HomeMy WebLinkAboutEXSY-11-2020-141764.TIF , ,' CATAWBA COUNTY Case# EXSY-I1-2020-141764
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Subdivision SPRINGHAVEN
Q Ill Environmental Health Division PIN# 374417212906
'(,... '� PU Box 389,25 Government Drive,Newton,NC 28658
/g, ,,, (828)465-8270 FAX(828)465-8276 TDD(828)465-8200 to"I'# 6
Site Address: 1245 VENUS ST, CONOVER NC 28613
Name on Permit: ASHTON HUBBARD
Property Size: Acres 0.4
Directions: Springs RD Left Houston Mill Right Springs Haven DR Left Venus ST 3rd from end on left
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.
ICAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-09-2020-35718, 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(15
A 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: 11/2C/2020
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)
Signatureqi Date/Time 5151 1,D
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
acknowledges the conditions and statements above.
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