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.ray'A • THIS IS NOT A PERMIT Case# RI3PR-05-2022-40916
d CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
/842 sM Residential BuildingPlan Review-BuildingNew
AUTH CONST- NEW WELL
G130 j)) ROI); d
Contractor SAME AS OWNER,,
Owner RICHARD HICKS,927 EUFOLA RD,STATESVILLE NC 28677
C:7049299024 DAYBREAKAGI@GMAIL.COM
NAME TO APPEAR ON PERMIT
Richard Hicks
SITE ADDRESS: 1163 CATALINA CT,CATAWBA NC 28609 PIN # 471003210497
NAME of SUBDIVISION: Lot# _ 24 Section/Block_ __
PROPERTY SIZE: Square Feet Acres 3.83
DIRECTIONS: Molly's Backbone to Monbo RD, Right N.Saunders DR Right Aeromarine Right Catalina CT go to the end
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLONS PER DAY: 360 WATER SUPPLY: Private Well
DESCRIBE WORK: 6/30/22 revised site plan received.
5/5/22 REVISED.60 X 60 HANGER WILL HAVE A 50x14 LEAN TO SEE NEW SITE PLAN
PREVIOUS DESCRIPTION: New 2 story 3 bedroom Single Family Dwelling 56x48 w/unfinished basement w/
breezeway attached to garage 25x25; Hanger 60x60 hanger will have half bath in the future
SITE INFORMATION
Do any of the following apply to the property for which this application is applied?
If the answer to any of the questions below is"YES",then supporting documentation is required:
Does this site contain any jurisdictional wetlands? No
Does this site contain any existing wastewater systems? No
Is any of the wastewater going to be generated on the site other than domestic sewage? No
Is the site subject to approval by any other public agency? Yes
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: New Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: Single Family Residence OTHER DESCRIPTION:
DESCRIPTION OF vacant lot
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 56x48
#OF NEW BEDROOMS:: 3
BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES
OTHER: INNOVATIVE: ANY:
Other described:
APPLICATION FOR WELL CONSTRUCTION
PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO
al,:wli:au„r. 06/30/2022 14:15 Page 1 of3
r � CATAWBA COUNTY Case# RBPR-05-2022-409 1 6
.t. Public Health Department. Ai,( • Subdivision
Environmental Health Division
PINE! 471003210497
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658
w
NAME ON PERMIT: (RICHARD KICKS),927 EUFOLA RD,STATESVILLE NC 28677
( Richard Hicks)
Site Address: 1163 CATALINA CT,CATAWBA NC 28609
Property Size: Square Feet Acres 3.83
Directions: Molly's Backbone to Monbo RD,Right N.Saunders DR Right Aeromarine Right Catalina CT go to the end
Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat
=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issued for
septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the
proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements
I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are
granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely
responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation
can be performed.
The undersigned is the owner of the property or legal agent of the owner.
Date: Signature of Applicant or Agent
If you need further information or assistance please call 828-465-8270
AREA4
***********$*********************4'*******************t*****************$************************************
FEENAME DATE FEE AMOUNT
Authorization to Construct Fee(New/Expansion) 05/03/2022 $150.00
Fee
Well Permit&Inspection Fee 05/03/2022 $300.00
TOTAL FEES $450.00
FEES ARE NON-REFUNDABLE
ONCE A SITE VISIT IS MADE OR
WORK ON A PLAN REVIEW HAS COMMENCED
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
•I I plir.itikm 06/30/2022 14:15 Page 2 of 3
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