HomeMy WebLinkAboutAUTH-01-2023-187750.TIF 410We CATAWBA COUNTY - Case# AUTH-01-2023-I87750
�1 t R f� Public Health Department Subdivision
'i.{(.,� i Environmental Health Division PIN# 372011763889
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2
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Site Address: 2264 MILTON ST, NEWTON NC 28658
Name on Permit: JONATHAN MCLELLAND
Property Size: Acres 11.21
Directions: From Startown turn left on Milton St lot is behind 2296 Milton St
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
toperty described above.
)01thheeYrplr As the property owner or authorized representative,1 have received the above referenced
permit(s)as requested in the application for service RBPR-01-2023-43156,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
JElectronic Image Transmittal/E-mail (Return receipt required)
V�It" 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:01/19/2023Q
Owner/Authoriz d Representative Signature 'e l-le9
- Date 1 Z7 23
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name cfperson sending permit)
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Signature 9t C., Date/Time j D 7 J�
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehp.nnu 01/27/2023 08.50
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CATAWBA COUNTY Case# At I"III-01-2023-187750
Public Health Department Subdivision
,� li Environmental Health Division PlN# 372011763889
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2
/84 v,
Site Address: 2264 MILTON ST, NEWTON NC 28658
Name on Permit: JONATHAN MCLELLAND
Property Size: Acres 11 21
Directions: From Startown turn left on Milton St lot is behind 2296 Milton St
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 Rulesfor Sewage Treatment and Disposal 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.
/ ice„ Eu4r13.
01/19/2023
Authorized State Agent Permit Issuance Date
12/27/2027
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpennit 01/27/2023 08:50