HomeMy WebLinkAboutBURLWOOD TERRACE Block 2 Lot 11
, APPLIC ~IT FILLS OUT UPPER HAL ONLY
Buyer
Address Zip Code
Lending Institution ~-:'~ /-~. , . ~ Phone
Street Locati~
Type of Resi~nce
~ingle Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
~ndividual A~ACH ~LL LOG. A w~l I~ is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Utility
Sewer Disposal
~ Individual Year IndivMual Installed:
~/Public ~ility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
L~&./~,F.~Y''''''¢"~''~ ENVIR D, ,I,', :t,.A. .k) Z',..TICN
f'0V 1 9 1982
RECEIVED
( ) APPROVED BEDROOMS 'COND,T,O.S OF APP.OVAL
( ~SAPPROVEO ~ ~ ~
( ) CONDITIONAL APPROVAL*DATE ~3 ~ ~.~ ~~[~1~~~
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3182)