HomeMy WebLinkAboutAUTH-01-2023-187523.TIF ,
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Sits Address: 5525 S NC 16 BUSINESS HWY MAIDEN NC 28650
Nano.on Permit: WESLEY SHAVER
Property Um: Acres 1 42
Directions. NC10 Left onto NC 16 Bus/N Highway 16 property on Right
Owner/Authorized Representative Acknowledgement of Permit Receipt
yi I certify (h,r1 I urn the o'.t ncr or authorized agent(Dormer's authorization required)representing the ut.ncr of
the property described above.
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{f As the property onvner or authorized representati'.e, I hate receised the:thrive referenced
permitls)as requested in the application our service RBl'R-09-2022-42170.by the foliowntg melhtxl(s):
Received in Person
Facsimile transmittal(Return form s'ith signature required)
J Electronic Image I ransmittal E-mail (Return receipt required)
- As the property inviter or authorized representative I have re%ies.ed and understand the specific conditions
of the permit issued, and further understand that all applicable regulator) requirements specified under the
North Carolina laws and Rules for Sewage Treatment and Disposal Systems(I SA NCAC I13A.1900),
and/or Well Construction Standards I15A NCAC 2C.0100), shall apply to the issuance of this permit and
the construction of the '.taste'.'.ater ssstent and or sinter supply '.sell permitted.
Permit Issue Date: 01/12'2023
(loner Authorized Representative Signature ',,,1,�,.�
Date (-27-23
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by roan,.•r,//k•rrr»r Wilding/,rrnurl
1,41 Signature Date time 4)/1)3
Method: Fat .I Email US N1ai1 Other
Owner's request to send by the abuse indicated method of transmittal in lieu of signature
We wantt tto hear from yo4Please ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttornerService
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