HomeMy WebLinkAboutRBPR-07-2013-17733.TIFContractor
Owner
Parcel Owner
THIS IS NOT A PERMIT Case # RBPR-07-2013-17733
CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
Residential Building Plan Review - Building New
IMPROVEMENT - AUTH CONST
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fF
NORTHWEST BUILDING CO INC, 134 WITTENBURG SPRINGS DR, TAYLORSVILLE NC 28681
B:828-459-5109 C:828-312-3535 RYAN MAYBERRYF :828-495-8571
_ _NORTHWES_T_BUILDING@_CH_ ARTS_ R.N_ET
HAROLD HUDSON, ,
13:8282561864
MAPLE GLEN LLC, 1067 RIVER HILLS CT, TAYLORSVILLE NC 28681
NAME TO APPEAR ON PERMIT
HAROLD HUDSON
SITE ADDRESS: 963 MAPLE GLEN DR, CONOVER NC 28613 PIN # 372320707078
NAME of SUBDIVISION: MAPLE GLEN LLC Lot # 7 Section/Block
PROPERTY SIZE: Square Feet Acres 0.9
DIRECTIONS: SPENCER RD NE/ TOWARDS MCDONALD PKWY, MAPLE GLEN SUBDIV ON LEFT
PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank
GALLONS PER DAY: 480 WATER SUPPLY: Public Water
DESCRIBE WORK: 2 STORY DWELLING W/ ATTACHED GARAGE & UNFINISHED BASEMENT
SITE INFORMATION
Do any of the following apply to the property for which this application is applied?
If the answer to any of the questions below is "YES", then supporting documentation is required:
Does this site contain any jurisdictional wetlands? No
Does this site contain any existing wastewater systems? No
Is any of the wastewater going to be generated on the site other than domestic sewage? No
Is the site subject to approval by any other public agency? Yes
Are there any easements or right-of-ways on this property? No
APPLICATION FOR:
STRUCTURE TYPE:
FACILITY TYPE: Single Family Residence
DESCRIPTION OF
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS:
NEW STRUCTURE DIM:: 56 X 55
# OF NEW BEDROOMS:: 4
BASEMENT? Yes
New Structure
PRIMARY RESIDENCE
OTHER DESCRIPTION:
# OF OCCUPANTS
PROPOSED CONSTRUCTION
BASEMENT FIXTURES? Yes
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE:
OTHER: INNOVATIVE:
Other described:
4
PLUMBING REQUIRED? Yes
CONVENTIONAL: YES
ANY:
1-9 - ehapplication 07/25/2013 13:51 Page I of 4
�ayA CATAWBA COUNTY Case # RBPR-07-2013-17733
Public Health Department Subdivision MAPLE GLEN LLC
Environmental, Health Division PIN# 372320707078
[.i vddv `C
PO Box 389, 100-A Southwest Blvd, Newton, NC 28658
1842 SM
NAME ON PERMIT: HAROLD HUDSON, ,
Site Address: 963 MAPLE GLEN DR, CONOVER NC 28613
Property Size: Square Feet Acres 0.9
Directions: SPENCER RD NE/ TOWARDS MCDONALD PKWY, MAPLE GLEN SUBDIV ON LEFT
Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An
Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well
Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility.
have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted
right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the
proper identification and labeling of all property lines and corners and making the site accessible sot complete site evaluation can be performed.
Date: ';7— / 3 Signature of Applicant or Agent
An Environmental Health Specialist will contact you within 2 wor�ng days -'Of application date.
