HomeMy WebLinkAboutMiscellaneous - Exception (767)• r �.. � ..y.
4 .. t.�1-v a n�.'
YES
'3.r s. '�.
YES
NO
YES
NO
,-QED
NO
DATE •
BY
r t
MAR #
,�.����.��
t?
%LOT.'
PARCEL #
`STREET
��L 1V/ /�Lv,&
' �OIV,STRUCTIO.N_A.PPROVA.L
HAS PLAN REVIEW FEE .BEEN PAID? NO
PLAN APPROVAL: DATE APP. BY
DESIGNER:�Yu�S/5E2) sT .P,r�� PLAN DA-fE..
CONDITIONS
WATER SU04Z[,
WELL PERMIT
WELL TESTS:
Y:
COMMENTS:
FORM U APPROVAL:
DATE ISSUED
CONDITIONS:
=TOWN WELL
_ DRILLER
CHE L DALE APPFiUVED
BACTERIA I UAiE (IPPRUVEU
BACTERIA II ATE APPROVED
APPROVAL TO ISSUE YE NU
BY '
FINAL APPROVAL:.
ALL PERMITS PAID
WELL CONSTRUCTION APPROVAL
SEPTIC SYSTEM CONSTRUCTION APPROVAL
OTHER
ANY VARIANCE NEEDED
FINAL BOARD OF HEALTH APPROVAL:
YES
NO
YES
NO
YES
NO
YES
NO
,-QED
NO
DATE •
BY