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HomeMy WebLinkAbout1637A � e � �r� �-;�w s�.mre»� mic �.?� mr� �?+3�+��ea�a�v#�rr�€^s�- a-�stesr . �j,�,,.'m�.-«�,� ... �^a»�e- ..�-,�-.s�.Kr.����e >*.s� �n�� +4^�.� a3' "� ,�,�, `�m�r3`�F+���».+�'� . . �-.�,r - �.�x �� �. ,�W6�RIYER'S �`OMpEN�Ar�IdN�E RA`f p� .•_. . � . .. . -. . _ F.E r i v � 2 , . " '9T 90oP oT'1�J 379? " ` . . � � hereby affirm ihdt�(have a cerhficote oM consent lb self - � � � . . .N u.._� .�._ ,.: :_ � . � . �'-msure ar"a tertifimte'pP Workers��ompenstivon lhsurd)ice'"6r. . 7en6a2o- ,� � �� � . ., . - -�yyy`,yi, yy� y�/��y/�� � CE808 �. APP���A��A7\y0 �/���■ b�\��1�� .. .. °b�rhfied cop ihereof(5ac"3B�lab C,) � � � � " � � � �� - Po1 cy No��Campany.. , ... _. Pis . .� ,._ . . .._ _ ._. ,� , . •�. �Cert f gd copy is ke�eby furnished. � . � ��� SEW�R�=�S�"V�fAGE bI�;P'y`C.�S� �m � ✓ `V' `� , �.�Certitied copy is faled�v�th ihe co�nty building inspectton . ' C�UNTYOFI.O3`A,NGE��� " _� ' ��BLI�L�SII�Csa.��1.�1F�T'�/����_�.-� �T.����.� � ��. �.--.-�.. : depa imen� .- ��„ -- . . � . . .. dete��Applicant ��' �,��'.�� .,_ FOR APPLlCANT TQ FILL 1N ` v � CONNECTI6N D`AT/l :` CERTIFI�MTE�SF��AnhTf�t�(fOM'�1b�fl�d eu2oiNc' ' � � COFI�PEt�5dfiltlKf'YN�Sf7"RAIV`C�" ,y o-noREss srarbN .' �d- 'oevrH.., � ,` . , .z �. ..�,,. ,,. ,� �,: _ . .�' � '•�. (This sectioq peed not�be completed�ihewoik involvacfb'y the .. � ^ - . -� n�tcNpo�eaepeeENee " . �} � � -` peYm t is��or ane hvridred dollars($160)or le9s) �" �oca.u7q; � . �o,�g- . .T ..�: r.,�w.?:�.. � -.,� i+: NEAkEST. .. ��.•� �.�'.. LL'. - TYPEDFC(7NNECTfO1J. •"" � ^� . , ....,...,.- _ . .0 ...tro s I Cert that � " '� i fy�. �n the perPormanFe,of t�ip wo,rk�or w`hTc� lhis ceOsssr v cuua " r� , �.c. ol�M7�: �J�� "p"eTm t.s�ssued I shall n¢t employ any person in any�manner � � . . .. � �4 ' ,,._,_. ��� s6 tYs fo become sub�ect to Phe Workers Compensattpn�laws. omhee`-.. �� co inac NO.'� .Cos No ",.,` .,�; s vt.�.r., ,...� a ra � ""xa °c --^, v.au - . _. . . Daf2 S RPPI Carlfw yt. . ,9.W i �`,_.v , n ._.: A�ODRE55�� �•:_ ift:N TRA FID'AY�TIT.'u WAIVER� EASE�v1ENT -kEC AD PERMIi NQ.� .. _ _. . '- •'"'°'"- .'..- � ORb,iN$TR.'NO�. D:4TE... `�: N�TICE'TO �"PP'LIC,4�11`�lf,'"afte�. ma�kin t7�is Cert��ica}e o4 .:� � .. �; Ezemption, you'sFoulii become sub�ect �to rhe Woikers . . . . � �-�.,... . :,. ' �,q'Co"m'pensfition provis.ion's of the�Cpbor code,:.you must forthwith aescai i�ioN '�orno Hun oa-sr.wi�eNi���. - � � � � � :,,.