HomeMy WebLinkAboutAUTH-01-2023-187581.TIF 1'R CATAWBA COUNTY Cae# AUTII-01-2023-187581
1... Public health Department Subdivision
iiqi • Environmental Health Division PIN# 460601055230
111.p 0 PO Box 389,25 Government Drive,Ne�ion,NC 28658 1.014 1 &PT 2
Sits Address: 4811 BURRIS RD, DENVER NC 28037
Norman Permit: GORDON&AMY CHAPPELL
Property Size: Acres 2.58
Directions: Turn on Catawba Burris off Campground Rd, 1.5 miles on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
MH I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
MH As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-06-2020-34771, by the following method(s):
Received in Person
r Facsimile Transmittal (Return form with signature required)
J Electronic Image Transmittal/E-mail (Return receipt required)
'i,MH 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:01/13/2023
Owner/Authorized Representative Signatureaidey.
Date 01/20/2023
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature (V Date/Time )j10)3
Method: Fax J .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 yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
ae, happca7v&3„a€4.
tt iN6ti€.a1eelbiti )(lei;net etiA
ehpennit 01%17'2021 lit 27
44, CATAWBA COUNTY Case# AiTI H-01-2023-187581
ty {_ Public Health Department Subdivision
molt Is Environmental Health Division
PIN# 460601055230
*if"
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 1 & PT 2
Site Address: 4811 BURRIS RD, DENVER NC 28037
Name on Permit: GORDON&AMY CHAPPELL
Property Size: Acres 2.56
Directions: Turn on Catawba Burns off Campground Rd, 1.5 miles on left
The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant
/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Authorization to
Construct Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Authorization to
Construct Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the
North Carolina'Laws and Rules for Setae Treatment and Disvosal Systems' (15A NCAC 18A.1900). Neither Catawba County nor the
Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time.
Any permit issued for a conventional system may be used for an accepted system without Environmental Health authorization or permit
modification.Please notify Environmental Health of this change prior to system installation.
01/13/2023
Authorized State Agent Penul Issuance Date
4/13/2025
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department
O1/19/2023 08:51