HomeMy WebLinkAboutAUTH-07-2016-074425.TIF .1ytti' • CATAWBA COUNTY
< Public Health Department Subdivision LAKEPOINTE NORTH
4 y Y Environmental Health Division PINN 462801372436
z, PO Bos 389, I00-A Southwest Blvd,Ne++4on,NC 28658 L.OTtt 5
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NAME ON PERMIT: JAMES BARTLEY, 108 PENWOOD DR, CARY NC 27511
' Site Address: 2572 PENNGATE DR, SHERRILLS FORD NC 28673
Property Size: Square Feet:48,787.20 Acres:1.12
Directions: Sherrills Ford Rd to elementary school / Island Point Rd left Pennegate/ right lot#5 125472 Pennegate Dr
Owner/Authorized Representative Acknowledgement of Permit Receipt
PI 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
(j.%
requested in the application for service RBPR-09-2015-22260 by the following method(s):
_ Received in Person
Facsimile Transmittal (Return form with signature required)
V Electronic Image Transmittal/ E-mail (Return receipt required)
/t As the property owner or authorized representative I have reviewed and understand the specific conditions
I 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: 07/12/2016
Owner/Authorized Representative Signature i�� r-\\v,
Date 7-15-2-01C,
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature •,Iar u t) Date/Time 7/13/i6
I 1
• 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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ehpennit 07/13/2016 12:32