HomeMy WebLinkAboutAUTH-09-2023-204104.TIF { r
Aiitt r CATAWUA COUNTY .
,�', 1-Ilk Public I leelth Department Subdivision
clit`1t t3 tatvironmcntal Health Division PI Nil 369601390742
*\\\r.o', PO[lox 389,25 Govemmenl Drive,Newton,NC 28658 LOP/
Site Address: 2394 JOE JOHNSON RD, CATAWBA NC 28609
Name on Permit: 'MOSS-MARLOW BUILDING CO INC
Property sire: Acres 69.5
Directions: Sherrills Ford Rd to Joe Johnson Rd turn Right 1.5 miles property on left.Gravel driveway.
Owner/Authorized Representative Acknowledgement of Permit Receipt
61i 1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
i( 51,1 As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service R13PR-05-2023-44486, by the following method(s):
_ Received in Person
Facsimile Transmittal(Return form with signature required)
7 Electronic Image Transmittal!E-mail (Return receipt required)
)( s6it 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 1 SA.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: 09/06/2023
Owner/Authorized Representative Signature__ 1, D 1-eve di Ate)
Date_ 4. , —
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ (name of person sendingl permit)
__________(4
Signature _i Date/Time (ItT 1/—)3
Method: Fax i Email US Mall Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoi.Please ttake a few momentts tto complette our custtomer service survey att
http://www,surveymonkey.com/s/ERCusttomerService
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Catawba County Environmental Health
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Parcel: 369801390742, 2394 JOE JOHNSON RD 1in=6Utt
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7Hs map/report product was prepared from the Catawba County,NC Geoapatlal kdormatlon Servloes. Catawba has made substantial efforts
m to emus the accuracy of location and labeling n� fomratlon contained on thismap or data on this report Catawba�ri omokes and osoo a nerds
the independent vrtrtiftalion of any data contained an this map/report product by the user.The CO utti of Catiiwba.its employees,agents,end
personnel. end star not be held liable for any and al damages,loss or liability,whether direct,indirect or consequereisi which arises or may
arise town Iliama sport product or the use thereof by any
p person
rIght or entity.Cabo/be County NC
WO r -OS-a033-LIL i tip, 09/06/2O23