HomeMy WebLinkAboutIMPV-08-2022-178144.TIF �,4`►:0�Y��, CATAWBA COUNTY
•;.I`6j Public Health Department Subdivision TERRANCE C+LINDA S HYL
. rt Environmental Health Division PINK 374519618991
40, PO Box 389,25 Government Drive,Newton,NC 28658 I QTq 1
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Site Address: 5511 SPRINGS RD, CONOVER NC 28613
Name on Permit *HOLLOWAY FAMILY HOMES NORTH CAROLINA,LLC
Property Size: Acres 2.65
Directions: Left off of N NC 16 Hwy onto Springs Rd. Right onto Three D Ranch Ln. First lot on right.
Owner/Authorized Representative Acknowledgement of Permit Receipt
1'"—'certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
fAs the property owner or authorized representative,1 have received the above referenced
permit(s)as requested in the application for service RBPR-06-2022-41310,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required) . .
' �YAs 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:0B/19/2022
Owner/Authorized Representative Signature_ '
'- 1 Date f-4v- z r-
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sendingpermiO
Signature Date/Time 121/1,?
Methnd: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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