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