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HomeMy WebLinkAboutIMPV-06-2016-073065.TIF D ' CATAWBA COUNTY Case# IMPV-06-2016-073065 ,� ©� Public Health Department Subdivision was, Environmental Health Division PIN# 368901092292 / PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 3 Igg2 NAME ON PERMIT: *COBBLE CREEK CUSTOM HOMES LLC, 1658 MAGGIE ST, CATAWBA NC 28609 Site Address: 1098 SHILOH RD, CATAWBA NC 28609 Property Size: Square Feet:49,484.16 Acres:1.136 Directions: Hwy 16 to IGA, Left onto Buffalo Shoals Rd, Right onto Shiloh Rd, Lots will be on the Right Owner/Authorized Representative Acknowledgement of Permit Receipt NI L P certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the property described above. ,c,l' As the property owner or authorized representative, I have received the above referenced permit(s) as requested i the application for service EHPR-05-2016-23867 the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) n Electronic Image Transmittal/ E-mail (Return receipt required) 5-N 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: 06/02/2016 Y/e,e0-- Owner/Authorized Re presentative Signature Date /0 /,ei 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 We want to hear from you. Please take a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/EHCustomerService elipermlt 06/03/2016 13 04 Page 3 of 3