HomeMy WebLinkAboutWELL-12-2021-163138.TIF CATAWBACOUNTY
j f \ Public Health Department Subdivision RHONEY ESTATES
d ;} ,.c,� Environmental Health Division PIN# 265701463867
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 13
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Site Address: 3315 NC 18 HVVY,VALE NC 28168
Name on Permit: RYAN HERNDON
Property Size: Acres 5.03
Directions: W NC 10 Right Cooksville Rd LEft NC 18 Hwy on right past roger hill rd
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.
\� (LAs the property owner or authorized representative,I have received the above referenced
/ permit(s)as requested in the application for service RBPR-10-2021-39041,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
1:e� As the property owner or authorized representative I have reviewed and understand the specific conditions
X 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(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: 06/24/2022
Owner/Authorized Representative Signature �_
Date
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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 yoLPiease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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.tipermit 06/27/2022 06:44
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Catawba County Environmental Health IMPV-06-2022-_1711550
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Parcel: 265701463867, 3315 NC 18 HWY VALE, 1 in=40ft
28168
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12/2212021-