HomeMy WebLinkAboutIMPV-07-2022-175259.TIF t t r4. f - ._
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y� nl 1 Public Health Department Subdivision R D RUFTY ESTATE-
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Env'roenml Health Division PINT! 378103119761
)I.' - PO Box 389,25 Government Drive,Newton,NC 28658 LOTS 14
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Site Address: 1822 ROBERT RUFTY LN, CATANBA NC 28609 •
Name on Permit EVAAND DANIEL HELTON
Property Size: Acres 13.39
Directions: NC 10, right onto Robert Rutty Ln,home is on the left
Owner/Authorized Representative Acknowledgement of Permit Receipt
0certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
te property described above.
, As the property owner or authorized representative,I have received the above referenced
peimit(s)as requested in the application for service EHPR-06-2022-41440,by the following method(s):
_ Received in Person
—j Facsimile Transmittal (Return form with signature required)
(� J Electronic Image Transmittal/E-mail (Return receipt required) '
1, 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(ISA NCAC ISA.1900);
and/or Well Construction Standards(ISA NCAC 2C.0100), shall apply to the issuance of this permit and T .
- ,the construction of the wastewater system and/or water supply well permitted,
.
=Permit Issue Date:07/08/2022
Owner/Authorized Representative Signature Ft&j 4y/ev. ,
f
Date
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Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
1
,, tt .*:,.,Permit.transmitted by (name of person sending permit) •
/ �121
h `Signature Date/Time 711
t • :Method: Fax 4 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 yoiPlease ttake a few momernts tto complette our custtomer service survey att
http://www.surveymonkey com/s/EHCusttomerServlce
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