HomeMy WebLinkAboutAUTH-06-2022-174617.TIF T ,
8: CATAWBA COUNTY Case# AUTH-06-2022-174617
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ET f x Public Health Department Subdivision CATAWBA FOREST
d -, '' Environmental Health Division P1N# 372520929114
U- PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 80
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Site Address: 3332 47TH AVE PL NE, HICKORY NC 28601
Name on Permit: REBECCA SMITH
Property Size: Acres 0.69
Directions: Springs Rd, Sulphur Sprins Rd NE, left 47th Ave PI NE, on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
Y _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 EHPR-06-2022-41460,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
1 Electronic Image Transmittal/E-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(15A NCAC 1 SA.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: 06/27/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sendingC permit)
Signature4E'
Date/Time U!/�J(JJ
Method: Fax V 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 yoLPlease ttake a few momentts tto complette our custtomer service survey att
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d pennit 06/27/2022 10:38