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Site Address: 1023 RUSSELL RIDGE DR, CATAWBA NC 28609
Name on Permit: 'TIM DELLINGER BUILDERS INC
Property Size: Acres 0.48
Directions: Sherrills Ford Rd to Russell Rd Dr, 1st Lot on Left
Owner/Authorized Representative Acknowledgement of Permit Receipt
XJ certify that I um the‘miter or authorized agent((miter's authorization required)representing the uN%ncr of
the property described above.
Xf(--) As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service 1413PR-03-2023-43578,by the following,method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
TElectronic Image Transmittal/ E-mail (Return receipt required)
As the property owner or authorized representative I have reviewed and understand the specific conditions
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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: 05/17/2023
Owner/Authorized Representative Signature_
7 Date )— Z-- Z 3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ (nunte of person sending permit)
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Signature Date/Time____tpl)
Method:. Fax Entail _US Mail Other
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° 4. .l jibe above indicated method of transmittal in lieu of signature
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. CATAWBACOUNTY Case AUTH-05-2023-195912
1.40111111. Public Health Department Subdivision RUSSELL RIDGE PH 2
Environmental Health Division PIN# 378004523853
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PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 27
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Site Address: 1023 RUSSELL RIDGE DR,CATAWBA NC 28609
Name on Permit: *TIM DELLINGER BUILDERS INC
Property Size: Acres 0.48
Directions: Sherrills Ford Rd to Russell Rd Dr, 1st Lot on Left
The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant
/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Authorization to
Construct Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Authorization to
Construct Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the
North Carolina'Laws and Rules for Sewage Treatment and Disposal Systems'(15A NCAC 18A.1900). Neither Catawba County nor the
Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time.
Any permit issued for a conventional system may be used for an accepted system without Environmental Health authorization or permit
modification.Please notify Environmental Health of this change prior to system installation.
05/17/2023
Authorized State Agent Permit Issuance Date
8/15/2027
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
elgtenntt 05/30/2023 08:53