If you need further information or assistance please call 828-466-7291
AREA2
MINIMUM SETBACKS FRONT: 40 SIDE: 10
FEENAME
Authorization to Construct Fee (New/Expansion)
Fee
Improvement Permit Fee
TOTAL FEES
REAR:
40 MAX HEIGHT:
DATE
FEE AMOUNT
07/25/2013
$300.00
07/25/2013
$150.00
$450.00
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
E9 - ehapplicalion 07/25/2013 13:51 Page 2 of
- ; i
CATAWBA THIS IS NOT A PERMIT
COUNTY ---� CATAWBA COUNTY HEALTH DEPARTMENT
Application for Environmental Services Page 1
Improvement Permit 0 Authorization to Construct 2KSeptic Repair ❑ Septic Malfunction ❑
Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑
Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑
Application is for New Construction �xisting Facility El
Property Address 963 MAPle. 6 lei, OP, e_ Subdivision /1441-YA, ie 6 1e 11
(m Hove ,-- Lot # % Acres o `?O
(j ,1 Section/Block/P�hase
Driving Directions ((to Property S�e✓tiCe C' LdZ N ��i-i D w�trep Seel'e?ylrt JUk tel t� If
v
i
NAME TO APPEAR ON PERMIT? 0 Ownerplicant Nrontractor
Applicant Contact Information
Name /VO +1�es, J B,,, Id,' �m we � ,qy1 y .:e.
Address �L) �� K�kr � rirv,;<',0r`ive �ylo✓SV�'1)2. Ak VGFI
Phone �a��- 3,a_ 3.'� 3. e v I Cell Phone
Owner Contact Information
Name H-�, r6a On.
Address
Phone ;Z56- I Cell Phone
Contractor Contact information
Name A)6 j- +kweS f R��
Address
Phone I Cell Phone
WHO WILL BE THE PRIMARY CONTACT? ❑ Owner plicant [] C ntractor
Description of Existing Structures on Site A)6 n e
# of Bedrooms ies
Structure Dimensions _,,, # of Occupants
Basement ❑ No Basement Fixtures ❑ No
The Applicant shall notify the local health department upon submittal of this application if any of the following apply to
the property in question. if the answer to any question is "yes", applicant must attach supporting documentation.
❑ Yes 2-9-0 Does the site contain any jurisdictional wetlands?
❑ Yes 0 No Does the site contain any existing wastewater systems'?
❑ Yes � Is any wastewater going to be generated on the site other than domestic sewage?
'es Ei No Is the site subject to approval by any other public agency?
❑ Yes 2 o Are there any easements or right of ways on this property'? Describe
Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi -Public Well
ounty/City/Township Water Line Is a public water supply available? ** es [:]No
If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s):
(systems can be ranked in order of your ere
0 Accepted 11 Alternative Conventional 0 Innovative 0 Other ❑ Any
i
CATAV\j TBA THIS IS NOT A PERMIT
COUNTY `y `y �y CATAWBA COUNTY HEALTH DEPARTMENT
Application for Environmental Services Page 2
Pro Facility Type j
Ef Primary Residence ff New Residence ❑ Addition to Residence # of New Bedrooms *t
Project Description ;5' KK
Structure Dimensions 5S'e 4 54"r? # of Occupants LL
Basement [Yes ❑ No Basement Fixtures Domes ❑ No
❑ Accessory Structure(s) Describe
# of New Bedrooms *t if applicable Structure Dimensions
# of Occupants Accessory Dwelling ❑ Yes ❑ No
Plumbing ❑ Yes ❑ No Describe Plumbing Needed
H Multi -Family Residence # Units #Bedrooms per Unit* 1
Total # Bedrooms *j' Structure Dimensions
U Food Service Specify Type
# Seats Floor Space -Entire Food Service Facility (Sq Ft)
# Employees per Shift # of Shifts Dining Area (Sq. Ft.)
❑ Business Specific Type of Business Retail Floor Space
# of Employees per Shift # of Shifts
❑ Other Facility Type Specify
If Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy
Application for Well Construction/Abandonment/Repair
Proposed Well Type ❑ Individual Well ❑ Semi -Public Well ❑ Community Well
Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown
Well Repair Requested ❑ Yes ❑ No Describe
Calculated Design Flow, Commercial t Additional information may be required to determine
design flow from certain facilities. This value will be determined during consultation with on-site staff.
*Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and
counted on all applications. The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time
of building permit issuance. This may prevent the need for septic system size increase in the future.
T If structure is plumbed but no bedrooms, calculated design flow is required.
** If No, a well permit must be issued with the Authorization to Construct.
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE)
Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified
conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not
transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application,
site plans or intended use changes for the proposed facility.
