HomeMy WebLinkAboutAUTH-02-2023-190269.TIF FROM :COOL PARK PUMPING, INC. FAX NO. :828 256 2926 Mar. 20 2023 04:36PM Pl.
49- CATAWBACOUNTY C �► ..AUTHfi2-2423wt90269
�+l Subdivision .
,, Public Health Department : . .
{.a„ • yie &iiuimenlsl Health Division PLN# 373408875778
'��./ P4 Box 389,25 Government'drive,Newton,NC 28658 LOU ' : . 7 .
flit In
Site Address: 4697 SPRINGS RD,CONOVER NC 28613
Name on.Pwmit DAVID FIGUEROA ZAVAIA _
Property Site: Acres 1.02
Directives: NC'16,-tedtonto County Home Rd,at the roundabout talte the 2nd exit,"tights"onto Springs Rd.emerty on the •
left -
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that i am the owtttr or aorized agent(owner's authorization required)representing the owt;t of
the property described above.
X �__ As the property owner or authorized representative,I have received the above referenced
perm t(s)as est► , �i in the application:forservice ENPlt-01-2023-4�3226,.by the-following rtsethod(s):. • •. :: , : .. : �.
i
Received in Person
� Facsimile Transmittal(Return form with signature required) . • . ' -
_
,/ Electronic Image Transmittal/E-mail (Return receipt required)
,-.... As the property owner or authorized representative 1 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 lssucfate_02/28/2023
Owner/Authorized Representative Signature +3L ..
"' . Date
Documentation of Permit(s)Transmittal , .. _
(permit transmitted by electronic or other means) .. : .. ' • .......
Permit transmitted by (name ofpersoirsendfngpermit) • ' •
Signature y Date/nate
Method: Fax J Email US Mail .......,• Other::.::. ,. .. . --
Owner's request to send by the above indicated method of transmittal in lien of signature
We warn tto hear from youPlease ttake a few moments tto complette our custtomer service survey ate
trap://www.surveymonkey.carn/s/EHCusttornerService
i 5 enhoWr C 1 t&rta. >v'h 13 L3
02f28l2023 t6A7
ehpermlt