HomeMy WebLinkAboutEXSY-06-2023-198405.TIF IN CATAWBA COUNTY Cate itEXSY-06-2023.19&105
i, �'� Public Health Department Subdivision CRYSTAL FOREST PHASE 2
11"pst . et Environmental Health Division PJNN 367804801112
\ /i PG Box 389,25 Government Drive,Newton,NC 28658 iota 4
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Site Address: 3302 TATTERSTONE LN,MAIDEN NC 28650
Name on Permit: 'CONSIDERING FIELDS LLC
Property Size: Acres 1.08
Directions: Hwy 16 S Left Rant Drum Rd. Right Crystal Forest on Tatterstone LN lot 4 on Left
Owner/Authorized Representative Acknowledgement of Permit Receipt
i
l certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
_ As the property owner or authorized representative.I have received the above referenced
ermit(s)as requested in the application for service RHPR-04-2023-43925,by the following method(s):
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_ Received in Person
_ Facsimile Transmittal(Return form with signature required)
_L Electronic Image Transmittal/E-mail (Return receipt required)
f. As the property owner or authorized representative I have reviewed and understand the specific conditions
the permit issued, and further understand that all applicable regulatory requirements specified under the
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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:06/19/2023
Owner/Authorized
Representative Signature '
—1 Date e9`O -� `e) 3 0i1,,A N, ,c-G k r
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Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted b _ . .. (name of person s nding permit)
Signature_ ----_-- -----_-----Date/Time_--
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Method: Fax r Email US Mail Other 1
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerServlce
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,,,,.., 06/20F2023 08.06
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