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HomeMy WebLinkAboutEHPR-2-11-9570 (2).TIF SBA C THIS IS NOT A PERMIT Case # EHPR 2 -11 -9570 ��� CATAWBA COUNTY HEALTH DEPARTMENT U .., �' Plan Review Application for Environmental Services 1842 /ski Environmental Health Plan Review - OSWP ,A d_i_I AII IMPROVEMENT - AUTH CONST )JI(1 K tia 1 NAME TO APPEAR ON PERMIT MP SIGMON CONSTRUCTION CO INC SITE ADDRESS: 4528 N CENTER ST, Hickory, NC Pin#: 371519517805 NAME of SUBDIVISION: Lot # 2 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.769 DIRECTIONS: N CENTER STREET PAST CLONINGER MILL RD ON RIGHT APPLICANT OWNER CONTRACTOR LYNN NGYUEN LYNN NGYUEN KEMP SIGMON CONSTRUCTION CO 4528 N CENTER ST 4528 N CENTER ST INC HICKORY NC 28601 HICKORY NC 28601 PO BOX 1303NEWTON NC 28658 828 -464 -2995 ACCOUNT: 6905 PRIMARY CONTACT: Contractor APPLICATION FOR: New Construction DIM EXISTING STRUCTURE: EXISTING FACILITY TYPE: N/A NUMBER OF EXISTING BEDROOMS: SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: EXISTING WATER SUPPLY IN USE: Public Water CALCULATED DESIGN FLOW: Public water IS available for this property. PUBLIC WATER TYPE AVAILABLE: DESCRIBE WORK: 2 STORY DWELLING/ ATTACHED GARAGE/ FINISHED BASEMENT with Exercise Room, Entertainment Room, Media Room, Game Room, Kitchen, 1 Bathroom/ * *Hickory Zoning and Water / LOT 1 & 2 COMBINED PROPOSED FUTURE ADDITIONS 50 X 20 SWIMMING POOL/ 20 X 20 POOL HOUSE / 18 X 18' GAZEBO OR IMPROVEMENTS: PROPERTY EASEMENTS: NO PROPOSED CONSTRUCTION PRIMARY RESIDENCE NEW RESIDENCE? New Residence # OF NEW BEDROOMS: 5 # OF STRUCTURE OCCUPANTS: 2 PROJECT DESC: 2 STORY HOUSE WITH FINISHED BASEMENT PROJECT DIMENSION: 64 X 96 BASEMENT? Yes BASEMENT FIXTURES? Yes 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 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. Any representation by you of house or structure location should conform 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 AREA2 *************************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 02/25/11 10:39 gA CATAWBA COUNTY Case # 'G Public Health Department EHPR -2 -11 -9570 �� H Environmental Health Division - Plan Review Subdivision � k 0 7 PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Lot 2 841A. PIN# 371519517805 Applicant/Owner LYNN NGYUEN, 4528 N CENTER ST, HICKORY NC 28601 Site Address: 4528 N CENTER ST, Hickory, NC Property Size: SF 0.769 ACRES Directions: N CENTER STREET PAST CLONINGER MILL RD ON RIGHT Minimum Setbacks: Front: 40 Side: 10 Rear: 40 Side St:20 Max Height: FEE NAME DATE AMOUNT BALANCE DUE Authorization to Construct Fee (New/Expansion) Fee 02/24/2011 $275.00 Improvement Permit Fee 02/24/2011 $150.00 TOTAL FEES $425.00 CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 02/25/11 10:39 $A Cp THIS IS NOT A PERMIT Case # EHPR - - 11 - 9570 H CATAWBA COUNTY HEALTH DEPARTMENT c) " 04$ ' '' Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - OSWP IMPROVEMENT - AUTH CONST NAME TO APPEAR ON PERMIT LYNN NGYUEN SITE ADDRESS: 4528 N CENTER ST, Hickory, NC Pin#: 371519517805 NAME of SUBDIVISION: Lot # 2 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.769 DIRECTIONS: N CENTER STREET PAST CLONINGER MILL RD ON RIGHT APPLICANT OWNER CONTRACTOR LYNN NGYUEN LYNN NGYUEN KEMP SIGMON CONSTRUCTION CO 4528 N CENTER ST 4528 N CENTER ST INC HICKORY NC 28601 HICKORY NC 28601 PO BOX 1303NEWTON NC 28658 828 - 464 -2995 ACCOUNT: 6905 PRIMARY CONTACT: Contractor APPLICATION FOR: New Construction DIM EXISTING STRUCTURE: EXISTING FACILITY TYPE: N/A NUMBER OF EXISTING BEDROOMS: SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: EXISTING WATER SUPPLY IN USE: Public Water CALCULATED DESIGN FLOW: Public water IS available for this property. PUBLIC WATER TYPE AVAILABLE: DESCRIBE WORK: 2 STORY DWELLING/ ATTACHED GARAGE/ FINISHED BASEMENT with Exercise Room, Entertainment Room, Media Room, Game Room, Kitchen, 1 Bathroom/ * *Hickory Zoning and Water PROPOSED FUTURE ADDITIONS 50 X 20 SWIMMING POOL/ 20 X 