HomeMy WebLinkAboutIMPV-08-2023-203044.TIF n CATAWBA COUNTY
Public Health Department Subdivision
.� Environmental HealthGovernment DivisionDrive, PIN# 3770031108471 Newton,NC 28658 LOTn #
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Site Address: 4093 TROUT POND RD, CLAREMONT NC 28610
Name on Permit: *CLAYTON HOMES#81 (BILLING ACCT)
Property Size: Acres 1.67
Directions: Turn right onto SW BLVD,Turn Left onto W C St,Turn L on NC-10 HWY E,Turn Right onto Balls Creek Rd,
Turn Right onto Trout Pond Blvd
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.
X As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-06-2023-44726,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
V 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: 08/22/2023
Owner/Authorized Representative Signature
2 Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Ofq/ Date/Time U 3j 1 )3
Method: Fax 1 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 yooPlease ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.corn/s/EHCusttomggrService
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ehpermit 08/222023 15:24