1215 HIGHLAND DR.PDF11111111111111
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1215 HIGHLAND DR
CITY OF EDMONDS — SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
/Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.
\Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday Inspections
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ADDRESS LOCATION OF CONSTRUCTION_.A".. � J;...--------0.. ...............C,-,AA .!r'�o........... NINS.......... ............
PROPERTYLEGAL DESCRIPTION.........................................................................................................................................................................
....................... ............................ _.......... ............ _............................................ U..................................................................................................................................
OWNER AND/OR BUILDER ........... cC �.._......... �..� --� .............
CONTRACTOR'S NAME & ADDRESS ............... ----...... ` .cam IS ................... -.......................................................
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Permission is granted ......... ...-..-...._.. ........-, ICE:—, � � 1for repair and/or connection of a side sewer to the city sanitary sewer
:._------- ------�
sm in accordance with City of Edmonds ordinances.
A NTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE No. Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED Date .....
.......................... By------.......--- Date.........-. ._.. B Date ............... _................... B
❑ _ y................................................................. y----------------
APPROVED �' Date. .., ------ BY..._....... _...._..................
Remarks: ......._.............................................................................................................................................................................................................
.....................................................................-...........----------------------------------------....................................._.................------------...... .......................................................
— BO Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection —
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I,.........P c..../... .......................
..-, hereby certify that the side sewer installation constructed under this permit
(Owner of Contiiiiaaacting Firm erforming Construction)
W Installed in accordance with all governing ordinances of the City of Edmonds. ^^��
Dated this ... �IVJ JJ .day of ........ l3.................................................. 19.........
d Check BEFORE you dig for': Water ❑, Gas ❑, - Telephone ❑, Power ❑, Sewer ❑, Other ❑
APPLICATION
The City of Edmonds for
SIDE SEWER PERMIT EASEMENT NO. .............------------------------ _------
REPAIRS
NEW CONSTRUCTION
� � ❑ LID NO. ASMT. NO...��-` `-� --
OWNER-,l14..-_W-�C�-IN_S COt�JS—CF�UCTl0�1CONTRACTOR -�- YIVNWO EP. PERMIT NO. .S2z
TOB ADDRESS 121� — 1— \C�H� L1lVp OF5NF-7is - LEGAL DESCRIPTION: LOT NO.. ------------------------------------ BLOCK NO. -------------- _------ _.._-..__.___.
NAMEOF ADDITION-------------------------------------------------------- ---------------------------------------------------------
-'------------
APPUCATION
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Ae City of Edmonds for EASEMENT NO- ----------------- --------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION ❑ REPAIRS E] LID NO_ ------------------ - ASMT. NO. ------------------
OWNER
----------- .............. CONTRACTOR
------------- -
JOB ADDRESS ...... ...... - ------ LEGAL DESCRIPTION: LOT NO. -_-----[a------------------------ BLOCK NO. ------------------------------------
---------- . ........ --------------------------------------------------------------------------
NAME OF ADDITION .....
I (. I? S I-cl
Approved:
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DATE----------------------- -------------------- By ----
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CITY OF E D M O N® S LARRY S. NAUGHTEN
DEPARTMENT OF PUBLIC WORKS (206) 771-3202 MAYOR
Edmonds, Washington 98020
Administration — 250. 5th Avenue North Maintenance & Operations — 200 Dayton Street
April 24, 1985
Dr. Pietro Poletti
1215 Highland Drive
Edmonds, WA 98020
Dear Dr. Poletti:
SUBJECT: BACKFLOW PREVENTION DEVICE TESTING
The backflow prevention device in your water supply
system is due for annual testing as required by State Code
WAC 248-54-500. Our records show a total of one device in
your system. Please have the testing performed by a person
holding a certificate of competency as a cross connection
specialist, issued by the State Department of Social and
Health Services (telephone - 464-7674).
If a device fails its test, please have the necessary
repairs made. Upon completion of a satisfactory test, have
the certified tester fill out the enclosed Test and Maintenance
Report and return it to this office within thirty days.
Additional information relative to this matter may be
obtained by contacting our Cross Connection Control Specialist
at 771-3202, extension 294.
Sincerely,
ARCHIE BRENA
Water/Sewer Division Supervisor
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Enclosure
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