HomeMy WebLinkAboutIMPV-05-2022-171645.tif �33• ,. CATAWBA COUNTY Case# IMPV-05-2022-171645
,.7' .1. 2 Public Health Department Subdivision
U„ig O 4 Environmental Health Division PIN# 360903410395
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
/842 sM
Site Address: 2293 FINGER BRIDGE RD, HICKORY NC 28602
Name on Permit: ROBERT WALKER
Property Size: Acres 2.88
Directions: Hwy 10 turn onto Finger Bridge Rd
Owner/Authorized Representative Acknowledgement of Permit Receipt
"4f/certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
XA/As
the property described above.
the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-03-2022-40368,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
1 Electronic Image Transmittal/E-mail (Return receipt required)
ke,siAs 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: 05/17/2022 �//
Owner/Authorized Representative Signature �42.�v%�+^----
Date �- . ' "2-�
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 yoiPlease ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/EHCusttomerService
chpennil 05/18/2022 14:05 I4