HomeMy WebLinkAboutWELL-07-2023-199687.TIF �8 • CATAWBA COUNTY Case# WELL-07-2023-I99687
�r G Public Health Department401
Subdivision
d Environmental Health Division PIN# 372119612638
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 1
i:42 w
Site Address: STARTOWN RD, HICKORY NC 28658
Name on Permit: TRIVIUM CORPORATE CENTER INC
Property Size: Acres 108.25
Directions: South on Startown Rd, pass Trivium Pkwy go approx.35 miles and turn left into a new construction entrance
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
YAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-06-2023-44608, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
J Electronic Image Transmittal/E-mail (Return receipt required)
AAs 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 (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:C6-
(name ofperson sending permit)
Signature Date/Time 7 )3
Method: Fa abEmail US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoaPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
h5} m foot)5CCtiet•Apt
i/
e?thrnnit 07/07/2023 15:47
t