HomeMy WebLinkAboutIMPV-05-2022-170674.tif t _a CATAWBA(:Ot1NTY
kill) Public Ilealth Department Subdivision SPRING ECHO
Environmental Health Division PIN# 362916933579
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 1-10
Site Address: 1965 TODD ST, NEWTON NC 28658
Name on Permit STEVEN VANG
Property Size: Acres 0.95
Directions: TR onto Hwy 10 TL onto Sigrnon Dairy Rd TR onto Shady Ln TR onto Barringer Circle TL onto Todd St
Owner/Authorized Representative Acknowledgement of Permit Receipt
S•v 1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
XSVAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2022-40379,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
JElectronic Image Transmittal/E-mail (Return receipt required)
i' S.V As the property owner or authorized representative I have reviewed and understand the specific conditions
T 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:05/04/2022
Owner/Authorized Representative Signature ` Va..1
Date 05/09/2022
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending perms!)
Signature 0
9 Date/Time5l1/d
Method: Fax I Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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