HomeMy WebLinkAboutAUTH-08-2023-203644.TIF r
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Public Health Department Subdivision
'i�` ,,,,, , 14i Environmental Health Division PIN# 365905083785
'1\/1 PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
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Site Address: 2150 CLAREMONT RD, NEWTON NC 28658
Name on Permit: LYNETTE PATRICK
Property Size: Acres 27.68
Directions: Turn on to Claremont Rd off of HWY 16,go 3/4 mile land is on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
XPI 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-08-2023-45113, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required)
gPAs 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 1SA.1900),
and/or Well Construction Standards(15A NCAC 2C.0100), shall apply to the issuance of this pennit and
the construction of the wastewater system and/or water supply well permitted.
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Permit Issue Date: 08/29/2023
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Owner/Authorized Representative Signature _P
Date G- 4. -3,3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature --. ____ - Date/Time Sl/ 311 )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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"� CATAWBA COUNTY Case# AUTH-08-2023-203644
4
Public Health Department Subdivision
r �' PIN# 365905083785
��� it.: Environmental Health Division
��� PO Box 389,25 Government Drive,Newton_NC 28658 I OT#
Site Address: 2150 CLAREMONT RD, NEWTON NC 28658
Name on Permit: LYNETTE PATRICK
Property Size: Acres 27.68
Directions: Turn on to Claremont Rd off of HWY 16, go 3/4 mile land is on left
The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant
!property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Authorization to
Construct Permit is subject to revocation if the site plan.plat or the intended use changes,or if site conditions are altered. The Authorization to
Construct Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the
North Carolina'Laws and Rules for Sewage Treatment and Disposal Systems' (I 5A NCAC I 8A 1900). Neither Catawba County nor the
Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time.
Any permit issued for a conventional system may be used for an accepted system without Environmental Health authorization or permit
modification.Please ratify Environmental Health of this change prior to system installation.
13ryr.t fO"k•t 08/29/2023
Authorized State Agent Permit Issuance Date
08/9/2028
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
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