HomeMy WebLinkAboutAUTH-08-2022-177715.TIF $' • CATAWBA COUNTY
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L Public Health Department Subdivision Fernwood Acres Sub Phase 2
.p-3 Environmental Health Division PINtt 363917009078
PO Box 389,25 Government Drive,Newton,NC 28658 I,01-q
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Site Address: 1906 APRILS WAY, NEWTON NC 28658
Name on Permit: NDM KENNEDY TRUST
Property Size: Acres 2.36
Directions: -
Owner/Authorized Representative Acknowledgement of Permit Receipt
XI 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
permit(s)as requested in the application for service RBPR-01-2022-39795,by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
JElectronic 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: 08/15/2022
Owner/Authorized Representative Signature
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Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name gf'person sending permit)
Signature C Date/Time S'a7`7/i Z 1)"
Method: Fax v/Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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elipennit 08/16/2022 10:01
Catawba County Environmental Health
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Parcel: 363917009078, 1906 APRILS WAY 1 in=80ft
NEWTON, 28658
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Copyright 2021 Catawba County NC
08/02/2022