HomeMy WebLinkAboutMiscellaneous - Ingalls StreetMAP # LOT #
PARCEL # STREET . .... ......
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HAS PLAN REVIEW FEE BEEN PAID? YES NO
PLAN APPROVAL:
DATE APP
DESIGNER: PLAN DATE
CONDITIONS
FORM U APPROVAL: APPROVAL TO ISSUEz-_�S NO
DATE ISSUED (3 AJ --BY .............. ....... ....... . ...... .... ....... .
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID
WELL CONSTRUCTION APPROVAL
SEPTIC SYSTEM CONSTRUCTION APPROVAL
OTHER
ANY VARIANCE NEEDED
FINAL BOARD OF HEALTH APPROVAL:
YES NO
YES NU
YES NO
YES NO
YES NO
DA I"E:.j
BY".
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.... ... ....... ............
WATER SUPPLY: TOWN WELL
WELL PERMIT DRILLER
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WELL TESTS: CHEMICAL
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APPRUVE.s
BACTERIA I
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(I[ -'IJ ROVED
BACTERIA II
DATE
APPROVED
COMMENTS:
FORM U APPROVAL: APPROVAL TO ISSUEz-_�S NO
DATE ISSUED (3 AJ --BY .............. ....... ....... . ...... .... ....... .
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID
WELL CONSTRUCTION APPROVAL
SEPTIC SYSTEM CONSTRUCTION APPROVAL
OTHER
ANY VARIANCE NEEDED
FINAL BOARD OF HEALTH APPROVAL:
YES NO
YES NU
YES NO
YES NO
YES NO
DA I"E:.j
BY".