HomeMy WebLinkAboutAUTH-04-2023-193755.TIF `~ MASA(1)1 %Tl'
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1 i I.muixtmerrtjJ Health Do.Eno+ 1'IN• 371519510347
\. , �� II.)Box)IY,2$timcromcnt I)r,.c.Nc.Non.NC 28638 I U f a
Site Address 4551 1ST ST NW, HICKORY NC 28601
Name on Permit. BERNARD WINTER
Property sire Acres 0 92
D+ractk,ns Hwy 127 N.left 1st St NW,property on left
Owner/Authorized Representative Acknowledgement of'Permit Receipt
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I trrtilj that I am the ow net or authorized agent(owner's atillwrilatiun required)representing the 4+ttno-to
the Pnpen) Jest shed above.
IV Y As the property owner or authorized representative. I have received the above referenced
permits)as requested in the application for service EHPR-03-2023-43725.by the following rnethod(s):
Received in Person
_ I acsimilc transmittal (Return form with signature required)
li Electronic Image Transmittal. E-mail (Return receipt required)
•C �, 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 fur Sewage Treatment and Disposal Systems(15A NCAC 1SA.1900).
andior Well Construction Standards(15A NCAC 2C.0100). shall apply to the issuance of this permit and
Mr construction tion of the wastewater system and or water supply well permitted.
Permit Issue Date: :;:::ati%c
Owner Authorized Signature -
r Date ri fro7A n zo a.....,....
Documentation of Permit(s)'Transmittal
(permit transmitted by electronic or other means)
Pcmitt transmitted by (more of person sending permit)
Signature Z- Date/Time .J/3IJ3
NitthOd: F'as J Email US Mail Other
Owner's request to send by the altos indicated ► ethod of transmittal in lieu of signature
We wann no hear horn yoePlease ttake a few momentts no complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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Catawba County Environmental Health
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Parcel: 371519520347, 4551 1ST ST NW 1 in=60ft
HICKORY, 28601
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04/11/2023