HomeMy WebLinkAboutAUTH-05-2023-195706.TIF „chi=e CATAWBA COUNTY •
.. Public Health Department Subdivision JAMES A KELLER
Environmental Health Divisionlikk PINK 370411550651
• PO Box 389 25 Government Drive,Newton,NC 28658(.......Zl►� LOTk 7
StteAddress: 544 30TH AVE NW, HICKORY NC 28601
Name on Permit: `PRIDE DESIGN CONSTRUCTION INC
Property Size: Acres 0.88
Directions: N Center St. Left 29th Ave Dr NW, Left 30th Ave NW, Right past 5th St PI NW
Owner/Authorized Representative Acknowledgement of Permit Receipt
50 I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
Kc. As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-04-2023-44094, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
SA✓ Electronic Image Transmittal/E-mail (Return receipt required)
�5 GAs 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 2 S 3
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
We wantt tto hear from yodalease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
If �) 1 'l: i
ehpermit 05/152023 16:44
ri ( . . ','
1