HomeMy WebLinkAboutIMPV-04-2018-097952.TIF ,visA�� CATAWBA COUNTY Case ti IMPV-04-2018-097952
ry fit 2 Public Health Department Subdivision James L Edwards
< ..arC.1 Y Environmental Health Division PIN# 378004928326
m
'dh- PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT#
/8.2 5.
NAME ON PERMIT: PEYTON/DANIELLE WINKLER, 6900 NAVAJO TR, SHERRILLS FORD NC 28673
Site Address: 5975 ALLEY RD, CATAWBA NC 28609
Property Size: Square Feet:2,089,137.60 Acres:47.96
Directions: Sherrills Ford Rd from Hwy 150, go 6 miles, turn right on Alley Rd go 1 mile, lot will be on right
r__s
Owner/Authorized Representative Acknowledgement of Permit Receipt
v^ �v I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
/ the property described above.
(/
dAs the property owner or authorized representative, I have received the above referenced
permit(s)/ as requested in the application for service EHl'12-02-2018-28542,by the following method(s):
V ✓Received in Person
t�d Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
b✓ 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: 04/11/2018
Owner/Authorized Representative Signature
Date /-‘7t0.-- Z//
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (ncnne 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
We wantt tto hear from youPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
81108161111 04/16/2018 08:46