HomeMy WebLinkAboutAUTH-06-2023-198850.TIF •
CATAWBA COUNTY . .._
Public Health Department Subdivision MURRAYS MILL SHEET 1
R�{-� Environmental Health Division PINt! 378003231660
ifPO Box 389,25 Government Drive,Newton,NC 28658 t 0Tt 2
Site Address: 5220 MILLSTONE DR, CATAWBA NC 28609
Name on Permit: JEFFREY THUMM
Property Size: Acres 3.02
Directions: East on Hwy 10, Right on Murrays Mill, Left onto Millstone Dr on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
tJTI certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
JT As the property owner or authorized representative, I have received the above referenced 7C
permit(s)as requested in the application for service RBPR-04-2023-44139, by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
JT 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 1 SA.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:06/27/2023
Owner/Authorized Representative Signature / 27L�G4/ 142,
Date 9-11-23
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name o_fperson sending permit)
Signature (4—€:, Date/Time 7)13I
Method: Fax " Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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Parcel: 378003231660, 5220 MILLSTONE DR tin=60ft
CATAWBA, 28609
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Copyright 2023 Catawba County NC
06/27/2023