HomeMy WebLinkAboutIMPV-07-2023-199938.TIF .
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Site Address: 2065 NORTHVIEW HARBOUR DR,SHERRILt.S FORD NC 28613
Name on Permit: PERRY&PATTI KELLEY
Property Size: Acres 0.85
Directions: Sheritils Ford Rd to Island Point Rd Left on Island Point,Lell on Northvew Harbcur Dr
(, Owner/Authorized Representative Acknowledgement of Permit Receipt
Ayfik, Ii,r � tl tii :::: : ;:m we„„neror.uithuriiedaccri((miler•••:ui(t,•rir.tti.+n required Ir;(+reintin_the ut+ncru1
the,Ripen) d:s: ti ll d.;h,,,c.
As the properr) owner or authorized representatite.I lute received the abort'referenced
permit(s):Is requested in the application for set ice RItPR-II5-2023-14313.by the following methnd(s):
Received in Person
Facsimile Transmittal(Return firm tsith signature required)
/� I Electronic linage Transmittal I.-mail (Return receipt requited)
r.l " As the properly ottner or authorized represritt.1lite I Nix r re iewed and understand the specific rundilions
l� (Lithe permit issued. and Iiirther understand that all applicable regulator requirements specified under the
North Carolina Laws and Rules for Sctrage Treatment and Disposal Systems(i SA N( A( IKA.191)0),
and/or Weil Construction Standards(I5A N('AC 2C.011)0), shall apply to the issuance of this permit and
the construction of the wastewater s%stem and't+r water suppl) t+ell permitted.
Permit Issue Date:0 7/1 212 02 3
OwnerAuthoriied Representative Signature 7‘ . . � -s
Date / 1 L-7 I (.3 /
I)ocumciuiiIinn of l'ermit(s)Tea its III iltaI
(permit transmitted h) electronic or other means)
Permit transmitted 1w4 nn,w, ,,;j',r,;,rt.+,u:/ini 1','rrniri
Signature I)ate I intr J7f)3
�lelhod: Vas J Email ... . Ps \lail Other
Owner's request to send li the abut indicated method of transmittal in lieu ofsignatur•e
We waritt tto hear front yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveyntonke.y.rom/s/EHCusttomerService
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