HomeMy WebLinkAboutIMPV-02-2023-188976.TIF z.`• CATAWBA COUNTS'
j.. Public health Department Subdivision LYNMORE
Environmental Health Division PINK 460904824173
PO Box 389,25 Government Drive,Newton,NC 28658 LOTS 7
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Site Address: 2106 LYNMORE DR, SHERRILLS FORD NC 28673
Name on Permit MICHAEL HAMBY
Property Size: Acres 1.08
Directions: HWY 150 East to left Sherrills Ford Rd turn right Mollys Backbone,left Lynmore. Property on right.
Owner/Authorized Representative Acknowledgement of Permit Receipt
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
it(s)as requested in the application for service EHPR-11-2022-42900,by the following method(s):
Received in Person
_,_ Facsimile Transmittal (Return form with signature required)
4 Electronic Image Transmittal/E-mail (Return receipt required)
t e property owner or authorized representative I have reviewed and understand the specific conditions
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e 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:02/10/2023
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Representative
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ _ (name of person sending permit)
Signature qf
Date/Time J
Method: Fax ./ 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 yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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iIc6prmw 02/10/2023 11.18