HomeMy WebLinkAboutAUTH-02-2023-188530.TIF fig: • CATAWBA COUNTY Case# AUTH-02-2023-188530
N t lleI Public Health Department Subdivision
`j Environmental Health Division PIN# 374518308224
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 1
18. 9.
Site Address: 5761 LEE CLINE RD, CONOVER NC 28613
Name on Permit: *JASON SUTHERLAND
Property Size: Acres.895
Directions: Springs Rd, Right on Lee Cline, Property on Right
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 RBPR-10-2022-42613,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
ttt___ 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 sendingpersont)permit)
Signature c (f.. Date/Time 'se to j)3
Method: Fax 1 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 youPlease hake a few momentts tto complette our custtomer service survey att
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ehpemut 02/13/2023 12:13