HomeMy WebLinkAboutIMPV-06-2023-197883.TIF ?'� CATAWBA COUNTY
-
►5{-f-Ks Public Heath Department Subdivision
. * Emu- mental Health Division PiN!! 373416824674
�\ GovernmentPO Box 389,25 Government Drive.Newton,NC 28658 LOTN 6
fit
Site Address: 4926 RIFLE RANGE RD,CONOVER NC 28613
Name on Permit: RICHARD KEISTER
Property Size: Acres 4.99
Directions: Springs Road to Rigle Range Rd.Site is on Left Look for VBH Signs
Owner/Authorized Representative Acknowledgement of Permit Receipt
eAI certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
�
the property described above.
x J"' As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2023-43771,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
fa
J Electronic Image Transmittal/E-mail (Return receipt required)
tfa 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(ISA 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:06/12/2023
Owner/Authorized Representative Signature __ .
Date "7/,3/2.923 .
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
yL
Signature 713Ii3
� Date/Time„_..,.._..�.
Method: Fax Email US Mall Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt Ito hear from yod lease ttake a few momentts tto complette our custtomer service survey att
http://www.sunreymonkey.com/s/DICusttomerService
f',ek I4( 3!er6 +/Gltce. t'f ►
l 1 tL+ 1y
*maw 06t15f202311:31)
I :a ram.,:. ...
... ;,�.:,. :.:,;. �.:n ..:�.CGyi� ,...,vyo `�' :. ..i. .e;;'.u�kuk.'��`% r.n...,.4".aggi
Catawba County Environmental Health
>?RPR-03-1,oZ - II 7 I
1mpv-°to -1023- 1198
Aug- +i78"g1
WGII -oy -WU - 1q 12 ��,°
I 1'
•
yJr 8Z
•
6 i
140
c.
,� S ya I �r°P br•; •
r‘i3Ai �rr 1p
to ST
yoi
351
—may Prop •
36g 1z'
F �o.
Wul for
2rea II
1r
J1 •
Parcel: 3734168216 4, 4926 RIFLE RANGE RD 1 in=60ft
CONOVER, 28613
This map/report product was prepared from the Catawba County,NC Geospatlal Information Services, Catawba County has made substantial efforts
to ensure the accuracy of location and labeling Information contained on this map or data on this report.Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user.The County of Catawba,Its employees,agents,and
personnel,disclaim,and shall not be held liable for any end all damages,loss or liability,whether direct,Indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
08/12/2023