HomeMy WebLinkAboutIMPV-01-2023-188018.TIF •
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y. CATAWBA COUNTY
j Public Health Department Subdivision
Ns? w Environmental Health Division PIN/ 462705089729
.t/ PO Box 389,25 Government Drive,Ncwton,NC 28658 i.oi'if 13
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Site Address: 9101 CLEMENT CIR,TERRELL NC 28682
Hams on Permit: *BLUEFIELD BUILDERS,LLC
Property Size: Acres 0.63
Directions: E NC 150 Right Greenwood Rd, Left Clement Cir at end on Right
\( Owner/Authorized Representative Acknowledgement of Permit Receipt
I' 1
certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the ropeny described above.
As the property owner or authorized representative, I have received the above referenced
1 permit(s)as requested in the application for service RBPR-12-2022-42963,by the following method(s):
_ Received in Person
_ Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
Y,
As the property owner or authorized representative I have reviewed and understand the specific conditions
("---2
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(1SA 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/ water supply well permitted.
Permit Issue Date:01/25/2023
Owner/Authorized Representative Signature
Date 9, 1903
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature 9 Date/Time 9 I.)3
Method: Fax I Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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