HomeMy WebLinkAboutAUTH-02-2016-069230.TIF 9 • CATAWBA COUNTY Case# ,.
,Ti Public Health Department Subdivision MURRAYS MILL ESTATES
d� Environmental Health Division PIN# 378003217999
.r�''`� PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LO'I# 6
18 N
NAME ON PERMIT: CRAIG BEDFORD, 4311 LANEY RD, MAIDEN NC 28650
Site Address: 1096 EUREKA LN, CATAWBA NC 28609
Property Size: Square Feet: 83,199.60 Acres:1.91
Directions: Hwy 10 right onto Murray Mill Rd, left at Center Church onto Sherrills Ford RD, 1st ST on left 1st House on
right Lot#6
Owner/Authorized Representative Acknowledgement of Permit Receipt
�sp I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
s% As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service RBPR-02-2016-23151 by the following method(s):
JReceived 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 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 M00), shall apply to the issuance of this permit and the
construction of the wastewater system and/or waters p:y well permitted.
Permit Issue Date: 02/16/2016 ��
/
` - caner/Authorized Representative Signature /�SG� A j / a
Date got 0- / I
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 02/16/2016 10:58 Page4 of