HomeMy WebLinkAboutEXSY-05-2022-172571.TIF ', (',%TA%%RA'COIN(i r "c 2 E\11'-U 5.a1?' I 1
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Public Ilnit�tkptttmtni tiuh.fitiir an MOBILE HOME ESTATE
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Site Address: 7679 SKYLINE DR SHERRILLS FORD NC 28673
Name on Permit: 'PHILEMON REALTY AND RENOVATIONS LLC
Property Stts: Acres 0 54
Directions: Leh off of Slanting Bnddo Rd onto Sky,ne Or 3rd tot on loft after Midway Ln
Owner/Authorized Representative Acknowledgement of Permit Receipt
r 4 I ccrtif, that I allthe owner or authoriicd agent limner's aulhnrirition required)represcnriny the uo ncr ill the property described ak se.
X (4 As the property owner or nuthoriied representative, I have rceeivcd the above referenced
pcnnil(s)as requested in the application for service 12111'R-05-2022-40943, by the following rncthodtsl:
Received in Person
Facsimile Transmittal (Return form with signature required)
JElectronic Image'fransmittal/ N-mail (Return receipt rcquired.l)
x® As the property owner or authori,ed 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 1HA .1900),
and/or Well Construction Standards (1 SA 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:05/31/2022
UwnerAuthorized Representative Signature (,d 0. 7'C�&len
mate -J(.l aoaa
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
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111
Permit transmitted by (name rfperron sending per,1;u
Signature °f . Date/Time (lbgf)•
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 compiette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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05'.31,2022 14,12
catawba county
public health
EXISTING SEPTIC SYSTEM INSPECTION
NOT FOR LOAN APPROVAL
Case Number:RBPR-05-2022-40943 ®Reconnection to Existing System
Property Owner/Applicant:SANTIAGO MORENO ❑ Mobile Home Park Reconnection
Site Address: 7679 SKYLINE DR,SHERRILLS FORD NC 28673 ❑Applicant Request
Type of Facility: ®House ❑Mobile Home Number of Bedrooms 3
❑ Business
❑Other
Proposed Addition/Accessory Structure:
®Approved ❑Not Approved Reason
❑Approval Not Required/System Location Only
Evidence of System Malfunction ❑YES ® NO System Type/Description GRAVEL BEDS
Noncompliance Items and Notes
• Maintain 5 feet minimum from home or decks.
• No grantee to the longevity of system.
Authorized State Agent p� -f Date 05/31/2022
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828,465.8270
MAKING. LIVING. BETTER.
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