HomeMy WebLinkAboutIMPV-02-2019-111758.TIF 4-1P1*` CATA11'BA CtM l Cases IM PV-02 2019-I I I758
t s Public ilcalth Dcpartmcni Sutxlrvision
• ..„,„ i Environmental ilcalihI)rvision PINM 369602961095
ilk..... PO Boa 389,2S(;uvrmmcnl l)rRc Nrvvtnre.NC 2xhSx 1.010 M 47
Site Address: 4691 RIVER HILLS DR,DENVER NC 28037
Name on Permit HENDERSON BUILDING GROUP
Property slzt.: Acres 1.06
Directions: Take NC 16 S approximately 24 miles,turn left onto Campground Rd,go.6 miles and turn left onto Catawba
Burns.go 2 miles and turn left onto Pebble Bay Dr.lot is.3 miles on right
Owner/Authorized Representative Acknowledgement of Permit Receipt
X 'certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
e pnnperty described above.
X —As the property owner or authorized representative, I have received the above referenced
nnit(s)as requested in the application for service ElIPR-I2-2018-3079.1, by the following method(s):
f
Received in Person
Facsimile Transmittal(Return form with signature required)
JElectronic Image Transmittal/ E-mail (Return receipt required)
i. As the property owner or authorized representative I have reviewed and understand the specilic conditions
f the permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Caws and Rules for Sewage Treatment and Disposal Systems(1 SA NCAC ISA.1900),
and/or Well Construction Standards(1 SA 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: 02/15/2019
Owner/Autho ized epresentative Signature_ _
Date 2D 22..._
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by' TlredCkks Z 1 2-14-Q-nC✓1 (name n/,)er.trui.vet ding permit)
Signature 4t, Date Time 1 )1.:(2)
Method: Fait I 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 yoi'lease ttake a few momentts Ito complette our custtomer service survey att
http:Owww.surveymonkey.com/s/EHCusttomer5ervice
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