WEST HILLS AREA WATER POLLUTION CONTROL AUTHORITY 257 LINDE

1602 ROLLING HILLS DRIVE SUITE 107 RICHMOND VIRGINIA 23229
1819 SY H3 HILLSIDES MENU MONDAY PORT SIZE
2017 SUNNY HILLS EAGER READER PROGRAM FAMILY INFORMATION SHEET

3 BARTON HILLS MEDICAL GROUP WHITEHORSE VALE BARTON HILLS
6201 WINNETKA AVENUE WOODLAND HILLS CA 91371 (818) 7196425
ADELAIDE HILLS VINE IMPROVEMENT INC 1ST MAY 2017 DEAR

WEST HILLS AREA WATER POLLUTION CONTROL AUTHORITY

257 LINDE ROAD KITTANNING, PENNSYLVANIA 16201-4719

PHONE: (724) 545-9126 FAX: (724) 545-9305

APPLICATION FOR DOCUMENT OF CERTIFICATION

Address of Property to be Certified:

______________________________________________________________________

House # Street City State Zip Code

_________________________________________ ____________________________________________

Municipality sewer account no.

Current Owner Information:

________________________ ______ ________________________________

Name telephone no.

______________________________________________________________________

House # Street City State Zip Code

_______________________________ ________________________________

Owner’s Real Estate Agent Agent’s telephone no.

New Owner/Purchaser’s Information: (a copy of inspection results may be mailed to the purchaser)

______________________________ ________________________________

Name telephone no.

______________________________________________________________________

House # Street City State Zip Code

Proposed closing date: _________________________

Filing fee of $100.00 paid on ____________ Check # ________ Rec’d by _________

(Payment must accompany application. Make check payable to WHAWPCA)

______________________________________________________________________

Application date Applicant’s name (printed) Applicant’s signature

_______________________________________________________ _____________________________________

Applicant’s address, if not listed above Applicant’s fax # or e-mail

Person to be contacted by WHAWPCA for scheduling a date and time for the inspection:

_____________________________ ____________________ _________________

Contact’s name Contact phone no. Contact fax no.

If violations are indicated on the certified inspection report, they must be corrected before the Document of Certification can be issued. All corrections must be inspected by a representative of the WHAWPCA.

There will be an additional $25.00 fee for these follow-up inspections.

ALGONQUINLAKE IN THE HILLS ROTARY GORDON AND JOAN LARSEN
AN ASSESSMENT OF HILLSLOPE STABILITY USING THE FACTOR OF
ANALYSIS OF IHD DATA FROM CLAYTON & HILLS –

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