HomeMy WebLinkAboutWELL-07-2022-176241.TIF CATANBA COUNTY
.i. , Public Health Department SAV1•is;..m EASTLAKE ESTATES PH 1-B
.st Env konncra i tteaith f), s:.m PS`: 376503114429
' PO Box)89.25 6overnmcnt l)rme.Newton.hC 2R65N t 01 4
Site Address: 3151 GREEN ACRES LN. CLAREMONT NC 28610
Name on Permit: JUAN HERRERA ROWAN()
Property Size: Acres 2.5
Directions: NC16-Right onto Oxford School Rd,Left onto Rest Home Rd,R;gnt onto Sheg Holier Rd.Right onto Green
Acres Ln Property on Right.
Owner/Authorized Representative Acknowledgement of Permit Receipt
��f\I certify that I am the ox+nor or authorized agent(owner's authorisation rcauircdi representing the Donor of
the property described above.
, 5 i As the property owner or authorised representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-06-2022-41277. by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
4 Electronic Image"Transmittal- E-mail (Return receipt required)
• 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 18.A.1900),
and/or Well Construction Standards(I5A 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:07r22/2022 —) I a
Owner/Authorized Representative Signatur
t _M,G"•l
7
Date ( I ?c:2. -
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted bs _...._-- (name of person
isending.perrn1)
Signature Dater Time t I))
_
Method: Fax .J 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 yotPlease ttake a few momentts tto complette our custtomer service survey an
http://www.surveymonkey.com/s/EHCusttomerService
j herr e '&1'I`1I I eI tia Lie. ��.�n
U7 22 2022 I t?I
'-k71
t
Catawba County Environmental Health
- o� -aoaa
ii-eIc " ' all
I - 0aa - 1 ; sg3 g
nfl�v ti
C,� 178.39
i UT g , %
• • • io a I.
20.7/
t ss _.
• I 7 , qs•
el; •
R,
(4, 30.72 7t
'0. 201.67
as
i, a, Q�� B
N l}N-O( N\ /fir Area �S ,
N _ h
r 9- 5° ' b. v)°��
1, e
1 2
``otl(oa 1,1 ?cold 4� .3151
�
Cti.1 s ( -- 11' plat Trench o)''' v
l 10 c 4- y-t neS U�
h ��� /s-�une1S �ach �C
_, 583.22
370.51
ii
, Parcel: 376503114429, 3151 GREEN ACRES LN 1 in=60ft
CLAREMONT, 28610
This mapheport product was prepared from the Catawba County,NC Geospalial Information Services. Catawba County has made substantial efforts
l0 emote the
independent verification of any data contained on this op/report product by map
he user.The Cou or data on this p y Catawba,its eort Catawba tmployees,agents.anromotes and dmends
Oa lonnee
persortnol,disclaim,end Shall not be held liable for any and all damages,loss or liability,whether direct,Indirect or consequential which arises or may
Asa from this mapheport product or the use thereof by any erson or Copyright 2021ntity.Catawba County NC
12/06/2022
i