HomeMy WebLinkAboutIMPV-10-2023-207483.TIF CATAWBA COUNTY ,
.f..11 Public Health Department• Subdivision SOUTH LAKES DEV PHASE 1
.�� Environmental Health Division PIN# 363918418942
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 4
Site Address: 2088 EVERGREEN DR, NEWTON NC 28658
Name on Permit: *ZUYITSA DIAZ
Property Size: Acres 0.57
Directions: 321 S, Right McKay RD, Left Evergreen D
Owner/Authorized Representative Acknowledgement of Permit Receipt
1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of X
the property described above.
rAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-09-2023-45543,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
xAs the property owner or authorized representative I have reviewed and understand the specific conditions
` of the permit issued, and further understand that all applicable .-tulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatmen :` •osal Systems(15A NCAC 18A.1900),
and/or Well Construction Standards(15A NCA .0101), shall :sply to the issuance of this permit and
the construction of the wastewater system and/or at,.r supp y ell per itted.
Permit Issue Date: 10/31/2023
Owner/Au hor zed Representative Signat all /1 A a.z I
Date t-l 2-3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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chpcnnil 10/31/2023 14:42