HomeMy WebLinkAboutIMPV-08-2023-201640.TIF c CATAWB:A COI'Nils ...
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Awl ironnuntal health I)Ivoi"n 1'INIt 461601364771
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Site Address: 8438 NOLLEY LN,SHERRILLS FORD NC 28673
Name on Permit: 'GRAINDA BUILDERS INC
Property Size: Acres 1.16
Directions: 1-77 W onto Hwy 150.Left on Slanting Bridge,Left on Drena Drive. Right on Giles Ave.Turns into Moore St
then Nolley
Owner/Authorized Representative Acknowledgement of Permit Receipt
....... I certiI\ that I am the owner or anthorired agent towncr's atlthuriratinn required)representing the owner of
the properly described shove.
. As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2023-43903.by the following mcthud(s):
Received in Person
Facsimile Transmittal(Return lbrn)with signature required)
IIileciionic Image Transmittal!li-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(I SA NCAC 2C.0100), shall apply to the issuance of this permit and
the construction of the wastewater system and/or water supply well permitted.
it
- Permit Issue Date:08Q/2023 ,, '
•
Owner/Aut)orized Representative Signature ) 6 rearlda., @wildwr,
— Date ._. (� .I 5! Z.
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (Milne o/person SOltd(i))C pt'rmir)
Signature 4c Date/'Time %hi/V
Method: Fax .1 Email US Mail Other
1
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yotPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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