Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1605A
- : r ^^r ""7 :`� x ,�� zz'� %;�'�,"r'_"�^ �'.'�.£t'°•` 3:'. 5"�"��-��.w�'gy�`` �s-���� . N' � e����' p�c„..��#;, k�p ''`u�. �'��''�z �"-�s+S�B=a*�*�:n+'.:z >,� %: Y1YORkERS COMPEf�SAT101�DECLARATiON �. . �,�� � � 3 ;yA ?' ^�k �i YS � �. I hereby affirm fhal�'1 hove�a�cert�tgte o�conSeM io se� .. .,„„. ;..,,.,.. _. . " rcsore or a ceHificate�of Workers'C9mp�rispf.ion lnsurance or �"b'��x°' � . .. �.".. .' .. � . , � _ , .�. � ,m.. „ _ _....... . .. . ..pcenfed��co �h�«o+ 5B� 3�«�,�q��., �, ��eoe�a£�B,B� .�, :. App�lCATION.-.FOR PERMIT � �-Policy�10� mpany � � • ��� . �s ;. . .. . . _. ._. . H �.�,� f� . " SEWER - S�WA�E DISPOSAL. � �Ce tif ed� �t�by fumished . . . � . . .. .. .�.. ` . . ���aremeno 'sAPpdcant �rpun�t,y��Id�n insecrion ` ~ FORAPPLf ANOOFiIIi�GE�ES , BUI INCOANDSAFETY .._ _ Q � . � �.,.,.. ..�, .., �� P ..._E.. ; . : .. .. . ._.... pY 9 ore �['L"��$� I a NNECTION DATA , h� �C`�`RtIFYC.AT �OF ES�,EM�`�'QfJ�fR�b"`��"1N����S ' euuoWG ry .-,.,..-w.M..._„�.._, . �... � -..- � }+ � STATION DEpTH � �y x��:�""�'� C�O'�N1P�N��71`��II�(S�Y1R%St'`IC� AC�RE55�- �,.- . .. .. . .. . . ... . ..- .owER— (This sec�on neec�nor l�e comp�lz�e�lf f�le WOIR InV4rVCJ.by iF1E ' .MANHOlE2EFERENCE '�e�in�"s�for qne hundred dollars�f$10D)or less) - �o�AUT� {�owea� . . � . ....„_ ,...«-....,� ..._....w.::.. TYPE OF GONNECLtQN'� ' IE�S67H F�CSM K .. .a..,�,..r � NlARfST� ' . � . � ..:a z"s�s to becoe e sub Qerformanee of"the wqrk'for whiih ihis, , cao6s st. � � - � � � v. � cuae v� M�*o v.0 "-�-.� ���� °�t t not gmploy any person in any manner . �- . . � - �" P:c Na '�', � �n I ct to the Workers Compensaf on Laws owNpa-� .�lj,� �� CO IMP.�NO.� JOB NO �%?aF � `S �4 q�•P ; ,twt�- y�,q. ' . � ���}}}^^^��� �p �] , . . . . .,_.._, . _ . ... . S ' ' '�� �* ��� �"`'�' �� •'"` X " ��RESS ���.k7�� ��ZS - �� TRUNKPERAAITNO , , ROADPERrNITNO� � Oate ' Applicant � - . . � „.� . .; ' '""" �7 """' ""." AiFIDAVIT WAIVER EASE11iENT REGOkD WSTR NQ:, DIHE -�N�T�C�E`�Yd.4P1�C(`CAIZ17 ff* aft"e'r`m�king this C�rtfi<ate of, aTy'. �.NA.��'�}�9�1�'��4�- � � ,, �.W.��. �. . � ,i�mpnpn, you shquld become'subiect.�.to th'e, Workers, �_.r� �E�Ai ` ' ::- /�,� . �� ��� ��..