HomeMy WebLinkAboutAUTH-09-2022-179737.TIF r
CATAWBA COUNTY • Case tl
.��� All"f tt-09-2U22-179737
Public Health Deparuncm Subdivision DEERFIELD 4
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�� Environmental Heal h Division i'IN# 268902875653
t PO Box 389,25 Government Drive,Newton,NC 28658 LOTH 73
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Site Address 6389 WILLOWBOTTOM RD,HICKORY NC 28602
Name on Permit: MICHAEL POE
Property Size: Acres 0.96
Directions: S NC 127,right Deerfield,left Fawn Tr,right Shireborn, right Wllowbottom Rd, .8 mile on left
AV/� 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.
"'As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-08-2022-42127,by the following method(s):
Received in Person
Facsimile Transmittal(Return l'orm with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
/r it 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(I5A 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:09/08/2022 j/ ` � �
Owner/Authorized Representative Signature‘/ ��
-1 Date V)41/->UG�
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Pennit transmitted by (name ofperson sending permit)
(n� JJ 1f Signature ? _ Date/Time % I,,7t)
Method: Fax �J y 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 yoaPlease ttake a few momentts tto comptette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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.hi... OW 12 2021 06 53