HomeMy WebLinkAboutAUTH-11-2022-184575.TIF CATAWBA COUNTY
. .
r, Public Health Department Subdivision WYNSWEPT PH 5.1
ls,, Environmental Health Division PIN# 367804628366
I / PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 69
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Site Address: 3180 TIMBER RUN LN, MAIDEN NC 28650
Name on Permit: *NEST HOMES LLC
Property Size: Acres 0.69
Directions: Intersection of Buffalo Shoals Rd &NC 16 S; NC16S to Left on Clayton Dr, left on Timber Run Lane
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
]C, As the property owner or authorized representative, I have received the above referenced
II permit(s)as requested in the application for service RBPR-07-2022-41616,by the following method(s):
Received in Person
4 Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
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: 11/16/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending
ggpermit)
Signature9fe / Date/Time f 4.P/R,
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 yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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elipemiii 11/17/2022 15:06