HomeMy WebLinkAboutALPINE VILLAGE BLK 4 LT 15
APPLIC FILLSOUT UPPER HAl ONLY
Prooerty Owner t ~ \ '\ ~ ~ Phone
Mailing Address I /-~
Lending Institution
- - ~ ' ~ - '~' ' Phone
Realty
Co.
&
Address~' ~( ~' d~.~. ~ ~ v~ Zip Code ~ ~'~ '-2, -~,
Legal Descrlpt~n L
Type of Resi~nce
Single Family
Multiple Family No. of Bedroo~
~ Other
W~ Supply
~lndividual A~ACH ~LL LOG. A wal log is required for all wells drilled since June 1975.
/~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual Year Indiv~ual Installed:
~ Public ~iltty When Connected to Public Utility:
Holding Tank ~ ~ ~ -
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time ,
Date Date[ (~) i~._ ~ ~..~ Date Da~::,_
Inspector Inspector Inspector Inspector
DFPT C,~
"T N"T'~-~_. ] o - / 3 - .oC'' 7,,.,_ ENVIR .,i ,l/',",,
i, U3 2 O i982
RECEIVED
( ~OVED BEDROOMS,~ *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROV/I¢,.*~
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Rece{ved
Well to Tank Septic Tank Size
72-023 (3/82)