HomeMy WebLinkAboutIMPV-08-2023-203051.TIF e .
437,11titi CATAWBA COUNTY
, •(.....j mil Public Health Department Subdivision ANNIE TRACE PH 2
'' s Environmental Health Division
'tI4.:; PINS 377108985423
. >) , PO Box 389,25 Government Drive,Newton,NC 28658 LOTS 12
f:ll►.
Site Address: 2807 1ST AVE NW,CATAWBA NC 28609
Nam on Permit •CLAYTON HOMES OF CONOVER#81(UNLICENSED GC-BILLING ACCT)
Property Size: Acres 0.37
Directions: Hwy 16 S Left Hwy 10 Hwy Econt. NC 10 Hwy E,Left onto 5th ST SW,Left Old Catawba RD,Right onto 5th
ST SW, Left 1st Ave NW
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.
if — As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-06-2023-44739,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
Date J'-3/-a-3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature O Date/Time 1,31133
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 yo&Please ttake a few momentts Ito complette our custtomer service survey att
http://www.surveymonkey.com/s/DiCusttomerServtce
rott.limiOvvtaeklitiodutialot
-3.- k .2)I 3
ehpermii 08/23/2023 09:30