HomeMy WebLinkAboutAUTH-04-2023-193718.TIF I f
41+ CATAWaA COUNTY' Case k •AUTH•04 2023�t937I$
Al-I. A Puklic Hcaith De
Al •8ubdly slon TRANQUIL VILLAGE,DEVELO
�,/OEnvironmental Health Division PINY. 3734151345613
PQ:0ox 359,25 Government D00,*Wien.NC 105.5 LOTS- 4
81te'Address: 5165.MAYS ST;CONOVER NC'28613
Name on Permit: LISBET IBARRA LEMUS
Property Size:- Acres 0.4
olreouons: Springs.Rd going to 16,,turn on Mays St property.is on the right.
Owner/Authorized Representative Acknowledgement of.Perm it.Receipt
N/ L I t.certify that I am the owner or authorised agent(owner's authorization required)representing the owner of
the property desoribcti above,
Kj As the property.owner or authorized representative;t.have received the above referenced
permit(s);as requested in the.appiication for service EHPR-01-2023-43141,by the following methods):
Received in Person
Facsimile Transmittal(Return form with signature required)
'
2 Electronic Image Transmittal/C.mail (Return receipt required)
IS 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 SewageTreatment and Disposal Systems(1.5ANcAC ISA.1900);:
and/or Well Construction Standards(I SA NCAC 2C.0100), ;shall::apply:to the'.lssuant a.of this permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date:04/14/2023
Owner/Authorized Representative Signature.
•nat•• S/if/6
Documentation of> errttlt(s)Transmittal.
(pertttit transmitted by, electronic or other means)
:Permit transmitted by. , (Ounfp of pei',,00,roull77$per,uiO:
Signature. Dute/Tinie �T
Method: :Fax Etna ii US Mail Other
Owner's request to send by the above indicated method of transmittal in.lieu of signature
We wantt no hear from yotPlease ttake a few.momentts;tto complette ottr custtorner service survey ett.
hitp://www.surveymonkey.tom/s/EHCusttomerSen/lce
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uiIp Ifl it. 00 2023:06:27