HomeMy WebLinkAboutEXSY-06-2022-172939.TIF � CATAWBA COUNTY' F.XSY-06-202s 172931
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/,•�. Public Health Department `ibdi,i"c„
'it lit Environmental Health Division {'IM 369903345963
PO Box 389,25 Government Drive.Newton,NC 2808 t.ora
Site Address: 1810 JOE JOHNSON RD, CATAWBA NC 28609
Name on Permit: AUSTIN HILL
Property Size: Acres 9.91
Directions: NC-16 S, lefto onto Bats Creek Rd, nght onto W Bankdys Cross Rd, lefto onto Buffalo Shoals Rd,nht onto E
Bandys Cross Rd, slight nght onto Sherrtlls ford Rd, right onto Joe Johnson Rd, home on the left
Owner/Authorized Representative Acknowledgement of Permit Receipt
144, I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the propert> described above.
•, .As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2022-40438,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
f. Electronic Image Transmittal/ [-mail (Return receipt required)
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(I5A 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: 06/06/2022
Owner/Authorized Representative Signature -
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"3' Date `q ,-
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ (name of person /12
sennding permit)
Signature DateiTime?i1
Method: Fax 4 Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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