HomeMy WebLinkAboutIMPV-07-2023-200655.TIF •
i•,•A r, CATAWBA COUNTY
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Public Health Dtpanmcnn Subdivisn
ssiq �! �i Environmental health Division PIN% 372314428844
/10 PO Box 389,23 Government Drive,Newton.NC 28658 LOT%
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Ski Address: 2914 SPENCER RD NE,CONOVER NC 28613
Name on Permit: MEGANNA GENTLE BENNER
Property Stu: Acres 0.54
Dlrectbna: McDonald Pkwy.left Spencer Rd(12th Ave Dr NE)on nght just past 28th St P1 NE.
Owner/Authorized Representative Acknowledgement of Permit Receipt
lv _I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
ly W As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-06-2023-44784, by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
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(1SA NCAC I8A.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:07/20/2023 �/�
Owner/Authorized Representative Signature t t _
Date Ai a.
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time $1163
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wants tto hear from yo&Please ttake a few momentts tto complette our custtomer service survey att
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