HomeMy WebLinkAboutEXSY-09-2022-180190.TIF CATAWBA COUNTY Case e" E,XSY-09-2022-180190
�yry Public Health Department Subdivision MOUNT ANDERSON PHASE
is r) Environmental Health Division NW 367602994627
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dif PO Box 389,25 Government Drive.Newton,NC 28658 LOT/ 82
Site Address: 4370 APEX DR,MAIDEN NC 28650
Name on Permit: STUART BAILEY
Property Size: Acres 1.43
Directions: 16s(R)Tower Rd(R)Sierra Dr(L)Apex Dr
Owner/Authorized Representative Acknowledgement of Permit Receipt
I/1
Y r I J jI certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
'` the property described above.
y q
i gtis the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-07-2022-41643,by the following method(s):
_ Received in Person
Facsimile Transmittal(Return form with signature required)
I Electronic Image Transmittal/E-mail (Return receipt required) •
L j 1As 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 (I5A NCAC I8A.1900),
and/or Well Construction Standards(ISA 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:09/15/2022 j/j
Owner/Authorized Representative Signature V i(;Ll(,/4 j ,l'j1,1,(Nkt
Date `J -:7;2 z7tt,V1
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by C (name of person sending permit)
Signature /L Date/Time9/��J,))
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 yotPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EliCusttomerService
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