HomeMy WebLinkAboutEHPR-2-11-9581 (2).TIF 4 ' A C O THIS IS NOT A PERMIT Case # EHPR - - 11 - 9581
ET Ai � CATAWBA COUNTY HEALTH DEPARTMENT
s TIOD Plan Review Application for Environmental Services
Ig 42 sM Environmental Health Plan Review - OSWP
if A , c "01 , « IMPROVEMENT
(4 (lint s 2))," 3)q1 t NAME TO APPEAR ON PERMIT
VICKIE WILLIAMS
SITE ADDRESS: 6576 CENTRAL DR, Conover, NC Pin#: 374502687827
NAME of SUBDIVISION: Lot # Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.819
DIRECTIONS: 16N/ LEFT ST PETERS CHURCH RD / RT VALWOOD/ RT CENTRAL / 2ND DRIVEWAY ON LEFT / STAY
TO SIDE OF GARAGE
APPLICANT OWNER CONTRACTOR
VICKIE WILLIAMS FRED WILLIAMS
6576 CENTRAL DR 6576 CENTRAL DR
CONOVER NC 28613 - ONOVER NC 28613
(828)855 -0131 28)855 -0131
PRIMARY - CONTACT: Applicant APPLICATION FOR: New Construction
DIM EXISTING STRUCTURE: EXISTING FACILITY TYPE: House
NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANTS: 3 EXISTING WATER SUPPLY IN VSE: Community
CALCULATED DESIGN FLOW: < --- '�
Public water is **NOT** available for this property.
PUBLIC WATER TYPE AVAILABLE:
DESCRIBE WORK: PVT ACCESSORY BUILDING 12 X 24
PROPERTY EASEMENTS: NONE
PROPOSED CONSTRUCTION
ACCESSORY STRUCTURES
DESCRIPTION: PVT ACCESSORY
# OF NEW BEDROOMS: 0 STRUCTURE DIMENSIONS: 12 X 24 ACC DWELLING? No
PLUMBING? No 0 # OF STRUCTURE OCCUPANTS: 0
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
Minimum Setbacks: Front: 30 Side: 10 Rear: 30 Side St: Max Height:
FEE NAME DATE AMOUNT BALANCE DUE
Improvement Permit Fee 02/25/2011 $150.00 $0.00
TOTAL FEES $150.00 $0.00
03/09/11 11:18
CATAWBA COUNTY Case # EHPR - - - 9581
11111M G Z Public Health Department
Subdivision
--1 Environmental Health Division - Plan Review
\ PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot#
i8 2 sM PIN# 374502687827
Applicant/Owner VICKIE WILLIAMS, 6576 CENTRAL DR, CONOVER NC 28613 -
Site Address: 6576 CENTRAL DR, Conover, NC
Property Size: SF 0.819 ACRES
Directions: 16N/ LEFT ST PETERS CHURCH RD / RT VALWOOD/ RT CENTRAL / 2ND DRIVEWAY ON LEFT / STAY TO SIDE OF
GARAGE
CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
03/09/11 11:18
/��\ CATAWBA' COUNTY
e_ er C' Case # WLS2007 -01546
7
F/ .' 4 ,.\ Public Health Department
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� Environmental Health Division Subdivision
\ J � / - PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Sect/BUPh /Lot #
`,/,„ .i..../. /
(828) 465 -8270 FAX (828) 465 -8276 TDD (828)465-8200 PIN# 374502687827
Applicant/Owner: FRED WILLIAMS
Site Address: 6576 CENTRAL DR CONOVER NC
Property size: SF .82 ACRES
Directions: 16N/ LEFT ST PETERS CHURCH RD / RT VALWOOD/ RT CENTRAL / 2ND DRIVEWAY ON LEFT /
STAY TO SIDE OF GARAGE " "home now has 4 bedrooms / 2 of these bedrooms will be combined into 1
(
bedroom and then that room will also be extend by 8ft x 15 ft " "total number of bedrooms in house will
EXISTING SEPTIC SYSTEM INSPECTION REPO 6T
Site /System Diagram Cz'‘‘ A `e. c ~
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Type of Facility: House X Mobile Home # Bedrooms 4
Business Specify
Other Specify
Proposed Additions / Accessory Structures: Q ,,,.,z rud,..a._ a a. y C ,, a; }, 1
4r .. !' 1 1S •iv 4- ' It...) rel at I.►c F'c..r jv ; 4- p.,- 1...n `c� -1-,_
Approved V Not Approved Reason
Evidence of system malfunction: YES NO System Type/Description
Authorized State Agent: 0 ---- a ` DATE: I L 1 (
NOT FOR LOAN APPROVAL Form E
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