HomeMy WebLinkAboutWELL-04-2023-194363.TIF .
+4+ CATAWBACOUNT1
Public health lkpartmcnt Sohdiv .ion ELLENS WAY
,� Environmental Health I)ntston PIN; 266903304296
iri • PO Box 3K9.25 Government Dmc.Nr�otun.NC _'Rh58 I p 21
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Site Address: 2308 DOBBIN Cl, VALE NC 28168
Name on Permit: CARLTON WILLIAMS
Property Size: Acres 0.86
Directions: Right off of Jacob Fork River Rd onto Bayleigh Dr. Left onto Dobbin Ct. Lot at end of rd.
Owner/Authorized Representative Acknowledgement of Permit Receipt
(CWI et:rtil) that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
Fv�11s the property owner or authorized representative. I have received the above referenced
CA
permit(s)as requested in the application for service RBPR-I1-2022-42834. by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
I Electronic Image Transmittal/E-mail (Return receipt required)
,i(e 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: 04/26/2023 /\ 1� .
•
Owner/Authorized Representative Signature . VV .......--/
Date _ I Cr
Documentation of Permits)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (nume of persY n sending permit)
Signature4 Date/Time 3I )3
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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Parcel: 266903304296, 2308 DOBBIN CT VALE, 1 in=60ft
28168
This map/report product was prepared from the Catawba County,NC Goospatlal Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and
personnel,disclaim,and shall not be held liable for any and ail�damages,loss or liability,whether direct,indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
04/24/2023