HomeMy WebLinkAboutEHPR-6-11-11198 (2).TIF .y��'� � THIS IS NOT A PERMIT Case # EHPR-6-11-11198
� � CATAWBA COUNTY HEALTH DEPARTMENT
c� , a;' ''C Plan Review Application for Environmental Services
Ig�2 SM Environmental Health Plan Review - OSWP
15 1 �Jti S� EXS SYSTEM
NAME TO APPEAR ON PERMIT
ROGER VANSKIKE
s�Te A��RESS: 1725 29TH AV PL NE, Hickory, NC Pir,�: 371420820403
NAME of SUBDIVISION:HERBERT LEE PROPST ESTATE Lot # 3 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.629
DIRECTIONS: NORTH ON SANDY RIDGE RD/ RT 29TH AV PL NE/ ON LEFT
APPLICANT OWNER CONTRACTOR
ROGER VANSKIKE JEFFERY MCBRIDE CROOKS CONSTRUCTION INC,
1725 29TH AV PL NE 4006 N CENTER ST APT 201 GERALD G
HICKORY NC 28601- HICKORY NC 28601 2182 TEAGUE TOWN
(402)630-0842 RDTAYLORSVILLE NC 28681-
(828)381-2023
PRIMARY CONTACT: Contractor APPLICATION'�R: New Construction
DIM EXIST{NG STRUCTURE: EXISTING FACILITY�
NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANT 1 EXISTING WATER SUPPLY IN USE: Public Water
CALCULATED DESIGN FLOW: 360
Public water IS available for this property.
PUBLIC WATER TYPE AVAILABLE:
DESCRIBE WORK: 26 X 39' DETACHED GARAGE/ 1 STORY / Hickory Zoning
PROPERTY EASEMENTS: NO
PROPOSED CONSTRUCTION
ACCESSORY STRUCTURES
DESCRIPTION: 2 car garage
# OF NEW BEDROOMS: 0 STRUCTURE DIMENSIONS: 26 x 38 ACC DWELLING? No
PLUMBING? No # 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
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Minimum SetbacKs Front: 30 Side: 5 Rear: 5 Side St:15 Max Height:
FEE NAME DATE AMOUNT BALANCE DUE
Existing Tank Check Fee 06/07/2011 $80.00
TOTAL FEES $80.00
06/IS/11 15:53