HomeMy WebLinkAboutWELL-01-2023-187785.TIF .
A. +`a C•ATAWBA(.(UNT1
Public Ilealth lkpaInnen! Suhdi',u.i n CYPRESS FARMS
tc,.,� i 1•:nvlronmental licalih Division
iI'INN 461703014173
PO Bnx 389,25 Guvcrnmcnl Olive.Ncolon.NC 28bjy 1.01 u 2
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Site Address: 8094 CYPRESS ST, SHERRILLS FORD NC 28673
Name on Permit: 'FOUNDATION HOMES RESIDENTIAL LLC
Property Size: Acres 0.79
Directions: Left off of Slanting Bridge Rd onto Drena Dr Left onto Cypress St.7th lot on left.
Owner/Authorized Representative Acknowledgement of Permit Receipt
yl certity that I am the owner or authorized agent(owner's authorization required)representing the owner of
the 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 11B1'12-09-2022-42257,by the following method(s):
Received in Person
Facsimile Transmittal(Return firm with signature required)
l_ Electronic Image Transmittal/E-mail (Return receipt required)
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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 I8A.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:01/19/2023 j
Owner/Authorized Representative Signatury. , .. .:;
—7 Date 2-^ 1 -2j.
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (nook,of person sending permil)
Signature f Date/Time J 1 i '2
Method: Fax Ni 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 yotPlease ttake a few momentts tto complette our custtomer service survey aft
http://www.su eymonkey.com/s/EH usttomerService
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Parcel: 461703014173, 8094 CYPRESS ST 1 in=50ft
SHERRILLS FORD, 28673
This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user.The County of Catawba,Its employees,agents,and
personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
01/17/2023
WPDT Report
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Area of Interest (A01) Information
Area : 3,134,508.65 ft2
Jan 24 2023 13:10:45 Eastern Standard Time
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8094 Cypress Street Sherrills Ford NC
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