HomeMy WebLinkAboutIMPV-02-2023-188983.TIF 4
al ,
4 ,,,w CATAWBA COt'NT10
3tlitPublic Health Department Suhdnnron
.,yt , s Fovuonmental Health Dntaron PIN 470103234555
i \/ Po Ism ISO,25 Government tree.Newton,NC 200)1
fir - I Otp
d i Site Address: 2040 BROWN CHAPEL RD CATAWBA NC 28609
I Nam.on Permit: BRYAN 8 KIM LEFEVER
Property Size: Acres 15 42
Directions: Hudson Chapel Rd.Right on Brown Chapel Rd,Lot on Left
Owner/Authorized Representative Acknowledgement of Permit Receipt
XB Li ccrtifl that I am the uwncr or authorized agent(otvncr':c authorization required)representing the owner of
the propert} described above.
Qt.-As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-12-2022-42956,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required)
I - 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 1 SA.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 ('-----
Owner/Authorized Representative Signature4,___:/
Gl...._S r---
Date .- - ls_ ) 3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature 1__ Date/Time 3/61)3
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/EHCusttomer5ervice
(\jQ$SoxiI' Ms 6grntd. Ciro
,
J
(� v
chpermit 02/10/2023 a 211
Catawba County Environmental Health
•
,N 1\\ 70'
Frt''
r,
Ni
poi/ewe, P�porP) "''
o Vcni\.kr7
P..
r m„�~SI
feeg , Iz-2_022' 14)g5b
i MPv. o,-,_v23- I Mg>
CO
0 0� 203-3 — 1sGI" c�
0 W L-1,L,- 02' ���3
•a
m
r
73 v ' /Ay
I GuA'
,/ s irf4ry
S4,,,n f
fl
1, $ ibe
s� S �I
),,,t_ A I r�
gl' b,
cDgs
•
geeNr
Parcel: 2u LID BROWN CHAPEL (-rec\ 1 in=100ft
RD CATAWBA, 28609 ►,�,�r^
bR- �ao� rr�
UVAZ
101 tra �'°f�r�� l
This map/report product was prepared from the Catawba County,NC Geos atial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling Information contained on this map or data on this report.Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user.The County of Catawba,Its employees,agents,and
personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,Indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
02/09/2023