HomeMy WebLinkAboutEXSY-06-2022-174535.TIF r' r
w,tr�v..> CATAWBA COUNTY Case iY EXSY-06-2022.174535
Al - 1s Public Health Department Subdivision CRABTREE MEADOWS
g.,_ fo Eoviranmental Health Division PIN/ 267701385695
`V./� .PO Box 359.25 Government Drive,Newton,NC 28658 LOT/ 4
Site Address: 3856 BRIDLE PATH DR.VALE NC 28168
Name on Permit 'CMH HOMES, INC.I()BA OAKWOOD HOMES#712(NEWTON)
Property Styx Acres 0.48
Dint-dons: TR on SW BLVD TRW C st
Owner/Authorized Representative Acknowledgement of Permit Receipt
CPI certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
i•_As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2022-40292,by the following method(s):
Received in Person
/ Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
it QO
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(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:06/24/2022 X
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Owner/Authorized Representative Signature
—1 Date rp -J?r Z Z-
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature 4i Date/Time Ip f 4 f^Ci
1
Method: Fax Y 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 yotPtease ttake a few momentts tto ctxnplette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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