�� � � --- � -- 'npeMqi�dn prov�srons of th�I,pbnr code;ypu must for(hw�rh , oesceierioN �oT Np r Hwv 6a 3T.wmewNc . � � � : _�nply with suth provs�ons or.�thrs permit shalf 6e,d@emBd „ _., ` " '�`- " '"'_ ' _""'"'""".""�.", - - - - . . _.,.,..._ _�.__.>....._...._ �`�'�EvOk6(��.� ' BIOCK' � `� � TRACf �� STATE ENCROACHMENT � ., . . �'� �'�� -'L�NSE G'rtb � �- a �.: ;. : .. .. .:., NtS�'b�'eib�� . � veaMirNo�. �.�, � . � �7��YO�1�ECC�R'A�IbY�] -.�'°q r a'�'�� �uv =r-•t: _.cs+c':�Nne� . SIZEOFLOi ._: ..:. NOW4Nl�T . . ._ _ . . . ... i.; f�e eby af��m that h�om license�vnc�er provis ons offCliapter use oF�' � '"'" "� " -�9 (commenc ng wUh�Secton 7000)of Div�ston 3 of ihe�,8us „ , , euimiNcs $lEl s �,�.$a � � � - - cHAa�es". -:�" "� �._' � - '` "�ssGrsb Professions Code and my license ts in full force and � - — �- � � ` e�feCt p �p�S ?y " *.�}� � CONTRACTOR � � - CONNECTION CHARGE FEE }. � L cense Num6er 4.�4i�$( Lm C�ass �7F4 �.. � nDDRE@S- .. � .� � , „ �•« .•,•• . _.. _ .,...,...._ ._-.,.n ' �., ,y�,E 'I�.ynB���� $/2Q'$� �� 15T . OU MAP ` P SEDBY � �Coniracfor � 1 Date � . arv �,.`t&3� �Q17Irr'T�, , �t No � 4 �� . � .':, ,_...; . ,:,.�',,�.�..,�i � ��, ., ,.,��r .... u �; . r7 ., ..- _ _,��- �,-».. l . . _ � v. ..._.�. E •, , .,-.-. Q I�p��g/�� D RICE NO� GR P ''. •. 'ROCES u V 'gG REIMdURSEMENTFE 8K O ❑I am exempt under Sec � of the L A Co .,�. ucense nio �(�8$� C sS � �5 C C� - — '� Plumbing Code arid/or Set �� � �� of ihe No , DESCRIPFIbN 4F`VJORK F"C�" '�`�"'",""'"""`"`""�"` . �. V ��� � w. �. � j �^'W'F, ��HOUSE SEWER Ci�NNECTING,TO�, '� � , DA E� ��� . VALIDAT ON . d� ; � � . aug�.icseWEA . ' - �.� �� �'.D / . ... . 0 8 P`.C�de for tFe following reason � .- �Sea'�c r.sNK 5eevaGE p�r oe � F�NAi ' '. .-- - Z � § G� . " d �' jk ; .,.z"� ^. .: �PRSANO/ORCIXAff�FlEIC aY ; 't" 3- S e 4 + Dpte_'qo- ��� :HOUSE S�NER CQNNE(,�ING„TU',� ;'� "" �. ' '�'�'� , "t "3 "� % �Z* . � PkIVAT OISPOSAL SVS7EM . . . ....... _ ......... .... . ...._... .. - `� 5ignpitlre � � � �CONNE ADQjrIONAL'BL�G O' '" � 1,. , � •`''"" -� 05i/N�,R B'C11L6ET�"D�C�A�2A�6�� '" woaK To HouBe� . . ._ . � .... � � ,;,�.,, _ �e t. �• 'WERFLOW 5 EPAGE PIT DRAINFIELD �I here�y�aff rm ihpf f-om exempt from}he Contractor s License :Ex?N,C645POOL�Rvwe1 tiv+NHOte . � � � � - - � � �' ;' Lo for tFie fo�lowmg-reuson(Secton 