HomeMy WebLinkAboutAUTH-03-2023-190563.TIF eilt
a CATAWBA COUNTY Case# A UTl t-03-2 023-1 90563
ti � Public Health Department Subdivision HAZLEWOOD
tom:' \/ Environmental Health Division PIN# 367703129962
>' PO Box 389,25 Government Drive,Newton,NC 28658 LOTH 4
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Site Address: 4160 S OLIVERS CROSS RD, NEWTON NC 28658
Name on Permit: CARMICHAEL HOMES INC
Property Size: Acres 1.18
Directions: Hwy 16 S.Right onto Buffalo Shoals,Left onto S Olivers Cross RD,lot on Left
Owner/Authorized Representative Acknowledgement of Permit Receipt
X00, I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
1` \\Y As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-02-2023-43384,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
I Electronic Image Transmittal/E-mail (Return receipt required)
AAs 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:03/03/2023
Owner/Authorized Representative Signature t!j--- --�—
1 Date 3-2-o` Z-
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit.)
Signature g.,
(ir Date/Time 314)3
Method: Fax J 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 yoaPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomer`service
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rhprnmr 03iO3.2023 16:56