HomeMy WebLinkAboutAUTH-07-2022-174941.TIF ct CATAWBA COUNTY Casert AITfH-07-2022•174941.
,� r ft Public HealthDepartment. Subdivision
'% n, Environmental Health Division PINK 380902563307 •
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'�&� ;tii;PO Box 789,25 Government Drive,Newton;NC 28658 LOW 1A
site Address: 6544'SHERRILLS':FORD:RD;:CATAWBA NC 28609
Name on Permit CJ HOMES,INC
Property Size: Acres.98''
Directions: CO ntinue straight on Buffalo Shoals RD.Turn Right onto E Bandys Cross Rdl'
Slight Right ontoSherrills Ford Rd;3rd Lot Just passed Barefoot Ave,
Owner/Authorized Representative Acknowledgement of Permit Receipt.
AVI certify that I am the owner or authorized agent(owner's authorization required)representing the owner.of
the property described above.
0/3As the property owner or authorized representative,li have received the above referenced
permit(s)as requested lithe application for service RBPR-06-2022'41256,by the following method(s):
Receivedin Person
Facsimile Transmittal(Return form with signature required)
Electronic.Image Transmittal/E-mail (Return receipt,required)W�//hd� As the property owner or authorized representative I have reviewed and understand the specific conditions
I of the permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for(wage Treat ent nd0 DisposalSystetheissA NCAC uanceoftISAe1900),
and/or Well Construction Standards iSA NCAC 2 ) pp y permit and:
the construction of the wastewater system and/or water supply well peimittedi
Permit Issue Date 07/01/2022
,y Owner/Authorized Representative Signature C. A44 t ---
if Date 7-I1-22
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other.means)
Permit transmitted by (name of person sendinglI permit)
an
Cir
Signature I Date/Time •DiZ
Method: Fax _Email US Mail Other.
Owner's:request to send by the above indicated method of transmittal In lieu of signature
We want tto hear from yo&lease ttake a few moments tto complete our,custtomer service survey'att
http://www.survevmonkey.com/s/EHCustomerService
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