HomeMy WebLinkAboutAUTH-10-2022-182820.TIF T:!a CATAWBA COUNTY
j,� {�ji Public Health Department Subdivision
:: Environmental Health Division PINk 369609061189
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PO Box 389,25 Government Drive,Newton,NC 28658 LOT# TR 5
Site Address: 4713 ZEB LITTLE RD,DENVER NC 28037
Name on Permit: JOHN FULLER
Property Size: Acres 7.41
Directions: 16S to 150E, Right on Zeb Little, Lot is at the end of the road on the right
r . 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
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/P' pr..•rty described above.
Alli/ As the property owner or authorized representative, I have received the above referenced
(rmit(s)as requested in the application for service RBPR-09-2022-42316,by the following method(s):
/
Received in Person
Facsimile Transmittal (Return form with signature required)
00 7 Electronic Image Transmittal/E-mail (Return receipt required)
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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
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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 ply ell permitted.
Permit Issue Date: 10/24/2022
Owner/Authorized Representative Signat e
"Date /O/ o?
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of personsending
��permit)
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Signature Date/Time joj;.t_ l2z.
Method: Fax ^+ Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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riiprmmit 10/24/2022 09:08
CA'I'AWBACOUNTY Casc# Al1TI1-10-2022-182820
4r ik•, Public Health Department Subdivision
< 'I Environmental Health Division PIN# 369609061189
PO Hox 389,25 Government Drive.Newton,NC 28658 l,o'f# TR 5
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Site Address: 4713 ZEB LITTLE RD, DENVER NC 28037
Name on Permit: JOHN FULLER
Property Size: Acres 7.41
Directions: 16S to 150E. Right on Zeb Little, Lot is at the end of the road on the right
The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant
/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Authorization to
Construct Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Authorization to
Construct Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the
North Carolina'Laws and Rules for Sewage Treatment and Disposal Systems' (I5A NCAC I 8A.1900). Neither Catawba County nor the
Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time.
Any permit issued for a conventional system may be used for an accepted system without Environmental Health authorization or permit
modification.Please notify Environmental Health of this change prior to system installation.
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10/24/2022
Authorized State Agent Permit Issuance Date
2/23/2027
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
chpennit 10/26/2022 08:58