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CATAWBA COUNTY
.� Public Department Subdivision ABERNETHY PARK PH 11
2 , .( Environmental
Health Health Division PIN# 279008876944
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PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 79
Site Address: 1498 KENSINGTON PARK CT, HICKORY NC 28602
Name on Permit: CONSTANTIN BOUREANU
Property Size: Acres 0.44
Directions: Right off of Orchard Park Dr onto Regents Park Dr. Right onto Kensington Park Ct. 2nd lot on right.
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.
As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-08-2022-41846,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required)
.( As the property owner or authorized representative I have reviewed and understand the specific conditions
r 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
-1 Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person t)sending permit)
Signature_C .--; Date/Time 3b1:1)33
Method: Fax " Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpennit 11/22/2022 11:28