HomeMy WebLinkAboutWELL-06-2023-198360.TIF •
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sits Addy.... 4278 f MAIDEN RD MAIDEN NC 28850
N.ms Oil►.re*. MEGAN VNKt.E
Properly Stu Acres 0 85
DMactbns' NC 18.tight onto E5.4( lo Shoats Rd,tent onto S Others Crossroad_rgre onto E Maiden Rd weevily on the
right
(htacr/Authorized Representative Acknowledgement of Permit Receipt
KMt•,1 i rib I)Ihal I am the ttssnct or authrmied agent(m►nefsauthoriiatxm rcyuireJI rcjur cnung the owner of
the rn,tterty des rrhed ahrse
;V'JAs the property owner or Authorized representative.I fuse received the above referenced
pertnit(s)as requested in the application for service EJIPR-06-2023-44523,by the futlowinh n,e(hIlsiIs)
Reserved In Person
_ I'acl1m,le Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
`( NO As the property other or authorized representative I have reviewed and understand the spec iI conditions
of the permit issued, and further understand that all applicable regulatory requirements specified under the
North Ca robes Laws sad Rates for Sewage Treatment and Disposal Systems(ISA NCAC 18A.1900).
sndlor N'eIl Construction Standards(ISA NCAC 2C.0100). shall apply to the issuance of this permit and
the construction of the wastew*er system and'o►water supply well permitted
Permit Issue Date:OtS/19,2023
()s.vier Authorized Reptesentative Signature`_I 0.12(3 LL:k --.
- Date 10-i3-().
Docaeentatlon of Permll(sl Transmittal
• (permit treueitted by electronic or other means)
Paoli trardmivad by -_(j` -� --.---- (name ref person sen.Jm,;permit)
Signature, .._. `�_.- Datef Time 7 131 )3
Method: tan Euwail US Mad _ Other
Owners request to send by the above iadicatrd method of transmittal in lieu of signature
We warn[tto hear from yotvkase oak*a few moments tto comp ette our custtomer service survey att
hetp.//w•wnr.s rweymonkry.cam/s/thtusttomerService
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Catawba County Environmental Health
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100.00 ,,.. —"'m"
02(5) RD
( , G 2 cal) J ,f �16.410A^uA
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Parcel: 367601265681, 4276 E MAIDEN RD 1in=50ft
MAIDEN, 28650
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Copyright 2023 Catawba County NC
06/30/2023