HomeMy WebLinkAboutAUTH-11-2022-185030.TIF act a CITAWBA COUNTY
Public ficatth Department
�✓1 Subdivision WYNSWEPT PH 5.'
,i, .� yi Environmental Ilealth Division f9Nk 367804626568
�\/if PO Box 389.25 Govcmmcnt Drive.\c»ton.NC' 28658
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Site Address: 3159 TIMBER RUN LN,MAIDEN NC 28650
Name on Permit: 'NEST HOMES LLC
Property Stu: Acres 0.73
Dtrectiona: Intersection of Buffalo Shoals Rd and NC 16 S;NC 16 S to Left on Cayton Or; Left on Timber Run Ln
Owner/Authorized Representative Acknowledgement of Permit Receipt
4,4°1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
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the property described above.
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As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application for service RBPR-08-2022-41897,by the following method(s):
Received in Person
T Facsimile Transmittal(Return form with signature required)
Electronic Image'lransinittal/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.1 900),
and/or Well Construction Standards(1 SA 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 Signature L P.C. -41-71.,.."----
'--7
Date 1,9-/b /d—D 3,-'Z
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by /Hume of person sending permit)
Signature Ci_E [)ate/TimeJ)/lI/77
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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