`Cb`Mply w�ith such provsions or this.permrt..shail be de,emed . � �� -� �. - : � ' �� � � � YCvok@(J � �� � B.00K�� TRACT STAICENCROACNMENT - " -�'� - �'� �'�� ", � `� � "' . - � PERMIT NO - ..LiC�EKISED��0�1�1`RALTC7RSbECLAkAT(ON ' No oF e�s � ...F S�2EOPlOr � NowtlFYi01` - -^^d. . y/� °��✓ � . _ � ,. . �G`.0 . ��CG �.'�.(SC/ � i 6ere6y aftvm that I am I cense ,unde�prov�s ona of�hapter . ���,. .. . . ,� , . � , �4(tommendng witfi�Sedion'�SYbbl afuDivision 3 of th�.:,8usi �;:. aui�olNGS � � �cHaRGes � ' -� ,"�-� r rcas;o*td Professnns,Cotle,�and my licanse is n fal��oice and ` �� �- � - � : e{feCt p . . CONTRACTOR � � � � CONNERIDN CHARGE PEE��� - - - �-License Number��� V �I.IC.C�a55 ��� � � REIMBURSEMEM FEE � - O� � .-.q ..� _. .• ._ '". AOPRESS . . > p y Q f ` O`Vr��•J �` .�J ��..� � .615TRICT�NO. GROUV. MAp..`-.,-•• ':PROCESSEDBV_�. " (�. ��Coniracior fe_�„� � � Cirv iE NO .,. . . . ..... ,. . _ . , ❑I am exempt onderSec � of tFe 1 A Co :. STceNs�'��o,;,��g�(�� � .. .-einSS � �� ��. .'�j �-//'�� '�. Q... eK v� a�.1. . �*,r r,.+, _ is,.,s -. .:..s. NO ,DESCRIPTION OF WORK. •,".FEE..,," ,� "' � � P-. „�- ' - .....,:o , _ " � . , P�umb,iog ,/orSec. ' � o�tfie � �. � . .++� r�Nn� � � � �� W� ' ....g . -HbUSESEWER�CDN,NECTJNGTO'." . . �. ` l� 6� DAiE ����y �. � VALIDATICjN... ........�.._ ` .- PUBLCSEVJER� ' , � J - B.8 P Code tor th followin reason �-�_�_ ��; , sePric rnrvK,s�anGe wY oq.: ''-��T � � . . .,- -....._.... �. -.PITS'AND/OR�➢RFCIhF1�LD'•"",. . ..' „ � FINAL . ' � .,�:. �_' ., � � D . . .�FRIVATEd5P65N�TINGT9�:��, , .�... , eY . , .. , S 9n . _ :CONNECT,460'71D17AC 6L6'G 6R. � - . . . ... .. ... .. . .... .. ... . . . . . . � OWNEft BUILDER DE�LAF�AjIfSN ` -waaK io uc3tisE's�' �.. � - � ���1 hereb�d�firm that �am exem i��r"om the � "� " -4��F�aNs�EPAcevR�anitiais[o , .- � y , j„ �p �Canttaetor s LiCense � EXTN.CE55pp�,'YSR�ECC'hl'Q}RRe _ ' ._ ,.. _ -. � .. ..._,. . :�Law for 117e fo)lowing�_repson($eCion 7(}�'1 5,�8Uisn�45 a'nc�Pr0 �AL1ER,REPAfk bR A A(�DpNifC��U5E . � � ' �� 6�j,7.A�� . � - Ire-3�3JOn3�ode � . �.SEWER OR qISPOSAL SY$iEM " 5 � I_I I,as owner of the property,or�my amployees wdh wag�s as � � �. #e o o-w '� [j � . . - � thev sole compensatron,will tlo the work.and the,sl.rqcWre ��. � � �. � � is nor"iniended or offered fo�:.sale(Secrion 7(Y44,Business - -� � � � ' � ..r `andPiofessivns�7.'oc7e)..