HomeMy WebLinkAboutIMPV-03-2018-097321.TIF (ATAWBA COUNTY Case if '
Q' .SI.
Public.Health n p' t Subdivision DOCKSIDE VIEW PH 4
(¢�,�SJ- ) 1inn hnn.nalHealth Di tsion I'IN9 460701267475
jPO Box 389_100-A Southwest Blvd,Newton.NC 28658 IOTA' 30
'HiatNAME ON PERMIT: *BURNETT HOME BUILDERS, 7887 MOUNTAIN SHORE DR, SHERRILLS FORD
NC 28673
Site Address: 3693 BURTON ST, SHERRILLS FORD NC 28673
Property Size: Square Feet 22,215.60 Acres:0 51
Directions: 150 East to Lek on Mt Pleasant lot on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
certify that I am the owner or authorized agent Comer'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 RBPR-01-2018-28245, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
qq Electronic Image Transmittal/ E-mail (Return receipt required)
'4.� l 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(ISA NCAC IRA.1900),
and/or Well Construction Standards(ISA 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: 03/28/2018
---
Owner/Authorized Representative Signature/
Date --/' (r
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name al 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
we wantt tto hear from yosPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
11, ., I uiyxyoII I1 17