HomeMy WebLinkAboutIMPV-04-2018-098361.TIF CATA\S'0A COD,\-fY Case if
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Public Ilculth Dcpa:onent Subdivision WYNSWEPT PH 3
'o„ Environmental IIcalll,Division PI Nil 367804622787
4-4- PO Box 389,IOO-A Southwest Blvd,Norton,NC 2225658
,. LOtil 46
NAME ON PERMIT: HECHT REALTY, 885 N HWY 16, DENVER NC 28037
Site Address: 4478 NORTH WYNSWEPT DR,MAIDEN NC 28650
Property Size: Squats Pecs 46,609.20 Acres:1.07
Directions: 16S/to Wynswept Subdivision/Cayton Dr to end/left on North Wynswept I go to end/lot 46
Owner/Authorized Representative Acknowledgement of Permit Receipt
2(_I certify that I urn the owner or authorized agent(owner's authorization reit uired)representing the owner of
the property described above.
XAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-09-2017-27508,by the following method(s):
_ Received in Person
acsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
y _ 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 Triathlon and Disposal Systems(ISA NCAC ISA.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 ,veil permitted,
Permit Issue Date: 04/18/2018 �/-
--a Owner/Ruth/ori'zedd Representative Signahtre �e I —t--r_t--
Date 1(�/ 11/9
Documentation of Perin it(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by ap - �rn
ra '{'h( (mune of person sending permit)
Signature DC7 1 YYY1
- '-PIT Date/lime "1- �g—�(9.ujc,m
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 yoiPlease ttake a few momentts tto complette our custtomer service survey art
http://www.surveymonkey.com/s/E1-1CusttomerService
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