HomeMy WebLinkAboutAUTH-01-2023-187864.TIF ,.ti}1Y CATAWBA COUNTY
(....,t. Public Health Department Subdivision
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Environmental Health Division I'INN 369901477166
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PO Box 389,25 Government Drive,Newton,NC 28658 LOU
Site Address: 6412 SHERRILLS FORD RD,CATAWBA NC 28609
Name on Permit: JESSICA&ANTHONY HOARD
Property Size: Acres 10.12
Directions: Buffalo shoals Rd,sherrills Ford RD
Owner/Authorized Representative Acknowledgement of Permit Receipt
01 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
sAs the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-I0-2022-42595,by the following method(s):
Received in Person
_ Facsimile Transmittal(Return form with signature required)
I Electronic Image Transmittal/E-mail (Return receipt required)
0 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:01/20/2023
Owner/Authorized Representative Signature
Date 07/?
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _(name of person sending permit)
Signature 9.� Date/Time C771J3
Method: Fax % 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/EHCusttomerServIck
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cbpcnnil 01/20/2023 16:22