7031 5,,B��sness and Pro- � athe,ReaniR'ott neaNCON FioUSe, " �. �- � . � � � ��.i �;�;�,rj j}� ' . �. . ,:'�*•IonS COCIE� '_ . _ ,. _.. -SEVlER OR OISPOSAL SVST[M �.. .. . . . . . . "' , ' , z �n � _- e� F r � _ ,.,� .: ' . +h�t_,��o,l w pensor on,will do the work and ihe strg�s as � � � o � � I as owne of rhe.propeity or'�myemp(oyeesw ih wa . . � - � �- y. . . . ... __.,_.,.....__ . . . ucture is nof intended of,offered tor sale(Secfiqn J044,,8u5inesV""' �� � � �- � � m�����".� ' ..�� _and Professians Codej �- � �� �µ�� �� �OWNER'S� - �.d .Q . ; Permrt $ _ ' ' ` " AU7HORIZATION '" �� i u t�1� x ❑I as owner of Ihe property am exclusively contracting with � . TOT01L FFE , `�7 �'}Q � � ' � �� ..;; Lcens . . .,, ._ . . . . m�d rnntrocTors to co�srrucr rhe pr,oject(5ecrivr.t-7,64d; . i Hqye nr Tr�s oq1E-A co T c7 kviTN.�He_HEREiN NAM n cor�iaaCroa ra - business dnd professions Code) � coNNECT rHe.neoV[p'ESCRi,Beo E%isnNG�,,,,�_i�E�IiNG 76'�'�Jei�G�E'�h'Ek", s ����"'�6 -�� � xu��;:,, CONS��l7�TIU��11E'h`fD��A�'a"EY��V ` � . y/ _ n�.b� . . . . � I hereby aNirm�ihot�here s a const uc�ign�ending ogency��� SIGNED'fHIS,.��_��DAYOF eY 19�. ��for'ihe e formance-of fhe work for,which this perm t is owNeg�oa - ��„�,.- , . . . _ _ P OWNrvR'S ACyENj issued(Sec 3097 Crv.C j. � � � - �. c�, . _ �. : . nPoaESs .., -r .; _.. - Lender s Nome � ,,,�,. : a �� ^*2`a�¢�-s.r� �� � rd � < �...�'� -t°�° .��. ,�- �,} , `s ; t �. �F � �� .��r`d'�^"�:`��`'�`�.'��^t r"�����'k�u'�, ����r� �., s�-r�� �`� � �.ro � �.q 'q _ ,:. LandarsAddress a,�� ,.�,a. ..� � � � - - ,�..-,.--. _«...a, ................. .r ,..r. ,.. �- (ce�ti�'ihat I'have�read this dpp�catron and,stafe that,the_, � � �� ��'�'� � � � � ., _ ..., ..� __..-..., a__.......,...,..,�_. . .: .__�_._c.., ._....___. ... �.._._ .,__.�_._._—__. __�. . _ _.. ,�: abo e nformat�an g co rect l.agree ia comply w th all County � - � -� , ;� ord nanc"es and State I`a�s regu(ating�Plumb ng onxi Sewers, � ' � � �, - - � � � � .�,....�..,,.._w. . �f and heieliy aufFiorize rapresenidt ves of�tliis County'.to'"enler "'' `.�.�:". '"" .`�.:. "":,. ..."". .``. . �... .. .. . . . . . , t}pon the obo�e meri�ioned proqerty for inspection puxpos05 � � . � �� � � �� - - � , .. - . � . . . � . �. ,.,x .- .. , �e��nr►�tt,e.