HomeMy WebLinkAboutIMPV-09-2023-203981.TIF 401140., CATAWBA COUNTY
�.l-t-�,!j, Public Health Department Subdivision PINEY RIDGE
.R 3 Environmental Health Division PINSI 267802652023
7), PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 14
t'IY s•
Sit.Address: 2601 LYNN MOUNTAIN RD,VALE NC 28188
Name on P.rmlt; *JOHN STUBBS BUILDING CONTRACTOR LLC
Property Size: Acres 0 7
Directions: Hwy 127 S, Right Hwy 10, Right Gracie LN, Right Lynn Mtn Rd,approx 1.1 mi sign on property
Owner/Authorized Representative Acknowledgement of Permit Receipt
e .
.I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
/1-7- -eics the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-07-2023-44899,by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
e Electronic Image Transmittal/E-mail (Return receipt required)
As the property owner or authorized representative 1 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:09/05/2023
Owner/Authorized Representative Signature
Date—_.°1� ��_.3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature _ Date/Time
Method: Fax 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 youPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
ehrenn r 1/9r07a023 I t 54
Catawba County Environmental Health
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Parcel: 267802652023, 2601 LYNN MOUNTAIN 1 in=40ft
RD VALE, 28168
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to ensure the accuracy of location and labeling information contained on this map or data on this roport.Catawba County promotes and recommends
the Independent verification of any data contained en this map/report product by tho user.The County of Catawba,its employees,agents,and
personnel,disclaim,and shall not be held liable for any and all damages, loss or liability,whether direct,indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or ontily.
Copyright 2023 Catawba County NC
08/08/2023