HomeMy WebLinkAboutEXSY-04-2023-192866.tif CATANBA COUNTY Case# EXSY-04-2023-192866
��'•' ,� Public Health Department Subdivision
d *1 Environmental Health Division 13lNri 373416949717
PO Box 389,25 Government Drive,Newton,NC 28658 1 OT#
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Site Address: 5207 DAN D RD, CONOVER NC 28613
Name on Permit: BOBBY HOUSTON
Property Size: Acres 7.43
Directions: US 321 Bus N/Northwest Blvd, Country Home Rd and Lee Cline to Houston Mill to D an D Rd
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.
XAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2023-43780, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
IElectronic 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: 04/03/2023
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 vi I)3
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 yoLPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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ehpcnnit 04/04/2023 13:47