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HomeMy WebLinkAboutRBPR-09-2022-42306.tif , . . . . a Catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: T` New Construction ❑Existing Facility Improvement Permit Authorization to Construct _ ❑New Septic Septic Repair/Malfunction 'ptic Relocation El Septic Expansion ❑ Existing System Inspection or Reconnection El New Well El Replacement Well ❑ Well Abandonment ❑Well Repair Property Address /73a 84i 1.p S7- _.__..._— Acres /, 70 Subdivision en 5eu TA/ Lot# Driving Directions to Property tot S -:?)a k S l� c; c c)r io �C e S4 cA-V. or\� St ` .or\Tx .r 1 c , ( \ hi ©.� .bcVeir nc �� c ( )1-.% , Descrii work rNiat Applicant Name R - 01..L.0.4.444- vek Applicant Address /73,2 3Qe%4201 S-TRecr Phone rag 3$i 3 731 Email 124 u.taJ,,,, aisp y0Gm rut .cei t Owner Name "n I f Owner Address \` i' Phone '' Email Contractor Name ND4w t� r9wA/CA Contractor Address ,\ v Phone '' 4 Email Name to Appear on Permit? [ti]^Owner 0 Applicant 0 Contractor Who will be the Primary Contact? ❑Owner ❑Applicant 0 Contractor Proposed New Construction-Residential Primary Residence 0 New Residence ❑ Addition to Residence #of New Bedrooms*t #of Occupants Project Description Structure Dimensions,also specify dimensions of decks&porches (Choose One) 0 Basement ❑Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choose One) 0 Basement El Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Re, 1.2--5 • Retaining Wall>2' ❑ Yes 0 No 'Ili Accessory Structure(s)Describe_apt_ Structure(s)Dimensions yp Pr X Pr Plumbing Erles ❑No Describe Plumbing Needed it r +Q,¢oarv. Ga✓c ear (Choose One) ❑Basement ❑Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes []"*No Retaining Wall>2' 0 Yes (E No Multi-Family Residence #of Apartments_ #Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space El Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wall>2' ❑ Yes 0 No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well El Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested 0 Yes ❑No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?❑Yes ❑No Environmental Health Catawba County Government Center,25 Government Drive I PO. Box 389, Newton, NC 28658 Phone: (828)465-8270 I Fax:(828)465-8276 I EHAdmin@CatawbaCountyNC.gov