HomeMy WebLinkAboutAUTH-05-2022-172466.TIF 0= e CATAWBA COUNTY
./.l j Public Health Department
Sutulivision WYNSWEPT PH 3
Q(rmt, w PO, Environmental
389,25 HealthGovern DimventisionDrive,Newton, 58
NC 28658 PIN# 367804616494
LOT6
Site Address: 4618 NORTH WYNSWEPT DR, MAIDEN NC 28650
Name on Permit: 'MODLIN CONSTRUCTION, INC.
Property Size: Acres 0.76
Directions: Hwy 16 S towards Denver once pass Buffalo Sholas intersect Wynswept is on left Left at 1 st intersection Lot
58 is on the Right
Owner/Authorized Representative Acknowledgement of Permit Receipt
'2 1 certify that I am the owner or authorized agent{owner's authorization required)representing the owner of
the property described above.
. ,�As the property owner or authorized representative, I have received the above referenced
Fiermit(s)as requested in the application for service RBPR-01-2022-39790,by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
_., Electronic Image Transmittal/E-mail (Return receipt required)
iAs the property owner or authorized representative I have reviewed and understand the specific conditions
6fthe 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 _ - =°' .-_.•
Date (9/i/4°4 Z".
1 j
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature _ _ ., _ Date/Time &b e,/.))
Method: Fax J 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 att
http://www.surveymonkey.com/s/EHCusttomerService
b mci ii .e ,�
r
.I:"..cnmi 05.'27;2022 16 19 V_ !