HomeMy WebLinkAboutAUTH-03-2023-192496.TIF S
� _�" CATAWBA COUNTY Case# AUTH-03-2023-192496
H �, Ii Public Health Department I Subdivision
„ , I 19 O i Environmental Health Division PIN# 369902690666
PO Box 389,25 GovernmentlDrive,Newton,NC 28658 LOT#
sw
Site Address: 6594 ADAM WRIGHT CIR, CATAWBA NC 28609
Name on Permit: DEBORAH CHAIN
Property Size: Acres 1.26
Directions: Sherrills Ford Rd, Long Island Rd, right Adam Wright Cir on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
l( 7 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
x10_
C As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-04-2022-40765, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
-7 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: 03/29/2023 '�'Owner/Authorized Representative Signature /41 I'L
V
Date gI if,
IIZS
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time
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 yotPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerservice
ig LiIuI�3
ehpermit 03/29/2023 11:10