HomeMy WebLinkAboutIMPV-11-2023-208311.TIF .p.4 • CATAWBA COUNTY Case IMPV-11-2023-208311
F. .. , , Public Health Department Subdivision
.� Environmental
25 HealthGovernment DivisionDrive, PIN 377218415292
Newton,NC 28b58 LOT#
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Site Address: 2824 JT POSSE DR, CLAREMONT NC 28610
Name on Permit: SONJA MASON
Property Size: Acres 0.44
Directions: Old Catawba Rd, left JT Posse Dr on corner of Sherbrook Ln
Owner/Authorized Representative Acknowledgement of Permit Receipt
Ai certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
he property described above.
As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service EHPR-03-2022-40563, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
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: 11/13/2023
Owner/Authorized Representative Signature hi '6 - 0y\.l
�ate 12' 13 " 23
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
We wantt tto hear from yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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ehpennit II/17/2023 07:55