HomeMy WebLinkAboutAUTH-01-2017-080743.TIF v\ CATAWBA COUNTY CaSe# AUtH-01-2017-080743
„Tat / Public Health Department Subdivision
C op'M •Y Environmental Health Division PIN# 365915720707
''� PO Box 389. 100-A Southwest Blvd. Newton. NC 28658 LOT# 8
/H. s.
NAME ON PERMIT: DRUMS PARTNERSHIP #1 , 411 E 20TH ST, NEWTON NC 28658
Site Address: 1943 SOUTH PARK DR, NEWTON NC 28658
Property Size: Square Peel:499,197.60 Acres:11.46
Directions: Hwy 16 South, South Park Mobile Home Park, Lot#8
Owner/Authorized Representative Acknowledgement of Permit Receipt
)( .., I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
Xc As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service EHPR-09-2016-24691 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
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: 01/06/2017
ter="-
-- Owner/Authorized Representative Signature
Date Y/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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ehpernut 01/09/2017 14:46