HomeMy WebLinkAboutIMPV-07-2023-200421.TIF 0
r ��A +f CATAWBACOUN'TY Coe w IMPV.07-2023.20042I
��-�. Public Health Department Subdivision
►� liut , !et Environmental Health Division PIN# 36970285 1
l/" Po Box 389,23 Government Drive,Newton,NC 28638 898
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Site Address: 6903 LITTLE MOUNTAIN RD.SHERRILLS FORD NC 28673
Name on Permit SHELIA CHAV IS SHEPHERD
Property Size: Acres 1.14
Directions: NC 16,left onto Buffalo S Floats Rd,right onto blUe Mountain Rd,keep right to stay on Little Mountain Rd.
right onto Cassandra Way,property on the right
Owner/Authorized Represeatative Acknowledgement of Permit Receipt
Xl certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above,
K3&As{he property owner or authorized representative,t have received the above referenced
permit(s)as requested in the application for service EHPR-03-2023-44288,by the following!method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
t f Electronic image Transmittal/E-mail(Return receipt required)
w`�As the nronerty owner or authorized representative I have reviewed and understand the sneciftc 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(]SA NCAC 18A.1900),and/or Well
Construction Standards(ISA NC AC 2(=.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:07/18/2023
Owner/Authori Zed Rei) si!ntative Sig natu
--� Date 7/0/ 2oL� __.
Documentation of Permit(s)Transm ittal
(permit transmitted by electronic or other means)
Permit transmitted by (name gfperson sending permi!)
in
Signature _ _ , __-_-- Date/Tlme 7J)?/
Method: Fax V Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tta hear from yorPlease ttake a few momentts tto CQmplette our custtamer service survey att
http;//www,surveyMonkey.com/3/EHCu$ttomerSewia , ,
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op., 01/1713023 10:04