71-T-5s
CHE E~J~IELD COUNTY HEALTH DEPi
CHESTERFIELD, VIRGINIA
Request for Lot Evaluation
For:
Applicant
Piione '1-~ b---- 1
~3wner
Phone
Address 2_~ ~_~ ~
Exact Location
of Premises
Lot
B]-oCk sedtEon Street ..... SUbdivision
Applicant /_~ Desires to have a lot opinion that is subject to re-
evaluation prior to issuance of Building Permit.
/__/ Is applying for Building Permit
~i~fpe of Construction ~,
_/_-7 Dwelling /~ Other~_/_-7 House plan not final
~ Auto. Washer ~-7 Garbage Disposal ubiic Water ~ Ind. well
Actual or potential bedroom ~---Estimated water consumption~.CTgpd.
Soil Study
Recommendations~
this lot has:
Ba~ed on present standards it is our opinion that
FAVOPJ~LE /-7 QUESTION~.~LE /~'.-7 NOT SUITED
for septic tan]: ahd draihfield instali~tion.
Thi's~ is not a permit to install a se'~'tic