HomeMy WebLinkAboutIMPV-10-2022-182842.TIF w`IM*. CATAWBA COUNTY
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it.s+, Public Health Department
, ri Subdivision
R , i Environmental Health Division PINK 361903003962
PO Box 389,25 Government Drive,Newton,NC 21658 LOT"
Sit.Address: 3538 ZION CHURCH RD,HICKORY NC 28602
Name on Permit *OAKWOOD HOMES#712
Property Sim Acres 5.54
Directions: Left Old Conover Startown Rd,Left Startown RD,Right Hwy 10,Right Ziopn Church RD,End at 3528 Zion
Owner/Authorized Representative Acknowledgement of Permit Receipt
CrI certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
�/the property described above.
J(�° As the property owner or authorized representative,I have received the above referenced
1 permit(s)as requested in the application for service RBPR-08-2022-41940,by the following method(s):
_ Received in Person
4 Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal!E-mail (Return receipt required)
2 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(1 SA 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: 10/24/2022
Owner/Authorized Representative Signature
-2 CIA-.
Date IU-'(.� -Z�
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time 17/_)03
Method: Fax t/ Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt to hear from yosPtease ttake a few momentts no complete our customer service survey an
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