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Home My WebLink AboutEHPR-3-10-4483 (2).TIF A Cpl THIS IS NOT A PERMIT Case # EHPR-3-10-4483 .i►~ CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 sM Environmental Health Plan Review - OSWP IMPROVEMENT - AUTH CONST APPLICANT OWNER CONTRACTOR Hickory Hollow LLC Hickory Hollow LLC 211 Fairway DR 211 Fairway DR Fayetteville NC 28305 Fayetteville NC 28305 (828)348-4230 (828)348-4230 NAME TO APPEAR ON PERMIT Hickory Hollow LLC Pin#: 376013233996 SITE ADDRESS: 3311 FORK CREEK LN, Claremont, NC DIRECTIONS: FROM INTERSECTION OF HWY 10 & BETHANY CHURCH RD/ LEFT INTO SHADY VALLEY / RT ON HANOVER & STAY STRAIGHT TO FORK CREEK LANE NAME of SUBDIVISION: COUNTRY VALLEY PH 2 MAP 1 I Lot # 38 Section/Block/Phase PROPERTY SIZE: Square Feet Acres .37 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home X Dimension of Structure 28 X 52 Bedrooms 3 Basement: Water Using Fixtures in Basement: 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 1 st 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 easements/right-of-ways recorded on this property? NONE Type of Water Supply: Individual Well Community Well X Municipal Semi-Public 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. y representation by you of house or structure location should c nform 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 AREAd (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 30 FEE NAME DATE AMOUNT Side 15 Authorization to Construct Fee (New/Expansion) Fee 03/22/2010 $150.00 Rear 30 Improvement Permit Fee 03/22/2010 $150.00 Max Hght TOTAL FEES $300.00 *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 03/22/10 16:10 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT A 'lication for Environme .tal Services Improvement Permit Authorization to Construct Septic Repair ❑ Septic Expansion El Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment 1. Name to Appear on Permit 1 roaL r- ) r!,A i4o 1 f ~U_j J_- f_G 2. Permit Requested By Trnz." Business Phone Sad 3+f h~a 34 Address 1,140 01ffi Home Phone 3. Property Owner H~rlkoo~ ~ w&\. L140 o Business Phone Address Q c Is".ne. H M Phone 4. Name of Subdivision c-%rv Lot # Section/Block/Phase Property Address , Directions to Property.: e'rer~ o- [aLJ lO s c R~ o- d r f AJ1r0 S 1 l~ , t-rr JAtkw&, a rxc~ s-~ roy Vb~ c,~ oA Q.. 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home . Dimension of Structure ?X Bedrooms* *Anyroom that will be intended for sleepingatltlie time of constroction or for future consideration sh~oold be riot. ~i as~a bedroom and counted on•all applications:- The riumber`of bedrooms will be confirmed by rooms identified on house plans asa bedroom at the time of bBaslemeper Mi, ip ]ance, 7 us ater,UsinntFixtures ino ~Basement lze urc, ase in the future. yes g y /no No. in Family Whirlpool Tub yes/Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms 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 1 st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes o 10. Is a public water supply available on or adjacent to the above property? Yes / No Check type that is available: [ ] Community well [ ] Semi-public well [ ] 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 PEERRTY, THERE IS AN ADDITIONAL CHARGE.- Date 3 /,Q a/ao10 Signature of Owner or Agent Y . Catawba County, North Carolina FN This nutp product wits prepared from the Catawba Coma ' NC, Geographic It formotion Si:stem- Calawbo Count, has made substomial efforts to ensure Ilte accurocv of location and labeling it formcuinu contoined on this nap. Colamba Counh, promotes clod recomnicilds the independent rerificalion of nun clola contained of this niap product bi, file user. 1 he Couot'v of Counrba, its emplovees, ogents and personnel disclaim, and .shall not be held liable for aov and all domages, /oss or liability, wheiher du'ect, indirect or cooseyueotial which arises or mqv arise from this map product or rite use thereof by cam person or enlih - Legend Selected Parcel Number: 3760-13-23-3996 t inch = 60 feet Prepared for 130 14 138 12 W W ~ ~ 4183 3162, P1at65-186 - 115 11155.( 1 130 c 5 R Plat ELK L 76 I V Q g 2g5 .~5 1s5:~~ 130 1999 5936 N 75.06 3Z 17 39 cr, 133 T RAL FIRE FIR THIS IS NOT A LEGAL DOCUNIFYI- - Nlonday, A7:n ch 22, 2010 04:00 Pill FIRL CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3760-13-23-3996 Name: HICKORY HOLLOW LLC Name2: Address: 211 FAIRWAY DR Address2: City: FAYETTEVILLE State: NC Zip: 28305-5571 Account: 159745351 Calc Acreage: 0.37 Tax Map: LRK: 301836 Deed Book: 2929 Deed Page: 0290 Subdivision Name: COUNTRY VALLEY PH 2 MAP 11 Subdivision Block: A Lots: 38 Plat Book: 65 Plat Page: 186 Building Number: 3311 Street Name: FORK CREEK LN Site Zip: 28610 Township: CATAWBA Fire Code: CLAREMONT RURAL City Code: COUNTY State Road: Total Bldgs Value: Land Value: $9,700 Total Value: $9,700 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 122 Watershed: WS-IV Protected Area Watershed Split: NO Voter Precinct: P5 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: DWMH-O,WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: CATAWBA Middle School: RIVER BEND High School: BUNKER HILL School Split: NO P&Z Case Number: Census Tract 2010: 011400 Census Block 2010: 2032 Small Area Plan: BALLS CREEK Agricultural District: Printed: Monday, March 22, 2010 04:00 PM CATAWBA COUNTY, NC 100-A South West Blvd PLAN INVOICE Q Newton, NC 28658- 0®~ (828)465-8399 Monday, March 22, 2010 184 2 sM www.catawbacountync.gov Plan Case: EHPR-3-10-4483 Invoice Number: INV-3-10-260672 Environmental Health Plan Review Invoice Date: 03/22/2010 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Authorization to Construct Fee Adjustable $150.00 (New/Expansion) Fee Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/22/2010 Credit Card -1 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 pl~~n inv<~ic~ Odt'I tY=1-4?(ii-~~r03-Rc1b-3~~Et2cl~~S}3R }-rp~ 03/22/2010 16:36