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NO. 11-00699 <br /> * ST, JOSEPH COUNTY HEALTH DEPARTMENT <br /> 227 W. Jefferson Blvd. SEAL <br /> ... �` 9th Floor County City Building <br /> South Bend, Indiana 46601 <br /> Phone: (574)235-9721 <br /> Fax: (574)235-9497 <br /> PROPERTY TRANSFER STATEMENT OF COMPLIANCE <br /> Water Supply and Wastewater Disposal System <br /> Address: 2018 S. Michigan Street <br /> City South Send State: in ZipCode 46613 <br /> Reference: <br /> Applicant William Dobslaw <br /> Representing: <br /> Date Issued: 04/19/2011 Expires six(6)months after date issued <br /> ' 4ased on the information provided by the applicant,the Health Department <br /> has determined that it appears the seller or their authorized agent has met <br /> the procedural requirements of the Source Water Protection Ordinance for <br /> the transfer of properties in St.Joseph County. The Health Department does <br /> Health Officer not endorse or approve any inspections or tests conducted to meet the <br /> requirements of the Ordinance <br /> m <br /> 2p—M - V1 M <br /> �� - tH^• � r�rs E+ <br /> Ord a to <br /> ro tY <br /> WOO in <br /> N C-i R+ fl1 <br /> �0 ra a <br /> ,a 0 <br /> ro � <br />