ 5 s dti d2 A,
5. Property Size: Square Feet `J 3S 6 y Acres 1 Date Platted/Recorded
6. TYPE OF FACILITY: House Mobile Home Dimension of Structure Bedrooms*
*Any room that will be inmidcd for sleeping at the time of construction or for fixture consideration should be noted as a
bedroorn and counted on all applications. The number of bedrooms ~yill be confirmed by rooms identified on house plans as a
bedroom at.the time of building, permit issuance. This may prevent the need for system size increase. in the,future.
Basement: yes/no Water Using Fixtures in Basement: yes/no No. in Family
Whirlpool Tub yes/no Gallon Capacity
MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms 3
DAY CARE: Number of Children
RESTAURANT: Seats Square Feet Dining Area -Square Feet Food stand/Meat Market Floor Space
TYPE OF BUSINESS: Number of Employees I st 2nd 3rd
OTHER: (Specify)
7. Do you anticipate any additions to Facility? Des No
If so, describe: 14u k C- P , S , l t A
8. Has any grading, removal, or addition of soil een done to this property? Yes /
If so, describe:
9. Are there easements/right-of-ways recorded on this property? Yes / No
10. Is a public water supply available on or adjacent to the above property? No
Check type that is available: [ ] Community well [ ] Semi-public well -h~ County/City/Township water line
**If No, a Well Permit must be issued with the Septic Permit.**
11. Well Type Applying For: [ ] Individual well [ ] Community well [ ] Semi-Public well
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 valid for 5 years or may be non-expiring under certain specified conditions. Improvement Permits and Well
Permits are transferable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An 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.
**IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPE T THERE IS AN ADDITIONAL CHARGE.**
Date 3 Signature of Owner or Agent -7~