__.. , ._. . .. .., ...: . .�.OWflER'5�.� .Perrltit � 5.. ���':��..�-�� � � em`27�JrO�r. . � ❑I as owner of the properry,am exdus�vely contraeting w th AUTHORIZATION TOTAL FEE °")y e s s I censed cont act4rs)o construcf the rb�ect"Section'7b"4'd," ' � •2 7'�`�J��� , � P I � 1 NAVE Ai THIS OATE.'A CONTRAQ W17H HE HERE:N NAMED�ONIRACiOK70 , Bus ness and PrqFpYssron,.s,a,Code) CONNER THE A8c?VE RESCR�BED"EX�STING DWEL4�N6,J0 TFJE PUBL C,SEVrEk. ' . � � .� �_r�L y,p_�-._ � . : CaON$TRUCTIVIV LEN�S(I�ICi.4�Eh7tY' �. � . . G V V ��I hareby affirm Fhat�fhere Ss d consiruction�lending,o�ency � SIGNEDTHIS�OkYOF �� � 19 ��, � ',�:,for the peforinancc��of ihe work for which his�perm�t is .own'Ek.Oa yy � _ � : iss'ued(Sec�9097,Civ:.0 j . . "'. -' � � -owNeasa.c� , �,_. T.. . . . '`Lender a Npme j nooREss � :'. ; . 5 -�- : .� . . .. . _ s a c � - . _„�. .. "-. .,. �;, , - :. . . � .�:; ��, Lenders�Address�� �� ' . . `� ,,.,,. . �- , :__: .,;. . .__ �:..: . . ,,,�.-..� - - � ce f that I have�'.read�this a� IicaYoo... . . ..� " '�. ` . "'��.... . .". - .. ._ ._ .,,- . .._.. . . . ... ,.. _�..- ':`+ y. pp i p7id state 1hAt,the �_ . . �.. - .�>-:. ...:�-. . �'� abov information is correct.,J�.pgree to comply v✓�ith dll County � . �� �� �� .. � � �� � �� � ��� - �� � � � � � �� � �: �-ordin nte@ and Stote�laws regu.lating Plumbing and 5ewers, -��� � -�� � �� �� � � � � -�� � � � � - � � � � � and ereby olhorizQ�representa'tives of.ih�is..Couniy tq;�enter - "�" ' ��-" -" � ' ` �� � ' . " -- ' ��� �� � ���� -� - -� -.�up .th o e- r ed property for inspectlon purposes :�:.� - . . - �-. . . . :.., , .._. .. . . ` ,:�: ,-_l ` � -.,. � � .. . � � .. . . . . .� . . . .. � � . . � . . .., :,. _.4U ... ., ,,:.. .........�:. �.,._ ,�._... _.,._>..,,. ......,._:_.._._ ._...:�.... , _.W....._..,_...... ' Signoture of Perm�iH� `" "''" �_ ''""'"""' . � . Dafe . ..-_`. ", .,. 5BE"REI,YEfBEfYYR"�XP'C7ST7AtC3kV�}t7�'�YJX'�. ... . . -..�au+o, � .s i - - _ _ _ . _ . , . . , . : . .. � �� � � ;�� � �� �,>v� � , .: ; .,_ , > ..�_.��.,._.c..n�� : .�:.�.�:� _ ; x � ` ,, : ,,� , 'ta�'��eso���wov� . 43�il�ht k3YJ�Y:�3�1�17���H.��P,�TI01� <, , � ::. ..--,^.�.-�---�—.,�. -�.' r - .,.��— �_ ��, ...., �.�.�. _. _ �, .. ,,,�_ .. . � dQ@'P�OL//lt� � . onre ..iwsxctoa's si�unn.iRe..�..�� _ �. '�� ....,�, . - .. .—�_.__.