HomeMy WebLinkAboutWELL-11-2022-183851.TIF r r
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Site Address: 3118 MOUNTAIN CREEK UR. SHERRILLS FORD NC 28673
Name on Permit: 'MJM TAILORED HOMES LL_C
Property Size: Acres 1.16
Directions: Left oft of Little Mountain Rd onto Mt Pleasant Rd 3rd lot on right
�/ '/ Owner/Authorized Representative Acknowledgement of Permit Receipt
J� -ecrtiti that I am thy%miler u:auihuriied went((miler's authnriiation required;prime m ntine the;rier of
1 the pnit,er* described:thine.
VAs the property owner or authorized representative. I have received the above referenced
p).rmit(s)as requested in the application for service R13PK-tN,-2022-41500, by the ti►Ilowing method(s):
Received in Person
I'acsii,tile Transmittal(Return firm with signature required)
Riot. Electronic Electronic Image Transmittal,'E-mail (Return receipt required)
X /11/As the property owner or authorized representative I have reviewed and understand the specific conditions
ofthe permit issued. and further understand that all applicable reeulatory requirements specified under the
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North Carolina l.aHs and Rules for Sewage Treatment and Disposal Systems(15A NCAC 18A.19(1(1),
and/or Well Construction Standards(15A NCAC 2C .01001, shall apply to the issuan.e of this permit and
the construction of the Wastewater system and/or water supply well permitted.
Permit Issue Date: 11f09r2022
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Owner%AuthorirrKI Representative Signature � '_
Date /(7V2C2•Z-
Documentation of Permits)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (flank aj/'erai„r sending perinii)
Ei.,,
Signature / 7
Dale: lime �fIt/zz
Method: . Fax V Email _ (!S Mail -- Other
Owner's request to send by the above indicated method of transmittal in lieu of sign:►lure
We wantt tto hear from yoiPlease ttake a few momentts tto complette our custtomer service survey act
http://www.surveymonkey.com/s/EHCusttomerService
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