20 POOL HOUSE / 18 X 18' GAZEBO OR IMPROVEMENTS: PROPERTY EASEMENTS: NO PROPOSED CONSTRUCTION PRIMARY RESIDENCE NEW RESIDENCE? New Residence # OF NEW BEDROOMS: # OF STRUCTURE OCCUPANTS: 2 PROJECT DESC: 2 STORY HOUSE WITH FINISHED BASEMENT PROJECT DIMENSION: 64 X 96 BASEMENT? Yes BASEMENT FIXTURES? Yes 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 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. Any representation by you of se or structure location should conform to applicable setbacks. � Date: 2 2 1(,, � Y Signature of Applicant or Agent , ,,,- -- / Or An Environmental Health Specialist will contact you within 2 w?1 ing days of application date. If you need further information or assistance please call 828 - 466 -7291 ARE A2 *************************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Minimum Setbacks: Front: 40 Side: 10 Rear: 40 Side St:20 Max Height: 02/24/11 12:41 � gA � CATAWBA COUNTY Case # EHPR - - - 9570 Public Health Department E Q 1. G Subdivision Envtronmental Health Division - Plan Review v 1 ` PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Lot# 2 /8.2 sM PIN# 371519517805 Applicant/Owner LYNN NGYUEN, 4528 N CENTER ST, HICKORY NC 28601 Site Address: 4528 N CENTER ST, Hickory, NC Property Size: SF 0.769 ACRES Directions: N CENTER STREET PAST CLONINGER MILL RD ON RIGHT FEE NAME DATE AMOUNT BALANCE DUE Authorization to Construct Fee (New /Expansion) Fee 02/24/2011 $275.00 Improvement Permit Fee 02/24/2011 $150.00 TOTAL FEES 5425.00 CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 02/24/11 12:41 THIS IS NOT A PERMIT d a CATAWBA COUNTY HEALTH DEPARTMENT " ' Application for Environmental Services Page 1 1$42 sx, Improvement Permit authorization to Construct 2 Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre- Approval Required) ❑ Application is for New Construction r El Existing Facility El Property Address ' jr /1/, Le -fh r S� ff I'c-K u/ Subdivision Lot # Acres --p Section/Block/Phase Driving Directions to Property f e y 1 '? /U 7 o 7 J t c Z > I" O d ' W CL NAME TO APPEAR ON PERMIT? ❑ Owner Applicant [Contractor „N�� `) • Applicant Contact Information 0 C c V Name /.< t S n, ,.s X52 - \ ° f� s m Addresses S A �-� ��e /0/ �'.o. t»rc 0 o ▪ Phone S y_ 29 F s' Cell Phone e 2 - : � 1 _ o y 3 Z z Owner Contact Information • Name /14c /.n /1 Z Address l/S2a At. C z , jL Q r. /V, c, N c-lc y fC, O Phone Cell Phone I• Contractor Contact Information 1,41 NameX c - �°•S- Addres sg /01 /4 3 = Phone - 2 /64- 2._`I Cell Phone -2 , Z/-> _ o Y3 Z Z WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant 'Contractor Description of Existing Structures on Site ,lo.1 # of Bedrooms *t Structure Dimensions # of Occupants l: Basement El Yes No Basement Fixtures El Yes Na �;� ' • Planned Future Additions or Improvements (Building Pe q i 0 I requested at�s time) OC Describe 2,0A-c, L "' l Oon\ 6o k Proposed Future Structure Dimensions � - 9 d ' # of Bedrooms *t if applicable J Are there easements or right -of -ways recorded on this property ❑ Yes 19 Describe Is a public water supply available on or adjacent to the above property ** Yes ❑ No Check type available ❑ Community Well ❑ Semi- Public Well R-County /City /Township Water Line Existing water su.. , in use ❑ Individual Well ❑ Community Well ❑ Semi - Public Well oun • ownship Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) „� THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT ¢ 74 40 7 Application for Environmental Services Page 2 . \842 sM Proposed Facility Type II Primary Residence n New Residence ❑ Addition to esidence # of New Bedrooms *t Project Description 77 ' ,o c<_5- c<_5- -e. - — �kivl ) - _ _ r Structure Dimensions b s&. L1 # of Occupants Z o Basement Fixtures Yes Basement [`"Yes ❑ [�- ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed n Multi - Family Residence # Units #Bedrooms per Unit *t Total # Bedrooms *t Structure Dimensions (i Food Service Specify Type # Seats Floor Space - Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Daycare Specify Occupancy Application for Well Construction /Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi - Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested n Yes n No Describe Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on- site staff. *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications. The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. - rIf structure is plumbed but no bedrooms, calculated design flow is required. ** If No, a well permit must be issued with the Authorization to Construct. 