I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state
officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I
understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site
accessible so that a complete site evaluation can be performed.
Signature of Owner or Agent
Printed Name of Owner or Agent
Date 7 02.5— � j
N
1 inch = 40 feet
I
n"0/
Catawba County, North Carolina
This map product was prepared from the Catawba County, NC, Geospatial Information System.
Catawba County has made substantial efforts to ensure the accuracy of location and labeling information
contained on this map. Catawba County promotes and recommends the independent verification of any
data contained on this map product by the user. The County of Catawba, its employees, agents and
personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect
or consequential which arises or may arise from this map product or the use thereof by any person or entity
Selected Parcel Number: 3723-20-70-7078
Prepared for:
No 9226
\" �\- �' 7, An -)
/29" 99
THIS IS NOT A LEGAL DOCUMENT
I &__j
70
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Date: 7/25/2013' Time: 1:17:14 PM
N
/29" 99
THIS IS NOT A LEGAL DOCUMENT
I &__j
70
-*%
000 _ r, \ \
Date: 7/25/2013' Time: 1:17:14 PM
CATAWBA COUNTY NC - Parcel Report
Information Regarding Selected Parcel(s)
Parcel ID:
3723-20-70-7078
Name:
MAPLE GLEN LLC
Name2:
Address:
1067 RIVER HILLS CT
Address2:
City:
TAYLORSVILLE
State:
NC
Zip:
28681-7615
Account:
Calc Acreage:
0.9
Tax Map:
LRK:
606245
Deed Book:
2766
Deed Page:
0712
Subdivision Name:
MAPLE GLEN LLC
Subdivision Block:
Lots:
7
Plat Book:
66
Plat Page:
148
Building Number:
963
Street Name:
MAPLE GLEN DR
Site Zip:
28613
Township:
HICKORY
Fire Dist:
ST STEPHENS
City/Tax:
State Road:
Total Bldgs Value:
Land Value:
$27,300
Total Value:
$27,300
Year Built:
Year Remodeled:
Last Sale Date:
Last Sale Amount:
Neighborhood:
57
Watershed:
Watershed Split:
NO
Voter Precinct:
P28
E911 District:
HICKORY
Zoning:
R-1
Zoning2:
Zoning3:
Zoning Split:
N
Zoning Overlay:
Zoning District:
HICKORY
Split Zoning Dist:
N
Split Zoning Dist(1):
0
Split Zoning Dist(2): 0
School District:
COUNTY
Elementary School: ST STEPHENS
Middle School:
ARNDT
High School:
ST STEPHENS
School Split:
NO
P&Z Case Number:
Census Tract 2010: 010304
Census Block 2010:
2002
Small Area Plan:
Agricultural District:
Printed: Thursday,
July 25, 2013 01:17 PM
wjAutt4L'
CATAWBA COUNTY
Public Health Department Case # WLS2007-01 l98
Environmental Health Division Subdivision MAPLE GLEN
\J\� Ah PO Box 389, 100-A Southwest Blvd. Newton. NC 28658 SecUBL/Ph/Lot #
7
�� A- �' (828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 PIN# 911372320709134-7
Applicant/Owner MAPLE GLEN LLC
Site Address: 968 TRACY LN
Property Size: SF 25,510 ACRES
Directions: MCDONALD PW KY TO 12TH AV DR NE/ GO APPROX 1 1/4 MILES SUBDIVISION ON RIGHT (OFF SPENCER RD)
Improvement Permit
Permit Valid ForEX;�IRE�D
years No Expiration
Facility (Residential): House
House X Mobile Home Multi -Family Bedrooms _3New? Addition?
Projected Daily Flow 3 `J g_p.d Water Supply Private Well? Public?� Semi -Public?
Basement: _Y Basement Plumbing: N,� -� 1� •� HotTub/Spa: N Special Fixtures (explain):
Proposed Wastewater System: �r ��Ys.�� o� Type:
Proposed Repair:
Permit Conditions:_ o��L(`�yL nurILI z& c 4L
Owner or Legal Representative Signature: Date:
Authorized State Agent: �¢._ R,S, Date:
The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property
owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to
revocation if the site plan, plat or the intended use changes, or if site conditions are altered. The Improvement Permit is not affected by a change in
ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Ltiivs and Rules for Sewake Treatment
and Disposal Svstems' (15A NCAC 18A .1900). Neither Catawba County nor the Environmental Realth Specialist warrants that the septic tank
system will continue to function satisfactorily for any given period of time.
