HomeMy WebLinkAboutIMPV-05-2023-195127.TIF •
=41b. CATAWBA COUNTY
•
I~ .f. Public Health Department Subdivision
S 1115
el `3 Environmental Health Division PIN# 367804838424
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
1842 w
Site Address: 2932 RANT DRUM RD, MAIDEN NC 28650
Name on Permit: RICHARD MARTOIA
Property Size: Acres 6.22
Directions: Hwy 16 N of 150 Turn E on Rant Drum RD, 1 mi to property on east side of RD
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
YAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RRPR-01-2023-43212,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
VElectronic Image Transmittal/E-mail (Return receipt required)
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: 05/08/2023
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature ___91,_
Dater lime 5/0/7,3
Method: Fax \/ Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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etlperniit 05/10/2023 05:34