HomeMy WebLinkAboutAUTH-04-2023-194272.TIF M.m
Cam:II Al t t t-ua•2o23•tr+4272
M
('.+ NA COI+'�'I1'
�,ti
Putr7t tieolih tktiann tiulxh+,vnm
ie„t I'lNB 374413147513
'Ct am }. I'm!momenta!Ilmlih l)1%Num I.nl q C
11;.,.. PO nn+ ?ts9, A Go.ernnxnl Ow rr.Nemen Sit 1MAS1r
•;
Site Address:
Name on Permit.
JEFFERY BOVvMAN
Property Size. Acres 0 94
321 to 16 north to C&B Farm Rd to Houston Mill Rd, turn left and po 1/2 mite to Brick House on the left
Directions
Owner•/Authorized Representative Acknowledgement of Permit Receipt
S. 3-13 emit) that Ian the ot%net or .iuthirriied agent It+t+ncr'+authnriiution required)rerrec nting the„%+ner ul
the pn+peet) ,Jes..ribecJ oho,c
X-7-1. f� As the property owner or authorized representative. I have received the abut.e reference
d
permilt•)as requested in the application for service EliPR-03-2023-43628. by the IbIlowing method(s):
Received in Person
hacsimilc-transmittal (Return form with signature required)
NI Electronic Image Transmittal/E-mail (Return receipt required)
,j8As 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 I8A.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:04/25/2023
Owner/Authorized Representative Signaturec\4 .ifioita...
sii+/!'lrA
9,3 Date . �•r r_q- . . .
Au n 1pi __________.
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted b q..c.... ___.__._._. (name a/'p re(,n sending permit!
Signature Date/Time
Method: Fax t Email US Mail Other
Y :: 4441
e
?+ —7i1,..1 rsq esl to send by the above Indicated method of transmittal in lieu of signature
1 rtii, r * Mfs wsntt Uo hair From yotPlease ttake a few momentts tto complette our custtomer service survey att
;' ' x, r. x. , ` 1,
http://www.surveymonkey.com/s/EHCusttomerServlce
1 A
• 2'� S ,i4 a �: /
r Jeff l m8`ni)Y a hoc..Ito _ �, S j z
t3
'.'-. if:Z4'Si" '''.i.' ,',. q ity `l f`\�j / /� rto- /fir
(1412er2e21 tit.02
1 -
a•<t.'t�Y �:�i�.r' ' t'i't t ., _ .s,..: ),i- ...`F Y:,..,-1 e-..1^,*,. r......_......... ,..,..«..✓..ur ei ssiote'k'sft.. a.