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�, - � .... .... ..._ 4 t .,.q- Y �a . ... , ,: .. "S t�u.�'0` � '�` � � 'F�4&;v 3'�5r"=�' �„�a"�°°..�rn,J,�a�,'�"'�.�,:�-.'".�."�` �.. ::�'r x��"`�i yr��� �..".a"s���v�'�"�.�::..,�..'�+:..^�a: .r�..r. +�.,r«:..i�=��,t:...�.F�.,.--.s.,..F. .z-.- .,, - .,;w��2S'� M SA� ��..�I'.�A� A �� .. . cs oa�t brw'a�re� , ., � ... . �. . ....: �,� . . .. ,. . J��r,�� !� � Pot c 1�a�o thedt-I fio e a certif mte of consen� to self �aacnzo - - � � - � msure br a certficate of Workers�Compensatii5n Insu�once,or �� � - ,.. ,.. . _,�� ,., ,., , � � CE 808.,.. /� p� /�._ /q �y}�y�^y'�+�,r :.:».. ...,,�......:......_ .�,..�._.. ... ..._.�� 1 ereya rmt �.._ PY reof(Sec:"3�61.a6C. .t p1�.p�,��rA���l�y �V� fCIC1Y�11 , , y .�C f � Compaoy 0 Pv���� y �,. �.� �.�.�� .���u � , .��._ aY ...��� .,., a:.�,�_.r� SEVUE� -�SEWAGE D`fSP�1SA�.. _ .. a Cen tied co is feed w�th�fie tounl 6 ' �. uilding inspeciion - -. COUNTY Of RQS.I�NCsEL'ES ' FfU�LbrNyG/KI�D SAFET�` " `N` " ' � "' � '�� flepartmenf � a � � .. . .` � � N ,f FOR APPLIC�4Ni7 Tb FILL fiV sTA��` � CO' w� Y Dateta � ��Appl caM ��✓� �-'� .. .. .. � . ... ...��- .. ` �E�itki�a,YE�"bF���`��Rtl1�C��3"6kR�k�"': � NNECTI`ON`D7i`�A.'" ,"`--.'�._�.,. � �.y ���pyy�s yry. BUItPING OEFTH � . co��IVS rtro�V�IV�U�I[f AooRE55 a � �. �x, .��_�µ _� (This section need noi`�F`ie complered��1(e w�oi�c n oi�vec�.�iy the i�Ai�tY p�p f - - nnnNh+ae-aekea�nee �� ✓ s�,�� � '- 'uPPER�� 3 ;' pe Fn 1 is for q'ne h`ndre`d dollars::{$1�'O)or leis j �� �. w� � . N�qRESS �� TYPE!OFCONNEC7'�6N' �"�'� LENOTHFNfYM "�.-y�," ' � i cert fy'thor in�(Fie perforrriance o'f'the�work#ar whidh th{s� ceoss si v � ..��ge a� nn 1,ro?t'.. �� p � �" p�FMu is.isse�ed 7 shall not empioy dny person n pny rtlqnner . � , . . -�� � , ; ,_ ... �' ^� so as Yo liecome s�b"ect ro ihe Worke�s Com ensahon Laws � � ?:c No � � - ,.. . I, y,;P .. , OWryEp, � - CO IMP NO.:- `fOBNO. ' � �. : -' �" ' .. �., . , � �yp�p . _.,:..,..�_, - :�.. ,��� ��_,.�,-• hr��dsv-. �Kr. .}..rak �` tlDRESS' +�^�SJi... ' 'RU�KPERMIT:IJO: ......�. . �.,....R6AD6ERMIT'NO:-.-. . DaYe -,. � ApP#(caN - .. C� - . . `� xz�' '��'' ,C„� .� AFFlCC.VR� N'AIVER EPSEMEM 'RECORp.INSTR�::NO. �ATE � � NDTI�E TO A'PYI,I�ANT tf, after,ma'�ung'ihs CCFSti�`cOre o�' � citv '�: Te[;No � ,.;E em tion, ou shauld becom'e subject �ffo the Workers' ' . . �: . ,.