HomeMy WebLinkAboutWELL-10-2022-183190.TIF 1"Iriy; CATARINAh0UNT1'
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Me mama: 2358 HUDSPETH RD,CATAWBA NC 28809
mimeo Permit: CLAUDE RENECIAR JR
Proverb OM; Acres 0.47
WrseMe. 10 E.right on Hudson Chapel Rd,left on Hudspeth Rd.home on the right
(honer/Authorized Representative Acknowledgement of Permit Receipt
Xli certili.that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property dcaaib d above.
As the prvpaty owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service EHPR-10-2022-42609,by the following method(s):
_ Received in Person
Facsimile Transmittal(Return form with signature required)
t f Electronic Image Transmittal/E-mail (Return receipt required)
/�( As the property owner or authorized representative!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(ISA NCAC 18A.1900),
a. !or Well Construction Standards(ISA 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: ::::ahivc
Owner/Authorized Signatu
( Date 1‘129 1 Z"Z.---
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by_ (nine r J person seOtit).)
t:ding permit)
SignatureCig —__--Date/Time (
Method: _Fax J Email US Mail Other
Owner's request to seed by the above Indicated method of transmittal in lieu of signature
We wenn Ito Mar from yaJlesse take a few momsntts tto complette our custtomer'entice survey att
http://www.surveymonkey.com/s/EHCualtomerServke
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