HomeMy WebLinkAboutWELL-03-2023-191265.TIF • CATAWBACOUNTY Case WELL-03-2023-191265
• .f.ft Public Health Department Subdivision
Environmental Health Division PIN# 371111565918
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# PT TR 1
Site Address: 3405 VALLEY ARBORS DR, HICKORY NC 28602
Name on Permit T&K UTILITIES INC
Property Size: Acres 8,84
Directions: Catawba Valley Blvd SE, left onto 21st St SE, right onto Mosteller Estate Ave,enter the roundabout,exit the
roundabout at exit 0, turn left
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
�, As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-03-2023-43650, by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
jElectronic Image Transmittal/E-mail (Return receipt required)
.i(J. 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(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: 03/14/2023
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature 1)' Date/Time 4/ .)/')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 yoiPlease ttake a few momentts tto compiette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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ehpermir 03/15/2023 07:42