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HomeMy WebLinkAbout1490A (8)WMXkRS COMISE(15A1ZT+IblUMM def f (ierey_affirm that I hove a' pFft�cate of totTsent oto xif 1�t_s�r@ ar a"Yeriflcate of Workers Com (tensahon InsUra'nce' ar'+""' �„ _ ,.-, .: ,t, ssr ,r.,..a,a�.;:+w...was•.. w Y 5r Ee t e i cop fi s e4f Ser Lob C. J E see faEd a 6f S ryl MEE: Company �'i"iT'C6�. - �s - - �� �,.,.xw.n>xwa w... •. 1'...1--t_C /� SPS �. ' .. EWER', rtk�C rrrfied copy is_flled v�4fh the cou»ry bw tdtng nepectloEl _ COUNTY OCOU L IMCr"%11ID SAET'G -m k�iepartmenr. - - - f bale «u' Q _ A I cant FI'e QIIi'eli'1 .. _ pP ,.� , «,w", ..„ FQR APPCrC�CNT 1"" IC "i:�,""`..«,`.- ,.".". STATION CONNECTION? ATC ,..............., BUILDING b1�R NS µry�S A.1 ADDRESS fr �43 0MANHOLE- UPPER Is s@ctiol� nee not 8 completed f 11'Ee work IntlplY�d by file LOO�m, 'REFERENCE rRfermit (sfor on@ hundred �{r�Ilam ($100) or less) - js ww'++nmF t -w= or: less.) ." NE4RE5T TY.PEOFtTDNNECYION IENGTN,fROM LOWER '1'"cert-iCiar In e - erformonta of rhe arbrk for yvh}ch this - tROSS:ST. Y CUR P �c P $; p"elm it Is. Issued Y shall not employ any, pel'san irc arry:monnar P c NO f `irs T6 bec�i ie sulltect to the WorrkerSY C rjTpen;orlon YLaws OWNER co. IMP. -No,- .lo No ` ry AP�ALDT Gid y�r1 it , 1 AdP rCp s`F4'�� J"14�t 1 MAI4 _22 - TRUNk PEmmI1rNO'. .ROAb FERt�,li`NO: ^' •.W: .. vuL p/� : 4 Y .ADDRESS PO 'Bo •:... y, p .�uAsi' tl4.1 AFFIDAVIT RIVER EASEMENT RECORD INSTR. NO -DATE- ; F76TILfE"`�f' o3}er mgking t Is Certlficar@ of uTr TE No mpiion fcsu ,s1,66)d become _subject, to the 1Norkers - LEwI ; frp'd'ri`sdflon provisions oTthe Labor code; you must,forthwlth - DESCRINrION :'4ot o _ HWY.'�OR$t WIT ENING nply w th such. provisions or. this permit shall be deemed cy ] - aJJ I 4 sr ENckOAcnXKENT > eyrlts, .,i. rro OF BTDaS PEARrreilT No. �{% ., - SIcCOF LOT NO ON'l0 1 eby affi}`m'� tXa) I am license ' nQpr provlslans of Chapter USEOTeg _ 9 commencing wlth Section 70 of Ni Siori3 of the Busl SulLDiNW ' ngg _ �ARGEs S• Pr„gfesslons=Cgrle andmy license fa m full force end � � ' " coNNEcnON CH4R6E FF'E • } I a eq.,yy,r������j��:ry�' CONTRACjOR - _ rYY p� ,�[s}yoL_Lic Class tiltense, ISum er ppag� REIMBUR$ NT F E ` ' , .,.... sDISTRICT tJO OUP MAP- 'PROCESSEa- + Conrrgrator ''I'E'@�an Dat .. cTv TEL rq PG Z '` I exam t under Sec of the .A Co ware - eS • u i� O 4m' P LICENSE No ©E acres t ���.' `�r,b, 6E5CRIPTIpN tfFWO K "fEE w �x r Plu bmg of nd/or Sec of the FINAL - ar ;`�'"' 'e.�. t5j a'' asa.. m a° :3: 3 '''[yes P�u�ICSEwERc4NNEct7Ntl. Dare /f? /�/-�. VALIDA-TIO_N __. y m- r B e Tor the fohfrowma reason - - _ Yq'h "1 RIM AN OR SEREPAGE P� OR. FINAL hIOVSE ffiWiR+".N G ... VA Dt5P0 P5 " ..`:977, V .� gnoture y, NEC _ADDI AL woaK To t16U a sr 9. � x��p : ....... ERFIOwSE PAGE PI DRP,INFlELD0. ' (I.'Q;� A � 1 f hereby offirm th6t I am exempt from the COntroCior 4 l.lte E YN , CE tlT. Di2YaEL AtAxHOLE L'- egg �w`'�or�,ttbie fglloWing I@asOn (Setran 7D3j-5,'8u stress once 'tllER. aEP �L jan's. Code) - SEWER ox DisP65al tEM"^ ..._ _ #� yin ,.YY.I+Nr._a. . 