HomeMy WebLinkAboutIMPV-11-2022-184516.TIF J
CATAWBA COUNTY Case# IMPV-1 1-2022-1845 1 6
4.111 Public Health Department Subdivision
• „4" ,, Environmental Health Division PIN# 363817019478
PO Box 389.25 Government Drive,Newton,NC 28658.....)
LOT* 2
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Site Address: 1949 KIRSTEN ST, NEWTON NC 28658
Name on Permit: JUSTIN MORRISON
Property Size: Acres 2.294
Directions: business 321 south to Rorto Jones Rd,turn right got 1 mile, left on Sigmon Dairy Rd,one mile take right on
Beverly St, lot end of street on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
S. ___I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
YAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-09-2022-42216, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
4 Electronic Image Transmittal/E-mail (Return receipt required)
y _ 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(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: 11/15/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature °I Date/Time /u/30f2 Z
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from y of Please ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/EHCusttomerService
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ch,,,,mi t t l/17/2022 14:47 r