Authorization to Construct New WellHARNETT DEPARTMENT OF PUBLIC HEALTH PERMIT
1lA TO CONSTRUCT A DRINKING WATER SUPPLY WELL
PIN #: Parcel #: Applicat'bn #: _ Subdivision: Lot #:
Applicant Name: -K4e*)it)¢o w
Address:
Type of Facility Served by Well: SFD
Sewage System: -Z1!Jr% 11.0��,
Permit Conditions:
General Permit Conditions:
• Drinking water supply well construction must meet 15A NCAC 02C.100 rules
• The permitted drinking water supply well shall be located in accordance with the SITE PLAN
• ANY ALTERATION of the site of the site (including location of structures and appurtenance) or modification in use of the well, may
subject this Permit to revocation
Authorized State e5 6Jrk0LJ te i
i V5, 44136 rC*T>e -
Application #: Applicant Name: Subdivision: Lot #:
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Well Construction Sketch
Well Completion Sketch