DR8902-CS 890720; (~
I!/J)~/j'~xg~)pell, Texas 75019
~ The City WJtb A Beautiful Future U
IIIiii ,,u~ ~.o~ /////.
STORMWATER DRAINAGE FACILITIES QUESTIONNAIRE
1. Name ~/~-
Address
Lot #, if known
Telephone H:
2. During the recent rains, we observed
3. f the wateL~h~d c.o.n~t~inued an°ther~-K~'~~'~'~, it
4. Specific p~opert~ ~t~a~ge consisted of:
~o~ :c~u~e~: ~e~ / no ~'~
6. We hereby grant the City permission to enter Our
yard/p~Perty to obse~e the conditions described:
yes ~no.,
~. ~e ~o.~ ~e ~o ~ee ~e c~t~ ~o ~ ~o~o~:
Signed ~~~~f Date
~ ~ / / /
RETURN TO CITY ENGINEER AT CITY ~LL