HomeMy WebLinkAboutIMPV-03-2023-191246.TIF CATAWBA COUNTY
• /� Public Health Department Subdivision
• ..0(;) Environmental Health Division PIN# 375019600534
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2
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Site Address: 2529 CLAREMONT RD, NEWTON NC 28658
Name on Permit: BRADLEY GOOD
Property Size: Acres 10.22
Directions: Claremont Rd-Go to Intersection-4th Driveway on right
Owner/Authorized Representative Acknowledgement of Permit Receipt
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I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the propertyro described above.
13" As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-02-2023-43431,by the following method(s):
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 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:43/14l2023 J 41111
Owner/Authorized Representative Signaturei'12-4/
'-' Date 3 ~z_.� z
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time
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 ycuPlease ttake a few momentts tto complette our custtomer service survey att
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ehpermit 03/14/2023 14.29