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! I <br /> c - c` I,� <br /> 2.0'i3 LRi�GE ,�i'URfVi t�FiPON.�sE l�A�°ER F�FfM CFiECi�LI.�T , <br /> �v <br /> llate ol inspeclbn.. _`��G�� Inspected�y: 1�� '��f"" __ � <br /> Address.�yl 1 .,(�u�d�'�ft,t�rs�)�/ria � � �:)Service Request Number._T__. .. ..__---. <br /> Residenf�/t1:�f�i11�-'_���1L�:1.°-__ O,vner? �Y[5 []F!0 <br /> Pnene Wumb^� --- --. .. - . _— . E'"rr!: _.. ._. <br /> General Duliding Details: <br /> Isthisbuildingwilhin�hec_mb:n<:dsee.cra,ic7 �,kIIFS j1t:0 C:,cs.`,�C�Ir!.nr,l��;i•.eaCdseir�.�nt� OO'fES ��'JC <br /> .� <br /> Does tbc builtl�ng have a backv;atci valw(6l'AQ? ❑Y[S [f P:O�� QI ycs)N'as BNlV ins(alled I�rouah Cily progiam �YC:S ❑ ta0 / <br /> Does�he b�.ii',tl:^y havu a sump pump'7 ❑YES.�Id0 Ooes Ihe Cu�Vlmg hace a c��rde�pumn9 [�Y�5 ;X'�t:0 <br /> SrormEventOetails: �1�1�� i�j CLt�r �c,d/" � <br /> '.'�here d�d walerenlering buil�ing romc fwm? �SURFACE FLOl1' ❑GROU!:D'i:hTcf� �:�j SE���R 6ACINP-FI�'iUP.ES []�.irlr:NO'.19! <br /> �/ �' I ' / / � J ,r � <br /> Deta:ls �!!S�•� ' Yn^,t ��t�t"`��,fj, lr i)a11�[ •/Y?tit�11?J'.!�,;'f�<_ S il/' ------ — <br /> ll'liete did�valcr yo vrilhin Uie buJding? 0 DASEfd'el•ll PERI��1[TER �,6ASEFdENT�[nR FIXTURES ❑O7 HER <br /> Dclails:_�_L � i>> '.�...r:�—L�L<I�E�%1h�,�1,.��iT . -- ------- - �-- <br /> ✓ <br /> � Site Observali is: <br /> Uovnis��out/sitcgradmgissur.snoled�_(S'n - .;,1L�;�r•6.�iY="Clp�1%i.1L(Y'�liu•� ..C.j1�l�n,_»��- , - --------- -- <br /> 1 <br /> fluildma elevat�on relahvc lo se�ver and sunounding area�ssues notci.___ _ -- <br /> Si�eE:umpi55uesnoted� . __- --- — - - ---_.----- - � - ---- _.—. <br /> Historical Information 1 Other Inlormation: <br /> Previous'tlooAing'issueServiceReyucsls;�;a�ldruss - . ---- . — -_—._-- - _ --.. _. .--_--..-- ._-.--.---- <br /> Previous`Iloodinp'issues uuted!�y hoiucmvner_���_. ----_�-------- -- <br /> Recent slormv,ale;I sewer projecls coniple!ed in area-___�Sj_i�_____Proposed slormwaler!sev�er pmjects In arr.;r�,��1. _ <br /> i <br /> Properly nv:ne.r interested in beginning Cily Dack�raler l'alve Pwgram al atlAre;s�.'�(YES ❑NO' De�ads: __ <br /> /- 7 /� � / � <br /> t�eles __�('_C!t!—�>lS. I '�th',�-:��4�iN ..�,�r�Lrl..�) --_. <br /> .-=;L�i_!'�1.1u=1�,� ��iL_� � �N :1G,/��L��., �[TU��7�SL�.�_ <br /> ✓ <br /> Revision: 3 TRbV 1 Thunclay, Sep�embcr05, 2U13 <br />