HomeMy WebLinkAboutEXSY-05-2022-171477.TIF `��sagp.• CATAW'BA COUNTY Case a EXSY-05-2022-171477
Public Health Department Subdivision CRESCENT LAND AND TIMBE
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w Environmental Health Division PINS 461601079593
PO Box 389,25 Government Drive,Newton,NC 28658 LOTS 19&ADJ LOT
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Site Address: 8176 DRAKE CT.SHERRILLS FORD NC 28673
Name on Permit: CIKESH PETER C TRUST
Property Size: Acres 1.05
Directions: 150 E,right onto Slanting Bridge Rd,bear left onto Drena Dr, right onto Giles Ave, righto onto Welbom Dr,
bear)left onto Drake Cr,turn right
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
e pr perty described above.
I)
As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-02-2022-40145,by the following method(s):
_ Received in Person
_ Facsimile Transmittal(Return form with signature required)
LElectronic Image Transmittal/E-mail (Return receipt required)
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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 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:05/13/2022
/
OwnerlAuthori- d Repre- ntative Signature "L.') / �-� /_-____
Date • .4' 7)
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permi!)
4,f
Signature Date/Time 5
Method: Fax s[ 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 complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
e i Kesh p@yahoo.61A
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