HomeMy WebLinkAboutIMPV-04-2017-084795.TIF ��y: • CATAWBA COUNTY Case# IMPV-04-2017-084795
ilr .I.ft Public Health Department Subdivision
. (.) 4 Environmental Health Division PIN# 360702853307
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 2&3
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NAME ON PERMIT: MARK DUNCAN, 5123 ORCHARD PARK DR, HICKORY NC 28602
Site Address: 8514 REEPSVILLE RD, LINCOLNTON NC 28092
Property Size: Square Feet: 811,958.40 Acres:18.64
Directions: Hwy 321 take Hwy 10 West, Left onto Hickory Lincolnton Hwy , Right onto Reepsville Rd, Property is
approximately 3 miles on Right.
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.
As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service EHPR-03-2017-25999 , 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: 04/27/2017
Owner/Authorized Representative Signature
Date
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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ripe,mit 04/28/2017 12:07