HomeMy WebLinkAboutAUTH-07-2015-062772.TIF •
s,A :� CATAWBA COUNTY ; Case AUTH-07-2015-062772
iT kin cr./ Public Health Department
G Subdivision
ippelt K Environmental Health Division PINK 460603341629
4.63 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 101
/R.2 ,w
NAME ON PERMIT: PETER THERN, 7508 BANKHEAD RD, DENVER NC 28037
Site Address: 7508 BANKHEAD RD, DENVER NC 28037
Property Size: Square Feet:72,745.20 Acres:1.67
Directions: HWY 16, TURN LEFT ON CAMPGROUND RD, 1/2 MI TURN LEFT ON CATAWBA BURRIS, CON'T 1.2 MI
TURN RIGHT ON BANKHEAD, CON'T 0.75 MI, A-FRAME HOUSE ON LEFT.
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that I am the owner or authorized agent (owner's authorization required) representing the owner of the
property described above.
As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service EHPR-12-2014-20625 by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
As the property owner or authorized representative I have reviewed and understand the specific condi
of the permit issued, and further understand that all applicable regulatory requirements specified under the
Carolina Laws and Rules for Sewage Treatment and Disposal Systems (15A NCAC 18A .1900), ands
Well Construction Standards (15A NCAC 2C .0100), shall apply to the issuance of this permit and the
construction of the wastewater system and/or water supply well permitted.
07/16/2015
Permit Issue Date:
Owner/Authorized Representative Signature
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit trans i ted b IMP t WI _ I f t •name of person .ending permits / DO
1 1 p i ►l nU)
Signature • jay I, a Date/Time I
Method: Fax mail US Mail Other
Owner's request too nd by the above indicated method of transmittal in lieu of signature Inn
� �
We want t hear from you. Please to a few moments to complete our customer service survey at
http://www.surveymonkey.com/s/EHCustomerService
ehpermit 07/16/2015 10.13 Page 4 of 4