HomeMy WebLinkAboutWELL-08-2022-178128.TIF 1
eit �yt CATAWBACOUNTY Case4 WELL-08-2 022-1 78 1 2 8
/• ate,+, Public Health Department Subdivision
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Environmental Health Division P1N4 371117213498
\ PO Box 389,25 Government Drive,Newton,NC 28658 LOTH 3
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8ite Address: 1856 CARL DEAN DR, NEWTON NC 28658
Marne on Permit OAKWOOD HOMES
Property Size: Acres 1.19
Directions: Oki Conover Startown Rd, left onto Settelmyre Bridge Rd,right
Owner/Authorized Representative Acknowledgement of Permit Receipt
1 22 I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
tl As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-08-2022-41947,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required) ._ --
Y'� 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 ISA.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:08/19/2022 `\7 2.
Owner/Authorized Representative Signature �`' 9 G.- if
,/( Date 75' Z) Z L
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name ofperson sending permi!)
Of
Signature ----__.__ Date/Time i)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 yo&Please ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/ENCusttomerServIce
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Parcel: 371117213498, 1856 CARL DEAN DR 1in=60ft
NEWTON, 28658
This map/report product was prepared from the Catawba County,NC Goosppatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on This map or data on this report.Catawba County promotes and reconunends
the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and
personnel,disclaim.and shall not be held liable for any and all damages,loss or Debility,whether direct,Indirect or consequential which arises or may
arise from this map/report product or the use!hereof by any person or entity,
Copyright 2021 Catawba County NC
08/19/2022
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