Authorization to Construct Wastewater Svstem (Required for Buildinq Permit)
* See site plan and additional attaclunents ( ).
Proposed Wastewater System:
Type: Wastewater Flow g.p.d
New Repair
Expansion
Soil LTAR: g.p.d./ft2
Type of Facility:
Basement: Y Basement Plumbing:
N HotTub/Spa:
N Special Fixtures (explain):
Wastewater Svstem Requirements
Tank Size: Septic Tank
gal
Pump Tank
gal Grease Trap gal
Drainfield: Total Area:
sq It
Total Length:
ft Maximum Trench Depth in
Trench Width It
Minimum Soil Cover
in Minimum Trench Seperation It
Distribution: Distribution Box
Serial Distribution
Pressure Manifold LPP Other
Additional Specifications:
Authorized State Agent:
Permit Expiration Date:
/ have read and accept the specifications and all conditions of this permit as indicated.
Owner or Legal Representative Signature:
,ATidin
Date:
Date:
Form B
c CATAWBA COUNTY
Case # W LS2007-01 198
Public Health Department
Environmental Flealth Division
Subdivision MAPLE GLEN
\Jz MW / PO Box 389, 100-A Southwest Blvd. Newton, NC 28658
SecUBL/Ph/Lot # 7
9a i' (828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200
PIN#
911372320709134-7
Applicant/Owner MAPLE GLEN LLC
Site Address: 968 TRACY LN
Property Si SF 21 ACRES
Directions: MCDONALD PWKY TO 12TH AV DR NE/ GO APPROX 1 1/4 MILES SUBDIVISION ON RIGHT (OFF
SPENCER RD)
® Improv tt� t Authorization To Construct
SITE PLAN
Well Permit
Scale
System components represent approximate contours only. The contractor must flag the system prior to beginning the
installation to ensure that proper grade is maintained. Do not install system under wet conditions. This permit is subject of
revocation if the site plan or site conditions are altered.
uthorized State Agent Date
Fo nn C
r':\T,de i, d\Fm rnrVIVLS,IUI).. nr
V
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES V
Sheet ii -fL
DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID #:
ON-SITE WASTEWATER SECTION COUNTY:
SOIL/SITE EVALUATION
//�� N -SITE WASTEWATER SYSTEM
OWNER: �O (Ckr-,, APPLICATION DATE
ADDRESS:J _ DATE EVALUATED: /D///n i
PROPOSED FACILITY: �OPOSED DESIGN FLOW (.1949): PROPERTY SIZE:
LOCATION OF SITE: � ' PROPERTY RECORDED:
WATER SUPPLY: 0 Private Public 0 Well 0 Spring 0 Other
EVALUATION METHOD: 0 Auger Boring � Pit 0 Cut
TYPE OF WASTEWATER: 1-7[Pewage 0 Industrial Process 0 Mixed
::.::::::::::::::::::::::::::::::::::.:::::::::::::: ••s YL >� �::...:.:::::::::::::::::::::::::::::::::::::
:Q.:.............................:.....::..............::... ......:.....Q......: bY,O ........:::::::::::::::::......:.....:::::.::::oT
..................:.:.....::::::::::::::::::::::::::::::::................................................................................................................................:...........................
.199:I ::::::::::::::::::::::::::::::::
:, ;::::;:;::;;:.;.:,.,....:::....................................,................................. .............. .._...... __..._.__......._.......
........................................................................................................:...::::::::::::::::
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::_::::::::::::::::::::::::::::::......::::::::::::::;:::::::::::::::::::::::::::::::::::::::::::::::::s::::::::::::::::s::::
:::..::::::::::::::::::::::::::::::::•::::::::..................................................... _.......................................................................::::..:.::::::::::::::::::::::::::::::
..........::::: :
::::::::':::"::::::.....:.::......::.... .......I..............
