BP-66760RESIDENTIAL
❑ Phased Approval (R106.3.3)
ZVVdLdi ouPpsy twwL cr+u 5041: I.n a wage uisposai System: Has application been submitted to the Historic COmmiission?
Municipal ❑ Private VVell unicipal ❑ On Site Disposal System ❑ Yes ❑ No Date:'
Revised 10111
CONSTRl1CTIUN PLANS SITE PLAN ❑ ENERGY REPORT