HomeMy WebLinkAboutIMPV-03-2023-191987.TIF S$' •
e C:ATAWBA COUNTY
ti I. Public Env Health Department Subdivision RALPH SIGMON
„ '3Environmental Health Division PINK 461703015921
PO Box 389,25 Government Drive,Newton,NC 28658 LOTtI 16
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Site Address: 4254 CANDLEWOOD DR, SHERRILLS FORD NC 28673
Name on Permit: THOMAS CORWIN
Property Size: Acres 0.64
Directions: Hwy 150, right onto Slanting Bridge Rd, left onto Drena Dr, left onto Cypress St, left onto Candlewood Dr,
property on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
Nil I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
kAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-01-2023-43214, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
J Electronic Image Transmittal/ E-mail (Return receipt required)
*..A 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: 03/22/2023
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 Date/Time 3134)3
If
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 youPlease ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/EHCusttomerService
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Parcel: 461703015921, 4254 CANDLEWOOD DR 14 1 il we �3 , ,�� 1in=50ft
SHERRILLS FORD, 28673
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Copyright 2023 Catawba County NC
03/22/2023