HomeMy WebLinkAboutIMPV-07-2022-176276.TIF v4c,„ CATAWBA COUNTY Case a I M PV-07-2022-176276
Sl I t Public Health Department Subdivision
't . f Environmental Health Division P[N8 277003126409
•$. PO Box 389,25 Government Drive,Newton,NC 2865N t OTil 1
w
Site Address: 7844 OREN STEPHENS RD, HICKORY NC 28602
Name on Permit TIM DOCKERY
Property Size: Acres 1
Directions: l-40west exit 121,right on Old Shelby Rd, right at advent crossroads onto George Hlldebran Rd.2 miles left
on camp creek rd,2nd drive on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
x-r
VI certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
/i 9 As the property owner or authorized representative, I have received the above referenced
permits)as requested in the application for service EHPR-05-2022-41084, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
./ Electronic Image Transmittal/ E-mail (Return receipt required)
9 As the property owner or authorized representative I have reviewed and understand the specific conditions
• r-
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(1SA 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: 07/22/2022
Owner/Authorized Representative Signature 7�--0 . • >til&y
Date FO B/,oz-
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Dtc_, _ _ Date/Time U II 7/)Method: Fax Email US Mail Other
Owner's request to send by the above indkated method of transmittal in lieu of signature
We wantt tto hear from yo/Please ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
/A to