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1 Public Health Department Subdivision THE SUMMIT AT LAKE NORM
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'ji,`^� Environmental Health Division 1IN# 471001153852
'l\�1, PO Box 389,25 Government!)rive,Newton,NC 28658 .yr8 50
PO Site Address: 373 HOPEWELL CHURCH RD,CATAWBA NC 28609
Name on Permit: *SUNSET HOMES LLC
Property Size: Acres 0.74
Directions: Sherrills Ford Rd Left on Long Island Rd Right on Monbo Rd Left onto Hopewell Ch Rd,passing 1st entrance
that leads to Summit Ridge Dr
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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.
As the property owner or authorized representative, I have received the above referenced
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permit(s)as requested in the application for service RBPR-07-2022-41708,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
IElectronic 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: 09/14/2023
Owner/Authorized Representative Signature 7:�1 �/1_
Date_09/28/2023
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature__ Ot . ,dE Date/'i'imeq/)8/).J —
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 yoLPlease ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/EHCusttomerService
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