1 os owner of fhe property, or eiaployees i4jih wages as . " - - _ - 1 nt 4 27-50 - '- their „sale compen$aton will do th@ wCrfc and the sfructux x snot, InLendQd�or offend for sale (Section 7044;`Bpsmess - -• r 7,7F Q•- _. b d Rofessions, Cgae) OWNER'S permit $ Q - Am.oitI2`ATm 1 cLsowrrer of the property am exclusively coritr'aciingwith TgTAC FEE';_ Q licensed contr9FOU to Construct the project (Section 7044 I' HAVE AT THIS DATE, A CCfp7aAP.T-Wit'H HE HEREIN NAWD"CON Ra TO�TQ, hui�'ness aPd,gp�rote on Coda _ .cONNE4r THE4OVE'DEscRIpYD"E7(SY(Nr;'D'N'E3fii 'f6,Y"0 C"�ONS.. SICzNED THUS -DA OF 19p ® . r 1 h - e a irm ibot there Ys' cr tbnstruct on le4,f�rng. ag�tic " - - i for etre Yperformance of the work for vq,fo this permit Is OWNER OR IsC,u d j5ec 3097 Civ C) 'owNeRs AGE6. a • -R -' - L,., ADD t'," ";tFrG-"r }d'.,.r* .6� ''N*. iSR' .E.; �.:5 a "G i'pc,#'✓ Pw�.Sa6 ,Jy._. W,w s' a�,i. ,+.:nw +mw ,T: Y ., .,, .. .. -., - ... ..... .. kg a, 1 certify I thar�ve read•t Is a cotonand"store that the - Len er s Address _ - 'Ts correct. I.agree to comply with -all County - - 'a a�b��gve iRformat p .. . , .. .. .... _ . . ot"dinances pnd-,$tq(e, Iaws,regulatingPlumbing'and Sewers, 2�13 }rerehy aurFian�e representatives of this County'fo enter - - - - h�$p't3r`t`ih9 above mentioned propenyfor Insrpe<t ort purposes Pit Mo 6=msµ r N . SEE VERSE`l;0'K'@k1�lAil`X'T$�°7"L'ATcYik.'iDCf:k�"""�` �' :x -u F tl T ,• Slgnaiure of Perm ttea Dgte r r ,.:..,. s INSPEtrO SNOYE� i9VAREjk 8tJILDR R iTAPi,Ai'iC N t �- 1 here y affirm that I eX,ln1,(g ftOYiP Y� LAntraetOP's A�PIt�WpeLS DATE iN57rECF R'SSTS`iNAiIYAE re9� ._......;. reason (Section 7031.5, License Law for the fdlowin SEMR -.' , and. Pnf"ti An city itty BfvSfPde3S ' 9Sv CO(deJ .COP! . NEW HOUSE —_--- :.,. ^^"' ^• - - - PUbi'Cb requires Permit to construct, after, improve, .NNECT ADDITIONAL CO BUILDING OR WORK ,,.. .. demoisb,'or �repo'k any Structure W 2 ;EO SLS issuance, - SEPTIC TANK, SEEP. PIT(S) > a rs app icn or swb pe de a also gvIre's the d n$ f i»PPa $O file ' AND/OR DRAINFIELD - 3S ed S$ntevHent. Sia$ be i3 licensed' prswRat t0 the CESSPOOL O. DRYWELL �. ,.,,..-.«.,. .mow.;: .. _ -.. '� ..'" .q..m�.. .. ..- < . , �: ,: - vass®tu Lhe Contractor',c,%vePase�, w y°C�Sa 9 . -.. , on 70tl vasa t'� . g withSection ®$ . .. 3 .the 31 ALTER, REPAIR. SEWER OR OR - " - ` - •»^ :: BaSdvtGFS and ProfessSOnS, Code) or that be SS a'k'ev%pt SEWAGE DISPOSAL SR ' PLUG AND < : - $hei'ejP'om and, the batt3 for the alleged exemp$dov. A DISCONNECT ',_ ABANDON HOUSE SEWER,...�*"riloda2ias of Section 7u^3l.$. any applMaw$for dt pevYPSSt }:..... BACKFILL SEPTIC_TANKS ® Snbfee# tba apP&Mt too clvllpenalty of not mom than ' ,�,.•-- SEEP, PITS ❑ CESSPOOLS _0 -- - hundred.,dollars. QS300A . '; five w L31 as the own otfnthe prop ork, and n ?' t ' +a n m .t x' e s not d or for sale W ! 7 th tructure is tends sv s {SSeccl 7044 Business and P%fessdons Coils 2L `G,m_td - _ ?-'# O✓S 9 Law does not a to an as o property wXra baetlds as aPiepsidvas thavea ,aped wbo,daes x " 77, sacb work bimsedf provided that S,.b h4mve»tents ! .. L. are°loo's sPtdessded or offered for 3aie. If, however, the :- w^ buadddug sr €Prr is sold wetben oPta'yeas of i = - -- compkaon, the owns badder mill have the burden - 1' =bf proving that he aid not baddd 'or improvefa9' the -; rd' '1 s f k�i r.{lx7 tpgse of ands.! :. w r A3 & P.C. for IAS 1T@Lii(9b5 Dace 777777 �. INSPSC70R`S NOTES rn f 1 r' � es rt --------------- 611,` l _ a x+ixaxv+* : °M- Y'rmGta. wiF -n -.: r.--: �>{... nv .rn W.TM" a:aMn"w_ }. rwvnrew .5•;•v..r .., ..xw-.ry h+,Y:,n e4.yp He.�Miawe®..x.qw,ttryty'fh"%'cv.@pVW?Y8�%$��bACrc.43.+`-5kr,..#atW4tith.�xax?3d yw..,.+N. �a..�•.rc3�.r+�a "svweu..,- A+...nr Y,=, emn",+^. 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