HomeMy WebLinkAboutWELL-12-2022-186426.TIF c •
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03• . CATAWBA COUNTY t
.t. y Public Health Department Subdivision FAIRWAY ACRES
Environmental Health Division PIN# 372017013906
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 4
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Site Address: 2972 QUAIL DR, NEWTON NC 28658
Name on Permit: *J&M PROPERTY INVESTMENT LLC
Property Size: Acres 0.59
Directions: Startown, Left Sandy Ford, Left Chestnut, Right Rosewood, Left Fairway, Right Quail Dr
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
tAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-10-2022-42470,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
jElectronic 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(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: 12/20/2022
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)
n
Signature _ Date/Time 1 ///} 3
Method: Fax v Entail US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoi.Please ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/EHCusttomerService
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ehpemtit 12/20/2022 15:46