HomeMy WebLinkAboutEHPR-02-2023-43372 ( ;) ENVIRONMENTAL HEALTH
Catawba County Government Center
catawba county 25 Government Drive I P.O. Box 389 I Newton, NC 2865$
public health Pone: (828) 465-8270 I Fax: (828) 465-8276
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[mail: CHAJminlorritivcAssistanis<::CotualioCcunhitdC.gov
,6Walk-Through Application
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Name ofAppliamt: lo? s 7l (g1166,5/4fif 6 i Ow- ST i2)
Canted Person: /lefich2 (2i2 A/U/)i
Mailing Address: / r /% Y-rT$/do gr/Y-e'
City/Town: /,����J iZ)i? State: Air Zip Code: a Phone:3310 59 0 b/ 7S Fax:
E-mail Address: b ak es h.eer fir& "wail .r'mrn
Location Address: gale/ /Vc- /0 h 'g
City/Town: e/a/r/170/?24- Zip Code: "2cS'1,/O
Type of Proposed Establishment: rood 7/'!lai (0/97f/ /may
Was this a previous establishment?
�les Name if known: lit ❑No
Type of water. Type of Sewage:
❑ Public Water ❑ Public Sewer
( WelI ari On-Site Sewage System
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I certify that the information in this application is correct.
Signature&Date: ,0a
(Owner or Respons Repiresentative)
$A CATAWBA COUNTY
��' � 100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
U 0 ,� PHONE:828.465.8399
Friday, February 10, 2023
\I$4 www.catawbacountync.gov
PAYOR:
Broadway,Krista
PAYMENTS
TRANSACTION NUMBER: TRC-57357031-10-02-2023
PAYMENT DATE: 02/10/2023
PAYMENT TYPE: Credit Card
300978368 -- ---. -----------
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
02-23-418150 110-580200-663000 Food and Lodging Review Fee $75.00
TOTAL PAYMENTS: $75.00
EHPR-02-2023-43372
CASE TYPE: Environmental Health Plan Review WORK CLASS: Other FLI
SITE ADDRESS: 4281 E NC 10 HWY,CLAREMONT NC 28610
Applicant KRISTA BROADWAY, 1735 RIVERSIDE DR,LEXINGTON NC 27292
C:3365900175 BABESBEERBAR@GMAIL.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 02/10/2023 10:43 Page 1 of 1