HomeMy WebLinkAboutAUTH-02-2023-189000.TIF ,=• CATAwBA COUNTY
t` Public!With Department Subdivision
.e! Environmental Health Division PINK 366604746905
, PO Box 389,25 Government Drive,Newton,NC 28658 LOTN A
Site Address: 3782 E MAIDEN RD, MAIDEN NC 28650
Name on Permit: *ROBERT LOCKMAN
Property Size: Acres 1.48
Directions: 321 Right onto Springs Foot RD, Left Buffabl Shoals RD, Right onto E Maiden RD property on Left
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.
St.As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-11-2022-42831,by the following method(s):
Received in Person
—y Facsimile Transmittal (Return form with signature required)
✓ Electronic Image Transmittal/E-mail (Return receipt required)
r5141PAs 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:02/10/2023
/ Owner/Authorized Represent' ive Si' ature
Date D3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature9 _ Date/Time .3/�Y/7-3
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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