HomeMy WebLinkAboutWELL-07-2022-175868.TIF i'i),c,10r,n+ n(` %ir;t
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4.47 rite,fr CATAWBA COUNTY •
Public EnvironmenHealthtal Deportment Subdivision CRESCENT LAND AND TIMBI
`c Ileotth Division PINe 480603317846
PO nox 789,25 Government Drive,Newton,NC 28658 LO'1'M 192
Site Address: 7286 BLACKWELDER RD,DENVER NC 28037 •
• Name on Permit WLLIAM KAYS .
property Size: Acres 0.86 .
Directions: Slanting Bridge Rd,take Independence Ln,take Blackwelder Rd,property on right
Owner/Authorized Representative Acknowledgement of Permit Receipt
_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 RBPR-01-2020-33653, 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 I8A.1900),
. and/or Well Construction Standards(ISA NCAC 2C.0100), shall apply to the issuance of this permit and
the consiruction of the wastewater system and/or water supply well permitted.
Permit Issue Date:07/15/2022 n� � '
Owner/Authorized Representative Signature /�"� I
• Date
7/ /t' -
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
•
•
Permit transmitted by (name of person sending permit)
Signature Y Date/Time r 1✓!J'„
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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