HomeMy WebLinkAboutWELL-06-2022-173933.TIF ,s • CATAWBA COUNTY
.' - ,f Public Health Department Subdivision
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0'-1 Environmental Health Division PIN# 376302688373
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 1
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Site Address: 4542 DEAL RD, CLAREMONT NC 28610
Name on Permit: *ROBERT&TRACY CERRITO
Property Size: Acres 35.43
Directions: From Oxford School RD, South on Deal RD lot on Left at power lines gate will need to be unlocked
Owner/Authorized Representative Acknowledgement of Permit Receipt
I 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
permit(s)as requested in the application for service RBPR-03-2022-40365, by the following method(s):
VReceived in Person
Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
As the property owner or authorized representative I have reviewed and understand the specific conditions
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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: 06/17/2022
Owner/Authorized Representative Signature ,z.e• . [' e- 1
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---- Date r) v2 2.
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name ofperson 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
We wantt tto hear from yod'lease ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/EHCusttomerService
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ahpe.„,it 06/17/2022 08:10