HomeMy WebLinkAboutEXSY-08-2022-176912.TIF 1.iie CATAWBACOUN'I'Y Case# EXSY-082022-176912
Public Health Department Subdivision RAINBOW HILLS
Environmental Health Division PIN# 370020719623
PO Box 389,25 Government Drive,Newton,NC 28658
l.oT# 68
Site Address: 4271 RAINBOW HILLS DR, HICKORY NC 28602
Name on Permit: GLENN PATTISHALL
Property Size: Acres.730
Directions: W NC 10 right Zion Church Rd,left James Farm Rd, right Rainbow Hills dr property on left before Daisy Ln
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
ermit(s)as requested in the application for service RBPR-01-2021-36580,by the following method(s):
r
Received in Person
_ Facsimile Transmittal (Return form with signature required)
./ Electronic Image Transmittal/E-mail (Return receipt required)
1. As the property owner or authorized representative I have reviewed and understand the specific conditions
9of 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:08/02/2022
/
Owner/Authorized Representative Signature IZZ
—3 Date 8/9/2022
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by_ (name of person sending permilj
Signature (T ..L Date/Time VII)3
Method: Fax 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
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