HomeMy WebLinkAboutEXSY-05-2022-172068.TIF CATAWBA COUNTY Case It EXSY-05-2022-172068
Public Health Department Subdivision PEBBLE BAY PH 3 REVISION
Environmental Health Division PIN# 460601266386
PO Box 389,25 Government Drive,Newton,NC 28658
LOT# 113
51,
Site Address: 7322 BAY RIDGE DR, DENVER NC 28037
Name on Permit: JACOB TERRELL
Property Size: Acres 1.62
Directions: 7322 Bay Ridge Dr
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
the property described above.
)(
'''t As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-04-2022-40606,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
Y _ 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: 05/23/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person
/sending permit)
Signature/ Date/Time ! Oki))
Method: Fax Email i US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from you Please ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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ehpennit 05/23/2022 12:28