>-.- . . ;.. � p ,�. Y 4. ' •� Y ... DES R PT.ION LQT NO . . ;�mpen'sphon prou�s[ons ofi�the la6or code, ou must forrhwdh �� � . . �-�- ';`:`c6mply.w�nh.soch.:prpvisiops�pr,:this peerriit.shall,�ss deemed � � � �� . .. . . Hwv ORSt;wmeNING �._ � . .. . .. . �' IC OICBd � '. -: -� BLOIX��� TRACT � STAiE ENCROACH/J�ENT�� �' � .-� �� ' uce�Ice�co�fr�,�t�'dRs`�e��rrCrl�; r,oaFai�cs ���-"o " ��"x ti�"��M . . 51ZEOF,tb1 NbPdOhYYdI" �l � 1 hereby a�ff rm ihat I nm f eansed�under provisidns of3C�hapaer �E pi� � ��p? ,r y�.;.�� �. ��. 9i wmmenan with�SectiOn 70p6'of Di:vision 3 of tlie)BusP " " -' �"� ' � "� '� � � cHaizceS" ' '���" ��'"�-`� � 9 � SUICDINGS' � � ..; rre"ss ancJ,Profesa ons�-Co'de,and rriy license�is�in t�ll forie and � � -����•,� _� .�..,w _.. _ _... '= efFe[f , �-r� �f /�� CONTRACTOR � �9 CONNECTION-CHQRGEFEE� ' � } � Cicense(�7iimber-��f7��� lic.Clcss.....�"'�.`R? � . - . .�'' �.. .. . .. '� - �. -. � `....- , vJ , ADDRE55 � - RFIMBURSEMENiC€E O .: . . �, .... ..��p- �'. ..-' g.� ./� �^`¢• DIST2KTN0. GROUP�.. MAP-..� . �PROCESSEDBY'. .. : Cof1lfQClo(��.�.Q��9�te ��. .�� CRv v TEl NO A 97"' 7 g.. z��. , . . �,, e.. , . BK PG . I am em t�ndec Sec - � of the Y A Co -' T-t SiATE LtC ) ,�- ,,�!-� Q� p ., . � , uceNse_ , t$ ' c�ass � ��kT �.�' ' �.�� ��' -fl � � t "'"''�" "`�`•^" "" �� `"'"' DESCRIPY(ONOFWORK' "F�"' �� �'" ; � P - ,w.r:�'„� ..e ,. . .. Pl�um�ing"�odedn'�`/orSec. - �, "�.ofrKe NO '- . �. -.:. FiNAi . .U.. "� -� " � ' HOJS�SEWfRCONhECTINGiO�.� � e�`f �ATE VALIDATION � � '� B &P� d,e for�he following rea�son '' � -P�g�ic'sety�rz} ' � }„�^��,c .. ,. .....� SEPTIC Tqr3K'S EPAGE PIT OR'-' = g .:, . .-rr-n---m.—. . : . - ; . ' - � ... . PIiSAhD/OKAf7A�NIFIELD .. . , B7p� H.- -. .� � : , HOUSESEWER"�C()(JNEC71NG70.,. � ., . _ . ei'�� . y ... , . — PRNA'FD15CC753L SVSiphC "..��✓ ,.:= :i rJl !la}U ' � ........ .,,..,. . ... .. ... .. . .. . . 9 �' : . CONNER A6DIT Al SIbG�dK � OWNER BUItDER DECLARATIbN woxKroHousese�R �: " �� � 8-^"' OVERFLOW SEE A'GE PI7 ORR FjE D �� � � ,��1 h�reby aYfiirm ihat I am eze'mpt from'ihe�Contractor's License Ex*N cessapaT Dev�lt�et�,'t�4NHo�e � � � ��- Law for�tNe folbwing�reason(5ecton 70.31:B;.Bu'sness ani]Pro -.