HomeMy WebLinkAboutAUTH-02-2023-189317.TIF t . •
.`.�4�et, CATAWBA CM iNTV {.Ail er AtITI1-02-2023-189317
i• �, Public Health Department Subdivision BETTS BROOKE PHASE III
Rf� _ lit Environmental I IcaIth Division PINS 362912755025
V/ Pt)Box 31t4.23 Government Drive,*mum.NC 25658 Lon 28
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Site Address: 2263 STARBROOKE DR,NEWTON NC 28658
Name on Permit: JEREMY EMIL NAGEL
Property Size: Acres 0.43
Directions: Startown Rd, left onto Starbrooke Dr, home is on the right
i Owner/Authorized Representative Acknowledgement of Permit Receipt
I certilj that I am the owner or authorized agent t000 ner's authorization required)representing the owner of
the property described above.
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r As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-02-2023-43360,by the following tnethod(s):
Received in Person
_ Facsimile Transmittal(Return form with signature required)
4 Electronic Image Transmittal/E-mail (Return receipt required)
p�, As the property owner or authorized representative I have reviewed and understand the specific conditions
ol`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:02/15/2023
Owner/Authorized Representative Signature __
.,_
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l Date 30
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ .__ (name of person sending permit)
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Signature Date/I'imc
31413
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 yoLPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EfiCusttomerService
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