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Tower Designs, Inc. P.O. Box 2022 Leavenworth, WA 98826
(509) 548-4496
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Request For Services Sewage System evaluation
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Request For Services Sewage System…
Requested Services & Estimated Fees
Site evaluation (see fee schedule for approximate cost)
Backhoe $
Yes. Please arrange for a backhoe.
No thank you. I will arrange for the backhoe.
Note: Backhoe fee is in addition to the site evaluation fee.
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
Property Information
County
*
Assessor Parcel #
*
Legal Description (Lot, Subdivision)
*
Property Street Address
*
Street Address
Address Line 2
City
Directions
*
Type Of Use
Residential
Number of bedrooms:
Commercial
Describe use:
Source of Drinking Water
Private well
Surface water
Public Source
System name:
Please submit a copy of the report to the Health District
*
Done
I agree to pay Tower Designs, Inc. the fees (from the fee schedule) for the services requested as soon as the work is completed and invoices are presented for payment. I further agree to pay the backhoe operator's fees if they are arranged by Tower Designs, Inc. It is the applicant's responsibility to obtain permission from the property owner to dig test holes if the property is not owned by the applicant.
*
I agree
File
Name & Date
*
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