HomeMy WebLinkAboutEXSY-04-2023-193208.TIF t
�y$' CATAWBA COUNTY Case#
;Q' t411" ,y Public Health Department Subdivision WESTON
J„�,-_� Environmental Health Division PIN# 266901458328
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 17
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Site Address: 1841 WESTON DR,VALE NC 28168
Name on Permit: RSH PROPERTIES FAMILY LTD PARTNERSHIP
Property Size: Acres 0.49
Directions: Left Radio Station Rd, Left Long Dr, Right Hwy 10W, Right Providence Church RD, Left Old Shelby, Right
Brittain RD, Left Weston Dr
Owner/Authorized Representative Acknowledgement of Permit Receipt
XI certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
_ As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-02-2023-43552,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
I Electronic Image Transmittal/E-mail (Return receipt required)
(f _ 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: 04/06/2023
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sendingl permit)
Signature9
Date/Time ! 1)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 yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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ehpermii 04/11/2023 09:52