HomeMy WebLinkAboutIMPV-10-2022-182206.TIF 1
AV,4 CATAWBA COUNTY ._... ______ _„ ___
1..ii ,� Public Health Department Subdivision MOUNTAIN CREEK RIDGE
s Environmental Health Division PIN# 369803105904
PO Bat 9, ox 389,2S Government Drive,Newton,NC 28658 LOT# 6
Site Address: 6165 FALLS RIDGE TR, SHERRILLS FORD NC 28673
Name on Permit: *MJM TAILORED HOMES LLC
Property Size: Acres 1.61
Directions: Mt Beulah RD, Right on Little Mtn RD, Left on Mt. Creek DR, Left on Fall Ridge TR
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
the property described above.
KAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-09-2022-42186,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
As 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(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: 10/13/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
eigSignature Date/Time j0 18i1Z
' 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 yos.Please ttake a few momentts tto complette our custtomer service survey aft
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e1lpennii 10/13/2022 13.47