HomeMy WebLinkAboutAUTH-09-2022-180474.TIF e ,
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CATAWBA COUNTY Case# AUTH-09-2022-180474
.�, ,t Public Health Department Subdivision HIDDEN CREEK ESTATES PE
d `) Environmental Health Division PIN# 370012950846
#) PO Box 389,25 Government Drive,Newton,NC 28658
18 sw LOP/ 15
Site Address: 1295 RIPKEN DR, HICKORY NC 28602
Name on Permit: KEN AND LAURA DONHAM
Property Size: Acres 0.35
Directions: 321 to River Rd turn left on River Rd, Hidden Creek on the right,take 1st right then left and house is on the
right
Owner/Authorized Representative Acknowledgement of Permit Receipt
KI 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-09-2022-42192,by the following method(s):
Received in Person
/ Facsimile Transmittal (Return form with signature required)
v/ Electronic Image Transmittal/E-mail (Return receipt required)
XAs 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: 09/16/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person
Qsending permit)
Signature Date/Time //�./ })
Method: Fax qj
Email US Mail rOther
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yozPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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{ipemrit 09/20/2022 0G:33