HomeMy WebLinkAboutAUTH-06-2022-173572.TIF ���� CATAWBA COUNTY
FT .t.MI ,y Public Health Department Subdivision
d --- '� Environmental Health Division PIN# 372020729350
PO Box 389,25 Government Drive,Newton,NC 28658
Ig ,� LOT#
Site Address: 1088 OLD CONOVER STARTOWN RD, NEWTON NC 28658
Name on Permit: PANUNCIO CARDENAS
Property Size: Acres 2.8
Directions: 1088 Old Conover Startown Rd
Owner/Authorized Representative Acknowledgement of Permit Receipt
certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the
property described above.
CAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-04-2022-40699, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
7Electronic Image Transmittal/E-mail (Return receipt required)
?( �J
s 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: 06/14/2022
911
Owner/Authorized Representative Signature
Date U - 0/D - J472c,2
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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dip m o 06/14/2022 09:10