HomeMy WebLinkAboutSUNNY SLOPES LT 60
ENVIRO~M£NTA/ ENGINEERI[',IG DIVISION JU~ 1.. 6 1979
Tdephone 284-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
)IRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
PROPERTY RESTDENT (If different fro~bove)
2. BUYER
MAILING ADDRESS
PHONE
PHONE
PHONE
3. LENDING INSTITUTION
MAILING ADDRES,~ ' ' -
4. REALTOR/AGrENT
MAILING ADDRESS
IP~ONE
5. LEGAL DESCRIPTION
STR EE~- LOCATION
B. TYPE OI~ R1ZSIDENCE ,,NtJMBER OF BEDROOMS
[] One [] Four [] Other
[] SINGLE FAMILY
[] Two [] Five
J~ MULTIPLE FAMILY [] Three ~ Six
7. WATER SUPPLY
[] iNDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
~ COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
,[~ PUBLIC UTILITY
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
)IRECTIONS:
1, TYPE OF RESIDENCE NUMBER OF BEDROOfvlS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified_ LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE /) ~,. DATE INSTALLED
E3PUBLIC UTILITY
Connection Verified ~' J~7~''/ili INSTALLER
E3Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
~-~ APPROVED FOR '~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate/~
[] DISAPPROVED
LEGAL DESCRIPTION
72-010 (Rev. 3/78)