HomeMy WebLinkAboutAUTH-12-2020-143251.TIF +� CATA BA COUNTY Case ft AUTH-12-2020-143251
d t, 2 Pu •
blic Health Department
Subdivision
.; Environmental Health Division
* PO Box 389,25 Government Drive,Newton,NC 28658 PIN# 360903424244
J8 4 s. (828)465-8270 FAX(828)465-8276 TDD(828)465-8200 LOT# 2
Site Address: 2169 FINGER BRIDGE RD, HICKORY NC 28602
Name on Permit: *SETZER PLUMBING&PUMP, INC,T(BLDG)
Property Size: Acres 1.26
Directions: Hwy 10 W, Right on Finger Bridge Rd, Property on Right
Owner/Authorized Representative Acknowledgement of Permit Receipt
(-certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the described above.
property
SAs the property owner or authorized representative, I have received the above referenced
1 'permit(s)as requested in the application for service RBPR-10-2020-36000,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
'S_ 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(I5A NCAC 2C.0100), shall apply to the
issuance of this permit and the construction of the wastewater system and/or water supply well permitted.
:::::::
12/31/2020
Representative Signature
Date 3 3co- 2-7.--
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name 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
acknowledges the conditions and statements above.
We wantt tto hear from yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
pufl
clhpciniii 12/31/2020 I1:05