HomeMy WebLinkAboutAUTH-08-2022-177667.TIF �$' . CATAWBA COUNTY
t f Public Health Department Subdivision
R ,'c Environmental Health Division PIN# 470004941489
im!`` � PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 7,8,9
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Site Address: 580 HOPEWELL CHURCH RD, CATAWBA NC 28609
Name on Permit: REYNARD&VELLA PETERS
Property Size: Acres 2.68
Directions: Gov DR, Right on Radiostation RD, Right on SW Blvd, Left on W C ST continue NC 16 S, Left on Hwy 10 E, ,
Right onto Murrays Mill RD, Left on Sherrills FOrd RD, Left onto Hopewell Church RD, Lot on Right.
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.
XAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-04-2022-40794,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
VElectronic Image Transmittal/E-mail (Return receipt required)
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: 08/12/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time
Method: Fax •f 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 yo&Please ttake a few momentts tto complette our custtomer service survey att
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ehpetmit 08/15/2022 14:55 IP t