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HomeMy WebLinkAbout1636A xi;�.�:x��suu- ua,.�„-.�a..,:� .-aa.m:.�e�z�+�.,r�« :r .�k ,m�, .cs,.roa..+w�:�:-m.�6a--.a;;err- ,z .i�.. r,�;•W�+-....��.�.am�r,.,�. � i ao: z,s xk- .: �.� � ,� d ���..y ,: 2+; � :�.;�.. ,� �,._awa...�.,.�».�+k„�....«... ... .v ,�..,s�,a:,�..,,.�� .� ,�.,r t3� . . _ _ ,..:. . W'�l�t� €"6�K��Y�i f`TS�'J"��AyiI��I° "`�` w. . _.: }�%' ' "._„ . --��.,�:. �� �9zooasoPws�s� 7 - msre,�or a�certrfic�ale� �ave a cerh{��4ote o,�consent to sel� '� " ��< �� Y �� . . . ]kP64R� � . . ,� bf Workers'Com ensof�on iosurapte,or � cE�� ., , . . /� p �r./�* �+' ... �+�"�'jy'`�` ...._:: � i a Cerfified,c,o�p,y�iti�reof(Sec.38d0,"b C.}�' .-p__ � P'1��"��{rl1�i����1����W�GRRYti1T _: ..,�. . ..__... .�" PofcyNaYCY7 �Company � 7 �.. O: �- ��-/� ��ry � ^�''�,�y�c p� .yr. . . _._ .._ : ..,� ,�_ .:; rMc. � . ��YYC� -.fi�YY IJ1"VJ/'\I. . . . , �Certrfigd copy is hereby fumished , , ' � ��� � ,��. r .,,. .. ,� _ ,. .. . _,;„ _,._ _ ; _,. ._ . .._ - -- �d�� . ..,,..,dd. ...,.:-�,.- � ,...: ._. -��_ �Cert fied<opy s filed with the caunty buJding mspec�ton �� ' �J�TY�SP C(SS�YJ�a„ELE'S`hM���A '� �' "�����. 1�tf,�j71F��'rY , ,, ti,,,,, , _, �. � �, departmertt . �, �� � _ " . � .� - �ate 8 r�.e� qppl cant � � PQR ApP1iCANY TO FItL IN a f CONNECTIOwI,DATl1`" � "� CEk7'i"F�CArE''OF E�aE`t�l�i�`I�'FrRROfu�(`i�y,Oki�°�'�S eui[ciNG G . �. � . �. � y_ ,���OA�PF�+IS�HTI�N I�SVR�IR�E �. ' AOORESS� SiAT10N � ."-.�^ DEPTH �� (This section n�ed notbe complei��i��the work irjvvlvedx�y ttiex� � � �- �� - nwNHo�e ae�aeNCe � � -�� � .. �- LOCALIiV - � � ' .,,. .... : petm 1 is for one hundred�)olla s�,($lOp)or Cess) � . . � '.� ���R� , - _ . t.,+ .,..,:.;.:, _. .: ,.._�-. NEAREST �.�. ... ' TVPEOFGQNNECY1017'•�' �.."` �N6TM FROM� � 1 ce t�y ihar in�tha`�erformdnce o�1F`e work{or w�i"iah this � � �� � .. .. p _-. . . .�. CRO55 ST Y CUR9.. P t . M L TO P`L.' �„" parrl�1 s ssued I shall not employ any person n any rqan er �� . . � . � .. �- - . . -�� � CD IMP t�.��.': P:C NO �, �'�� s6 as lo become sub�ect to the Work.ers Coreipensqt on laws . . owNea� '�`�� � '�- -oe No' ' �' ^ ��. : a ,� ,,� : . •. ,: -� :�• �: �� ,y�<: v''�" ' AD�R�55��� ��.� TRVNK PERMIT NO: . .. ...ROAD PERMITnlO:..' '' Dote Applimnt ' . �)�.. . .. '��ompen`satw�ro1v s on�s o{ihe lqbor code}�qou must or hkwi h � oEscRiP� � � ^R�oavi7�. wniveR,EnsEn,teNr Recoao'iysrR��r�o; �onre "� � .� �a -- � - _ n E��PY�� Y...�,,. . . I tei:No ' i 4C �" " � � .. k.,�., .,,.,: _ ', P � .. TION IOTNO � HWV ORST WIOEN�NG� "s cet I with sucR provisions or ihis parmrt..shatl be-deemed � � � ' ` ��� �� �� � �� �-- �� "YEVOke(� � � ' BLOCK'� iRACT STA7E ENCR�:4CY/fT�M � "�' ��-' � q � � a � � � h� � � - .. � . ���NO OF BI,OGS PERMIT NO �- � - ,,zUCE[dSEbtdjJTHA�i25�,FFS`U�C1�4kAT10N � sz�or{or NowoN�or. . . ���:....�J�� .