�rw►e?wv' c4z' �—S=9G . -.. , Sign.atureo�rmi}Yee . . . �afa .,".-..'�" • '��.�-'• �„�•�,-" '"S`Et"kEfiERi'€�'d�tERWZiCKIAYi9RVLYcNII;UAG'E-. . . . - . . . : . . . � . .: , .. .. .: . . ;{ . ,. . .� .. . ., '[_' _ „ .. . . �.-�-: ,.:; r �.. .w s. , ._ . .. . „ .:. ,�,.:_ , . ;"` �r , 4„ �< <.r:.' r.,,� � �., � �- -�_ - ., ,.:,. . . . _. „��`�. ., i �..; --- - __ _ . _, - -_ __. _ _-- . ,. _ � �. �,Caf,2: ;,,s ,,.Y,,: . .�� AP�R@V�eLS-�� �.onre����c cioz�ic ruae� ��;�� ��.,�e*�'�a,,�,iN3PECT�R S NO4ES . _. ,,.� � ;� �� "g���a��rin�hae�ata��xc�sgt frpm tTs ...::,..�:: ; _. �. ._ ����;��QN s cmr' . NEw t+ous�sewea ..:. . ... ...: . .. :��..r :;a ,, r.;�_; a.�� �... < � . .. . . . LiceaSe Law fm•elte�ollowim�reason 9S�zaiosc 70�T.5� � � - .-.:_ . Bwzmess�nd��''srofesafoms�Codok Any ciey or county. . �� COtJf�EfT�ADDITiONAL �^�•. aunoiNeerewo�c .. . .. . -. ..:� ' � . �.-'. . . wlricl;�segs�sres ce.�ermrsr�sa�ronstsrect�ad8er,�ianprovs, '` sEvric rnNec.�s�r,aRts) :: • � ... . . .deennPish��s"ra,��yr o�y s,r�sc6eer�ej,��iqa�.'1,�:�tssuance, ; �' AND/OR DRAINFIFID . qyJsp ( �.�, _ . . _.- ... �.� . . . - , .. .reqsda�es tbe'a,�ip%icaria .smcb'. eranse.so f'rYe.a �' Q �:,.,c�ssvoa p ozrweei.❑ : ,.'�� �..:,.. _. .:' . : .:.� , ', �. ' ssgsied s&e�anaerit�Bhoe he.as..Pieevued prarsuraat.8n abe " rahre,eevaa.sEwea oe �,,,�. P�visimsxs of tbe�ConerrastoP's I.acense LaF�(Cba¢}�ter 9 f � ' �.;. s�vnc�oisrosn�svsreM .. .. . . .. � � .. . - ...�. (enmmeesci�g wsab Sertaon 7Df1d91 of�T.�viadon 3�of tbe �- qSLONNEGT PIUGAND�.� . - . � ' .'�� �-.'-. �.�: . B76.SA9S&53 IIM�P70,�BSSIOW3 COd�BJ�OY$F96$Ol¢9S¢9fQ8Dt�$ :�; ABANDON:HOU5ESEWEk..� , '�:... . .:. _^.^ .. . ._.:__"; PIJSf'BfR9HeldAO"4IlB.L38'SS,f.53'.`�J¢�E�i2g8.�I&Y8i78�PtOR.AfYj! �'+ az.cocFnysevne rAraKs❑ ; '.. srioJasioa o,SecBeoox 703Y:5 b a �- s�Er cirls ❑ cessvoots p seb�ecPs�e appTic�¢aas so a es 1��Tty»jaa�vm��e� �„._; r :.. -.LL (^'z�..�� ;�:,-�'� �� - �ve bsxdred dolPat's�'$36Q1>r , ��. { _❑I,as the mwnee ef fl�e p ePdil do thewark,�nd _�. ;_ _ �. ; , �,- e , �_ :,� �, � x ,t �� �":��°�' 1'� �L� #he stcaetvs°�is aiot�ntended or offered#ar sake: ; . � ,.+ (Sec. 7044 Bruisye,s,s��+end Professaosis�oile Tif-"�'-an- ` � � � sacborem k An„ase yraooded tbae strscb �� ... ,. , :3k� r�C� . „� ; ' �y ._ k � � ' �� - QYOf1EYiy 3DdlD�Paf�S�w a99l�bTOVBs t�IBT8091r ll9Ma wdlO[lo¢S ` , . __., .... �,e s - . . . �_._,. .