HomeMy WebLinkAboutAUTH-11-2022-185187.TIF s CATAWBA C01:NTV
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s Nim •I Environmental Ilealth Division PIN I 377003018895
`� Po Box 389.25(iovennnent Ihi%e.Neuton.NC 28658 LUTt) 2
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Site Address: 4071 TROUT POND RD, CLAREMONT NC 28610
Name on Permit: ERIC CHILDERS
Property Size: Acres 2.36
Directions: NC 10 W,turn right onto Balls Creek Rd, right onto Trout Pond Road.grey 2 story house on the right hand
side of drive
Owner/Authorized Representative Acknowledgement of l'erm it Receipt
x(77e1 cent I') that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
CZ7C As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application for service Eli PR-08-2022-41928, by the I flowing method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
fElectronic Image Transmittal/E-mail (Return receipt required)
c'Ve 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 I 8A.1900).
and/or Well Construction Standards(I5A NCAC 2C .01(10), shall apply to the issuance of this permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date: 11/29/2022 Owner/Authorized Representative Signature r2te Z7 C/Ge ¢//
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Date 12/08/2022
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Di e I)ate''fime /448ID7__
Method: Fax Email (1S 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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