HomeMy WebLinkAboutIMPV-10-2022-183098.TIF �� �e C.ATAWBA COUNTY'
(I.1.I Public Health Department Sutxln tsion
'1 - Environmental health Di%tsinn PINM 375414227592
Pt)Box 389,25 Government[hne,Newton.NC 28658 p tlTe
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Site Address: 5230 SWINGING BRIDGE RD,CONOVER NC 28613
Name on Permit: JACOB SHEPHERD
Property Size: Acres 6.62
Directions: Turn Left onto Swinging Bridge Rd from Houston Mill Rd
Owner/Authorized Representative Acknowledgement of Permit Receipt
X.
I certify that I am the ooncr 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 RBPR-08-2022-41972, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
4 Electronic Image Transmittal/ E-mail (Return receipt required)
BAs 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: 10/27/2022
/- _
Owner/Authorized Representative Signature •/I t-''/.'
.-D/' Date 10/31/22
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by ___ _ (name of person sending permit)
/
Signature Date/Time !0/� t7 f/�)
Method: Fax CEmail US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yotPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHtusttomerService
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0„,„n, 10 27.2022 10 57