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RUI3LIC WORKS <br /> E'�«ett fNSPECTI4N REQUEST <br /> � Address ��Q�'L.�,/ri1��3`:� <br /> . Contractor <br /> Owner ,C�T-I� ��N� � <br /> Date Time <br /> TYPE OF INSPECTION REQUESTED <br /> ❑ SIDESEWER ��(��M, f �//2/a <br /> ❑ CURB/GUTTER/SIDEWALK <br /> ❑ STREI�,T �/ l <br /> � h� � IP/` /`I�An� rii/ /�f / <br /> � - <br /> INSPECTION REQUESTED ON_ p rE @ ,�NE <br /> ❑ APPROVAL ❑ PARTIAL APPROVAL <br /> O VIOLATION ❑ CORRECTION REQUIRED <br /> ❑ Corrections listed below MUST BE MADE belore work can be approved. <br /> ❑ Please contact inspector and arrange for appointmeM. <br /> ❑ Was not able to pertorm inspection. <br /> ❑ CALL 259•8810 FOR REINSPECTION —24 hour notice required. <br /> A CERTIFICATE OF OCCUPANCY SHALL BE ISSUED AND POSTED ON <br /> THE PREMISES PRIOR TO OCCUPANCY. <br /> � � � Z � �,'s� <br /> Inspector �-- _Date <br />