HomeMy WebLinkAboutIMPV-05-2022-172328.TIF 1 •
.4wY CATAWBA COUNTY Case 0 IMPV-05-2022-172328
Air(.,1- Public Health Department Subdivision PEBBLE BAY PH 4
iirl , ,t, EnvironmentalHealthDivision PIN# 369604838164
./� PC Box 389,23 Government Drive,Newton,NC 28658 1.0141 198
4�
Site Address: 6919 SEA GULL WAY,DENVER NC 28037
Name on Permit: JOHN MILLER
Property Size: Acres 1.98
Directions: Catawba Burris Rd, left on Goose Point Dr(Pebble Bay Entrance),left on Sea Gull Way,lot on the left
Owner/Authorized Representative Acknowledgement of Permit Receipt
Ni certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
e property described above.
'O s the property owner or authorized representative,I have received the above referenced
ermit(s)as requested in the application for service EHPR-04-2022-40785,by the following method(s):
Received in Person
___f Facsimile Transmittal(Return form with signature required)
v Electronic Image Transmittal/E-mail (Return receipt required)
NOAs 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(I5A 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:05/26/2022 t(,
Owner/Authorized Representative Signature (kW({n"k
Date le' fZ/L1---
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time 10131 3)
Method: Fax Y 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 yoaPlease ttake a few momentts tto compiette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomer5ervice
i, PIO lit(f Nii yal'"'t 1
d pamil 05[2612027 1328 6(7