HomeMy WebLinkAboutAUTH-07-2022-176207.TIF 44•=t CATAWBA COUNTY
el . �1 Public Health Departmem Subdivision
R.11111 774 Environmental Health Division PIN/ 376302863009
///OP PO Buu 389,25 Government Drive,Newton,NC 28658 LOTH 18ADJ
:OrSite Address: 4925 OXFORD SCHOOL RD, CLAREMONT NC 28610
Mame on Penrntt: 'JEREMY MORRISON
Property Stec Acres 40.17
Directions: Turn Lefet at Oxford School RD/Lookout Dam RD. Property on Left
Owner/Authorized Representative Acknowledgement of Permit Receipt
XI rtify that I am the owner or authorized agent(owner's authorization required)representing the owner of
2e property described above.
the property owner or authorized representative, I have received the above referenced
rmit(s)as requested in the application for service RBPR-06-2022-41302,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required)
Y _As the property owner or authorized representative I have reviewed and understand the specific conditions
t/` f 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:07/2212D22
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Owner/Authorized Representative Signature /
L� V
el Date�U(. ' a)�L1 2,„�.
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by {name of person sending permit)
Signature 'L Date/Time 7(2 7/)
)
Fax i Email Method: US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We want(tto hear from yooPlease(take a few momentts tto complette our custtomer service survey att
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