HomeMy WebLinkAboutMOOREHAND #4 LT 11
APPLI¢ JT FILLS OUT UPPER HAl.. 3NLY
~ . ~- Phone
Property Owner ~01~/~ ~ ~ ~ ~ ~L ~0/~
Buyer
Address Zip Code
Lending lnstitution ~'~ ~/~-~ ~.~/~ ~ ~ ~ -'-'~ ~ m
Address ~/~ ~ ~ ~ ~ Zip Code ~(~ ~ ;'
Realty Co. & A~nt Phone
Address Zip Code
Legal Descript~n ~~~ ff~~ ~ ~: ~
Street Locati~ ~// ~'~' ~-~ , ~>- ,~,/~-, ~ ~ ~'¢r~'~ ~
Type of Resi~nce ~~ ~/ ~-
~ngle
Family
~ Multiple Family No. of ~
~ 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 (attach log if available}~
Public Utility ~
Sewer Disposal ~ ~: ~,-~ ~'~" ,, ~ ~ ;:~.j ~72_
Individual ~' : .~ ~,~ Year Individual Installed: ,~ L ',
Public Utili~ / 7 '~~ When Connected to Public Utility: ,,~ ,- ,/~/ .; :- ? P.
Holding Tan~
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE
BY:
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72.023 (3182)