HomeMy WebLinkAboutAUTH-05-2023-195793.TIF -�ti�`� CATAWBA COUNTY
i 1 - 1 Public Health Department • Subdivision
y . Jet Environmental Ilalth Division PINA 385910458725
�\/, PO Box 359,25 Government Drive,Newton,NC 28658 I.OTO
SN.Address: 2454 COLEY FISH POND R0,NEWTON NC 28858
Nam.on P.rrrtlt MELLISSA HARRIS
ProQarty Sits: Acres 0.78
Directions: S NC 16 Hwy left Coley Fish Pond Rd on left past Dale St
Owner/Authorized Representative Acknowledgement of Permit Receipt
thb
ft I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
. e property described above.
' di As the property owner or authorized representative,1 have received the above referenced
.•rmit(s)as requested in the application for service EHPR-05-2023-44232,by the following method(s):
_ Received in Person
Facsimile Transmittal(Return form with signature required)
TElectronic Image Transmittal/E-mail (Return receipt required)
Nf I L 1 a
•s the property owner or authorized representative I have reviewed and understand the specific conditions
• e permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(1SA NCAC ISA.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: 05/16/2023 }� ,
Owner/Authorized Representative Signature -1 '( a+�Q l �
Date SJ3 /c 3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted byI)1 (name ofperson sending permil)
Signature Date/Time 613b17.3
Method: Fax ` Email US Mail Other
Owner's request to send by the above indicated method of transmittal is lieu of signature
We wantt tto hear from yorPlease Stake a few momentts tto complette our custtomer service survey art
http://www.surveymenkey.com/s/EHCusttomerService
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