|
, -�.�C7 "` ��.�f ��
<br /> ,��-,.'���`'� ,: °�:�� � � �
<br /> Cffi�Clt OPs I.ZST !dA Z33UAliCB OP pERlitTS
<br /> _ '���' FOR OPPICE USE ONLY
<br /> .�>�:
<br /> �"1�=��ss 39� o �- _.._,, ,d.,,� _ �1�02� t —
<br /> � �.u� n�r�rzox:
<br /> .x,; _ �Z.. ..� ZZ ��'��
<br /> , �:,� 11$ �.3 �2. w E��� �t.►���
<br /> �, .. �u� P ��t Q�,-�-�-,r�N -. ��N�s �-�Dn.� ,
<br /> � <.� � or ,ro�c:
<br /> ,�:.��- ..:_; �. � ----------------------'
<br /> -- ------------DATB
<br /> `�c,.�CBM 82! AYPROVSD s
<br /> � C F ` .'. , � V��_^ ..
<br /> ���r�'';'��� �:g.l= .DATB AYYROVP•Ds 3-4 ' 90 -
<br /> �
<br /> "sr� � '' _� �� , �� � DATE s
<br /> ,,.�.�,��HZt �_�---------�------------------------��-- -- f.
<br /> �,�;� � = Misc. Fesa Calculatad Bys
<br /> +;�r '� � _ SEkER UNIT $
<br /> ` I� - Yea� No_...
<br /> 5r ��;� � � //
<br /> fi '
<br /> Yes " No_,_, SEWER CONNECTZON
<br /> � . " ' �.4 ✓ WATER CONNECTION
<br /> GS.�'-; es lso
<br /> . Y
<br /> r:;.;,; _�. —
<br /> ,,,�+'n -
<br /> �,.. �
<br /> F �5 .
<br /> ��� ;� Yea No_, PARK PEE
<br /> ,�.;_ �' r�
<br /> � y
<br /> " �`.: yQy_ No SITE INSYECTION K�
<br /> .. : � — ��'�:
<br /> " �' �,��, ;�,� ' OT�R (specify) _ ;�:
<br /> ° r;� *''� '�� . ��.._.�__��..._�--�w�-- / __.._ —
<br /> ������� �����
<br /> ��r ♦yI� Zon3_nq Distzict: �L�
<br /> �
<br /> i<;' .. /U' ��,rr
<br /> �
<br /> w . ct: ,
<br /> stri
<br /> '� ��_ Post Oftice:� School Di �' �s
<br /> �, ts" ��,
<br /> �
<br /> Depth:_ �
<br /> f: :A�,`-r-'. Wid ��
<br /> ;t
<br /> ;,;,� s,� , �
<br /> •`��ttedi�Yes� Date of Survey: <
<br /> Ho_„_, W�:
<br /> . .� x��,�� ;:
<br /> u y�K,j�—y'�����L��` « -
<br /> C�LJQ{i7LiSA� . . ��. . .
<br /> �tT+akl�r�s� ' � Riqht Side:
<br /> � ���g��,`a ; :
<br /> �.; ��aist�3�: Left siae.:
<br /> r
<br /> ���- TI'T@t�.sIld 1
<br /> �t�3tttsctnres z Pro osed
<br /> ��� �;�� , ; Exiat q p
<br /> +co'�v+esr"a`75''�k ' . . , .
<br /> .
<br /> :�� � $=
<br /> "� ,�=230','�F '�� ',
<br /> ����, ��� ..,..
<br /> �� �
<br /> � �' Ce geqn3red: . Yea_ No_ Date of Counci�. Apgroval:_,_ �
<br /> :��,y��"z�<1� y . . :-' Conncil Approval Datas ''x
<br /> _ � rflval Datez HY=_--
<br /> ��4 � w .`�
<br /> - ,.�. a����� �� � _ BY:_._— .
<br /> ��F�va3~-�Dater ' , '; .,.:
<br /> ' )S� T`R e��A.+r+.Y ..' . '....• . 5��:.
<br /> , y � • (p� Reaolution Dates �3 L$439�
<br /> M k.�� s , Resolutioa �z —
<br /> � ,e�,+tt; t i'? lty i �. .:.r,"�� �', ' . � il y
<br /> ����, ��
<br /> �.'� �'t-,,�;:,1qw q$�'V"es.'-' '~'� �AI'��s f . . . � � , . . �
<br /> y r�... �C.d�l,iy�,:,,t'`t �t1 � . . J
<br /> ..�y% '�4�3y�'�pt�'Y �'i.��C � ��'����� ) . •
<br /> ���„a� ;y�r. 1� ���::V +�TY`�` ;�- i •;'C �y��w
<br /> •.�d�' '4 h1` "J Y '�:
<br />
|