1442 ...............
E.:..:.::...:............::::::::::::::::::::::::::::::::::.::;:::.:::::::::::::: ::...........:................
......:::::::::: :::::.::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::......::::::#::::::::
:. ..::::::::::1441..................................1441..........................SOIL................................::::::::::::::::::::::;::::::
SLAP::::::::::...........................::: •.::::::::::::::::::::: ::::::::::: ,.,.:::...:::::....:::::::::..........:::::::::::..:.:.:............:....:.:.............
PROEl LE..
:...... 'rC1R :::::::::::::: ONSISPEKCEI:::::::::1 L`�1VESS/::::::::SQII;::::::::::SA1!llf} : ?` :RES1"it':' ::.::::;:::....:::::
...........................:....::::.....:.::.:::::::..:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::...............::::.::::::::::::::::::::::::::::::::::::::::::::::::::.....
.......................:E1ET:lIRE::::::::::::::::::: I . :::::; ::::DEP:TH :::.::::.: ::::::::: CLASS::::
.....................................M..NERALOGY.............COLOR.................................CE,A::::.::::HORIZ:..
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::......:................&
..................................................................................................:........................................................................................................................... ........:..::::::...............................
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DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM I OTHER FACTORS (.1946):
SITE CLASSIFICATION (.1948):
Available Space (.1945),� IJ I I
61
System Type(s) ate, EVALUATED BY: —IT, , HO U `
y, ' OTHER(S) PRESENT:
Site LTAR , �d
COMMENTS:
LEGEND
use the followine standard abbreviations
NOTES VP (Very Plastic)
HORIZONDEPTH In inches below natural soil surface
DEPTH OFFILL In inches from land surface
RESTRICTIVE HORIZON Thickness and depth fmm land surface
SAPROLME S(suitable) or U(unsuitable)
SOIL WETNESS Inches from land surface to fret water or inches from land surface to soil colors with chrome 2 or less - record Munsell color chip designation
CLASSIFICATION S (Suitable), PS (Provisionally Suitable), or U (Unsuitable)
Evaluation of saproGte shall be by pits.
Long-temr Acceptance Rate (LTAR): gal/day/fl?
Show profile locations and other aIle feat uretfdimens(ons, refe'ence or benchmark, and North).
e
.... .... �, ..... .. .... {.... ..... ...........'........:....... i....... i.......:. ......................... .. .............. .. .............. ..........
......:.......:........j......j.......:......5.......:... ........ .... p...... �.... .. .... t.......:.... .. .. .. ... .. .. ...
+ .. .. ............. ....
:
:
:............. .
.......:...... t....... .;......:........i......:...... .....
....... :...... ,...... y........... .. .......... .. .. .. ............ ....
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SOIL
CONVENTIONAL
LPP
MINERALOGY/
LANDSCAPE POSITION GROUP
TEXTURE
.1955LTAR*
.1957LTAR*
CONSISTENCE •
STRUCTURE
CC (Concave Slope)
I
S (Sand)
.1.2-0.9
0.6-0.4
NEXP (Non -expansive)
G (Single Gram)
CV (Convex Slope)
LS (Loamy Sand)
SEXP (Slightly Expansive)
M (Massive)
D (Drainage Way)
EXP (Expansive)
CR (Crumb)
DS (Debris Slump)
II
SL (Sandy Loam)
0.9-0.6
0.4 - 0.3
GR (Granular)
FP (Flood Plain)
L (Loam)
SBK (Subangular Blocky)
FS (Foot Slope)
ABK (Angular Blocky)
H ([-lead Slope)
III
SCL (Sandy Clay Loam)
0.6-0.3
0-3-0.15
PL (Platy)
L (Linear Slope)
SiL (Silt Loam)
PR (Prismatic)
N (Nose Slope)
CL (Clay Loam)
R (Ridge)
S(CL (Silty Clay Loam)
MOIST
WET
S (Shoulder Slope)
Si (Silt)
T (Teske)
VFR (Very Friable)
NS (Non -sticky)
IV
SC (Sandy Clay)
0.4-0.1
0.2-0.05
FR (Friable)
SS (Slightly Sticky)
Sic (Silty Clay)
Fl (Firm)
S (Sticky)
C (Clay)
VFI (Very Firm v. Very Sticky)
VS (Very Sticky)
O (Organic)
None
ER (Extremely Firm)
NP (Non -plastic)
SP (Slightly Plastic)
*Adjust LTAR due to depth,
consistence, structure, soil wetness, landscape, position, wastewater flow and quality.
