HomeMy WebLinkAboutIMPV-09-2016-076676.TIF ,4, CATAWBA COUNTY Case#
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.71;e S Environmental Health Division PIN# 379002681654
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�p PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 3
NAME ON PERMIT: NICK & KAYLA PATTERSON, 6606 TRITON LN, CATAWBA NC 28609
Site Address: 6606 TRITON LN, CATAWBA NC 28609
Property Size: Square Feet: 85,377.60 Acres:1.96
Directions: Hwy 10 W, turn right on Hudson Chapel Rd, turn right on Bolton Rd, turn right on Triton Ln, Lot on right
Owner/Authorized Representative Acknowledgement of Permit Receipt
• I ertify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
99 property described above.
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As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service RBPR-06-2016-24096 by the following method(s):
Received 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 .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: 09/11/2016
Owner/Authorized Representative Signature /C% �2'
----) Date • _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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ehpemiit 09/12/2016 08:32
CATAWBA COUNTY e . •7 od .10 Case# IMPV-09-2016-076676
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`� -1Subdivision
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4 — 7, Public Health Department Environmental Health Division 379002681654
PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 4 G 71; ' L Y LO"P# 3
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�A Permit# Auth-9-2016-076677
�G CATAWBA COUNTY
i:: E: BA Z Public Health Department Name Nick Patterson
.: Address 6606 Triton Ln
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w ,14117 PO Box 389, IOOA Southwest Blvd, Newton NC 28658 Lot# 3
I$42 sm (828)465-8270 Fax (828)465-8276 TDD(828)465-8200
SITE PLAN
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