HomeMy WebLinkAboutAUTH-07-2023-200681.TIF l l
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(,6i CATAWBA COUNTY
(� t 11 Public Health Department Subdivision ASTORIA
Environmental Health Division PIN/ 471004541304
1. PO Box 189.25 Govcmment Drive,Newton,NC 28658 LOT# 4
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Site Address: 984 ASTORIA PKWY,CATAWBA NC 28609
Name on Permit_ WAYNE AND AMY STEVENS
Property Size: Acres 0.5
Directions: Sherrills Ford Rd I Hopewell Church Rd go thru Monbo Rd intersection!right Regal Blvd/right Astoria Pkwy/
lot 4 in cul,de-sac
Owner/Authorized Representative Acknowledgement of Permit Receipt
02_. __,:-1
I certify that I am the owner or authorized agent(owner's authorisation required)representing the owner of
the property described above.
XAs the property owner or authorized representative,I have received the above referenced
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permit(s)as requested in the application for service RBPR-0S-2023-44453,by the following method(s):
_ Received in Person
Facsimile Transmittal (Return form with signature required)
`r Electronic Image Transmittal/E-mail (Return receipt required)
i
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 1SA.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: 07/21/2023
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Owner/Authorized Representative Signature
Date_Z./Y.63 ,
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature4
V Date/Time I 11)3
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lien of signature
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