HomeMy WebLinkAboutAUTH-01-2023-188077.TIF f
4011r 11 CATAWBA COUNTY Case# AUTH-01-2023-188077
1y .;.,�',.�j` Public Health Department Subdivision PEBBLE BAY PH 4
{�.� , Ii Environmental Health Division PINii 369604838154
\�, PO Box 389,25 Government Drive.Newton,NC 25655 I.OT# 196
:OPSite Address: 6919 SEA GULL WAY,DENVER NC 28037
Name on Permit 'MILLER HOME IMPROVEMENTS INC.,JB
Property Size: Acres 1.98
Directions: Catawba Burris to Goose Point to Seagull Way
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
the property described above.
IS'! As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application for service RBPR-12-2022-42966,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
'J Electronic Image Transmittal/E-mail (Return receipt required)
14/0 As the property owner or authorized representative I have reviewed and understand the specific conditions
of the permit issued, and further understand that ail 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(1 SA 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: 01/25/2023 / �,.c_
Owner/Authorized Representative Signature_` ,
Date e/zo L
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _.- (name of person sending permit)
Signature4 DatelTime t i
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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