SDTF-69-04_PERMIT_RENEWAL_LANDOWNER_AUTHORIZATION

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Landowner's Authorization to Operate a Septage Detention or
Treatment Facility
North Carolina Department of Environmental Quality
Division of Waste Management - Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699-1646
Hanna Marrett: (name of site owner) hereby certify that I am the owner of
133 acres of land located 135 John Pollock Rd. Grantsboro, NC 28529
and
identified by 6428436364 (book and page of recorded deed or tax map parcel) and
that I agree to allow Dixon Landing RV Resort, LLC (SDTF permit applicant) to use
10 years i� ezc ao��ooz1e,F IDT
said land for a septage detention or treatment facility for a period of
of time), beginning 14 Sep. 2024
(give date) and that I have read the North Carolina
Septage Management Rules *. I further understand that no septage may be stored or treated on the land
until the Division of Waste Management has issued a permit for a detention or treatment facility. The above
described property is owned solely by me or jointly with none
(nampc of Al rn-nwnprc or Gtatp nnnP)
Signature of landowner Date
Signature of landowner Date
Sworn to and subscribed before me this -2lv et- day of , 20.
(NoWy Public)
My Commission expires: 3 1 -7 1 20 2�(
* 15A N.C. Admin. Code 13B Section .0800
(OFFICIAL SEAL) G 11c �14 1!&,,,
s NOTARY
PUBLIC
Rev. 01-07-16