HomeMy WebLinkAboutIMPV-09-2023-204380.TIF CATAWBA COUNTY Case# IMPV-09-2023-204380
Public Health Department Subdivision OAK VALLEY
.� i Environmental Health Division PIN# 365806494024
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 13
a.
Site Address: 2400 OAK VALLEY LN,MAIDEN NC 28650
Name on Permit: FRANKLIN AND ELLIE GROSS
Property Size: Acres 0.58
Directions: NC 16, right onto Providence Mill Rd, right onto Bud Arndt Rd, righto onto Oak Valley Ln, property on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
1 As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-08-2022-42075,by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
I Electronic Image Transmittal/E-mail (Return receipt required)
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 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: 09/11/2023
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature i
CI Date/Time W)131)-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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ehpermit 09/14/2023 05:27