HomeMy WebLinkAboutIMPV-09-2022-181475.TIF •
CATAWBA COUNTY Case#
r(t
�111 Public Health Department Subdivision W000RIDGE
...
, Environmental Health Division PIN# 279119629274
PO Box 389,25 Government Drive,Newton,NC 28658 urns PT 80
Site Address: 5346 DRIFTWOOD DR, HICKORY NC 28602
Name on Permit: NATHAN WATTS
Property Size: Acres 0.34
Directions: Zion Church Rd left Bethel Ch rd right rose wood dr right onot woodridge circle right diftwood dr home on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
K140I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
X,C\11.) As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-02-2022-40023,by the following rnethod(s):
_ Received in Person
Facsimile Transmittal (Return form with signature required)
IElectronic Image Transmittal/E-mail (Return receipt required)
.t((3As 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(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:09/30/2022
. fI '-1{tk
,,
Owner,r Authorized Representative Signature' U Vi v__,,_ Lv 1 _
Date 10 i 14 1
i
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name ofperson sending permit)
Ir if
Signature Date/Time lO /.ipt
Method: Fax J 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 complette our custtomer service survey att
http://www.surveymonkey.cam/s/EHCusttomerService
Wet tk r\ 2067d g nil. &Wl
Re
,Itp;nmi 09/30/2022 10-00