HomeMy WebLinkAboutAUTH-08-2023-202528.TIF 41, a CATAWBA COLN'!Y
Ili Public Health Department Subdivision CRESCENT LAND AND TIM.c �i'di BE
Environmental Health Division PINl1 460701254843
l\` L1/ I'0 Box 389,25 Government Drive,Newton,NC 28658 1.0TN 44
Site Address: 7285 PEBBLE LN, SHERRILLS FORD NC 28673
Name on Permit: KENT& KAREN MCBETH
Property Size: Acres 0.71
Directions: Mt Pleasant Rd, Right on Dockside LN, Left on Burton St, Left on Pebble Ln, Property at end
Owner/Authorized Representative Acknowledgement of Permit Receipt
/<)` I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-02-2023-43498,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
ti 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: 08/14/2023 (('��,,��,,f�/�� G
Owner/Authoriz d Representative Signature .Ant Jvlc Betfi
Date "I 1 /23
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ _ (name of person
sendding permit)
Signature_ ______V_ Date/Time O I3o/ 3
Method: Fax 4 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
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ehpennn 08!15i2023 07:49
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