HomeMy WebLinkAboutAUTH-07-2022-175574.TIF -i •
• CATAWBA COUNTY Case# AUTH-07=2022 175574,-'
Public Health Department Subdivision APACHE HILLS
6)t K Environmental Health Division PINK - 369607698748
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# PTS 15& 16A
Site Address: . 6813 NAVAJO TR, SHERRILLS FORD NC 28673
Name on Permit: VONDA KRUEGER
Property Size: Acres 0.36
Directions:' E NC 150 HWY, LEFT MT PLEASANT RD RIGHT NAVAJO TR ON RIGHT
• Owner/Authorized Representative Acknowledgement of Permit'Receipt
• y I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
(_ 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 EHPR-05-2022-41200,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: 07/13/2022
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)
(}ESignature Date/Time -7l/ /1Z
• Method: Fax v 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 youPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService L.
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