HomeMy WebLinkAboutIMPV-10-2022-182418.TIF Er
\Y CATAWBA COUNTY Case# IMPV-l0-2022-182418
tPublic Health Department Subdivision WOODLAND OAKS
'.1s Environmental Health Division PIN 376004935167
`� PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 37
Site Address: 3958 HOKE ST,CLAREMONT NC 28610
Name on Permit DAVID STEVENS
Property Size: Acres 0.63
Directions: NC-10 E, right onto Balls Creek Rd, right onto Hoke St, last lot on ST at Cul-de-sac
Owner/Authorized Representative Acknowledgement of Permit Receipt
W 7 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-09-2022-42201,by the following method(s);
_ Received in Person
Facsimile Transmittal (Return form with signature required)
TElectronic Image Transmittal/ E-mail (Return receipt required)
As the property owner or authorized representative I have reviewed and understand the specific conditions
VI
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 11 permitted.
Permit Issue Date: 10/17/2022
Owner/Authorized Representative Signature
Date /O/3I/ZZ-
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ (name of person sending permit)
Signature Date/Time i(;L As!')
Method: Fax Email US Mail I Other
Owner's request to send by the above Indicated method of transmittal in lieu of signature
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