HomeMy WebLinkAboutAUTH-07-2022-174953.TIF $ C COTY # AUTH-07-2022-174953
PublicATAWBA Health DeUNpartment Case Subdivision
Q Environmental Health Division PIN# 369902563307
113 l'i
PO Box 389,25 Government Drive,(.......
Newton,NC 28658 LOT# 1 B
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Site Address: 6546 SHERRILLS FORD RD, CATAWBA NC 28609
Name on Permit: CJ HOMES, INC
Property Size: Acres.99
Directions: Continue straight on Buffalo Shoals RD,Turn Right onto E Bandys Cross Rd,
Slight Right onto Sherrills Ford Rd, 3rd Lot just passed Barefoot Ave
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
I)(
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-06-2022-41254,by the following method(s):
Received 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
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:07/01/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
()IC/
Signature Date/Time -7 OZ
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 yoLPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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