HomeMy WebLinkAboutALDERWOOD Block 3 Lot 3CucuA w ova
G/6
3 3
APPLIC' iT FILLS OUT UPPER HAL''ONLY
Property Owner q ~_)I,~ ~/4'? /.ct ~ ~one
Type of Resi~nce
~ Single Family
~ Multiple Family No. of Bedr~
~ Other
Water Supply
~ Individual A~ACH ~LL LOG. A w~l Icg is required for all wells drilled since June 1975.
~ Community For wells ~illed prior to that date, give well depth (attach Icg if available).
~ Public Utility
Sewer Disposal
~ Individual Year Indiv~ual Installed: ,/
When Connected to Public Utility: /~-,~-
Public
~ility
~ Holding Tank
NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED,
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
(--2_}_APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE "~-- f~- ~;) ~
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3/82l