HomeMy WebLinkAboutWELL-08-2023-203354.TIF dotloop signature verification:a.ipu ,dl
`, , CATAWBA COUNTY
+;7 -' Public Health Department Subdivision
i Environmental Health Division
�i''aR PINS 373520901895
aY PO Box 389,25 Government Drive,Newton,NC 28658 LOTS
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Site Address: 5846 WESLEY ST, HICKORY NC 28601
Name on Permit: JOHN GAUGER
Property Size: Acres 8.17
Directions: Head E/SE on Wandering LN from Sulphur Springs, Left on Wesley St and continue onto private rd heading
east on Ray Circle
Owner/Authorized Representative Acknov- - ient of Permit Receipt
isw John Gauger, applicant Mack Cook/Cook Heirs 10(
. hen X. _I certify that I am the owner or authorized agent(owner's authorizatio $ id)representing the owner of
fo the property described above.
pty John Gauger, applicant Mack Cook/Cook Heirs
r
As the property owner or authorized representative,I have received,:"`,;''nke referenced
permit(s)as requested in the application for service RBPR-08-2023-45081,by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
.J Electronic Image Transmittal/E-mail (Return receipt required'
yy ohn Gauger, applicant Mack Cook/Cook Heirs
b'. As the property owner or authorized representative I have reviewed anfE'.;t'l.'.Land the specific conditions
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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:08/24/2023
Owner/Authorized Representative Signature j1.4 4'"�9'.'"` °P.4.,t0• ohn Gauger,applicant(BUYER)
W�VDN,-,.„,DxP
,%� Date QK��«09/14/2023 dotloopverified Mack Cook/Cook Heirs(SELLER)
09/14/23 9:42 AM EDT
EXII.HP05.GVE8-DGCS
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time 4/I/11In'3
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpcmnl 08/28/2023 1141