HomeMy WebLinkAboutIMPV-04-2023-192945.TIF =`o ('ATA11 nA c�oltN't Y r"d n
( iruhi,e(lcl1, Ikp.ntolrnt StaAni.um INDIAN TRAILS
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} I.nvlronmrnl.d Ilealth I1iti.ion I'tN r 365609055846
v PO MA 3!lN,25 Gatanmcnt Ihitr.Ncatnn.NC 2x65i t in a PT 13
Site Address: 134 SHAWNEE TR,MAIDEN NC 28650
Name on Permit: MARILYN MCREE
Property Size: Acros 6.35
Directions: Rock Column entrance at end of cul-de-sac on Shawnee trail
'/ �7, Owner/Authorized Representative Acknowledgement of Permit Receipt
J� tl! I certify thal I aln t lt he uucr nr utcti auttwrired agent( er'J authorization required)representing the(miter Uf
r the property described above.
f !. As the property owner or authorized representative,I have received the above referenced
permit(.)as requested in the application for service RRPR-02-2023-43508,by the following ntethod(s):
_ Received in Person
Facsimile Transmittal(Return font'with signature required)
JElectronic Image Transmittals E-mail (Return receipt required)
S.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 requirement.;specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(I5A NCAC 18A.1900).
and/or Well Construction Standards(ISA 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(0h12023
O vnerfAuthorized Representative Signature Or-
Date)/y/21.._..
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted 1w 'many'of person sending permit)
Signature V ______Date/Time q J,)I)3
Method: Fax F.rnril US Mail Other
S
iI
Owner's request to send by the above indicated method of transmittal in lieu of signature
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