HomeMy WebLinkAboutWELL-09-2023-204250.TIF w
A `y. CATAwBA COt:NTY Case N 11'Et.I.-09.2023-204250
ill-l!r Public Ilealth Department Subdivision HOLLAR HOSIERY MILLS INC
t �s Environmental Ilealth Division I'IN# 371515525877
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'1\/>, PO Box 3tt9,25 Governmcnl Drive,Newton.NC 28(,58 U71 N 14
taltSite Address: 4634 1ST ST NW,HICKORY NC 28601
Name on Permit: BRYAN AND KATHY RUPPLE
Property Size: Acres 0.7
Directions: Springs Rd NE, right onto Kool Park Rd NE, road name changes to Cloninger Mill Rd NE.road name chagnes
to 1st St NW,property on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
K �f ' I certify that I am the owner or authorized agent Omnees authorization required)representing the owner of
__
the property described above.
'am As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application for service EH PR-06-2023-44595.by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
4/Electronic Image Transmittal/E-mail (Return receipt required)
X `7 -s . 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(I5A NCAC 18A.I900),
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:09/07/2023
Owner/Authorized Representative Signature
Date 9- 2?.2°Z3
AiStfl\ a blir‘40/1/ .11.04,11
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person see ding permit)
Signature Date/lime )bl)3
_ _� __
Method: Fax J 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 yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://ww.v.surveymonkey.com/s/ENCusttomerService
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