HomeMy WebLinkAboutWELL-09-2021-158050.TIF tt CATAWBA COUNTY Case# WELL-09-2021-158050
�� •-: ` Public Health Department Subdivision
''� s; Environmental Health Division
4`�.:� .,. P1N# 366601456985
Vfif. PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
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Site Address: 3438 E MAIDEN RD,MAIDEN NC 28650
Name on Permit GLORIA MCGEE
Property Site: Acres 4.3
Directions: E Maiden Rd,on left before Honest Bob Rd
Owner/Authorized Representative Acknowledgement of Permit Receipt
};1 in`i certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
•
_ As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service EHPR-08-2021-38476,by the following method(s):
PYCReceived in Person
_ Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
)3Slets 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(15A NCAC 18A.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 well permitted.
Permit Issue Date:09/22/2021 J7' -A (1^V I V 1.Owner/Authorized Representative Signature i >6W
Date'1— /6 ' 2.3
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
We wantt tto hear from yoiPlease ttake a few momentts tto complete our custtomer service survey att
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ehpc+,nit 09/22/2021 16:36