HomeMy WebLinkAboutEXSY-10-2023-205822.TIF 4i . CATAWBA COUNTY Case# EXSY-10-2023-205822
. .j-ia ,Z Public Health Department Subdivision
"w! •, "I Environmental Health Division PIN# 460602553363
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 3
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Site Address: 7875 BANKHEAD RD, DENVER NC 28037
Name on Permit: TIMOTHY&MARIA GREGORY
Property Size: Acres 0.69
Directions: NC 16, L onto Campround Rd, Lon Catawba Burns Rd changes to Burris Rd, Ron Bankhead Rd, Property on
Right
Owner/Authorized Representative Acknowledgement of Permit Receipt
XI 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-04-2023-43946,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: 10/02/2023
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)
� j r Signature4 ' Date/Time [ [�4)3
Method: Fax 1 Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpennin 10/03/2023 09:37