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. O CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN W ADDITIONAL CHARGE (SEE FEE SCHEDULE) O. I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental C Health employees to go on this property for evaluation purposes. I certify the above information to be correct and understand O 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 transferrable, but may be revoked if this information, site W plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for CO (5) five years from the date issued and is not transferable Signature of Owner or Agent �5 , Z Printed Name of Owner or Agent 1.-K►- 54--4_ i e- 1, ; - 1-4-I 4 — Date 2 — /5 - / / twv FILE4C a a 4ry on Feb ia et 03:4:00 prn Excise Ta $0. ..r (BR) :. Ili ' ®® 'I ST. # 03 ET � 1 N A HIGKS SPENCER, -f, J -: $8gi8ter4r Howls I ® �,. t 03 6 0001-0002 NORTH CAROLINA GENERAL WARRA .DEE % a Excise Tax:$ NO REVENUE All __;1 , Parcel Identifier No. Verified by - . Oo' ly on the day of , 20 By: ''''' Y 'Mkt,. .i,i Pn, ✓Mail/Box to: Wesley E. Starnes, P.C. PO Box 11139 Hickory, NQ 860 ' e;e This instrument was prepared by: Wesley E. Starnes, P.C. .'i ' c Brief description for the Index: J' " 1 e� THIS DEED made this I7' day of February , 2014159 and bet% 1. GRANTOR _j GRANTEE i. VUI THI NGUYEN, unmarried = VUI THI NGUYEN, unmarried 804 46' Avenue Drive NE :e... ` ��`� 804 46 Avenue Drive NE Hickory, NC 28601 ^y... _ ;14, :. j' Hickory, NC 28601 . if The designation Grantor and G4 et as used herein shall include said parties, their heirs, successors, and assigns, and shall include singular, plural, masculine, f i. ine or neuter as required by context. WITNESSETH, that the .for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and by these presents da ii grant, *pin, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land situated in the City of Hickory g, Township, Catawba County, North Carolina and more particularly described as follows: ,. fijik = 1r�'t*i k P g BEING all of Lot IVox4 and 2, of the Christopher and Charlene Schlitt Minor Subdivision, according to a plat the same reco * d in Plat Book 64, at Page 43, in the Office of the Register of Deeds for Catawba Cou L , / reference to }yhich recorded plat is hereby made for greater certainty of description. THA PUIet7,S.OBl1'HIS DEED IS TO COMBINE THE ABOVE PARCELS INTO ONE BUILDING LOT. !_ I X11 or'a of the property herein conveyed includes or XX does not include the primary residence of a • the individual nor law firm preparer of this instrument performed any title examination or pa,;t' ipated in a closing for this property. ,i ,, The property hereinabove described was acquired by Grantor by instrument recorded in Book 2915 page 1259 . A map showing the above described property is recorded in Plat Book 64 page 43 _ NC Bar Association Form No. 3 © 1976, Revised 0 1977, 2002 James Williams & Co., Inc. Printed by Agreement with the NC Bar Association - 1981 www.JamesWilliams.com 2 parcel of land and all privileges and appurtenances thereto belo `d �_ TO HAVE AND TO HOLD the aforesaid lot or _ P P g PP A g to thrantee in e fee simple. j , i ,, a /sl ii And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the righttbggjtvey the sarrit in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend The title against the lawful claims of all persons whomsoever, other than the following exceptions: .)lr; AP' , t de IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year tlrs)''4ovFcwritten. =1 -A. 0002 _ (Entity Name) �' (SEAL) VU H UYEN i t i By: Title: ' r / ' ;r . (SEAL) By: ' y�� • ,, °� Title: r t�,, (SEAL) By: a'� Title: '�I ■ (SEAL) State of North Carolina - County of Catawba �� 1, 04Z45711/ b mt,.,,,py , the dersfgned otar Pbblip of the County and State aforesaid, certify that VUI THI NGUYEN personally appeared before Ibis day at(& knowledged the due execution of the foregoing instrument for the purposes therein expressed. Witness my hand anotarial-stam` al this q I ,ry````p�NUllt �l, y �sT day of Gti/IA�aq 2011 . My Commission Expires: 11 ( 11 Z„ 1 2. ' 1, `= Y %�P S. ec 1 f„.4,„.021,M4...— ,,! a : , - -4 , , ,, , ; ,.,,j " Notary Public n n ' , U . . _ 1 4 ST;Itt3 rnt,WOy State of North Carolina - County of Catawba c / r O c I, the undersigned Notary Public � � ,li Iv s c , , . .c ert i fy that personally ca before me this day and acknowledged that he is th ti `..4i ,, n q , a North Carolina or corporation/limited liability corpfany /general partnership/lr titer partnership (strike through the inapplicable), and that by authority duly given and as the act of s , ntity, she signed the foregoing instrument in its name on its behalf as its act and deed. Witness my hand and Notarial stamp or. this _ day of , 20_. My Commission Expirdtt, f� ',`', - , 4 6 Notary Public The foregoing• rtificate(s) is/are certified to be correct. This instrurneihland this certificip are duly registered at the date and time and in the Book and Page shown on the first page hereof. Register of Deeds for County. By: _ - s Deputy/Assistant - Register of Deeds /f rJ, NC Bar Association Form No. 3 0 1976, Revised ® 1977, 2002 James Williams & Co., Inc. Printed by Agreement with the NC Bar Association - 1981 www.JamesWilliams.com : ; ma c _ RESIDENTIAL APPLICATION , ; r, � � � FOR ZONING / GRADING PERMITS Hickory Office (828) 323 -7410 (A City of Hickory application becomes a permit upon approval County Zoning Office (828) 465 -8380 Hickory Fax (828) 323 -7474 by a City of Hickory Zoning Administrator.) County Zoning Fax (828) 465 -8484 I If proposed land disturbance is 1 ACRE or MORE, applicant must obtain Erosion & Sedimentation Control Plan approval from Catawba County Erosion & Sediment Control. (828 -465 -8161) Parcel Identification No 37 il S1 7 ' a bate :- -/ /- 1/ Project 911 Address:-' !U . G � 4 ;- 5 N ' c_ L o . y The building or land was previously used for: , :, ,,,, ,, t 1 0`t` Proposed use or change to this building or land: / :� • t L� , I c: ia.. j •,"::—. Applicant: i t, 9 S' L6 , : , s 7 1 : Applicant's telephone No i 2S- - / / -) ? X7.5 Applicant's Address: „Z Co lz ; rt,,; -) 4 v . > , 2 i C ! ((> t r� x 1 Applicant's Fax: `�2k " 11/6 Y'" .;;,9-1 t/ 1 1 Applicant's Email Property Owner: / - ./.� -t /) ILe ct .` v) Owner's Telephone No.: Owner's Address: i'01-/ I 'y (v f /i A V ? ,f k„ Al C . ti . c i =� r- - 21 L . = S O (- ? - -Z ALL BUSINESSES OPERATING IN THE CITY LIMITS MUST HAVE A PRIVILEGE LICENSE This Permit is performance - oriented Property owner is responsible for taking any additional measures not shown on the approved plan to prevent erosion and offsite sedimentation. f Applicant's Signature_ /(J2,v`� " Date .2I %�� I/ FOR OFFICIAL USE ONLY 4b( � ZONING CENSUS TRACT Front Setback Size of Lot Approved PD U - Side Street Setback Lot of Record / Approved Minor PD Side Setback Use Permitted j Elevation Certificate Required - Rear Setback Flood Plain Maximum Height 6„„n1) Watershed 1 2 _ 3 4 Protected Critical Other (Dr--,cribe): "21 L�.n: : :. _..i,i,, . ermit Apprt - a -a ti - :2D // Zoning Administrator Conditionse Approval: Ehsurr /5 not. , • e uiq . , . /dr /1 /� 77 �.Sb t e o C. . t'tr.... • . _.� A.. ! - - - - C S - Zoning/Grading Permit Disapproved: Date: Zoning Administrator Reasons For Disapproval: Rev031909 Received By: ; *V Date 1 ,. i e _ , �„ ,. 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