HomeMy WebLinkAboutWELL-07-2022-174964.TIF % CATAWVBA COUNTY Case 0 WE_LL-07-2022-174964
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t Public Health Department Subdivision JOHN F CARPENTER 3745
<y r„f Environmental •Health Division PINS/ 374501497077
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� PO Box 389.25 Government Drive,Neuron,NC 28658 LOTH PT 4
"4.841=
Site Address: 1473 WEDGEWOOD DR. CONOVER NC 28613
Name on Permit: HERBERT AND MELISSA PEARCE
Property Size: Acres 0.32
Directions: Hwy 16, left on St.peter Ch Rd,lefot on Valwood,left on Wedgewood,2nd house on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
r
Jstili 0 # at I am the owner or authorized agent(owner's authorization required)representing the owner of
1J� the property described above.
iCp i property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-06-2022-41272, bythe following methods :
P b ( )
Received in Person
Facsimile Transmittal (Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required)
. 41- /.,�,•�rty owner or authorized representative I have reviewed and understand the specific conditions
of I rmi 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 t-' X_- c.��;-
Date 1 7 0 e- € - -').,
iel La rdP111'_e>fltj &
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Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature _ Date/Time 10111/ ?z
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 yo&Please ttake a few momentts tto complette our misnomer service survey an
http://wi.vw.surveymonkey.com/s/EHCusttomerService
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.Irpunmr 07r01.2022 I I.35