HomeMy WebLinkAboutWELL-08-2022-177468.TIF r •
`4;1s CATAWBA COUNTY' ,,,,,,, .._ _
4"11111.1 vc..(..vci 1,. Public Ilcalth lkpnrtmcnI Subdivision PINE BURR
r : tF Environmental Health Division PINII 368703415377
PO Box 389,25 Gmemment Drive,Newton,NC 2811511 LOT# 1 &5
Sits Address: 4172 WINONA DR,MAIDEN NC 28650
Neme on Permit: RICHARD(LOGAN)*RIDDLE
Property Size: Acres 1.03
Directions: S Hwy 16,Left on Mt Beulah Right on Winona Lot of left
Owner/Authorized Representative Acknowledgement of Permit Receipt
Lcertify that I am the owner or authorized agent(owner's authorization required)representing the owner of
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the property described above.
4-,As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-04-2022-40586,by the following method(s):
Received in Person
_ Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
`v"--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 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:08/10/2022
Owner/Authorized Representative Signature K� — fit 4__ f/e
Date — 1S .G'•)-`
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
C
Signature t
__.________ Date/Time 7 iisizI ,
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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