HomeMy WebLinkAboutIMPV-06-2023-197305.TIF � f
41$ CATAWBA COUNTY
Public Health Department Subdivision
Environmental Health Division PIN# 460606399457
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
/H42 w
Site Address: 4331 EDWIN&GURLEY DR, SHERRILLS FORD NC 28673
Name on Permit: *MARCUS&TAMMERAH GARREN
Property Size: Acres 5.41
Directions: Hwy 150 to Stonewall St to Edwin&Gurley
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that I am the owner or authorized agent(owner's authorization required)representing the owncr of
the property described above.
K _ As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-11-2022-42714, by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required)
As 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(I5A 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: 06/05/2023
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)
yet
Signature l� Date/Time tF/Ui-173
Method: Fax N 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 yojPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
posolley, pt 6-pi
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ehpennit 06/07/2023 06:08