HomeMy WebLinkAboutWELL-02-2023-188440.TIF 8' CATAWBA COUNTY Case# WELL-02-2023-188440
ti c Public Health Department1st Subdivision WRENNS ESTATE
Environmental Health Division PIN# 368620728456
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PO Box 389,25 Government Drive,Newton,NC 28658 I,O'I'# PT 54
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Site Address: 4972 WRENN DR, DENVER NC 28037
Name on Permit: RANSFORD PROPERTIES
Property Size: Acres 1.27
Directions: S NC 16 Business Hwy left Canada Ln, right Wrenn Dr left on private drive
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.
yAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-12-2022-43013, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
TElectronic Image Transmittal/E-mail (Return receipt required)
•Ni, 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
Owner/Authorized Representative Signature
9. Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature t£ Date/Time 3/lo/3 3
Method: Fax
YYYY •J 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 yodPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveym nkey.com/s/EHCusttomerService
CO n S a . b i 0 Ke 1 ,a2.11, ea-A
chpennit 02/01/2023 16:16