„�.. „_....._ .,, .. _. . ._.. .�: '� - ' 1V/ . . : �.� g 89qf11'0;18 89iL4 �..�'. ; , �. .._ r � . � are�io8 iiidevarleid��or afferart,gor sale.�,a�howav�ew, abe _ _ _ ;� ;�ssi5; ;nx�f� . , ,_, d,tiarldirig or ffxprou@ew°.ea�sr.sol�auitdkra nts�year af �..._.. �Y. _. ' '. '�,. �� `� �.��., — - .. ._ � coe s$e burden. �. ` ' L � J`^ s�,,a,; rovs Yha� e��SwaGd�or�'�rove for tb¢ a- : - � �a� � .m �.. t,ti�,. . ; _ Psr�osa of sale.e`b�t 'h.^.',:^1, ; s�.��, .�: .-. . .��, . .. . �.� a '. �Y��t7'.Yr o �. :. • ,_, .<..- :� 9 - -� � �..: { . " --, , . . .,:a �.5 a-Tq i'_t�..:1..C," •_._�.�.�� ..C�� °.:�`$HA�S�jSL Yll'I�1'"�" ,..H . . - ._ ,, : .' � . . ""a '���., j ..5 ; °�; .'-r '��'t . �"YE€�''�+.E��_ B��c��'.�(➢f#d11S SQ3SOh : .„„ ,� - . I �- - ,,, ..- ._ . �._ . �. -- . . , aix � n � � � � �` � � � :�.. . . n4`f:.W ka t h ,�;�` .. ,. _ _ . . , , .. . .::.+ . � . ,:.»... � � ,". � . � ����v��V'�'�,�^rt}l �' _Va�. ....... .. .. ....._... _ 1 t ` ., � .- . ` �` i - - ' - � � � - � f)Wil@�' ,i, -. .. ,�.._ ..- - ,.... ._,,... .. .�.�. ,.., �.�.._. �... ,.. ... .... .. �. .. .. �>.., .,.. . , .,. .., :..::......__.:�_ , . ,:: _.�. .�..: , . . .. .: .. . . ..,. ,;' �NSPECT6AR'S NOTES , _ �.___ �._., ._._ � . , __. _._.. .. ' a : y' . : �� ��;,G.,.�.;�.;.�::� `' �.,.�z.v a�. ,.. . . � � _ ._...a.��_ ..�. .:�:�..�. - . , �.,�.�,��.�,a,,.. .. _: , - �'..;. , ,':�. . ' , �. , .. �,:. . �.� ,. -- '. ' '�. , _.�.,+��.�_ ..._ :.. .. . ....:�_ ..w.�;J.�,_.<... �. ". 4 m � .}ye- ✓'i�g� TrtYb d a'w.�s�.r. s �.c�..�w1s uw. r�.�, S•+ n.t� (taa�.�v�.u... aY s�� 9'� �.eFk:K.e. L��. i t:. ,:. a � ;� ,r, n, �r ' �... � w«, .. ^�s��^ � , �,.� � ��.���,..,, � .,,.,��.s�[..�,;�.,.. , � v �.;3"'x `.�t _ 7 6�^'�'. � .�, ., .� e _ a. r-�r»d . ��a4 �4���� �.�'���YrJ`��'.a���st� .S'..i,��:^x z;�Y�'', _ ta.-aaa.�.." ....�:'.« , „.u....��#„m�,.a.;a?�... w.�.a.�o::e�,�. '�.i,„.ww4i.%.w�:us.,»,,.M., ..-, . -�. . ,.. . . , �'.__..._.,... .:.�� ���:.. .,, -".'.:..,. .,�..... ,.�'�.�Ha..:.�aa:-au...�,s.s��a.mu:<n:».+.�+ww.�.�wsw�wwzsa.w.wx;.�..w+w,�,,.,,:,:; :'�7, 4 t �__,g � _`'y . . .. ,... _9..1 r. . _' .b .lr.d:a- ....a.,�.�,t�?u �-� � � . _ .�`.