HomeMy WebLinkAboutAUTH-09-2022-180886.TIF f ,
(0� ,- CATAWBA COUNTY C�# AUfH-09-2022-I80886
v`./' �J�,�y Public Health Department Subdivision
,i�,,`.: It Environmental Health Division PIN# 371212874023
V.:...0 PO Box 389,25 Government Drive.Newton,NC 28658 LOT/
Site Address: 359 21ST ST SE,HICKORY NC 28602
Name on Permit LESLIE KENWORTHY
Property Size: Acres 0.35
Directions: I 40W Exit 126 and turn right,left at light on 21st St SE,house on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
7 Q certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
t e property described above.
J>�As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service EHPR-09-2022-42267,by the following method(s):
Received in Person
___ Facsimile Transmittal(Return form with signature required)
Electronic image Transmittal/E-mail (Return receipt required)
i , As the property owner or authorized representative I have reviewed and understand the specific conditions
o 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 I8A.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:09/22/2022
Owner/Authorized Representative Signature,/ I�,b/1...ht
Date q,30•21.
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Cit (i Date/Time ))
Method: Fax 1 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 youPlease ttake a few momentts tto complette our custtomer service survey att
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Parcel:371212874023,359 21 ST ST SE 1 in=40ft ,
HICKORY, 28602
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Copyright 2021 Catawba County NC
09/22/2022