HomeMy WebLinkAboutEHPR-4-11-10670 (2).TIF � � THIS IS NOT A PERMIT Case # E�R-4-11-10670
� � �� � CATAWBA COUNTY HEALTH DEPARTMENT
c� yp ''C Plan Review Application for Environmental Services
Ig�2 5M �nvironmental I�ealth Plan Review - Septic Malfunction
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GI �(F�,�Pc'( n�C, NAME TO APPEAR ON PERMIT
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SITE ADDRESS: 4679 DIAMOND ST Claremont, NC Pir�: 375419503269
NAME of SUBDIVISION:OXFORD PARK Lot # 7 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.61
DIRECTIONS: HIGHWAY 16 N- TURN RIGHT INTO OXFORD PARK - TURN RIGHT ONTO OPAL ST - TURN RIGHT
ONTO DIAMOND ST - 2ND HOUSE ON RIGHT
APPLiCANT OWNER CONTRACTOR
WA HER XIONG WA HER XIONG
4679 DIAMOND ST 4679 DIAMOND ST
CLAREMONT NC 28610-8615 CLAREMONT NC 28610-8615
(828)459-9836 (828�59-9836
PRIMARY CONTACT: Owner APPLICATION FOR: Existing Structure
DIM EXISTING STRUCTURE: 29 X 43 EXISTING FACILITY TYPE: House
NUMBER OF EXISTING BEDROOMS: 4 SEWER TYPE: Septic Tank �
NUMBER OF EXISTING OCCUPANTS: 6 EXISTING WATER SUPPLY IN USE: Public Water
CALCULATED DESIGN FLOW:
Public water IS available for this property.
PUBLIC WATER TYPE AVAILABLE: County/City/Township Water
DESCRIBE WORK: SEPTIC TANK BACKING UP IN HOUSE - THIS HAS BEEN GOING ON SINCE THEY HAVE BEEN
THERE ABOUT 10 YEARS
DESCRIPTION OF 2-STORY V1NYL AND BWCK HOUSE
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPOSED FUTURE ADDITIONS NO
OR IMPROVEMENTS:
PROPERTY EASEMENTS: NO
PROPOSED CONSTRUCTIOfV
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 senre 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 nor�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
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04/28/ 11 16:31