HomeMy WebLinkAboutIMPV-08-2023-203172.TIF •
CATAWBA COUNTY
.f.a Public Health Department Subdivision LONG BAY
,� Environmental Health Division PIN# 470002796977
46
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
:4
Site Address: 1684 PARKSIDE DR, CATAWBA NC 28609
Name on Permit: STANLEY JOSEY
Property Size: Acres 0.82
Directions: End of Long Island Rd , Left Kale RD, fe w hundred yards Left Long Bay, Left Longbay
Owner/Authorized Representative Acknowledgement of Permit Receipt
16 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-02-2023-43542,by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
J Electronic Image Transmittal/E-mail (Return receipt required)
NI' As the property owner or authorized representative I have reviewed and understand the specific conditions
of the permit issued, and further understand tfiat 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:08/23/2023
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by 4/E
(name of person sending permit)
Signature
Date/Time
Method: Fax 4 Email US Mail $f 3 ) Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yotPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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Parcel:470002796977, 1684 PARKSIDE DR 1 in=50ft
CATAWBA, 28609
This mapheport product was prepared from the Catawba Cou ,NC Geospafel biformation Services. Ca awb•County has made eubetandai efforts
to ensue the accuracy of location and Meting 1Euim Yon linied on die romp«Am on this report Catawba County promotes and recommends
the Independent vea l:Edon d any data=tined an this damages,
product by the user.The County of Catawba.its empbyees, end
end shsI not be held Rabb any and a and a mages,loss or lability,whether direct,indirect or consequential which wises or may
arias from Ns report product or ihe we thereof by any person or @nay.
Copyright 2023 Catawba County NC
08123/2023