HomeMy WebLinkAboutAUTH-02-2023-190135.TIF •
CATAWBA COUNTY
• ii Public Health Department Subdivision
\� Environmental H Div PIN#
PO Box 389,25 Governmentealth ision Drive 366803120121,Newton,NC 28658 LOT#
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Site Address: 3081 N OLIVERS CROSS RD, NEWTON NC 28658
Name on Permit: *MICHAEL BROWN
Property Size: Acres 7.61
Directions: US 321 S Bus, left onto Prison Camp Rd, right onto Jack Whitener Rd, right onto saint James Ch Rd, left onto
Fred Beard Rd, right onto Providence Mill Rd, left onto Water Plant Rd, left onto N Olivers Crossroad, property
on the 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
1 the property described above.
XAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-01-2023-43138, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
V- Electronic Image Transmittal/E-mail (Return receipt required)
•
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 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: 02/27/2023
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
1/4 7
Signature l.r Date/Time 314 s /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 yotPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerservice i
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chpennit 02/27/2023 09:40