HomeMy WebLinkAboutAUTH-05-2022-171322.TIF 4c, • CATAWBA COUNTY
Public Health Department Subdivision
i Environmental Health Division
R <-� PINH 374419517390
" PO Box 389,25 Government Drive,Newton,NC 28658 LOTH 3-C
Site Address: 4816 LEE CLINE RD.CONOVER NC 28613
Name on Permit: *CLINE CUSTOM BUILDERS INC
Property Size: Acres 1.01
Directions: Head East on 40 Take Exit 132 and turn on NC-16N turn right on NC 16N 1st Ave N turn Left C&B Farm Rd
turn right on Lee Cline destination on right
Owner/Authorized Representative Acknowledgement of Permit Receipt
?c.
/",cam certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
f.L-As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2022-40539,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
nn// v Electronic Image Transmittal/E-mail (Return receipt required)
L/ .As 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 I8A.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:05/11/2022
PadOwner/Authorized Representative Signature 'L`IU,
'--- 'Date 5/18/2022
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature ff Date/Time dill))
Method: Fax 4 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 yo.iPlease ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/ENCusttomerService
P9
averunt 05/16/2022 08:00