HomeMy WebLinkAboutAUTH-05-2023-195704.TIF yyg• * CATAWBA COUNTY Case# AUT11-05-2023-195704
•• -.'� ,. Public Health Department Subdivision FOX TRAIL
d , i. y Environmental •Health Division PIN# 364920919262
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 4
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Site Address: 1970 GAIL ST, NEWTON NC 28658
Name on Permit: MICHAEL FURR
Property Size: Acres 0.48
Directions: 321 Business S, left Smyre Farm Rd, approx 1.5 miles, right St James Church Rd, 1 miles left onJenkins
Pring Dr, left Carla St, right Gail St, home on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
4 I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
}( As the property owner or authorized representative, I have received the above referenced
1` permit(s)as requested in the application for service EHPR-05-2023-44280, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
4 Electronic Image Transmittal/E-mail (Return receipt required)
'I 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: 05/15/2023
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)
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Signature C Date/Time (��
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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http://www.surveymonkey.com/s/EHCusttomerService
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