HomeMy WebLinkAboutWELL-01-2023-187752.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)
Lel
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