HomeMy WebLinkAboutDALE BRIGGS BLK 1 LT 11dale Briggs
Block 1
Lot I I
#050-181-14
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APPLIC�NT
FILLS OUT UPPER HAl'ONLY
Property Owner hO�
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Phone
Mailing Address w — 1
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Date
Bayer;
Date
Address
Zip Code
Lending Institution
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Phone
Address
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Zip Code
Realty Co. & AgentL
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Phone
Address
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G / Zip Code
Legal Description
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Street Location
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Type oo esidence
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Ingle Family
❑ Multiple Family
No. of Bedrooms
( ) APPROVED BEDROOMS
❑ Other
*CONDITIONS OF APPROVAL . i7
( ,CDISAPPROVED
Water Supply
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( ) CONDITIONAL APP 9VAL•
❑ Indivlduai
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ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
❑ Communily
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For wells trilled prior to that date, give well depth (attach log It available).
❑ Public Utility
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BY:
we Disposal
Individual
Year Intlivitlual Installed:
Solis Rating
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When Connected to Public Utility:
❑ Public Utility
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Well Log Received
Li Holding Tank
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Well to Tank
NOTE: THE INSPECTION FEE MUT ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
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Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
J U L 2 21983
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( ) APPROVED BEDROOMS
*CONDITIONS OF APPROVAL . i7
( ,CDISAPPROVED
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( ) CONDITIONAL APP 9VAL•
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DATE
BY:
Solis Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
Well to Tank
72 on (seri