Laserfiche WebLink
�-- Ta/jt- 5-641 43 <br />CERTIFIED 3 <br />EXPIRES: <br />City Of Orono <br />C:;.f^•'.; Point of Sale Sanitary Sewer Scr%ice Inspection Application <br />Inflow & Infiltration (111) Compliance Inspection <br />Bella,. ;uiy tn, :1 ;:.,'I':, Ica :k; ,.11, 1! 11,.5.1 .11, 11111ow Jud hlfiitlatiun(H) Inspection rtlust be completed. <br />T1,: itist".IW11 15111 lUuk 101 .1111' 1111111Upe1 til Simllhcalll defevis til the sallitaly sewer %c•Ivlce pille. <br />Fur pttgn 11ia that pass inspection, the City issues a Certificate of l,1 C'onipliance which is valid lot 10 peal,. <br />Propelties that don't pass inspection are 6suctii a Lori ectiun notice delincalintt the prublems. I2CRails ,hould 1•r <br />comidewd within WI days of th,: lila inspection. If rcp3il i eamwt he cumplateJ pour to dle uunsfel of a <br />pruperty, proof of an escitew eyualinit 1 IM. of the estinlaled cost of repairs shall Ik provided to the city. If <br />repairs are not completed a munllliy surcharge will be applied to the utility hill until the property is in <br />eumnliancc See City website Lit call 19521249-4600 fur more information. <br />Pro c V Information <br />Application Date: <br />City Review <br />'3 Fee Paid: Yes No <br />Property Address: <br />Inspection Date and Time: <br />I'll): D -117 <br />Inspector: <br />Owner Information <br />+ 19+- <br />irCom <br />Namc: D e <br />C- NO <br />Ak <br />Mailing Address: <br />Iit'drffrn-nr fraan wA iaf+.-it 0 17 1(v S— <br />r ear y SS39/— <br />Phone: - <br />E-mail: 4.94LAe3/0/9' ~ .e►4g <br />Fees - lnqwction Fec due at time of application <br />Re -inspection Date & rime: <br />Residcntial Inspection S250 <br />I'm- at cit- hall or ('all 145')1•!9-4600 to <br />Conmtcrcial Inspection: 5750 <br />t%, hr phone <br />Private Inspection Option <br />If you would like It1 hire a private inspector <br />ilDlcad Of a110%ving a city inslIvetur to <br />complete the inspection please provide the <br />following. See private inspection info sheet. <br />Ins cchon Cont <br />Certificate of Sanitary Service Line Inflow and Infiltration Compliance _ <br />Date: Certificate of Compliance <br />3 - 2)-o o10 Expires: 3-3-a03� <br />lns ectors Name: <br />Signature: <br />Phone: <br />Email: <br />5i alum <br />A licant-c Name <br />Applicants Signature <br />Uatc <br />// C <br />p <br />PJ <br />Application Date: <br />City Review <br />'3 Fee Paid: Yes No <br />Inspection Date and Time: <br />\ a'. t7D <br />Inspector: <br />+ 19+- <br />irCom <br />Compliant: <br />liant: Yes No <br />Ak <br />If not compliant - <br />Corrective Action Required: <br />3 <br />Corrective Action Due by: <br />Re -inspection Date & rime: <br />Inspector: <br />Compliant: Yes No <br />Certificate of Sanitary Service Line Inflow and Infiltration Compliance _ <br />Date: Certificate of Compliance <br />3 - 2)-o o10 Expires: 3-3-a03� <br />Signature: <br />Name <br />PJ <br />