HomeMy WebLinkAboutWELL-03-2023-192360.TIF r r
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�$• • CATAWBA COUNTY Case# WELL 03 2023 192360
4 in Public Health Department Subdivision
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Environmental Health Division PIN# 374413147513
PO Box 389,25 Government Drive,Newton,NC 28658 LO"1'# C
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Site Address: 1375 HOUSTON MILL RD,CONOVER NC 28613
Name on Permit: JEFFERY BOWMAN
Property Size: Acres 0.94
Directions: 321 to 16 north to C&B Farm Rd to Houston Mill Rd, turn left and go 1/2 mile to Brick House on the 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.
Y.. As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-03-2023-43628, 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:03/28/2023
Owner/Authorized Representative Signature
Date
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Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted b (name of person sending permit)
Signature Date/Time 7h v)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 yolPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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