HomeMy WebLinkAboutAUTH-4-11-17373.TIF Apr 27 11 02:23p DV Wise, Inc. 704 248-8299 p.1
CATA W BA COU NTY' Case �l
Public liphh Dcpartmrnl Subdivision LAKEPOINTE NORTH
� Grrvi�nmcntal Fleatth Division
PO Box 3R9, 104-A Southwest Blyd, Newton, NC 28G58 Lat �i z �
�' , P�n'� 462801381529
Applicanvowner DV WISE INC TOIvI V�ISE
Site Address: 2485 PEt�'�VGATE DR, Shemlls Fo�d, NC
PropertySize: SF 0.819 ACRES
Direciions: 150 � LEI-I' ONTO SHERRI�L3 FOkD 1tll, ftlGHT ONTO tSLAND PQTV7' RD, L£FT ONTO PGNNGAT� DR, LOT 21
ON I,EFT ]US7� �EFORE CUL D£ SAC
Owner/Authorized Representative Acknowledgement of Permit I��ce�pt
_ 1 ceRify that 1 am the owner or authoriaed 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 permit(s) as
requested in the application for service EHPR-3-11-14170 , by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signalure requ�red)
ec onic Image Transmittal/ E-mail (Return receipt reqaired)
As the propecty owner or auchocized representative I have reviewed and understand the specific
conditions of the permit issued, and further understand tl�at a]( applicable regulatory requirements
specified under the �1orth Carolina Laws and Rules for Sesvage Treatment and Disposal Systems (15A
NC�iC 18A .1900), and/or Well Const�uction Standards (LSA NCAC 2C .0100), shall apply to the
issuance of ihis pernli� and the consiruction of ttie waste�vater system and/or water supply well permitted.
Pernut Tssue Date: 04/27l2011
Owner/Anthorized Repr�sentative Sigaature ` ��� �
Date
Documentation of'Permit{s)'I'ransmittal
(perroit transmitted by electtonic or otber means)
Pennit transmitted by l�ii- � L (name ofperson sending permit)
Signature Date/Time :�? 1�,j �
Method: Fax J Email US 1�Iai1 Oiher
Owner request io send by the above iredicsted mcthod of trans;nittal in lieu of signature
acknowledges the cvnclifions and statements above.
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