HomeMy WebLinkAboutIMPV-02-2023-188539.TIF �ye CATAWBA COUNTY Case# IMPV-02-2023-I88539
g, t iii ,� Public Health Department Subdivision BATTLE RUN CREEK PHASE
Q ', Environmental Health Division PIN# 368901197319
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 1
Site Address: 5201 BATTLE RUN DR, CATAWBA NC 28609
Name on Permit: TERRY WHITENER
Property Size: Acres 2.00
Directions: Buffalo Shoals Rd, right Battle Run Dr on right just before Musket Dr
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.
1( As the property owner or authorized representative, I have received the above referenced
permit(s) as requested in the application for service EHPR-12-2022-42913, by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
As the property owner or authorized representative I have reviewed and understand the specific conditions
i. _
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: 02/02/2023
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
()I
Signature '((r �1 Date/Time 0/0 3
Method: Fax •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 yosPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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elipennit 02/02/2023 16:10