HomeMy WebLinkAboutAUTH-05-2022-172215.TIF rt CATAW'BA COUNTY Case M ASS-201
,:•,%� . Subdivision E Pfeil
I.' ' Public Health Department Plus 3734
Z i Environmental Health Division
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>l, PO Box 389,25 Government Drive.Newton,NC 28658 LOT% PT$
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Sth Address: 1503 TURTLE DOVE RD, CONOVER NC 28613
Name on Permit MAXIMILLIAN TARLTON `t~'_'
Property Um: Acres 2.87 a; . ,.
Directions: NW Blvd to County Home RD,to Springs RD,Left Turtle Dove RD at the end of RD ,
Owner/Authorized Representative Acknowledgement of Permit Receipt
/\11�cenify that I am the owner or authorized agent(owner's authorization required)representing the owner of
, .,
the property described above.
)(14� As the property owner or authorized representative,i have received the above referenced
permits)as requested in the application for service RBPR-04-2022-40695.by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
n 'C 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
Pp 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:0524/2022 _ i
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Owner/Authorized Representative Signature
----- Dat . a Zi
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
________(name of sending permit)
Permit transmitted by
Signature
_____________us_ Date/Time D.)
Method: _F*
Email
request to send by the above Mail
Owner's requther
ove indicated method of-----------transmittal
transmittal in l
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