HomeMy WebLinkAboutALDERWOOD ADDITION #1 BLK 3 LT 6
APPLIC NT FILLS OUT UPPER HA[ ONLY
Phone
Property Owner "'%] E:/'/~ ~ ~: ,'~' ~r
Mailing Address ~i/',,/~/~. ? ~ ~,,' /,, ..- ,z' ~/___~j,' . '~/~' ~ ~ / ZiP Code
Lending Institution Phone
Address Zip Code
Realty Co.& A.nt ~ ~(~ ~tt~ ~ ~ ~:
~hon~
Address , ~ ~ ~/ Zip Code
L~al Descript~n Z~~ / ~ ~~ ~ ~/~ ~, ~ ~>~ ~
Type of Resi~nce
~ Single Family
~ Multiple Family No. of Bedroo~
~ Olher
Water Supply
~ Indivi~al A~ACH ~LL LOG. A wal log is re~ired for all wells drilled since June 1975.
~ ~mm~ity For wells drilled prior to that date, give well d~pth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individ~l Year Indiv~ual Inslalled: ,
~ Public allity When Connoted to Public Utility:
~ Holding Tank
NOTE: THE I~SPECTION EE aUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector ~'~
Field Notes: NgJNICIPALITY OF ANCHOK/~G~-
DF~T C" '. .... -r, ,~.
RECEIVED
( __~ ~ APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
BY: . .
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
~Well to Tank Septic Tank Size
72-023 (3/82)