HomeMy WebLinkAboutIMPV-07-2023-200878.TIF l 1 Art. CATAWBA COUNTY
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1. Entaamenul health Divmon
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Sas Adams: 8120 COOKSVILLE RD,VALE NC 28158
Kama on Permit RYAN RHONEY
Properly Sty: Acres 12 52
Dkacttons: NC 10,Right on Cookavdle Rd.property on right
Owner/Authorized Representative Acknowledgement of Permit Receipt
x 1k t certify that I am the owner or authorized agent(owner's authorisation required)representing the owner of
(� the property described above.
RI_ As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-06-2023-44674,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
—7 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(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:07/25/2023
Owner/Authorized Representative Signature t j,,(1?
_� Date It 'r./-`� , ,
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending perm//)
Signature C E Date/Time V 1 f 1 f)3
Method: Fax Ni Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wanat tto hear from ya.lease ttake a few momentts do complutte our custtomer service survey att
hnp://www.surveymonkey.com/s/ENCusttomerservke
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