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• C <br />Matheson <br />Mining <br />Consultants, Inc- <br />2801 Youngfield St., Suite 171 <br />Golden, CO 80401 <br />303 -456 -5638 <br />Toll Free 888 - 456 -5638 <br />Fax 303 - 456 -5639 <br />www.mathesonmining.com <br />CONDITION INSPECTION <br />CLIENT: 1 OLCI rn Ua i t rZ LOCATION: & ickc, kLE , CbL.G g_ist <br />INSPECTOR: [oky jpu kg i! ) Ec JOB NO.: INSPECTION NO.: <br />DATE OF INSPECTION: 3105 1 2ba TIME OF INSPECTION: 2 e, 3 0 <br />INSPECTION TYPE: COMPLETE If.INTERIOR ONLYfI EXTERIOR ONLYC REFUSAL( <br />OCCUPANT: KitHAIQD 2- 5 N CIA Fro OWNER TENANT n <br />INSPECTION ADDRESS: /055 COM T Y iw#L 6 <br />OWNER & ADDRESS: grC/4/ Q c.5r' M1 a- FroN Po Box 4 (JAL DALE_ C .0 12°222 <br />GENERAL INFORMATION: <br />FOUNDATION TYPE: (LC OLP ETC COMMENTS: <br />SIDING TYPE: WOO 1) COMMENTS: in) E-A-7 - fb„EI) <br />ROOFING MATERIAL: TI COMMENTS: <br />CHIMNEY TYPE: 5cbj P. COMMENTS: <br />AGE OF STRUCTURE: 35 veftes `L Iq."i 3) NUMBER OF STORIES: Ls' <br />• PORCH/DECK LOCATIONS & MATERIALS: - ot3T1k EN <br />SIDEWALK/DRIVEWAY LOCATIONS & MATERIALS: k AlVtAkOrk ,lam *AV E. <br />BASEMENT /CELLAR: YES❑ NO J STRUCTURE FRONT FACES: SOO Ti-4 <br />BROKEN GLASS: N O E OS 1 WO <br />paoy-Eti et:-K5:5 IQ iftel,ri4 EnicLoCts PoPt Pl <br />DRAINAGE: <br />ROOF DRAINAGE ADEQUATE: YESN1 NO❑ PORCH DRAINAGE ADEQUATE: YEW NO[] <br />RAIN GUTTERS: YESI NO[ DOWNSPOUTS: YES) NOn <br />DOWNSPOUTS DRAIN TO: EARTHZ1 TROUGHL] SEWER' <br />LOT: FLAT ►:1 HILLY[ FILL❑ LOT DRAINAGE FLOWS: 1J. p ril <br />EROSION NEAR FOUNDATION WALL YES[ NQK COMMENT IF YES: <br />WALL ALIGNMENT STRAIGHT: YESSNO❑ COMMENT IF NO: <br />SETTLEMENT: YES❑ NOj ' COMMENT IF YES: <br />UTILITIES: Z 5 <br />WATER: CITY( WELL OTHERL] WATER PRESSURE: HIGHE] MEDIUMN LOWPI <br />HEATING: ELECTRIC[ NATRUAL GAS O STOVER. <br />SEWAGE: CITYE SEPTICZ OUTHOUSE[ <br />Denial Signature: <br />110 Inspector's Signature: <br />( /s '- <br />