HomeMy WebLinkAboutPermit SUB Sanitary Sewer 1984-10-31
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ACCOUNT No(\9D - 6 J Co '9; 0
INSPECTION OAT~q..'t-.J ~ TIME 10
REINSPECT ION DATf
, ,""'- \
CUSTOMERS NAME \~\ \
ADDRESS ~,\C; N'\ \Q k)
O.~ 1.......--.
ZIP CODE L tLl I J
HOME -'/11 1~9.^{i
PHONE ;...., , -"I QU'i
TIME
k1o~, ~
N-d-O.
lOW INCOME
BUSINESS
PHONE
(NO, OF UNITS)
BUILDING TYPE
KWH SAVED
PREVIOUS INSTALLED MEASURES
Ut'ility BoaFrd
INSPECTION FORM
AUDiT DATE_
I n - 2) \ -- p)U.
INSPECT10N NO,
I INSPECTED
BY C ~
INSPECTION NO,
OWNEP:S NAME ~<:--A m-Q..
iNSPECTED BY
ADORE 55
STATE
OWNER'S PHONE
ZIP CODE
ALL MEASURES COMPLETED
CHECK TO O/C
PREVIOUS REIM, TO CUSTOMER
IAQ SUBTOTAL
I
I
~,r--
D>!; I STORM WINDOWS
I
()7 r vI PA TIOI FR E NCH DOORS
,I WALL I NSULATI ON
\
@{j- tr CEiliNG INSULATION I! R'ADOED ,
b~ I
I
MEASURE
AREA
..,'4 eft
if- 2 :5-
IL2..{ zj;
122.{ 7b
FLOOR INSULATION
WEATHERSTRIP
DOORS / Wi N DOWS
CAULKiNG
SEAL DUCTS
DUCT WRAP
I CLOCK THERMOSTATE
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I
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OTHER
TOTAL
---.
I
I' INSTALLED
I FOR
I~~
COST
--r- REIMBURSEMENT
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27ft
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MEASURES APPROVED ,/1 . ,"? --
REiMBURSEMENT BY: .~j";./1.,- /J l1f.{, 'I-t",'-;.r-y'\.J
. DATE:
1/3 /.~~-