HomeMy WebLinkAboutIMPV-11-2022-184916.TIF 4.4° • CATAWBA COUNTY Case 4 IMPV-I 1-2022-184916
�'�, Public Health Department Subdivision
(.... 1R )s Environmental Health Division PIN# 372416942148
PO Box 389,25 Government Drive,Newton,NC 28658 LOTH 2
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Site Address: 3452 33RD AVE PL NE, HICKORY NC 28601
Name on Permit: DEVIN WATERS
Property Size: Acres 0.95
Directions: County home to Springs Rd, left at first light,go right on Sulpher Springs Rd 4/10 mile go left on 33 rd Ave PL
NE
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.
i( _ As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-11-2022-42655, by the following method(s):
Received in Person
-__1- Facsimile Transmittal (Return form with signature required)
1 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: 11/22/2022
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)
Signature7:V _ Date/Time !/1 ff
Method: Fax ,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/EHCusttomer5ervice
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Catawba County Environmental Health
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Parcel: 372416942148, 3452 33RD AVE PL NE tin=501t
HICKORY, 28601
This map/report product was prepared from the Catawba County,NC Geospallal Information Services. Catawba County has made substantial efforts
[thee Independent serf the Melon of aon nyand data contained Information
map/lained reeport on this product byP o user.The or data on hls Counnty of Catawba,Its rt.Catawba employees,agents,anddromotes and mends
personnel,disclaim,and shall not be held liable for any and ail damages,loss or liability,whether direct,indirect or consequential which arises or may
arise from this map/report product or the use thereof by C Copyrightn 2or 2enti 1 Catawba County NC
11/22/2022