HomeMy WebLinkAboutAUTH-05-2023-195205.TIF t . r
' CATAWBA COUNTY
.F' .t.11 ?. Public Health Department Subdivision
Q.�O Environmental Health Division PIN# 361702672075
PO Box 389,25 Government Drive,Newton,NC 28658 LOTH 2
Site Address: 3647 WILFONG RD, NEWTON NC 28658
Name on Permit: UNDERWOOD, RICHARD WAYNE
Property Size: Acres 5.12
Directions: Startown RD cross 321 Right Blackburn Bridge RD, Right Wilfong Rd on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
Sire7/
1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.X
.A/As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-04-2023-44110,by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
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As the property owner or authorized representative I have reviewed and understand the specific conditions
f 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: 05/08/2023
Owner/Authorized Representative Signature /i rrJ
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Date
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Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by_ (name of person sending permit)
Signature Date/Time
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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05/10/2023 05:30