HomeMy WebLinkAboutAUTH-12-2022-186414.TIF u �millibbr% CATAWBA COI:NTV' Caw M W l 1.1.-U2.2U23-188558
Public Ilcalth Ikpartmcni ' Subdi+aum
vim, . ,�: Envtronntcntul ikatth Division I'INM 367804549503
��,I.� Po Ilor 389.25(io+'rnnunt Drive.Nc++ton,N(' 28658 I o1M D
Site Address: 4557 LITTLE MOUNTAIN RD. CATAWBA NC 28609
Name on Permit: DYLAN RIDDLE
Property Site: Acres 2 83
Directions: Left off of S NC 16 Hwy onto Buffalo Shoals Rd. Right onto Little Mountain Rd 4th lot on right after Beverly
Hills Or
Owner/Authorized Representative Acknowledgement of Permit Receipt
certif.) that I atn the owner or authorized agent(owner's aulhoriiation required)representing the u%%ncr of
the pre perty described above.
As the property owner or authorized representative. I have received the above referenced
RR
pennit(s)as requested in the application for service RII31'R-12-2022-42955. by the following; method(s):
Received in Person
f Facsimile Transmittal (Return form with signature required)
I Electronic Image Transmittal/ 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 (I5A NCAC ISA.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: 02/03/2023
Owner/Authorized Representative Signature
Date 2 • , y • 1 3
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted bye. (name (J person sending permit)
Signature _ Date/Time a Ii /)3
Method: Fax 1 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 yot,Please ttake a few momentts tto complette our custtomer service survey att
http://wv.rw.surveymonkey.com/s/EHCusttomerService
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