18921 78TH PL W.PDF111111111111
6741
18921 78TH PL W
APPLICATION
for
The City of Edmonds SIDE SEWER PER T
TION
F1' W CONSTRUC REPAIRS
LCE
OWNER ...... . /'Y- __-------- - 0-e ----- ----------------------
/ I , t�x"
ADDRESS ... 2—) ........ gL_�_ ............
....................... .................
�7
EASEMENT No. ..., ........ .............................
CONTRACTOR
. ..... ..) ....... PERMIT No.
6&1 16P
+
t
Z1, Of
"Jot:
J A i
Approved:
CITY OF",'IDMONDS
, TE Call 'PR6,�pect 44107 when .or*
1-j*` -ER�� EVVER''DEPARTNUENT
CIV11C -CE WAT -S
Is re:�dy foT,j�ispectlpn. (No � ins
Pee)-, N2- 155:2
tions Saturday, Sun 0 �Oti"Ys.
SIDE, -SCEWER'."PERMIT.
ADDRESS..-" ...................... ............................ ---------- ................ w .............................................................
Brblm
.......... ..... .. .... ..
............. ................ ........ ................ . ............... CONTRACTOR --- 01V-MD-i-C --- View ... Pl.u.mb-ing ....................
, Per ii-is,grant�d jainuAr7 30...
--- -------- 19.5-7, for ---- ----------------- days', to REPAIR or CONNECT a side sewer
. ... . ............ "" - . .9 .
_it f;Sewers;1in accordance with application on file and goVerning ordinances.'
E
XTTENT'ION.'IS D TO THE FOLLOWING:
NOTE o. 1�Th6 owners, oi�-the pri5p�)rty may obtain a permit to construct sewer inside property line.' A licensed Side Sewer Contractor must
be,employe&�t6,construct side 'sewer in street area. Do not cover any. portion of sewer befor 'bee I ed.
e it has n nspect
NOTE No. 2—,'Obtain� fulU , inforni,ation'regarding Ordinance 11.16.GM and Regulations governing side sewers when you get permit.
NOTE No,� 3—Top of. side. sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minim . um grade of 2%.
No bends - iii. � e sharper than 3A will be permitted.
NOTE No. 4-7'renches,in:sireet must be water settled ai�d' 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. '��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 ap-
purtenan6es exbept. to insert, the pipe into the wye.
Critical Areas Checklist
Site InformUREET FILE
Project Name: 9� dki Ko Permit Number:
Property Tax Account Number: ;6� e5
$ite-Location: i'�RIA D
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions
1. Has the site been cleared or logged? Date of most recent action:
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
3. Describe the general site topography. Check all that apply.
Flat: less than 5 feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of greater than 30% present on site.
Comments
Hydrology[Vegetation
4. Site contains areas of year-round standing water:.
5. Site contains areas of seasonal standing water: kl/� Approx. Depth:
6. Site is in the floodway fl oodplain of a water course.
7. Site co . ntains a creek or an area where water flows across the grounds surface?/L—flows
are year-round? Flows are seasonal?
8. Site is primarily: forested ;meadow _;shrubs ;mixed
9.- Obvious wetland is present on site: 04141
f 0'.- 1 Wetland inventory or map indicates wetland present on site:
11. Critical Areas inv�ei'tory or map indicates any Critical Area on site:
For:.Gty: Use: Only
STUDY REQUIRED: Critical areas study is required.
CONDITIONAL WAIVER: Critical areas study not required if specified conditions satisfied.
WAIVER: Critical areas study is not required.
.Determination Number7.. viewer
Planner
:Re VY27/9.2
,�5-A - q 2--7
8.90 .1914
City of Edmonds'
Critical, Areas Checklist
The Critical Areas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for the City of Edmonds prior
to his/her submittal of a development permit
to the.City.
The purpose of the Checklist is to enable
City staff to determine whether any potential
Critical Areas are or may be present on the
subject property. The information needed to
complete the Checklist should be easily
available from observations of the site or
data available at City Hall (Critical Areas
inventories, maps, or soil surveys).
An applicant, or his/her representative, must
fill out the checklist, sign and date it, and
submit it to the City. The City will review
the checklist, make a precursory site visit,
and make a determination of the sabsequent
steps necessary to complete a development
permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map
of the parcel with enough detail that City
staff can find and identify the subject
parcel(s). In addition, the applicant is
encouraged- to include any other pertinent
information or studies in conjunction with
this Checklist to assist staff in completing
their preliminary asses . sment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Q?v51-q1f41-1 . ��o ekl)CI-11<0,
Name 1-1
Title -7St vN kQ)-. Lc
Ile
Street Address
City, State, ZIP 5—phone
Signature Date
Applicant Represer��tive:
�,-Lld,zz
NZ5
Title
Street Address
7,2-11
Phone
Date
/f
. @KOM, cpcqxc�-,
'00 -ME Ow': =14;
O&OP7 wjk., a7at
c4arw - -fA%&rc-c
Ato W
46044'46'W 0
lora
S4ZAT7
lw
ZZ-%os
Z3:5416
c R/af O-oc A
occondf"q
OYC W.,dl
0
IrRcra, 464
Mep,-/- "*,fC4 15 OAC
I
14,
'armcc
fie
Z yc
hey
AA
do
AvgrsAff,
-I, r47Cr
-1he Alml Zbr;
vh�ff
740
"CA! _4
V*,
ec3;?;
;r
44
so
A
A
pp
30
4p
2910
21,0
'20
iZ �115-
N
27
19
TI-41
1.3
2r,
(OP-1 All
2S
A/
24
— 'X
0 1 W. IT
4)
10 0 25
silo 12 lo\
lit
6
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set for ' th on these
map(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may'not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
empl-oyee-s or officers sh-all be Ha-ble for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).