HomeMy WebLinkAboutIMPV-01-2016-068521.TIF ,g • CATAWBA COUNTY Case# IMPV-0 1-20 1 6-068521
„f t !'"L Public Health Department Subdivision
2 Environmental Health Division PIN# 460703039476
°�� PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOT't 1
/82 ,u ,
NAME ON.PERMIT: *CARMICHAEL HOMES, INC., PO BOX 878, DENVER NC 28037-
Site Adcl ess: 7172 ROLLING HILLS DR, SHERRILLS FORD NC 28673
Property Size: Square Feet: 38,768.40 Acres:0.89
Directions: Hwy 16 South, Left Hwy 150, Left Little Mtn Rd, Rolling Hills will be on the Left at the corner of Rolling Hills &
Little Mtn Rd.
��pp Owner/Authorized Representative Acknowledgement of Permit Receipt
�l'`� I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
J As the property owner or authorized representative. I have received the above referenced permit(s) as
requested in the application for service EHPR-01-2016-23027 by the following method(s):
\_/Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
•
J"V As the property owner or authorized representative I have reviewed and understand the specific conditions
' of the permit issued, and further understand that all applicable regulatory requirements specified under the North
Carolina Laws and Rules for Sewage Treatment and Disposal Systems (15A NCAC 18A .1900), and/or
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.
Permit Issue Date: 01/26/2016
>wner/Authoriz/ed Representative Signature
Date 2/"`5-A4
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpermit 01/26/2016 12:09 Page 3 oil