HomeMy WebLinkAboutWALTER G PIPPEL ADDITION BLK 6 LT 6A
'ApPLIk ~,NT FILLS OUT UPPER H.~.._,.? ONLY
'~roper,y L-.'A'~JI II. /l/),._.~,~O~.'~
Address Zip Code
Lending institution ~. ~ ~ ~ ~A ~J (~ ~ ~:~ ~'V) ~ ~:~C?~ Phone
Address ~-~'~ ~/~ ~ ~'C, ZipCode
Realty Co. & Agent Phone
Addreas Zip Code
Legal Description ~J. ~ , ~)1 '
Street Locati~ ~,J ~'1~ *~U~'~/ ~T~' ~' ' ~t"~ ~ ~ ~
Type of Residence
~ Single Family
Multiple Family
~ Other NO* of Bedroo~_
Water Supply
Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
Community For wells drilled prior lo that d~te, give well depth (attach Icg if available).
~- Public Utility
Sewer Disposal
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility: '7 /~_ ~
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATBD.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Insp6ctor
Field Notes:
( ~ROVEO SED~OO~S
( ) DISAPPROVED