HomeMy WebLinkAboutEHPR-3-11-9986 (2).TIF .,� THIS IS NOT A PERMIT Case # EHPR-3-11-9986
� �� CATAWBA COUNTY HEALTH DEPARTMENT
c� '�t' Plan Review Application for Environmental Services
Ig�2 SM Environmental Health Plan Review - OSWP
I S�) � � r�.� � IMPROVEMENT
��� 3��i1� ` NAME TO APPEAR ON PERMIT
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JEFFREY P BROCK
SITE ADDRESS: 4283 W LAUREL HILL RD Claremont, NC Pir�: 377401068475
NAME of SUBDIVISION: Lot # 5 Section/BlocklPhase
PROPERTY SIZE: Square Feet Acres 0.589
DIRECTIONS: HWY 16 TO OXFORD SCHOOL RD TAKE OXFORD SCHOOL RD TAKE LEFT ON BOLICK AND LEFT ON
KEMP TAKE LEFT FORK AT BOTTOM CORNER OF WILKERSON
� �
APPLICANT O.WNER � CONTRACTOR
JEFFREY P BROCK � JEFFREY P BROCK
184 HIDDEN VIEW RD 184 HIDDEN VIEW RD
BOONE NC 28607- BOONE NC 28607-
828-2447446 828-244-7446
PRIMARY CONTACT: Owner APPLICATION FOR: New Construction
DIM EXISTING STRUCTURE: EXISTING FACILITY TYPE: House
NUMBER OF EXISTING BEDROOMS: SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANTS: EXISTING WATER SUPPLY IN USE: Private Well
CALCULATED DESIGN FLOW:
Public water is ""NOT** available for this property.
PUBLIC WATER TYPE AVAILABLE:
DESCRIBE WORK: BUILDING NEW A-FRAME CABIN
DESCRIPTION OF NONE
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPOSED FUTURE ADDITIONS NONE
OR IMPROVEMENTS:
PROPERTY EASEMENTS: NONE
PROPOSED CONSTRUCTION
PRIMARY RESIDENCE
NEW RESIDENCE? New Residence
# OF NEW BEDROOMS: 1 # OF STRUCTURE OCCUPANTS: 1
PROJECT DESC: A-FRAME CABIN
PROJECT DIMENSION: 24X28
BASEMENT? No BASEMENT FIXTURES? No
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. 1 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
AREAZ
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