HomeMy WebLinkAboutIMPV-09-2022-180801.TIF Jc=�, CATAWBA COUNTY '
6 a Public Health Department Subdivision RODNEY WHITE LAKE PROP
1 e> Environmental Health Division PINK 460803014087
i
' . il, PO Box 389,25 Government Drive,Newton,NC 28658 LOT!! PTS 5&6
Site Address: 7039 WILSON RD,SHERRILLS FORD NC 28673
Name on Permit DAVID BARRINGER
Property Size: Acres 0.54
Directions: Right off of Mt Pleasant Rd onto Locke Dr Take nght onto Wilson Rd. 2nd lot on left.
Owner/Authorized Representative Acknowledgement of Permit Receipt
4 I certify that 1 am the owner or authorized agent(owner's authorization required)representing the owner of
property described above.
'' As the property owner or authorized representative,I have received the above referenced
IF
rmit(s)as requested in the application for service RBPR-I2-2021-39686,by the following method(s):
_ Received in Person
Facsimile Transmittal (Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required)
MOP As the property owner or authorized representative I have reviewed and understand the specific conditions
7. e 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(1SA 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:09/21/2022
Owner/Authorized Representative Signa-- E_ &to t,Css__..
.Date ! -ale� � T
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sendingpermit)qypi,)
Signature e Date/Time
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 ycuPlease hake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EfiCusttomerService
de1s,c Eeppia.6ya _ D.tion
chp,ii,i, 09/2 t/2022 12 02