HomeMy WebLinkAboutAUTH-03-2023-192501.TIF ..
!_ CATAWBA COUNTY Case# AUTH-03-2023-192501
•
• Public Health Department Subdivision
LtJ�I Environmental Health Division PIN# 363905280977
R ^ O
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2&PT 3
Site Address: 1396 SIMMONS ST, NEWTON NC 28658
Name on Permit: VA YANG
Property Size: Acres 11.86
Directions: NC-10, right onto Simmons St, home is on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
1 _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-08-2022-42061,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
J Electronic Image Transmittal/E-mail (Return receipt required)
1` 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
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature qt Date/Time
44)-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 youPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
VanS707& t .e
NNL A\4\ 13
ehpennit 03/29/2023 11:23
Catawba County Environmental Health
ENPR-08-Lout- motor
ALAI,-03 - .0u - 19Zs°1
Z.,04‘
o,,
.k •1396 #\'‘...4111r,
el`
0
'tom 1
.
II
r r. it `
r ' o
•1404 3
f� 9 'v
f
X4 O
w
Parcel: 363905280977, 1396 SIMMONS ST 1in=50ft
NEWTON,28658
I
This map/report product was prepared from the Catawba County.NC Geospalial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling Information =Wined on this map or data on this report.Catawba County promotes and recommends
the Independent verification of any data contained on this map/report product by the user.The County of Catawba,Its employees,agents.and
arisefrom thismap/report any e el, . nsh d not be held or the liable for
any
and all d am gg snUl�s or liability,whether direct,Indirect or consequential which arises or may
Copyright 2023 Catawba County NC
03/292023