HomeMy WebLinkAboutEHPR-5-11-10819 (2).TIF � O� THIS IS NOT A PERMIT Case # EHPR-5-11-10819
� �� � CATAWBA COUNTY HEALTH DEPARTMENT
- e► Plan Review Application for Environmental Services
j842 SM Environmental Health Plan Review - OSWP
i �� �' (� J� S'tl �f p shc�:�.' ABANDONMENT
(� , �1 �C� l,��f� pl�v� C[)11�(��'I��I NAME TO APPEAR ON PERMIT
KIM CLARKE
SITE ADDRESS: 3441 BRIDGEFORD LN Newton, NC Pin#: 371019523436
NAME of SUBDIVISION:CATAWBA COUNTRY CLUB Lot # 3 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.469
DIRECTIONS: ON SANDY FORD RD 1/2 MILE WEST OF ROBINSON RD INTERSECTION ENTRANCE TO CATAWBA
COUNTRY CLUB IS ON LEFT. PROPERTY IS STH HOUSE ON LEFT AFTER COUNTRY CLUB. HOUSE
FACES SANDY FORD BUT ADDRESS IS SIDE STREET BRIDGEFORD LN
APPLICANT OWNER CONTRACTOR
KIM CLARKE KIM CLARKE
3441 BRIDGEFORD LN 3441 BRIDGEFORD LN
NEWTON NC 28658 NEWTON NC 28658
828-320-5526 828-320-5526
PRIMARY CONTACT: Owner APPLICATION FOR: Existing Structure
DIM EXISTING STRUCTURE: 35X50 EXISTING FACILITY TYPE: House
NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANTS: 2 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: ABANDONING WELL TO ADD ADDIT[ON TO HOME
DESCRIPTION OF SINGLE FAMILY DEWELLING
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPOSED FUTURE ADDITIONS NONE
OR IMPROVEMENTS:
PROPERTY EASEMENTS: POWER LINE ROW
PROPOSED CONSTRUCTION
APPLICATION FOR WELL CONSTRUCTION/ABANDOiVMENT/REPAIR
PROPOSED WELL TYPE: ABANDONMENT TYPE: Drilled
WELL REPAI REQUESTED?
I understand that this is a formai application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposai
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 norrexpiring 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 ob[ain 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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Minimum Setbacks Front: Side: Rear: Side St: Max Height:
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