HomeMy WebLinkAboutIMPV-09-2022-180907.TIF CATAWBA COUNTY
Public Health Department Subdivision
Environmental Health Division PINN 376402853673
PO Box 389,25 Government Drive,Newton,NC 28658 LOTN
5145 CORBAN ST,CLAREMONT NC 28810
a: DIANE&WILUAM DEMAURO
Acres 9.35
Exit 3 off 1.40 NE on Rock Barn RD, Left Oxford School RD,Right River Bend RD,Right Bolick RD,Left on
Corban ST
Owner/Authorized Representative Acknowledgement of Permit Receipt
:rtify that I am the owner or authorized agent(owner's authorization required)representing the owner of
teny described above.
the property owner or authorized representative,I have received the above referenced
s)as requested in the application for service RBPR-08-2022-41878,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
7- Electronic Image Transmittal/E-mail (Return receipt required)
/the property owner or authorized representative I have reviewed and understand the specific conditions
'ermit issued, and further understand that all applicable regulatory requirements specified under the
Carolina Laws and Rules for Sewage Treatment and Disposal Systems(ISA NCAC 18A.1900),
Well Construction Standards(ISA NCAC 2C.0100), shall apply to the issuance of this permit and
struction of the wastewater system and/or water supply well permitted.
Issue Date:09/22/2022 n (� p
'Authorized Representative Signature J 4)-- a M._ f—�F'J L.L A...,
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person.sending permit)
Signature Date/Time ('�f)D`))
Method: Fax VEmail US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yo&Please ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EhiCusttomerService
QnQ.Clehtlaiii06?14ilDe.lq,l
► - ok
1r9R217012 14:14 ��