HomeMy WebLinkAboutWELL-03-2023-192247.TIF ,
-,11/`• CATAWBA COUNTY Case# WELL-03-2023-192247
t~ ��"'l ,y, Public Health Department Subdivision
'-3 Environmental Health Division PIN# 378104740908
PO Box 389,25 Govermnent Drive,Newton,NC 28658
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Site Address: 5715 HUDSON CHAPEL RD, CATAWBA NC 28609
Name on Permit: J.B.'S GRADING INC
Property Size: Acres 6.96
Directions: NC 10, right onto Hudson Chapel Rd, right onto Isenhour St, property on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
f., As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-03-2023-43754,by the following method(s):
Received in Person
Facsimile"Transmittal (Return form with signature required)
NI 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: 03/27/2023
Owner/Authorized Representative Signature
L-7
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by s_. (name of person sending permit)
Signature Date/Time 11114)3
Method: Fax Email f US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoi.Please ttake a few momentts tto complette our custtomer service survey att
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ehpennit 03/28/2023 I I:35