HomeMy WebLinkAboutAUTH-05-2022-172461.TIF , r ,
fps CATAWBACOUNTY Case# A UTH-05-2022-1 72461
Public Health Department Subdivision ST JAMES VINEYARD PH 2
(., ."Q: ,, Environmental health Division PINS 375008887488
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 62
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Site Address: 1542 ANTIOCH DR,CONOVER NC 28613
Name on Permit: 'HELMSMAN HOMES,LLC
Property Size: Acres 0.5
Directions: take right off of Judea Dr onto Antioch Dr.2nd lot on left.
Owner/Authorized Representative Acknowledgement of Permit Receipt
XX 1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
•
X As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-11-2021-39363,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
I Electronic Image Transmittal/E-mail (Return receipt required)i. x 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:05/27/2022
Owner/Authorized Representative Signature Mu
Date 1t21, 12OZ2
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Cif Date/Time /ON))
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 comptette our custtomer service survey att
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401114 05/2112022 16:1 S
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