HomeMy WebLinkAboutEXSY-02-2022-166382.TIF 4< a 4Y CATAWBA COUNTY Case LXSY 02 2022-16b382
• 1111 Public Health Department Subdivision
• " .
Environmental Health Division PINS* 374409060205
PO Box 389,25 Government Drive,Newton,NC 28658 LOTH
Site Address: 1168 HOUSTON MILL RD,CONOVER NC 28613
Name on Permit: 'J MARSHALL CONSTRUCTION
Property Size: Acres 0.68
Directions: Springs RD,Take Right at Dollar General go.25 of a mile property on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
cc ify that I am the owner or authorized agent(owner's authorisation required)representing the owner of
y described above.
As he property owner or authorized representative,I have received the above referenced c\.
tl s)as requested in the application for service RBPR-U2-2022-40U72, by the following method(s):
Received in Person
_ Facsimile Transmittal(Return form with signature required)
d Electronic Image Transmittal/E-mail (Return receipt required)
As th property owner or authorized representative I have reviewed and understand the specific conditions
o it issued, and further understand that all applicable regulatory requirements specified under the
rth Carolina Laws and Rules for Sewage Treatment and Disposal Systems(l5A NCAC 18A.1900),
and/or Well Construction Standards(15A NCAC 2C.0100), shall ap,ly to the issuance of this permit and
the construction of the wastewater systen an r water supply well permit 'd.
Permit Issue Date:02/24/2022 1
Owner/Aut on s
d Representative Signature_ _- ue
A
—=,- - - -
-IP
Date---
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature (i)1,t... Date/Time 5 /3/a 3
Method: Fax J 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 yoaPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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