HomeMy WebLinkAboutAUTH-08-2022-177543.TIF •
CATAWBA COUNTY Case a AU'fl I-08-2022-177543
Public Health Department Subdivision WESTOVER WOODS
Environmental Health Division PINW 279116849384
,r�' • PO Box 389,25 Government Drive,Newton,NC 28658 1.OT# 41
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Site Address: 5143 MORRISON DR, HICKORY NC 28602
Name on Permit: AMBER ZEZECK
Property Size: Acres 0.7
Directions: NC-127/Brookford Blvd, right onto Leslie Ave,right onto Morrison Or,property on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
t_ I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
t e property described above.
XAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-08-2022-41835,by the following method(s):
_ Received in Person
Facsimile Transmittal (Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required)
O._
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(I SA NCAC I8A.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: 08/11/2022
Owner/Authorized Representative Signature
Date
8/20/22
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ (name of person sending permit)
Signature !i Date/Time �iji Z 2-
Method: Fax b 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 yoaPlease ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/EHCusttomerService
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