HomeMy WebLinkAboutAUTH-01-2023-187060.TIF ��� CATAWBA COUNTY
t. Public Health Department
Environmental Health Division Subdivision
�� PO Box 389 25 PINp 368704510094
(.....
Government Drive,Newton,NC 28658
LOTS
Site Address: 4210 WINONA DR, MAIDEN NC 28650
Name on Permit *KERRI&ADAM MCBRIDE
Property Size: Acres 11
Directions: 16 South,Left on Mt Beulah, Left on Winona
�r�,�,,� Owner/Authorized Representative Acknowledgement of Permit Receipt
�fN.1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
�yy'"theme property described above.
As the property owner or authorized representative, I have received the above referenced
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permit(s)as requested in the application for service RBPR-08-2022-41982, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
I Electronic Image Transmittal/E-mail (Return receipt required)
f% \ "As the property owner or authorized representative I have reviewed and understand the specific conditions
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of the permit issued, and further understand that all applicable regulatory requirements specified
q p i led under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC 18A.1900),
and/or Well Construction Standards(1SA 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:01/04/2023
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Owner/Authorized Representative Signature At, G
.Date f)l4 5 _.__._______
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name ofperson sending permit)
Signature _ Date/Time• i }
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 yorlPlease stake a few momentts tto complette our custtomer service survey att
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"''' 01/18/2023 0907