HomeMy WebLinkAboutIMPV-09-2022-180438.TIF SS a i. CATAWBA COt:NTY
Punt c Ilc.lib Department Sulxlivrsmn
< ��� Environmental Ileulth Division PIN# 368702970751
®� I'O Box 3R9,25 Govcmnicnt Drive,Nctston,NC IRht5 l,t)l p 24C&ADJ
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Stu?Address: 3555 MT BEULAH RD,SHERRILLS FORD NC 28673
Name on Permit: MARGARET PEMMARAJU
Property Size: Acres 2.17
Directions: N Bus Hwy 16,nght onto Mt. Beulah,property is about 2 miles down Mt. Beulah on left,property is before
Lineberger Rd Intersection,red barn
Owner/Authorized Representative Acknowledgement of Permit Receipt
1'" ri certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above,
‘14 s the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-07-2022-41544,by the following method(s):
_ Received in Person
Facsimile Transmittal(Return form with signature required)
I Electronic Image Transmittal/E-mail (Return receipt required)
pid 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(I SA 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
r
Owner/AuthorizedAue Representative Signature
a
1 Date -r o (1{ --o) .
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature
nC 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 yoiPlease ttake a few momentts tto comptette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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Parcel: 368702970751, 3555 MT BEULAH RD 1in-60ft
SHERRILLS FORD, 28673
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Copyright 2021 Catawba County NC
09/16/2022