HomeMy WebLinkAboutIMPV-07-2023-200119.TIF 44, • CATAWBA COUNTY
F� Ilit Public Health Department Subdivision MUNDY ACRES PHASE III
d lal Environmental Health Division PIN# 369604813951
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 25
/842 tw
Site Address: 5112 LINEBERGER LOOP RD, DENVER NC 28037
Name on Permit: THOMAS GRIFFIN
Property Size: Acres 1.36
Directions: NC 16, left onto Campground Rd, left on Catawba Burns Rd, Left on Lineberger Rd. Keep Straight to get on
Lineberger Loop Rd, Property on Right
Owner/Authorized Representative Acknowledgement of Permit Receipt
1 1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
F As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-06-2023-44530,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
J Electronic Image Transmittal/E-mail (Return receipt required)
C 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 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: 07/14/2023
Owner/Authorized Representative Signature
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name ofperson sending permit)
Signature Date/Time —7J 77 j)3
Method: Fax J Email US Mail r Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpennit 07/17/2023 14:08