HomeMy WebLinkAboutPARKER LT 86 ocK
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Property Owner ~-'~L-~:.~.,!...~- : ~_,.-->,/-, ,...C' .-~~. "-{~. L .....
Mailing Address --'v~.-,-¥~->.----:¢jgg-=~Tr'-:~-~.--~~--~''~- _> .............. ~.~..~ zip Code ~~- I
Address ,., Phone
Lending Institution t
~ddress , t~ / ;t_ '" ~' :';' '~' k~'~ ~ [ .... ' ' '~ "~ '-' Zip Code '
. .... Phone
Address ~:-~-."-~ ~-. )' ~'-" ~'~ ' ;-~ ~ '" ~'~ ZipCode~:-/'/
Legal Description ~ . ._ ~' '.~: ~_.( ~::;~ '_.:,
Street Locat[~ ' ~ :- ~ ~':b :' ' '
Type of Residence ' .
~ Single Family
~ Multiple Family No. of Bedroo~_ ~) "'-'~ : ''''' '-'L - · ".~
~ Other
Water Supply A~ACH WELL LOG. A well Icg is required for all wells drifted since June 1975.
~ Individual For wells drilled prior to that date, give weft depth (attach Icg if available).
~ Community -
~ Public Utility
Sewer Disposal Year Individual Installed: ' -
~ Individual When Connected to Public Utility:
-~ Public Utility
Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time
Time
Date Date Date Date ~'--
Inspector Inspector i . Inspector Inspector
O\
*CONDITIONS OF APPROVAL
( ) APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE
BY:
Soils Rating Date Sewer Installed Well To Absorption Area Weft Log Received
Well to Tank Septic Ta~k Size
72-023