HomeMy WebLinkAboutAUTH-10-2022-181683.TIF A % CATAWBA COUNTY Case 0 AUTH-I0-2022-181683
III Public Health Department SubdivisionF Environmental Health Division
(....
R •� PIN 370220906244
. PO Box 389,25 Government(hive.Newton,NC 28658 i t>TN
Sits Address: 1640 6TH ST SE,HICKORY NC 28602
Name on Porml: 'THOMAS JONES CONSTRUCTION
Property Size: Acres 3.83
Directions: 70 W from Newton,turn left onto 6th Street SE
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
ys.,
the property described above.
lcCr;the property owner or authorized representative.I have received the above referenced
permit(s)as requested in the application for service EHPR-09-2022-42406,by the following method(s):
Received in Person
_ Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
N As the property owner or authorized representative I have reviewed and understand the specific conditions
11/4,
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 I8A.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: 10/04/2022
Owner/Authorized Representative Signature_? 9-Al/V
Date �O/y0/) _
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ (name of person sending permit)
goie
Signature _Date/Time )0 f 131))
Method: Fax I 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.com/s/EHCusttomerService
4LL$jV.CS5,)s0S c. (er►
.h„..,,,u, 10:04 2022 11 56