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Home My WebLink AboutIMPV-5-11-17849.TIF , , `�(�--�--�-� �. �, i�(,: �:��:-��-�'�_��`,c��f 23�5 v� �` �j`�h�� il;�C� �.r�� ' � ` �a � �, f -��;;�� vc ,�r;.�. ir�s Sc - �a fr�rn cre�� ,�,' j �, S s � ► �., ��,��, �;� �ab- , -�i-o�, �►� � ��.�r ` , 1C�-�a. . } � � 1 , �. � t r^ s-}r u c-}�x� S, � f � (� �, � C o�II�I p S Gr^� fe�q�r �,�rr�, t iti�� On+YXJ� C' rl�� Y1'''t.•_ �' �.� �� ` 1�� 1 � � � `� > �1) �1e If '� �W' " 4 �� Y80Nti^ S� �`'� G � � b�; 3 bQ�`y�-� �� o � � J �k n U�� ,'1 , ( � _ � /bO�F.� -}-� L-}4' {�'., �. Ay` �'J()O"� . ��5[, �' 4 "� '`�i� �� `�� 1�5D � ,.. � �ir� � / � �� :;� ��t� ►Y�� ` �� _�c,.�. -�ror� a^y � ,i� � 5 io� ii , � - � -�� r6 � �' � � s S�-"^ 1 ��1 �,� - �° _ �oo�. -�Yo y �, � � W�� +��cr, '.}�� , � p�Yc�a� � �� 1 �t\ �. � �o --�i� �' Ke� v�l �i �� kz �� -� �'' J I a �� t� � V��,\� ( �,i�lc� �d�S Y�17� d�i11Y�. c� '.✓��'T ` � v�K'.l � v � . /, ��'�-� � � w ��z !'Ai i �`t�vt 5��v` -� _ m . tl �� (.�o � v � `' �-- We�l �C�. �� .� vJ��• � " 63 -`-._�. �--�� w s ��:1� � ��1�;�1 �; ��`�-� �-�► �,,,�,�,« � �� -�o�.s�. � / .z.. � ,�,�� t ; �� ` , 1°p k� � � -�j��e✓ db� Y��- � E � �>� � . � � C, ��' r�n� I�►�� ,� `�'�,� V�l�: ,-�l� BQY.. '': � �� 1' ` ,�c- ,�r c�l. �1� c•ts ,� jq � ��, X BC� ,' �:. �ep}�c, „f rZO�ir�. l�p,_ , � 4 "' � � �u"k � lofd ��.ir�.- `�kis �� / (��L �So (c �.5 � 5�+�5 a °"�-----� � 30� , 0.� �. � ,r � �t�� -- - -- - -, - `E �i(.- c 'r'�1!� �re� i ht7�Z br w�T t�S S�I�, a��• �� xy,_� � _ / `�iJ �� ,�i Sea �'�'J I . � �- � T 1''-1oc' ,y�S,� CATA��'6.4 COUN'1'Y Cx,c � Public i lealth llepanment /� �'>. suhd�vision j '� • � [nviroumrntal Hcalth Di��isiun f."I � 'N�� NC) Boz 3g9. IGO•A Soulht�est Blvd, Nc�clim, NC. 28ti�b \�4i PIN� ;7ti1I28G28Gi ApplicanUOwner KF,1��iP SIG�10N Site AddreSS: 23R5 OLU IS1.A�D FORU RD. Claremont, \C Property Size: SP 89.62 ACRES DireCtions: OLb CA �nWBA KD i JB Kf:� ; C)LU ISLaND FORU RD Q�vner/Authorized Representative Acknowtedgement of Permit �teceint � I certify that t am the owner or authorizcd a�ent (owner's authorization required) represcntine the ow�ner of the property described above. � 11s the propert�� owner or authorized representative, I have received the above referenced permit(s) as requested in the aJ�Plication for service F,HYR-4-11-10694 , hy thc i�llowing method(5): Received in Person Facsimile 1�ransmittal (Return fonn with sianature requiredl _ Electronic Image Transmitlal! E-mail (Return receipt required) As the property owner or authorized representative I havc re��ie��ed and understand the specific conditions of the pennit issued, and turther understand that all apE�licable regulatory requirements specitied under the North Carolina Laws and Rules for Sew�a�e Treatment and Disposal 5ystcros (15A NCAC 18A .1900), and/or Welt Construction Standards (15A NCAC 2C A100), shall apply to the issuance of this permit and the construction of the ��-aste��ater system and/or water supply ti�ell permitted. Pern�it Issue Date: pj! � p/�p � � . -- Owner/Authorized Representative Signature _ Date � ----------------------------------------------------------------------------------------------------------- Uocumcntation of Ycrmit(s)'1'ransmittal (permit transmitted by electronie or othcr means) Perniit transmitted b�• tnain� o ��per.son se:n�lir�g perrriil� Signature _ DateiTime Mcthod: Fax Email US i�lail Uther O«�ner's request ko send by the abo��e indicated method of transmittal in lieu of signature ackno��ledges the conditions and statcments abuve. os�ivii os:is