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19422 81 ST PL W
APPLICATION
for
E
The City of Edmonds STR F#* WER PERNaT
C ION )�— REPAIRS 0
De e- -q
OWNER..............................................................................................................
ADDRESS ... 14
.................... ..... Z.1 ................ ------------------------
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EASEMENT No . .........
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CONTRACTOR ......................................................... ..................... PERMIT ;Ql
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LEGAL DESCRIPTION: LOT No . ............ ................................. BLOCK No . ............................................
NAME OF ADDITION ........ 5.10--t2!Z26 ......... ........
. ................................ ......................
3
APR 19
Approved:
DATE.......... --------- )/ ............. By ......
NOTICE:
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 forth on these
map(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
."-.-tfie -map(s), including, but not limited to,
th e 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
emp[o-yee-s o-r office-rs -shalfl be Via-b-lfe for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 7.76-1107 for side sewer inspections BEFORE covering any portion of the const t,
r"
(inspection will be provided within 24 hour. after request. NO Sat., Sun., or holiday inspections.
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ADDRESS LOCATION OF CONSTRUCTION .............. ...... m� ................ .......... .......
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PROPERTY LEGAL DESCRIPTION ------------------------------------------- ...................
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OWNER AND/OR BUILDER ------- m�t ...... n ................ ......................................
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---------------------------------------------------------------- .......... n ------- ------------
---- ----- -- - -
CONTRACTOWS NAME & ADDRESS-_':t'_2� ----------- 1� ;,_
ion of a side sewer to the city sanitary sewer
.... for repair and/or connect
trmission is granted .......... M��. ....... m ............... es.
_ysteoln in aecordanoe with City of Edmonds ordinane
cE,TION IS CALLED To THE FOLLOWING: i permit to construct sewer inside Property line. A licensed Side Sewer Contractor must be employed to construct
, E No. 1—The owners of the property may obtain i
ea. Do not cover any portion of sewer before it has been inspected.
side sewer in street ar -of-way requires an Invasion of Right-of-way Permit obtainable from the city Engineer's office.
NOTE No. 2—All work performed in city right Perm
on regarding Ordinance 11.16.030 and Regulations governing side sewers when you ge . t it. mum grade of 2%. No bends in grade
NOTE No. 3—Ohtain full informati st have at least 30 inches coverage at property line and 12 inches inside property line; mini
NOTE No. 4—Tcp of side sewer mu
sharper than % will be permitted.
st be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
NOYE No. 5--Trenches in street mu r of completion.
work which may develop within one yea vided for in the permit, or to do any work on tl�e main sewer or its appurtenances . except to in -
NOTE No. 6--It is unlawful to alter or do any other work than is pro
sert the pipe into the wye.
DateBy ................ Date --------------- - ------------------- By ................
DISAPPROVED F4 Date ... -------- _ By_9�-_7 ---- .................................................................................
M.- 1 - -1/ ...................... ---
APPROVED Date --- ........... ............ By.�
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........ . .. ........ av
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pies NIUST e pitgned,, y Owner of Firm Performing Construction PRIOR To Request For Inspection
BOTH Permit CO 'B . ........ ... I hereby certify that the side sewer installation constructed under this permit
.................................... . ............... ...... t tion
(Owner of Contractin ' F`irm Performing ond
Fl
Wit all go_"
installed in accordance 't al rning r 1 ances of the City of Edm. App..L . ................
--- ---------- day of ------ ........ 11111111L!".
Dated this ---------- 1.1
v v check BEFORE you dig for: Water C1, Gas n, Telephone [1, power 0, S�Wer 0, Other