HomeMy WebLinkAboutAUTH-08-2023-201835.TIF •
CATAWBA COUNTY - _
Public Health Department Subdivision
+,., I Environmental Health Division PINt 279110467724
`� PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2
Site Address: 2322 MOSS FARM RD, HICKORY NC 28602
Name on Permit: RONALD CHAPMAN
Property Size: Acres 11.28
Directions: Right 127, North on moss Farm RD,Access to the property is by a paved 25" deeded ROW off of Moss Farm
RD,going to an adjoining with 2314 Moss Farm RD
Owner/Authorized Representative Acknowledgement of Permit Receipt
XI certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
XAs the property owner or authorized representative, 1 have received the above referenced
permit(s)as requested in the application for service RBPR-06-2023-44756,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
7- Electronic Image Transmittal/ E-mail (Return receipt required)
�f As the property owner or authorized representative I have reviewed and understand the specific conditions
r�l 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: 08/04/2023
Owner/Authorized Representative Signature
'' j Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by [' (name ofperson sending permit)
Signature L Date/Time. S'i14✓3
Method: Fax ,/ 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 youPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
drew. ChaprhaA Dogma, Con
ehpennit 08/042023 13:41
Catawba County Environmental Health
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Parcel: 279110467724, 2322 MOSS FAF 1 RD 1 in=80ft
HICKORY, 28602
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