HomeMy WebLinkAboutIMPV-03-2023-192744.TIF A s: CATAWBA COUNTY , Case if IMPV-03-2023-192744
• 1..II Public Health Department Subdivision DANE MILLS UNRECORDED
'It3 tit
it Environmental Health Division PINT 363817022309
PO Box 389,25 Government Drive,Newton,NC 28658 1,01'# PT 4
Site Address: 5396 STARTOWN RD, MAIDEN NC 28658
Name on Permit: KEY BUILDERS, INC.
Property Size: Acres 2.82
Directions: Hwy 10 W,left Startown Rd, on left past Tripletts Farm Rd
Owner/Authorized Representative Acknowledgement of Permit Receipt
MH I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
1., MU As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-03-2023-43630, by the following method(s):
Received in Person
T Facsimile Transmittal (Return form with signature required)
*1 Electronic Image Transmittal/E-mail (Return receipt required)
is
MB 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(I5A 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: 03/31/2023
Owner/Authorized Representative Signature 444 "Y r 4 '
Date 04/21/2023
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name a/person sending permit)
Signature Date/"Time ill DI I)3
Method: Fax f 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 yat.Please ttake a few momentts tto complette our custtomer service survey an
http://www.surveymonkey.com/s/EHCusttomerService
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