�� n�ha keaniz'prs nB,4Np6n7'rlbpsE ""�' '""� � � � `:���fe55fOf1S COl�E�' . .. SEWER OR DI POShI SVShTN-.., � . . . . . . :r :.::. , �, ,. .... , .... . . . . . . ,..; - :.;_' . ' . ��. . . : . . - ', [�i as�owner of thej�roperry,or m�employeeswrth w�a.gesvs � iheir sole compensahon w 11 do the wo k and ihe str�i�ture . - � �� . . �, is rtof intended or�offered fo�sale(Sec(ion 70�4,��Busmass �' P2Ftttit �.$ � � �j.�7�Q�� .. u � _,n. ❑nd Professions Cdde) ` OWNER'S 'G9_ �" _ ❑I ps owntr of ihe property,om exclusrveiy corttracting with AUTI'IORITATrOI�E TQTAL FEE - �m o e � � (} � licer},sed contraciors to consirucf 1he pro�em(Secf on 7D4A �Hqvy:qr TH�s pq�e n Cb1�tttACT pTTH THg.NERE�r3 K1.4MY£b"Co,'NTeqGYOR'fo' . � , Bus ness and Pro�ssions Cod'e� CONNFCT THE ABOVE9ESCHIBEO E%ISTIIJG DdJ€LL NG TO 7HE PUBLIC SEWEQ"" : � ! q.'o�'�j a . = C(7NSTR(JCTf�hll'ENU'IFI�AG�M17�CY �. � � .. - - �z . � I �iereby'�qf��rrri 1T�iat�fl�iere�s�a�consfruci�ion lending a�ency� SiGNEDTHIS DAYO � � 19� �� ,- o s m 27„�} �,,,� � ' �for fhe,pe formance.of the work for which ihis permit is � owNEa-oa . � ��� - 'i issued(Sec 30�7%,CiJ:.0) . „.�-'... . ..., owNEa�S nGENT .. �. . ... . . � � �1 C 6��-�,7 lender 5 NV ... _^� ..,. ' . „ '_.:: ,. ., ..'�: ..:, , .a �nODRESS _ . " ...-;.� .' . . . � x- ame .: '��� �:: ..,: �:, : .. # � �,�,�„ �. . . .�: .. .. ,, . : Lende s Address y.. ._....;�. .,.,_a _ .:;,�:.Q_:.�..�. .,.,.,,�,.�F>-�„�..:�.�w=..,,�.-:;�«-.�.,..� «,�,.s: �,.�.�....., ,,. �. i�,«.�-p x ., , , ..-., ;. _. `&:. ,.��.. .,:. ,�.:. ..,.. �,;-:. ., _. ..�s;..�-� ., .... ,. ::.. � f certfy�t�iat�l (iove��r'ead this applfcation'apid stota ihaY the . . . � � � �'�" �ove informatron is corrett I„qgree Yo comply w�th pll Cqunty.-� � - � � � � � - �. - � � ' or nances qnd 5tate�.(aws�regufating Plumbmg and Sewers, . � �-,�, "� � '�� � ���� - � � � �a d hereby outhorize�representaUves of this�Counry,to;:enter `� � � - �-� � � � � � pon t}�e.ab -men��wBtf�oroperiy for.inspecibn p�rposes, . " ' `:::-. . � ' '�: ., � :: . . , , . ;: . ... ' ... . - - c . . � ,. . ,. . .. . .. . ... . ._ . _. . . _ � ...-�1-�--�� a . _ ,.,.. _ � Si natora o e m�ttee DoTe_ .��. - SEE REVER5�'XbR E��LANATbRY[ATl�i17CGE� _ ' ' "� "��� ` � � �� " 9 , -, .., .� :, �, �. � . � . -�.� ��., �..;_ - . '_ _ ' - - _-.7.,.. �c�.- ...n4 _ _ i : ,., �.�._., �; _ ;;� � � ... . _��.��, ...