HomeMy WebLinkAboutAUTH-06-2023-197336.TIF •
�` CATAWIBA COUNTY '
+. °' Public Health Department Subdivision
Environmental Health Division
'Ilk(....... PIN# 373417105428
otait/ PO Box 389,25 Government Drive,Newton,NC 28658 LO1'#
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Site Address: 4748 RALEIGH ST,CONOVER NC 28613
Name on Permit: GEORGE TAYLOR
Property Size: Acres 5.51
Directions: County Home Rd,Noah Path Left Raleigh St on Right
y �^ Owner/Authorized Representative Acknowledgement of Permit Receipt
-C r l certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
F C he property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-04-2023-44054,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
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:06/05/2023
Owner/Authorized Representative Signature _ 6-------
Date 415'''LCSl
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person se'ding permit)
SignatureDtf Date/Time V �,S j)
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 yozPlease ttake a few moments tto complette our custtomer service survey att
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chr,„:i:: 06/07/2023 06:33