HomeMy WebLinkAboutIMPV-09-2022-181560.tif ..4,1y)4, w CATAWBA COUNTY
IT f Public Health Department Subdivision RAYNEBOW ACRES.
Environmental Health Division PIN# 364915549613
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 10
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Site Address: 1586 NATHANIAL ST, NEWTON NC 28658
Name on Permit: JOANN ELLIS
Property Size: Acres 0.63
Directions: HWY 16 to Smyre Farm Rd to St James Ch Rd to Nathaniel St
Owner/Authorized Representative Acknowledgement of Permit Receipt
x7 g I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
y3 As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-07-2022-41597,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
IElectronic Image Transmittal/E-mail (Return receipt required)
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 18A.1900), :
and/or Well Construction Standards(15A 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
e,Owner/Authorized Representative Signature el/ 1";
Date A/0/27__
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means) -
Permit transmitted by (name of person sending permit)
Signature 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 yotPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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ettp mnt 09/30/2022 15:24