HomeMy WebLinkAboutIMPV-05-2021-151356.TIF 4.�I'.MN. C ATAWBA('OI I 1
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See Mem : 6648 LONG ISLAND RD,CATAWBA NC 26609
Plante en Penult AUSTIN HIRSCH
Property ilea: Acres 14 a 1
Directions; Shen,Is Ford Rd.Long Island Rd,Properly on Leh lust past Bolton Rd
OwncrlAuthorized Representative Acknowledgement or Permit Receipt
ikI certify that I am the irony,or autlsr ireJ aµertt(oorwt's euth.,rirru,m rcgwrcdi represcnung the inner nl
the pmperty described alritc
yAs the property owner or authorized representative,I have received the above referenced
permits)as requested in the application for service RUPR•04-2022-4119314,by die following method(s):
Received in Person
Facsimile I ransmittal(Return form with signature required)
✓ Electronic Image'1'ransmittal/E-mail (Return receipt required)
DCAs 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(ISA NCAC ISA.I900y,
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 well permitted.
Permit Issue Date:05/27/2022
Owner/Authorized Representative Signature ,___ ___
Date 7— —
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by . (name of person se Jr l permit)
Signature Date/Time 6/ 1)
Method; _Fax -4 1 J/ Email _IIS Mall Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
i
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