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i <br /> PUBLIC WORKS <br /> ���«tt INSpECT10N REQUEST <br /> � Address ��,., �—� �s"l ��� S�� <br /> Contractor <br /> �4=/��_ <br /> Owner <br /> Date?���`�'/� 7ime _ -- <br /> TYPE OF INSPECTION REQUESTED <br /> XSIDE SEWER <br /> ��,] CURB/GUTTERiSIDEWALK <br /> � STREET <br /> CI — — <br /> �-� � - -' Cc.�-: c <br /> INSPECTION REQUESTED ON__,L/ � � "°—L=----�? � <br /> � o n rnno- <br /> APPROVAL G PARTIAL APPROVAL <br /> ❑ VIOLATION ❑ CORRECTION R[QUIFED <br /> ❑ Correclions lisled below MUST BE MAD[before evork can be appruved. <br /> ❑ Please contacl insp�ctor and airange tor appointmenl. <br /> C. Was not able to perform inspeclion. <br /> ❑ CALL 259•8810 FOR REINSPECTION —24 hour notice required. <br /> A CERTIFICATE OF OCCUPANCY SHALL BE ISSUED AND POSTED OIJ <br /> THE PREMISES PRIOR Tp OCCUPANCY. <br /> ) � <br /> , _ <br /> Inspector / � �/� Date � " _ � <br />