�, �.. . ..... ... . ... ,. '7 hereby aff rm that I'am I censed-un er p ov�s�ons�of�CTitrpter�� use0e�� `� " - .:�(commencmg wi,rh�Section 7tlbbp of bivsbn 3 of tfye.,Bu4 .. euiminics : ��� � � �� � �p.pQu���--� „' n��aniJ Profess onrCode,and my 7�cense is m ful�fortQ and � . .�,� �. � �� `�@ . � V . , , , r . . CONTRACTOR �� ' CONNECTIONCH RG �- -' f � : � A E FEE....., . ." . �ry ��^ � y ,_ ,�License�Jumber3�T��b�{�Lic.Class .�'^-���. ..::.� n�Dkess � .:. . ;.... . - . ReinneuaseraFNT e _.. �..,. . .. �,.�.. ' � ^ te L�r, jj 7 � c � . ['.,:.. D�STRICTNO. GROUP MAP. .. .. .PROCESSE�BV.'... ().. - Contfactor � �(j CITY ... �� IEL NO JT � � ' �� C]lomexem underSec � � oftheLA Co SraTe" � � i � y� ` irc � _. ���. ��� G � f a . , fICEN5EN0 .W = ClA$5 "� � ; s .a� .._�- ..w ._. .-r � N� . DESCRIP'".fON OP WORK ` FEE' .,,..,.�-. , ..�:. ..� �' /� �..... �.. �,��` Plum�ingCo an r5ec� ` " ofihe �� �- �-��� =iNnt , ' � ,. U - _../'�' ,. ..�. _,- � ��; . �' }� rioose sev,�a c�NNec�iuc to'- ( 0� a,nre `� VAL(R4�710N� w � [ PU6�,7CSEWEk:. {.� ���y.� . � 4,��' C e for fh fplloWing�reasan �SEP71C TANk,SEEPAGE PIT'UR � � FINAL ���' � � � � . . _ . .:., -. • '. '. � PIiSAND/ORDRA�NFIEClS ' ' " gY � ` HOVSE SEWER CO71NECiING TO� " ' " � �� $ noi�� � PoVA'EOISPOSAlSY E'M , �"'.".A`�*e+� _ . „. `. g Ur'e /`� .� :ONNF�GT,ADDIjIONAL 84DG�OR. �. » , - .. � . . . ..... . . . . .. . . . OWNER BUI[DER DECLARA710tJ ' �- �waRK�oHcsusEse� "' . '>^*".� 'oV�RftOw$E�p�,4�PIT 6RAW FlECU � ' :�1 here6y aff�rm ihat�'�am exeMp�rom the�ontractor s L cense ExrN'cpSsvodf,p'avwftt t�r�.4Nwo�e � � (pw'for tha following ieason(Seclan 763'7 5���uisness and Pro- "ntiEe kEanie oR aBANfSON'Ho�SE, � - � � �. , #essrons�gda) . ._. , _` sewEzcraotsvo'sa1sVSTErn '� . : _ . . . . . _ _. $1 b�bA - � ❑I as qwner of the properry,ormy employees w th w,ages as � iheir sole compensahon,will do the work;and rhe struct�re � - � " � ` � _. �. . . tf e • •.,o.'( Q� � �. � s�of inte��ed or offered for sale(SEction'7�a$;Buiiness � � . � and Professions�ode),' OWTIER'S PermiT s �Q. ,$"Q � ,� 6 2.7,Jc p ❑I,as owner of the�property am eX�lus�vely contraqfing with � AUTNOR�}ZATI�N T(�T�L FE��� �� ��!�"' � � - licensed contracfors fo co1n.sfruct�the project�(Secfio�704d. � �HqVE:Ar THIS PArE A CONTRAtr'VdiT}(THE NEREIN NAAAED:,oN'RA4TOR To .� . ._ .. . . . ���p 2 7'������- � EUS nC55 anCl PYp�ESS On5 I.OtIBJ � CONNECT THE ABOVE PESGR18EI7 f%ISTIAG DwEItIFJG TO THF�PI�BIIC 5EWER � � � � �oNsr�ucT�oN CE�t�i�tc a�er�cv � � ,��'' � �� � I Q 2 6-&�7 �i here6yR'affirm fhat`ihere�is a const ucron,lending agency � SIGNEDTHIS �.4vOF i� ^ '��.,for fhe,perfo�fnance�of the w9rk foi whic6 this perm�t 's owNex oa ��_ � � = '' _. . ..�... OWNERS AGENT � ' ' ,''.,�sSVed($ec 3097 Uv:.0 J - . , . . , p . _;. � . � . ' - �ACDR�55 ' ^ '-�Lender s Npme ' � � i �� .� � �: ,.�a . i ..,, ° :"< , ,,��: c� ,..,„�S � �' . _ - � . . � ._. ._ ... . . � ,;.;:�., .,. .,�. .,.d., .a:.. . ... .- .K.m .-e..:� L r's�Address ;,-.. , ..�.