HomeMy WebLinkAboutIMPV-02-2023-188427.TIF g,• e CATAWBA COUNTY Case# IMPV-02-2023-188427
E~ 1.II ,� Public Health Department Subdivision LONG BAY
." Environmental Health Division PIN# 470002896343
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 62 and 63
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Site Address: 7877 LONG BAY PKWY, CATAWBA NC 28609
Name on Permit: JOE AND WENDI DRYDEN
Property Size: Acres 2.78
Directions: NC 10, Hudson Chapel Rd, right onto Kale Rd, right onto Long Bay Pkwy, property on the left
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.
As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-11-2022-42705,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required)
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: 02/01/2023
��j Owner/Authorized Representative Signature
1 Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature ei Date/Time 01)3
Method: Fax ' Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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cI ennit 02/01/2023 16:13