HomeMy WebLinkAboutIMPV-05-2023-196328.TIF �$4.D
CATAWBA COUNTY ._____
,y Public Health Department AI
Subdivision LOELL DEAL PROP UNREC
< Environmental Health Division PIN# 368902594461
PO Box 389,25 Government Drive,Newton,NC 28658 I.OT# 2W
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Site Address: 1383 SUGARFARM RD, CATAWBA NC 28609
Name on Permit: MICHAEL MICHAUD
Property Size: Acres 3.82
Directions: W Bandys Cross Rd, L onto Buffalo Shoals Rd then R onto E Bandys Cross Rd, L onto Sugarfarm Rd
Owner/Authorized Representative Acknowledgement of Permit Receipt
X __I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
XAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-02-2023-43447, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
J Electronic Image Transmittal/E-mail (Return receipt required)
__ As the property owner or authorized representative I have reviewed and understand the specific conditions
77 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: 05/22/2023
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)
n M)3Signature t, Date/Time IP
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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el:I:mut 05/26/2023 05:22