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71-T-4s CHESTERF~D COUNTY HEALTH DEPART~N'.'~ CHESTERFIELD, VIRGINIA Request for Lot Evaluation For: Ap p 1 i c an t ~ ~ Ad d r es s/~O~ Phone ~ ~/_ ~-~;~_~ , Owner ~9~ Address ............. Phone " Exact Location of Premises ~ Lot Block Section Street ~/ SUbdi Vi s i©n Applicant /-7 Desires to have a lot opinion that :~..~ ~'~?~,?J:t to re- evaluation prior to issuance of ~..J..i~!f'~.c? ?~-mit. Is applying for Building Permit Type of Construction /~-7 Dwelling ~Other /-7 House plan not final /~? Auto. Washer /-~ Garbage Disposal /~-7Public Water /~__-7 Ind. Well Actual or potential bedroom ~stimated water cnnsumption ~~. Recommendations: this'lot has: Based on pr_s~..~nt stand~rds it is our opinion that S/o~' FAVORABLE /-~ ~;~ ~ ~'~': ~,~-~' ;~ '~ ~ _~ t~ ......... ~..~.,~.,~,~ /--7 NO~ SUITED 1 for septic tank and flrainfi?~2~5~ i~,~v~!!ation,~'~ ~hi~. ' ' ~'~~ ~~ ~ . . Posted Grid o o 7/5/67 D..M.R. 7,/'~,/~ W W P £ ISTRICT & ZO BL6 AKS- 5£C, C ION 8 1-16