HomeMy WebLinkAboutIMPV-08-2023-202989.TIF •
Arty, CATAWBA COUNTY Cuse H IMPV-08.2023-202989
4 ilk Public Health Department Subdivision
IPit
t ��
"it ,�14 Environmental Health Division PINY 365902995996
%N./ PO Box 389.25 Government[hive,Newton.NC 26658 LOTH
1:9
Site Address: 3009 YOUNT RD,CLAREMONT NC 28610
Name on Permit CHRISTOPHER TALBERT
Property Stze: Acres 6.33
Directions: NC 16,left onto Claremont Rd,keep straight to gel onto Bethany Ch Rd,right onto yount Rd
w r/A th rized O ne u o Representative Acknowledgement of Permit Receipt
C V 11 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
1 Ni afAs the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service EHPR-08-2023-45145,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
LElectronic Image Transmittal/E-mail (Return receipt required)
114IAs the property owner or authorized representative 1 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:0/3/212023 �/
Owner/Authorized Representative Signature hc
L Date 9 - c 0f3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by_ _ (nacre of person sending permit)
Signature_ OleDate/Time t /3J/23
Method: _Fax J 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 yosplease Cake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EfiCusttomerService
JlvY1c, QIblii-120hO Mu 60 b��s1�
5�
ehprnon OVI I R023 1146