�;,, .. .r�.. .. . , ..,. „ , ..,::.. ., . _.. . . . � � ' .' �.._ . . _ ,.: �:.:. . ,:� ,. _.n :... ����� abov informationis PP ..tthe .�� . ,�� .. .. .. . � � . � o din egsaanldh51a1eTlaws'he �d[lo a fYl mb d si�d Seounty ,� � �. � . . .. . . - ... . 5orrect.I a ree to cqm I wrtlr aR C, , 8� 9 9 wer5, � .... . .. :. .. . .. .. . '�-.� and�ere6y aufhorize�represenia4 ves of ihis County to enrer � - � - ' - �� � - � " � upo ihe gbov entio pr perty for inspetfon purpqses. ' . , ' ::� „ .�.'.� .. . . '.'-:.. . '::`.� -.....- ..�. � . , C . . . . . , �. � . _ C�-z7,cn <� .�°�.� .�G�—�a3.°-�'�' ' �_ , Sigrtature p4—'Qermtttee Dofe. , � � �� ,SEE R�VER5E FOR EXpC/CNATtlRY`LANSE,OFtGE: ';.�, �,- ,� �� ;,,;,.., �, _-_ , , � . .. , d - ,� _ -� �- , . - ^ r ��, ; � �� �, � . ,�, . , . ,_i .. , � . _ . . . ` ��i �;' ��; s x�z .•.ard�+��ts�s sao9�s C3�INE�s't�L1�Eit`I7L��,.9R�4`3�43N .,: , � „ � ,,,v,_r �,r. �_,.,;� �F.,�.,�.,, � — � , � onr� iv�s�`tfoR3 siwuniva,e ,..-.-, . ,:., ` �'. .� � . , . .� �... ����i here6 affinu ffa�f I�aeh exem'e fto�th�Cd�ate�eto�'s'� ReP4�ROl0:�L$ - Y . g .. . ' .. ,= `"'� . .:Litense Law for r$e follownng reasasn(SecEOos�7Q31o3,"" NPN HOUSE SEWER ; : . ,� �: � . ` �.o �P . .... _ _ . ._., , . ., . �„ ..�i ,..z.. wsros¢as Pofassso�s "osi¢f:L�a�� ce'�y mr r.vannay' - - .-.. ��,.-� �� ,. : B . caraNecr,nooinoraaa , , ., s ``,�!i+s"+�eb re•q'saerrs c pe�ss t.o,.�,onstwsa aTssr,;,amproo�; BUIIDING OR WOR1C ' -,, .-.� . .� . : ;. T � . . - � . . ' SEPTIC TANIC:SEEP:PIIl51 .... . .. . -�—�---s „--�--�-.... � dEl13o 5.8 OP Y�.tpy�T�ap�y S3f'aGCtfbT¢� oY�O sds 453fd6ftE¢e . `�ND/OR PRf,INFIELb :' ', � ,*.. . � • .. ,.�., t . ... � �o fe�tfETBS' db8 mpQYs`cz� `jaa°s'�'ernis'�"�o fiPe o... . _. __._ ._ ,a .; : `" " . -.„ ., zd sta ent t p � � . . � , . 4 �cigaE. , .. baE"33�dt SB�n:sed 9ue�suQaaC to E43e,.. ...{ . .-.�...� _ ��; �`����_� ."...._ �.:. �� A.rotissions�of Sbe't,^orataacears Lscevzs�Laur(CbapEew 9 � . tEssPca❑ oanu�tt p , :., a�.a _._ r^"-grssrvaess"��#'rafastiovu""'ai$er o � ALTER,PfEFA1R,SEWER OR 7 . `Gof➢i9P.eeaGYR t�sxIIa Se,�siott 70Q(BJ�oJ vavasaoaa��3 nf the SEWAGEOISPOSAt�SYSPEM l" ` .. .y S'TJ�&�!E AF ,(..�m�Jt... . 'Yt? .: "'� .. ._. '.•.':. . . ".,. ; �.... ,� r .. . . . � . dYSCONNECT FLOG AF10 dAc'xFlus�Pnc Tn��s k �., . ,.. . ,....; ,. . .. .. c y. -,....- ..¢., ... ...,. .. ��u���ectdafa��D3 a cs"vid�yn�ad arzeaxiga�ro�x.AwY, . �_. . ' � . Appls'caxi;fae�aparm%&��. . SEEP.PIT S❑ cEsSroas� � �� y..�.Y . bj ¢p' � d8y of naSmore tdxcas � - ..._.. ........ ._:� .._... ,._,.. ...,..,c„, ., r �. � �. ,fsv��s Kts�sdred doddaPa C$500).. .,:, �.. . . . . � r . ,„. ., . .. „ � ; .� �. ' , �- � � . . :, . . _ �. �f .• e'"t,� -& � y�i "�' �, Y,as 8he ownea of�t3ie ropzrtg�wilS do Rh�'eaoak,and' � .. :._ .� � �.. .. . .�, . ` p ,.�..,.... �_ 'd_ ,.�� ^a<<,.- ^-^�.t..—�� � . ,.. _ .., - �. . . � - ^ __ . _.. ,: ;� ,. � �-ihe sxreictute a�xiog in4euded qr±�€de'red far saT�. 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