HomeMy WebLinkAboutIMPV-07-2022-175266.TIF .-.e. x. --- r-. -w+."IM'Vv, V -rts
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e CATAWIA COUNTY'
t‘P Public Health Department Subdivision
'1l J Environmental Health Division PIN" 376304626837
t tit�za PO Box 389,25 Government Drive,Newton,NC 28658 LOT"
Site Address: 3999 DEAL RD,CLAREMONT NC 28610
Name on Permit: GUILLERMOURIOSTEGUI MELCHOR
Property.Size: Acres 28.61
Directions: Bunkerhill School RD the property will be located on the left after passing noy field. Coming from Oxford
School RD located on Right. Land is cleared.
// Owner/Authorized Representative Acknowledgement of Permit Receipt
�T t�/nil'y that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
Ur19olhe property owner or authorized representative, I have received the above referenced
permits)as requested in the application for service RDPR-05-2022-41201,by the following method(s):
_ Received in Person
Facsimile Transmittal (Return form with signature required),
�/ '7 Electronic Image Transmittal/E-mail (Return receipt required)
U1 /As the property owner oc 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:07/08/2022
Owner/Authorized Representative Signature G enmo Un+'Mao,
Date 7/14/2022
'Documentation of PermIt(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by lei
(name ofperson sen'di/ng permit)
Signature Date/Time 7/j7)r))
Method: Fax Email US'Mail . Other
Owner's request to send by the above Indicated method of transmittal in lieu of signature
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