HomeMy WebLinkAboutIMPV-08-2023-201770.TIF CATAWBA Col Nil'
!L -i Public Ilcalth Department Subdivision CRESTVIEW DEV
s.,��s' hnvironmental Ilcalth Division PIN), 365914249309
��,,,„," PO I3ns 389,25 Government Drive.Newton.NC' _'Kh58 LUTe 17-20
Site Address: 2283 HILLSIDE DR, NEWTON NC 28658
Name on Permit: CESAR GUERRERO
Property Size: Acres 0.45
Directions: NC 16, right onto Crestview Dr,left onto Hillside Dr, property on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
�I certify that I am the owner or authorised agent km autht�ri/<ntion required}representing the owner of
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the property described:Mine.
)(at'As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application fur service EHPR-05-2023-44470,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
f_ Electronic Image"Transmittal/ E-mail (Return receipt required)
LmitAs the property owner or authorized representative I have reviewed and understand the specific conditions
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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(I5A NCAC I8A.1900),
4 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:08/03/2023
Owner/Authorized Representative Signature`yr
,� nate3/Jl/23
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
-
Signature Qeei Date/Time u b!b3
Method: Fax v 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 yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomer5ervice
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