__ �� Y hea•.�try,:affitm eh.ar�l('nm es�ampt Loun clne�dn¢raca�r°� �. � .. .. :. . ,, ..:.. . ;. • �'� . . .<,., ..,. -���Lioense�.aiv fai�.the-ffuih�ning'reasom l�ectio;s 7fJ31.5...... N�vwousessw�te . . : .-. � � �xfssners..rca�.Fvofessaoet�.CadeJt Assg.clty or�aorswty.:. . ..: �:_'_ . ,.. . ... ,., . .., . .. .... � COF1NECiADDtt10NAL .�. .... � � ._ _ ' ' . .. _:�. n.. aueair��ors woaK .. ..`,.:" •r `.r��-��� . ......� . �.,. . �, .;�:. . . ��. . .. . , .. w,besb rzg"paires n pemg.e�to eons�raee �BR�r,�.;snesp�oye..-.�.. '$EPTI4 TANK,SEEP,�PIP(S) � ... _ —'—=— �� ',_•-�.•_—�W.x...-., �. . ; . . flbOJASb�OP tpM . �. . ....die r�nsr asa�s cture�rc�P do eEa-sssuanr.e- _ nNoiqa ouawFie�o . �. , . . ;� ,; ; . ��a�so reqac�s &be�dfc¢�st}oa sttFks pnevxat��ao fele a �� � _.. ....._ � ., . :::. . - .•.... . sr s8� st�be ecemsed rs o t eessPaoi O � ouwrac❑ ... . �. . �. .--�-.,.� . ...8+i¢d tesnerst . zs $ou auex be _. ;.. �. >�; 'prov€s�a s a�ila¢CoriEA'ae'Lors b semse�'ar�.i(C,6apeer 9 ��� . .ureti.�Rtvaia seweaoa�— : �� . ���, .. �. . .� �»ur� a�a�wr m 7�01�f L'asasaors�3 of 8Se sEwnce ois�dsni srS`r�i.t , . � """� �" . ,` "".. gussn�.ss araw Pro}sss�ns"zr� ¢J`ar 7aRt k�e°'s's eagvis�" . ... dseoNr�ecrr�_�c'zt�o . _ _ ` , M Sberefroo-n aaa�abe ba.ru fcs�-sba�t/e ed�evrz teors �3n ABANDONF-0OUSESEWER �. =•=..�r.--�—��--�-"-.t-:.-- „ .. '.. ... . ,� �� •� . --- , ..`:� ' vFaTuEsoac of S¢staoa,7��1.5 by�ny appdu�.sfor a p¢c^aiadt... � BACKFI.L$£P5'IC TANKS Q . . -. : . . ` ��. . 5eev,r�t s Q u.ssPoots❑ . ..'. . �' ,,.,....._:. -� ' .. ; srabje e ag,p it n S cavli�aazadty a}na.. e bRn .. ... t&s 8h 1 tt & o a t anar S ._.._ ._.... ,. .,� :.. «��+,�::w�.a•w.....erv".�:.� "- 3- . ,.,fdveasa;aarsddotd¢ss�.fSDOJ ` - . . '� � � ." .� . �,: �� >.., .. y� ,�,�_? ��"s i > ": �-�. � "�I,gx rhe'ow�zee oF ah.e�pr�pesY�ir il1 do si�e�r�,asatS.. � ,,...�,. . .. 4 .. '. . .�.-._ _.-.. _ .�. . . . �_ ` �,.�a ��the smaceai�e as noe angen eti esr n..ec�t toz..ale �.. : . � ,�,���. - �- . � �.�a ,�,,. � � °Sec 7�J44�'��usvsvaeess arard Profrrasz"onrs�Caze;�R�sz�o ... _.___ ..._ '_. _. _ ., _ .'�• " .'",•'"r�r`�^�'er'a's'�;scensa"La:2.+"�'ve3`so"t'a�'Zy aco"�e'oaua¢er of' .. k.-. . . .. . � � ' '� ;;. ,�., ..�� _ . �„ ro ...±,'� ;- ��.�._. _ .. �.p3popea�Ey abbo$rzc4Tds ar smjr:roves�h eoss.'and svTia>do�es'� . 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