HomeMy WebLinkAboutIMPV-03-2023-191379.TIF =� CATAWBA COUNTY CaseN IMPV-03-2023-I91379
�!(.......-� Public Health Department Subdivision
3, R� Is Environmental Health Division I'INN 378213133213
PO Box 389,25 Government Drive,Newton,NC 28658 I,pIN
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Site Address: 5112 E US 70 HWY,CATAWBA NC 28609
Name on Permit: CHENG THOR
Property Size: Acres 17.23
Directions: East on 1-40 exit 138,left on Wike Rd, right on E NC 10 Hwy, at the stop light make a right on US Hwy 70,
property is a quarter mile on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
certify that I am the owner or authorized agent(owner's authorisation required)representing the owner of
the property described above.
1As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-02-2023-43480, by the following method(s):
Received in Person
JFacsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
C 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:03/15/2023 Owner/Authorized /Z3
esentative Signature7/441V
3/ 29 Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person send g permit)
Signature _ °jig
Date/Time 3 D�1 a3
Method: Fax • Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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