HomeMy WebLinkAboutLot 17, 18to'T-
Block
Time "Time ,
Date Date Date
Inspec~'(~"r' Inspector Inspector !
Com~rnsnts ~ Conditional Approval
( ) Cc'~MiUonal Approva]/,~
Date Sewer Installe~l- Permit No. Septic Tank
Holding Tank Size
Soils Rating ~' Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
q
Address
Typ~ Residence ~ .,
~Single Family~ ",
~ Multiple Family No. of Bedrooms
~ Other
Wat~PSu pply
'ID Individual A~ACH WELL LOG. A well log is required for all wells drilled since June
fd Community 1975. For wells drilled prior to that date, give well depth (attach log if
[~ P. ub!!9 ~.tili~y. availa~e¢)
Se~
Disposal
~lndividu~l Year Individual Installed:
~Public Utility When Connected to Public Utility:
Q Holdin~ Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.