HomeMy WebLinkAboutSFPR-04-2021-37467 ENVIRONMENTAL HEALTH
(i) Catawba County Government Center
25 Government Drive I P.O.Box 389 I Newton,NC 28658
Catawba county Phone:(828)465.8270I Fax:(828)465.8276
public health Email. EHAdrrdn;.i)CatawbaaCountyNC.gov
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Environmental Health General Application
Case# `` � (n� -�
Property Location: )LI 10 tp ii2 CM L Sd. IUt� "- Ale �r 1 cv.ii"� 6.-
Street Address:' �1 tJ 10 J3ASa✓`_ _lv. J
City: __ iC i4V.. State: NC Zip: 0651
Contact Person: _____?_ffnt i l n fA4:o✓N-
Contact Phone Number: 7a{-956- 3QCa-
Contact Email Address: de"tils`VS i_CrfkillinS M.k,[P
Establishment Name: _}lor i 2.or$ t(IdS t /`C,
Architect Name(if applicable):
Email Address:
Architect Address:
City: State: Zip:
Phone:
Please Note: Plans drawn to scale and specifications shall be submitted to the local health department for review and approval prior to
initiating construct on.Plans drawn to scale and specifications for changes to building dimensions,kitchen specifications,or other modifications to
existing establishments shall also be submitted to the local health department for review and approval prior to construction.The local health
department shall visit or inspect an existing or proposed center,within 30 days of the request,to determine compliance.
Establishment Type _
Child Day Care LodgingM/
Bed and Breakfast Home — Bed and Breakfast Inn
Residential Care Rest/Nursing Swimming&Wading Pools,Spas, School Building
Splash Pads
Water Supply Type Individual Well ❑ Community Well I I Public Water Unknown I I
Sewer Supply Type Individual Septic ❑ Public Sewer Unknown I I
All applicable information must be provided prior to submission. Contact Environmental Health for
applicable fees.
Applicant Signature -r' Date 1))OV�20ao
ENVIRONMENTAL HEALTH
Catawba County Government Center
ttl) 25 Government Drive l P.O.Box 389 I Newton,NC 28658
Phone:(828)465-8270(Fax:(828)465.8276
cdtzi-..711,, r'(ulti
• trnitil. EHAs s+ixi@C,atawbaCnuatyNC,. err
Environmental Health General Application
Case#
Property Location:
Street Address: 14410 10. .n.. d-
City ._L11Lr1t t^- _ State: NC Zip: 2Cd bcV
Contact Person: ZatinatAroir,
I CrtA j/� -
Contact Phone Number: 70 t`- I SP - 341
Contact Email Address: dS.MLAf'i VS Cr(63n6•N c hor%Zcn k. (O.„,..
Establishment Name: _ )Orjl0'15 rC;JS / L,L(.. -_
Architect Name(if applicable):
Email Address:
Architect Address:
City: State: Zip:
Phone:
Please Note: Plans drawn to sole ano specifications shall be submitted to the local health department for review and approval prior to
initiat ng construction,Plans drawn to scale and specif caticn.s for changes to building dimensions,kitchen specifications,or other rnod;flcations to
existing establishments shall also he submitted to the local health department for review and approval prior to construction.The local health
department shall visit or inspect an existing or proposed center,within 30 days of the request,to determine compliance.
Establishment Type _
Child Day Care lodging Bed and Breakfast Home Bed and Breakfast Inn
~
Residential Care Rest/Nursing Swimming&Wading Pools, Spas, School Building
Splash Pads
Water Supply Type Individual Well Community Well FR Public Water i Unknown n
Sewer Supply Type Individual Septic n Public Sewer n Unknown ri
All applicable information must be provided prior to submission. Contact Environmental Health for
applicable fees.
A licant Si nature Date Otl-AG' 2iciR I
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