HomeMy WebLinkAboutAUTH-02-2016-069273.TIF ,y9 • CATAWBA COUNTY Case# AUTH-02-2016-069273
imfiwllnL y Public Health Department Subdivision G S HILDEBRAN FARM
< .toy ,a Environmental Health Division PIN# 370015740738
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Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOT# 33 & PT 34
1842 s..
NAME ON PERMIT: TERRELL & MAXINE HUFFMAN, 2079 ZION CHURCH RD, HICKORY NC 28601
Site Address: 2079 ZION CHURCH RD, HICKORY NC 28602
Property Size: Square Feet:48,787.20 Acres:1.12
Directions: From 140 exit 123 (Mtn View), Left onto Zion Ch Rd, 2.5 miles & the house is on the Right.
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.
As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service EHPR-02-2016-23164 by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
.f t 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: 02/17/2016 /�
Owner/Authorized Representative Signature `/•F/l'�-tl� 4 zid
of -
Date 2-`/)]—a o1 (tj
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 02/17/2016 10.37 Page 4 of4