HomeMy WebLinkAboutWELL-12-2022-185975.TIF 4,y,zillr, CATAWBA COUNTY Case# WELL-12-2022-185975
0 t_ Public Health Department Subdivision
Environmental Health Division PIN# 371318309170
, PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
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Site Address: 144 15TH ST SE, HICKORY NC 28602
Name on Permit: BOBBY WALKER
Property Size: Acres 0.41
Directions: McDonald Pkwy SE, left onto Tate Blvd SE, right onto 15th SE SE
Owner/Authorized Representative Acknowledgement of Permit Receipt
y. _I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
XAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-12-2022-42979,by the following method(s):
_ Received in Person
Facsimile Transmittal(Return form with signature required)
I Electronic Image Transmittal/E-mail (Return receipt required)
'J _ As the property owner or authorized representative I have reviewed and understand the specific conditions
rf' 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: 12/09/2022
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)
Signature c� Date/Time 1)/1S/Zz.
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 yoLPlease ttake a few momentts tto complette our custtomer service survey aft
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chpcnnit 12/09/2022 15:32