HomeMy WebLinkAboutEXSY-07-2023-200829.TIF I I '49`ipi. CATAWBA COUNTY Case itEXSY-07-2023-200829
4-IV, Public Health Department Subdivision
3 i
es Environmental Health Division PIN# 369719505236
Mk... 1� PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 3
LTVSits Address: 6548 EMERALD ISLE DR, SHERRILLS FORD NC 28673
Name on Permit: FUTRHOMES LLC
Property Size: Acres 0.46
Directions: Hwy 150, Left onto Mount Pleasant Rd, Right onto Emerald Isle Dr, Property on the left
// Owner/Authorized Representative Acknowledgement of Permit Receipt
42����
"'K,II- litthal.I em the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
S �61)As the property owner or authorized representative,1 have received the above referenced
permit(s)as requested in the application for service RBPR-04-2023-44096,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
1( As the property owner or authorized representative I have reviewed and understand the specific conditions
I 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:07/24/2023
Owner/Authorized Representative Signature .eY_'v GlJc/aei
Date 8.8.23
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by , (name of person sending permit)
I �1
Signature Date/Time �1 '3
Method: Fax I Email . US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoaPlease hake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerServke
LSwi ISiY- @ p(ofc1M.. bLlJk' ç. aim
chpennii 07/27/2023 07:I 1 ri