HomeMy WebLinkAboutAUTH-02-2023-189441.TIF i
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Sib Address: 105 4TH ST SE.CATAWBA NC 28609
Marne on Permit 'BEATRIZ DOMINGUEZ
property sets: Acres 0 45
°tractions: 105 4th St SE. Catawba
Owner/Authorized Representative Acknowledgement of Permit Receipt
I
1B)DI ctrtif‘ that I am the oi%na or authunicd agent(owner's atrthorintian rexry
ire RPM-'nting the owrtcr or
the pniperl} described ab %e.
214)As the property off ncr or authoriled representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-01-2023-43147,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
NIElectronic Image Transmittal/E-mail (Return receipt required)
i. BAs 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(ISA NCAC 1 BA.1900),
and/or Well Construction Standards(ISA CAC 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:02/172023
Owner/Authorimcl Representative Signature Q.LRI) kr)Q C,.+
Daea-DS 3
ktd fi'el Att.-t (6 i vt ills 5 _
Documentation of Permit(s)Transmittal cofq (1) WA e
(permit transmitted by electronic or other means)
i n Sitt Ltf ), ,.
,A Permit transmitted by (name of person sending permit)
rG
` Signature DatdTme ���3
Method: Fax ,t Etaa11 US Mali Other
Owner's request to send by the above indicated method of transmittal in lien of signature
Ws urantt tto hear from yoJleas.take a few mom.ntis do complette our custtomer service survey att
hixp',//www.surveytnonhe'y.com/s/t HCusttorner'ServIce
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Parcel:378111774397, 105 4TH ST SE 1 in=40ft
CATAWBA, 28609
This map/report product was prepared from the Catawba County,NC Geospallel Information Services. Catawba County has made substantial efforts
to enure the accuracy of location end labeling Infomullon contained on this map or data on this report.Catawba County promotes and recommends
the Independent verf6catlon 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 d 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 2023 Catawba County NC
0312812023
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U`?4- "i Puree liFdlh Iktnllrnem '��I„In„ .. I11f1IIL1:,1I Al;I I;ID,MI ',Ili 1\ay , 1► 1 Inunnattrul ticahh Ulrrrun I9'.1 t r t11 1 1:'i 1
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alto Address: 105 411-1 SI SE,CATAWIIA NC 70609 1\ l q)' ()1 ) ,' ) , LI {('I
Name on Permit: 'OEATRIZ DOMINUUf_Z
Property atm Acres 0.45
Directions( 105 4th St SE Cntnwba
Owgcr/AutkorVctl Itepresentulive Aekrim%lodgenrent 111' I't'rntit Ilcrt'ipt
Pth4)+Crtih that I um the of iR'1 ill illltlllllln'11 IIp1'lll(u+111el\illlth11r1/atlbin 111111i1C11)rlVIC\1111I111' Ills't n1 i i'I
e I�nlpertl dcslnhed utt,lvr.
fu !.l\s the property owner or nuthoriied representailve. I lime received the above referenced
permlt(s)ns requested in the application for sett ice 14111'14-111.2023-43147.by the fullu+vinl' nnclhtnf('.1.
Received in Person
Facsimile Transmittal(Return form with signature required)
1 Electronic Image Inuismittal/1 itiriii (Return receipt required)
1s the property owner or nulhnrind representative I have reviewed and understand the specific condition,'
or(Ile permit issued. and further understand that all uppficltblc regulatory requirements specified under the
North Carolina Laws and Rules fur Sewage Tri uttnenl and Disposal Systems(I5A NCAC INA.1900).
and/or Well Construction Standards(ISA NCAC 2C.01001, shall apply to the issuance of this permit mid
the construction orllle wustevsalcr system and/or water supply well permitted.
Permit Issue Date:02/17/2023
47t.aili /4
Owner)Authorircd Representative Signature g
si 1Ikj2117, V z{(r� Dant/9476 .
....-IfDate3- -23
Documentation of I'crmit(%)'Transmittal
(permit transmitted by electronic or other means)
Permit transniltied by (urune r f/,ersnrr iruuln'permit)
Signature 4 ej
Dale/'fins ✓1 l I)3
Method: Fos " Email US Mail Other
Owner's request to send by the abuse Indicated method of transmittal in lieu of signature
We wantt Ito hear from youPlease ttake a few momentts Ito comglette our custtomer service survey att
http://www.survcymonkey.tom/s/ENCusttomerService
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