HomeMy WebLinkAboutIMPV-05-2023-196967.TIF , • f.
/��}�1.tt', CATAWBA COUNTY ..
/ 'Ij Public Health Department Subdivision WILDERNESS TRACE PH 5
t Environmental Health Division PINK 375504846638
\mili PO Sox 389,25 Government Drive,Newton,NC 26656 LOU 160
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Site Address: 3194 MEDICINE BOW, CLAREMONT NC 28610
Name on Permit: "OAKWOOD HOMES
Property Size: Acres 0.46
Directions: Right Radiostation, Left321, Right Conover Blvd,S Rock Barn RD, L 16. Right, Right Oxford school RD,Left
Rest Home,Right Wildner Trace, Left Great Divide, Right Medicine Bow
Owner/Authorized Representative Acknowledgement of Permit Receipt
Xcertify that I am the owner or authorized agent(owner's authorization required)representing the owner of
ciS.
the property described above.
t'f As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2023-43811,by the following method(s):
_ Received in Person
Facsimile Transmittal (Return form with signature required)
I Electronic Image Transmittal/E-mail (Return receipt required)
IAs the property owner or authorized representative I have reviewed and understand the specific conditions
:::��ToFthe 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:05/31/2023 !�
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Owner/Authorized Representative Signature , /r,.z
Date e j 7i 2Di r
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sendingpermil)
Signature _._._ C).
Date/Time 41/47/
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 yoiPlease hake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.comis/EHCusttomerService
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