HomeMy WebLinkAboutHealth Permit # 8/26/1998 *** rok
(9 1� :� " (9
3
� � r C)• Z o RIl i A
�• O� **« air
N �
N � D
� 3
N m
A _
._ N (D
CL
p r O
0 0 O O o 'A .
N A Y
rn
0Q
O A y
is � C N
N
3 m
D �
p O O O
n � Q
O C
O 2 �
m cn
D O
_ r
rn
'\ Cr r- o
V' o�� 3
O -0
S o
f+ O
O Z w
r"
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERN I IIT
DATE: CURRE NT INSTALLER'S LICENSEM--_ r
LOCATION: f /Y 15 7 /S
LICENSED INSTALLER:
SIGNATURE: TELEPHONE9
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
$115.00 Fee Attached? Yes v/ No
Foundation As-built? Yes 1" No
Floor plans on file? Yes No
Approval
Date:-