HomeMy WebLinkAboutIMPV-12-2022-186453.TIF ............. �.11"
�+.t CATAWBA COUNTY Case tt 1MPV-12-2022-186453
fl4 Public Health Department Subdivision
n Js Environmental Health Division PIN/ 460701095413
Y0 PO Box 389,25 Government Drive,Newton,NC 28658 LOTS 5
t:ESite Address: 6861 LOCKE DR,SHERRILLS FORD NC 28673
Name on Permit: KEVIN LYNCH
Property Size: Acres 1.126
Directions: NC 10,right onto Murrays Mill Rd,left onto Sherrills Ford Rd,right onto Mount Pleasant Rd.right onto Locke
Dr,propety on the left
Owner/Authorized Representative Acknowledgement of Permit Receipt
rtify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
►i As the property owner or authorized representative,I have received the above referenced
III permit(s)as requested in the application for service EHPR-09-2022-42302,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
?I'4
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC I8A.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 0--?&till ------
.�� Date C d ell/ 2)
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signaturej'4 '/ Date/Time I hito
1.
Method: _Fax 4 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 yoaPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
) It.ineJob osigentzi.o. 6011
rhp rinit 12/212022 10:26 J
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