HomeMy WebLinkAboutIMPV-11-2022-185009.TIF •
Tin CATAWBA COUNTY Case e
11+ Public Itcalpartment Subdivision
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s Environmental I lcalth Division Pl ti 376501265069
'��CY W/� Po Box 389,25 Government Drive,Newton.NC 28658 ion 1
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Site Address: 6958 RIVER BEND RD, CLAREMONT NC 28610
Name on Permit: CHRISTIAN HUFFMAN
Property Size: Acres 3.246
Directions: NC 16,right onto Oxford School Rd, left onto Rest Home Rd,right onto Shell Hollar Rd,right onto River Bend
Rd.property on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
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l. t1 I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
f` As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application for service F.HPR-I1-2022-J2673,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
F,lectronic Image Transmittal/E-mail (Return receipt required)
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uvl 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(I5A NCAC IBA.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: 11/23/2022
Owner/Authorized Representative Signatur•
Date IZ-9- ZZ
Documentation of l'ermit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time iD/0)
Method: Fax J Email _US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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