HomeMy WebLinkAboutAUTH-03-2023-190558.TIF .. r
4, a CATAWBA COUNTY Case a AU11l-03-2023-190558
• }.11 Public Ilealth Department Subdivision HA2LEVVOOD
Environmental Health DivisionPINt 367703221655
PO Box 389,25 Government Drive,Newton,NC 28658 t.OTe 6
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Site Address: 4168 S OLIVERS CROSS RD,NEWTON NC 28658
Name on Permit: CARMICHAEL HOMES INC
Property Size: Acres 1.24
Directions: HVVY 16 S,Right onto Buffalo Shoals, Left onto S Olivers Cross Rd,Lot on Left
Owner/Authorized Representative Acknowledgement of Permit Receipt
1` &" I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
X "As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-02-2023-43378,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
—7
`` Electronic Image Transmittal/E-mail (Return receipt required)
IAAs 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(I5A 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 Signatt --
Date 3 - ZCy—Z 73
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature __ — Date/Time -31)d/?3 __..-
Method: Fax J Email US Mail `Other
Owner's request to send by the above indicated method of transmittal in lien of signature
We wantt tto hear from yoxPleese ttake a few momentts tto complette our custtomer service survey att
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