HomeMy WebLinkAboutAUTH-07-2023-199676.TIF e
.p• ,'d, CATAWBA COUNTY Case# AIJTH-07-2023-199676
G Public Health Department Subdivision ORCHARD HILL
dlel:: Environmental Health Division PIN# 373319612589
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 30
18 w
Site Address: 1377 PEAR DR, CONOVER NC 28613
Name on Permit: SANDRA BERRY
Property Size: Acres 0.82
Directions: NC 16 Bus, left onto US 70A W/1st St W, right onto Herman Sipe Rd NW, right onto Pear Dr, property on the
right
Owner/Authorized Representative Acknowledgement of Permit Receipt
XI 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
permit(s)as requested in the application for service EHPR-06-2023-44650, by the following method(s):
Received in Person
_ Facsimile Transmittal(Return form with signature required)
,/ Electronic Image Transmittal/E-mail (Return receipt required)
f As the property owner or authorized representative I have reviewed and understand the specific conditions
F 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: 07/07/2023
Owner/Authorized Representative Signature
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ (name of person sending permit)
Signature ___*__ Date/Time_7/)A/)3
Method: Fax I 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 yo&Please ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/EHCusttomerService
gancitiobeity@alli net
chprrnit 07/07/2023 15:.32
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