�"� Yras��csoors�o€�s ° ,. � A�, � s . &�WNE3�'$I3II.I�lE12 DECI,,�R�'T'[�7I*I � . -�-�--x , . . .v � r _�.., <a-->.�. ...�� ��_�f .. . ��--�cs---rn---p ,-�--�..,�.. �_�._�. ..,._,�.._.� . .. . ._ ..�. . . . . � ... . � � ��pp���,pa`$ - onre � irsaEvou�`s scrutuRE��"� � II hereby affiem tPnat f am exeraipe fmm Che Conasar`tor's�_ � � .. .. ..�-- . ,. ._��:.... _�_ . �� ... .... ... .. ... ....:L4revse L"aw?or`tkz�foPlbwing seAsou f�ec!%¢ia 7031�.5? � � NEW fiOUSESEWER . , . . . . . � .. . ..; . �Sf4S1938S5�936L�TOfCsSko�b'.GOII¢J:�.A98� CZLh/.+lT[.Ye@6F$y .. ..'... �.-:_ , ... � .. _ .::. , � ..� . . . � "__ . ... , _.. 9 � ...:. .�....� t�_ : �,�,_._. Sru�c4, a$Eax,...am r s cvJwaecr no�rtior�nt� . .._,,. ,�, � , � ; :�.. . ,.,. ""�"sv8%ch,ioQutpes a�,9erert3�t t�.Eoa?s.. . {7?3',r . . BUILDING OR WORK '� � ���� � ' � p. SEPTICTANK SEEP.PIT(S) ., -. . ,:.:_'.... _` ,� �'.... .P.-,—`... ,- . SSI9 t696�fC J1#par`surb�eJ7JJiL��T.'.Sua#C0� . . l�SHtO� n Pf ME 0.4f Cj�d�" . . 0/OR DR.4INFIEI�. .... _, '�` �� $ p�' � 3 � p � P�N �arso s�e urr�.s i�e a �"��.Te¢ � _ . _._.,._._... , - sigaed statemexE sbag.$e as Zsie�."sedpmrssr.mrs to tba . . c'�ssvo� ❑ pnvweu p ' �""-- ��•��,� � ....�.....,_. _.,,.... � ._...__ _.....-...�__ ._._,_..__ provessosas o,j#b�Cott33°sacBmY's�sssmse Laev(L'b tf r'9.. . �- qtTER,�REPAIR,5E5MEROR"..._..__:. ._. . .:, .-_c� r- .-� .: ...� �CO?12fJdBP4Ci96g�witl9 SEGLSo9t 7000��O,�ZDSa65Yfi9&�OJ Lj3C'. $EWAGE�ISAOSALSYSYEM . : . .. ... ;v+..•: ^ „ -•-...,-„m-....M ..,... . .. . . . .�.. ,.. . .,_.. ,. . � . ��u"serosess anr8 Y''rofess'daiee�Coi1e'or thaE h¢is exerie,iE� .. WSCONNEC PLUG'AIdD .. . . ... . . . ...� . . �. . � ' - ' . ABANOON HOUSE SEY�IER . .. ... �.. ..�SBYC,fTOpt 6Nd EHB LkSfs foT 81Je R��e$¢rZ�z¢SvafiSfa)ft..tfl9YJ1. . cksuiserncTaNKs�p � .. . ' .�.. .... _' .. +no7ation�o Se 'osi703138 ara�ia ' x1 a�r.a erarsit . '� - SEer,art(s � cesseoous O � . ��, . c. � � ssabjeei�abe�a,��»t 10 a cer sl penal�of vsoa mor$e abceas��. .. ... _... . .:. �....::_ :.�....r.�..�.�.+�.-.. ,.�.w-..»�.�.��-m��;. ��� .-:.....:_�ve{randrerl rtoTlars d$300�t '- �:., :. ,. _ . ' � . .,.: . ., „ : �.�., , ,� " . . . " .��. .... , . ,,�. ..., > k �,.r., - '; t ; ��- �..�. �� ��:�L�T,'as the o'Evvaer o4.he�r,ogerfp.wal(�da 2he wark,anti�. 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