HomeMy WebLinkAboutKINGSBERRY BLK 1 LT 13
APPLIC UT FILLS OUT UPPER
Buyer .~ ~ ~ j-/~
Address Zip Code
Lending Institution ~ ~ ~. Phone
Address Zip Code
Realty Co. & Agent /~/~J~J ~r~-~[~ Phone
Address ~ ~. ~d~/~ ~Z~' ZipCode
Lega~ Description ~, J~ ~, ~ ~ ~-~
Type of Resi~nce
~ Single Family
~ Multiple Family No. of Bedrooms
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~Community For wells drilled prior to that date, give well depth (attsch log if available).
~ Public Utility
Sewer Disposal .... ยท
~ Individual Year Individual Installed:
~ Public Utility 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 Date Date
Inspector Inspector Inspector Inspector
ENVIRONMENTAL PROTECTION
RECEIVED
( ~ APPROVED BEDROOM8 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
CONDITIONAL APPROVAL*
DATE
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3182)
