HomeMy WebLinkAboutAUTH-08-2022-178586.TIF 4r11188r CATAN'BA COUNTY Case r AUTH•08-2022.17s $6'
Initt Public Health Deportment Subdivision CHARLOTTA COURY
/ Environmental Health Division PINT 376303037728
PO Boy 389,15 Government(hive,Neµton,NC 28658 LOTH 43-47
Sib Addm•: 4080 CARLTON DR,CLAREMONT NC 28810 •
Name on Permit GREG SHREVE r ,?';
Property Stu: Acres 0.89
Directions: US 70 E,keep straight to pet onto Rock Barn Rd NE,left onto Lavine Ln,lotto ont Carton Dr,home Is on the ;
left a :wr
Owner/Authorized Representative Acknowledgement of Permit Receipt
Ka I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
a As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service EHPR-08-2022-41996,by the following method(s):
_ Received in Person
Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
GC 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(ISA 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:08/25/2022
Owner/Authorized Representative Signature
Date tc/30 7Z Z
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature1„,e Date/Time V f.)s13.)
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 youPlease Hake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerServ1ce
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