HomeMy WebLinkAboutEHPR-3-11-9868 (2).TIF xs$ • THIS IS NOT A PERMIT Case # EHPR -3 -11 -9868
CATAWBA COUNTY HEALTH DEPARTMENT
leo "C Plan Review Application for Environmental Services
1$42 5M Environmental Health Plan Review - OSWP
J *l EXS SYSTEM
eerb(.S 3),)11,1 NAME TO APPEAR ON PERMIT
RICHARD WATSON
SITE ADDRESS: 4127 WILSON RD, Vale, NC Pin#: 268703417298
NAME of SUBDIVISION: Lot # 1 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.889
DIRECTIONS: NEW 321 S/ EXIT 42 HWY 127/ RT ON 127 S/ RT ON HWY 10/ LT ON BANOAK/ LT ON WILSON/ ON RT
APPLICANT OWNER CONTRACTOR
RICHARD WATSON RICHARD WATSON
4127 WILSON RD 4127 WILSON RD
VALE NC 28168 VALE NC 28168
(704)462 -2981 704)462 -2981
PRIMARY CONTACT: Owner APPLICATION FOR: New Construction
DIM EXISTING STRUCTURE: 24 x 52 EXISTING FACILITY TYPE: House
NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANTS: 2 EXISTING WATER SUPPLY IN USE: Private Well
CALCULATED DESIGN FLOW:
Public water is **NOT** available for this property.
PUBLIC WATER TYPE AVAILABLE: N/A
DESCRIBE WORK: 12 x 24 Storage building with electric
DESCRIPTION OF mobile home
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPERTY EASEMENTS: none
PROPOSED CONSTRUCTION
ACCESSORY STRUCTURES
DESCRIPTION: 12 x 24 Storage Building
# OF NEW BEDROOMS: 0 STRUCTURE DIMENSIONS: 12 x 24 ACC DWELLING? No
PLUMBING? No # OF STRUCTURE OCCUPANTS:
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: 5 Side St: Max Height:
03/21/11 14:40
,z1 gA • CATAWBA COUNTY Case # EHPR - - - 9868
Public Heal Department Subdivision
Environmen Health Division - Plan Review
v` 7r, F17 ' PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Lot# 1
PIN#
268703417298
Applicant/Owner RICHARD WATSON, 4127 WILSON RD, VALE NC 28168
Site Address: 4127 WILSON RD, Vale, NC
Property Size: SF 0.889 ACRES
Directions: NEW 321 S/ EXIT 42 HWY 127/ RT ON 127 S/ RT ON HWY 10/ LT ON BANOAK/ LT ON WILSON/ ON RT
FEE NAME DATE AMOUNT BALANCE DUE
Existing Tank Check Fee 03/16/2011 $80.00 $0.00
TOTAL FEES $80.00 $0.00
CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
03/21/11 14:40