HomeMy WebLinkAboutSWG2022-00179 HOMEOWNER INSTALL REQUEST - SWG Application - 8/23/2022 . -4.
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HOMEOWNER OSS INSTALLATION REQUEST
Name of Applicant.Thv ner: criNv*-..4.....0 "S'1.'" CC"'"Pity's\'1/4- - Date: -t' tt
Mailing Address of Applicant: 3 Zo$ t.,.2t,.-, \-tak,v..**.o, br.
City: ._.,,.._..ON'll;rrt State: t"...141. lip:
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Pbone Number: (...,?:. -0 3C1- ota.S.. Email:
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12-digit Parcel Number: _ _ _ 4 2.I cs:4
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Approved Sepik Permit ‘untber: SVk 6_2,02.1.- 09‘,14.,........ fsei page I of design ji)rrut
Septic Design Expiration Date: 44-ki.,. 2 F7 Out pap 2 of*sir foron)
Septic Designer or Engineer: Anrt.N...) S-Q..91.-")c.. Ztertvs."5 'ver page I of deSirt form.)
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Designer-Engineer must stamp their upprotal for home(?),fier Mitalltultm.
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Jain lin primary muter of lita wOPP,Viivrehnt reshienwi t prvperr.-.and
thoutil be en primary ressdence. I have read arra unierssond Me
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auachnt"Mert County Homeowner CAS instailatt6vt Inforemeton"
i week)Aeon the Aftium Cowry procedure standar&arod 1
4wyttrobt4,ter Ion durmg olio instal:quiver with eke rotrAtrusoding
that fakirs to clo sr may render es).design/errnia void or unusable I
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Signature 4-..f Applicant-Owner
HEALI H DEP Nit I 'II N I l I. ()MA
Request Rev ten: :_. Appro•cd L:,' Denied
INSPECTION DAUS
Name of EN . cultist.
• Pre-imits0 Mertert 61'2-3
signature: i Date: i-?-7 -e2,3
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