HomeMy WebLinkAboutWELL-3-10-5087.TIF
~A C CATAWBA COUNTY Case # EHPR-2-10-4008
Public Health Department Subdivision
Z Environmental Health Division Section/131/Ph/Lot#
PO Box 389, 100A Southwest Blvd, Newton NC 28658 PIN# 266702682979
(828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200
1842 spa
Applicant/Owner Kathie Rhone
Site Address: 8352 JC Rd
Property Size: 1.309
Directions:
Improvement Permit ❑ Authorization to Construct ❑ Well Permit
SITE PLAN
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System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not
install system under wet conditions. This permit is subject to revocation if the site plan or site conditions are altered.
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AUTHORIZED STATE AGENT DATE
CATAWBA COUNTY Case a
Subdivision
Public Health Department SS Lot
vision
Environmental Health Divisiun PIN#
PO Box 389, 100A Southwest Blvd, Newton NC 28658
w (828) 463.9270 Fox (828) 465.8276 TDD (828) 465.8209
AUllicant/Owncr i
Site Address-
ProperTy Size:
Directions:
Owner/Authorized Representative Acknowledgement of Permit Receipt
a/I certit~ that I am the owner or authorized agent (owner's authorization required) representing the owner of
the properly described above.
As the property owner or authorized representative, I have received the above referenced permit(s)
as requested in the application for service, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
t~ 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 3J3 JID
Received Date
Catawba County Public Health
Environmental Health Section
I/ Jd..'
Owner/Authorized Representative Signature
Date
Documentation of Permit(s) Transmittal
(pcr 't trnnsmittcd by electronic or other means)
Permit tr ittedy (name ofpersun~3~d►ng permit)
Signature Date/Time 3o
Method: Fax V Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
acknowledges the conditions and statements above.
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