HomeMy WebLinkAboutAUTH-06-2022-174863.TIF .
dotloop signature verification:dtip.us/ILAV-kOlhoymne
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E =s. CATAWBA COUNTY t --- . -, -- --- ..--
,:2l`� �i Public Health Department Subdivision --- -- . ..
' ,). st Environmental Health Division PINS 267901492879
.Ab'= t®•. PO Box 389,25 Government Drive,Newton;NC 28658 LOTH
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Site Address: 7674 COLINY RD, HICKORY NC 28602
Name on Permit ALEXANDER LONG
Property Stra: Acres 13.57
Directions: Old Shelby Rd,lot on right just before Coliny Rd strip
Owner/Authorized Representative Acknowledgement of Permit Receipt
.id,U" ,bnify that I am the owner or authorized agent(owner's authorization required)representing the owner of
dot verified nY described above.
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a, the property owner or authorized representative,I have received the above referenced
a°a ermi(s as requested in the application for service RBPR-04-2022-40657,bythe followingmethod(s):P � ) q PP ( ):
_ Received in Person
Facsimile Transmittal(Return form with signature required)
ALElectronic Image Transmittal/E-mail (Return receipt required)
aeYg ��� s the property owner or authorized representative I have reviewed and understand the specific conditions
.rI 2` To 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 IBA.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:08/30/2022 dotheop// ��jj
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l``(�Owner/Authorized Representative Signature Ksswcee .aollsmOv
Date 07/11/2022
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Documentation of Permit(s)Transmittal .
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit) ..
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Signature GE, Date/Time / 11%172
6
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 yo2Please ttake a few momentts tto complette our custtomer service survey att
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ehpennit 06/30/2022 11:05 Y e