HomeMy WebLinkAboutIMPV-06-2022-172943.TIF ,
CATAWBA COUNTY
• �. Public Health Department Subdivision BUMGARNER GARDENS
• . ��� y Environmental Health Division PIN 373418306337
- PO Box 389,25 Government Drive,Newton,NC 28658 l,0"I'k 6-10
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Site Address: 4746 RANSOM DR, CONOVER NC 28613
Name on Permit: 'KEY BUILDERS, INC.
Property Size: Acres 0.47
Directions: Take left off of County Home Rd onto Allen Ln. Right onto Ransom Dr, 2nd lot on left.
Owner/Authorized Representative Acknowledgement of Permit Receipt
t'Sfj I certify that I am the owner or authorized agent(owner's authorisation required)representing the owner of
the property described above.
X6 As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2022-40510,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
4 Electronic Image Transmittal/E-mail (Return receipt required)
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.AcAs 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 I8A.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 SignatureQa
Date (¢1-3r 1 oQ Q
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature9 Date/Time 67/7/5J
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 yoaPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerservice
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elgw«mn 06/06/2022 16 24