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Site Address: 1721 BOLTON RD, CATAWBA NC 28609
Name on Permit: JOHN SPURRIER
Property Size: Acres 1.91
Directions: NC 10,right onto Hudson Chapel Rd, right onto Bolton Rd,right onto Boca Springs Rd.propptty on the left
Owner/Authirrizcd itcpresentatiVe Acknowledgement ledgement of Permit ltcccipt
X ✓ t certify that I am the owner or authorized agent(owner's author iratiun required)representing the owner of
the property described above.
X �As the property owner or authorized representative, I have received the above referenced
permits)as requested in the application for service ElIPR-12-2022-43075, by the 1oliowing method(s):
_ Received in Person
Facsimile Transmittal(Return form with signature required)
7Electronic Image Transmittal/E-mail (Return receipt required)
x 1/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(I5A 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:03/02/2023
Owner/Authorized Representative Signature_
Date( Z,S! .2-3
Documentation of l'ermit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (oriole n/person sending permit)
Signature r_
Date/'l'inte 3/A)/) __
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 youPleasc ttake a few n)omentts tto complctte our custtomer service survey att
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