HomeMy WebLinkAboutAUTH-6-11-18792.TIF � CATAWBA COUNTY Case # AUTH-6-I 1-18792
�- ? Public Health Department
d �
.� Environmental Health Division Subdivision
�� `<' PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot # 1
1 2 '° PIN#
369804921373
Applicant/Owner $�E BEANE
Site Address: 3094 MATTIE WADE RD, Sherrills Ford, NC
Property Size: SF 0.779 ACRES
Directions: HOPEWELL CHURCI-1 RD 1'O MATTIE WADE, PROPGRTY ON LGFT PAST POWERLINE
The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the
applicanbproperty owner to insure that all Catawba County Planning/Zoning and [3uilding Inspections requirements are met This
Authorization to Construct Permit is subject to revocation if the site plan, plat or the intended use changes, or if site conditions are
altered. The Authorization to Construct Permit is not affected by a change in ownership of the property. This permit was issued in
compliance with the provisions of the North Carolina 'L�rws nnrl Rtrles for Sewnge Trenlment and Dis crd , cf�mc' (15A NCAC 18A
.1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to
function satisfactorily for any given period of time.
Jason Boyd 06/10/2011
AUTHORIZED STATE AGEN7' APPROVAL DATE
Permit Expiration Date: 06/08/2016
No gradzng or construction activity is al[owec� in a��eas designated for systenz ancl reparr without approval of the Health Department.
06/10/I l 08:33
From: John Beane Fax: +1 (88B) 316-3879 To: Tina Propst Fax: +1 (B28) 465-8276 Page 1 of 1 6/10/2011 1027
�CATAV4�A CDUNTY �g {�
�:Pu6licHarlthDcparttnent ---. �--------- - -..._.._._ .
Q'- Envirwim�nlN HcalthDivision Subdiv�Sion
PO Box 389, I00-A Souch►rtst Bivd, Newtv7� NC 2$65$ Lof !� t
a. PIN# 369Bi?�921373
Ap�3lcantlOwRer �� BEAI�IE
5ite Addreas: 309� MAT[�E WADE RD, ShcrriIls For3, NC
Property Size: SF �Q ACRES
Direc�Cians: HOPEWE[.I. CI�JRCH RD TO MA"T"tTE WAD�, pROPL�RTY ON LE�I' PAST?OWERLQ•iF,
Uwner/Aut�orized Representative Acknowledgement of Permit Receipt
� I certify that I am the owaer or auttzorized agent (ov►�er's authori7ation require�} representing the owner ofthe
property described above,
�As the progerty ownet or authprized represenfative, I have received t�te abo�e refe�enced �ermit(s) as
�equested in the application for service EHPR 6•11-11090 , b� the fol2owing met3lod(s):
Received in Person
Facsimite Transmittal {Retum form with signatute required)
� Electtonic Image Tmnsmi#tal/ E-mail (Retuan receipt required)
� As the property owner or authorizetl representative I have reviewed tutd understand the specific
co�dttions of the permit issued, and fur+,her understand that all applicable regulatory requ�rements
specified undex thc Nortb Carolina Laws and �ales for Sewage Treutmen# and Disposal Sysfems (15A
NCAC 18A .19�0), andlor Well Cons#ructian Standards f 15A. NCAC 2C AI00), shall apply to the
issuance of this permit and the construetion of the wastew�ter system and/or water supply wel] permitted. �
�ernut �ssue Date; 06I10/2011
OwncrlAuthorized Representative Ssgnature �'
Date � r ( 6 � � `
Do�u�enta�ioa of P�rmit(s) Tr�nsmittal
(permit trxnsmitted by electronic or other meaas}
�e�snit transxnitted by ' (name o_ f'person sending permi!)
Signature ! Date�I'ime . �Q � yy�
Method: Faac Email US IV�ail Other
Owner's reqaest to send by the above iadicated met3�od of transxnittal in [ieu of signature
ack�owlcdges thc cunditioas und statemea#s $bove. �
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