P (Plastic)
NOTES VP (Very Plastic)
HORIZONDEPTH In inches below natural soil surface
DEPTH OFFILL In inches from land surface
RESTRICTIVE HORIZON Thickness and depth fmm land surface
SAPROLME S(suitable) or U(unsuitable)
SOIL WETNESS Inches from land surface to fret water or inches from land surface to soil colors with chrome 2 or less - record Munsell color chip designation
CLASSIFICATION S (Suitable), PS (Provisionally Suitable), or U (Unsuitable)
Evaluation of saproGte shall be by pits.
Long-temr Acceptance Rate (LTAR): gal/day/fl?
Show profile locations and other aIle feat uretfdimens(ons, refe'ence or benchmark, and North).
e
.... .... �, ..... .. .... {.... ..... ...........'........:....... i....... i.......:. ......................... .. .............. .. .............. ..........
......:.......:........j......j.......:......5.......:... ........ .... p...... �.... .. .... t.......:.... .. .. .. ... .. .. ...
+ .. .. ............. ....
:
:
:............. .
.......:...... t....... .;......:........i......:...... .....
....... :...... ,...... y........... .. .......... .. .. .. ............ ....
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HICKORY
Hickory Office (828)323-7410
CITY OF HICKORY Hickory Fax (828) 323-7474
Norte Carol,na
Life. Well Crafted. RESIDENTIAL APPLICATION
FOR ZONING / GRADING PERMITS
(A City of Hickory application becomes a permit upon approval by a City of Hickory Zoning Administrator.)
Ifproposed Iriitd distut'banc�-ii$li-- 1 C -%6i;M.(_ .x t� ,ti ct tt=ii t1$t:ob ai yErdsi ':Bc=Se i
- -- ..
In. approval frr�-atmvba ,ountjr,'rasioi< 5iiment:Cntra:<(828=46S=81tS1):
Parcel Identification No. 3 7,� aR 3 � o 7 � � C� �� Date
Physical -Address:• 3 ,�"tct -e Yt 1, V e 6 n e U e (`
The building or land was previously used for: vet t q n.
Proposed use or change to this building or land: ` 5 r (
Applicant: /k)o r A We Applicant's telephone No.:
Applicant's Address: J3.9 r' n fit �i•� {� '� d+f f v, �1 � A) L•`
'V -- V
Applicant's Fax: Applicant's Email_44l'kweSI/J:t,►'%�tXCLp <4flee, ,l,
Property Owner: HcirolcQ It A_e_k Dn Owner's Telephone No.: 46 9
Owner's Address:
ALL BUSINESSES OPERATING IN THE CITY LIMITS MUST HAVE A PRIVILEGE LICENSE
This Permit is performance -oriented Property owner is responsible for taking any additional measures not shown on the
approved plan to prevent erosion and offsite sedimentation.
AppIicant's Signature Ar ��r Date 7 —CPX1-1 3
FOR PLANNING & DEVELOPMENT USE ONLY
,y ZONING Q `� OVERLAY DISTRICT
'40 Front Setback + J Size of Lot Approved PD
4 0 Rear Setback s Lot of Record Approved Minor PD
10J Side Setback Use Permitted Elevation Certificate Required
0701 Side Street Setback /,JU Flood Plain
's5' Maximum Height -ARD- Watershed 1 2_3 �4 Protected Critical
Other (Describe): —
'Conditions of A
Zoning/Grading Permit Disapproved:
Reasons For Disapproval:
Rev122012
Zoning LAdrumistratort
P 1'n S , n./-- UD
Zoning Administrator
Dater
,O P
Date: