21101 80TH AVE W.PDF111111111111
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21101 80TH AVE W
CITY OF EDMONDS
NEW
ADDITION
RETIREMENT
ASSET INFORMATION SHEET
STREET FILE
ASSET NO. ao
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION DEPT. NO.
"PURCHASE ORDER NO. *PROJECT NUMBER
PURCHASE ORDER DATE PROJECT COMPLETION DATE
COST COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
**SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
I ACCOUNTING ONLY
E� DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
INITIAL
DATE
VERIFIED BY
PROCESSED
BATCH NO.
&P)
FINANCE PERMANENT FILE
...........
COST
ACQUISITION DATE
USEFUL LIFE
ANNUAL
DEPRECIATION RATE
MONTHLY DEPRECIATION RATE
YR
DEPRECIATION
ACCUMULATED
DEPRECIATION
BOOK
VALUE
YR
DEPRECIATION
ACCUMULATED
DEPRECIATION
BOOK
VALUE
1
2
26
27
3
28
4
29
5
30
6
31
7
32
8
33
9
34
10
35
11
36
12
37
13
38
14
39
15
40
1E
41
17
42
18
43
19
44
20
45
21
46
22
47
23
48
24
49
25
50
I
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8 9 0 - 19 C) -
9ty of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number., ?6,.�
Issue Date:
A. Address or Vicinity of Constructiow 21101 "B" 80 Av W (9613592)
B. Type of Work (be specific): Tnntall SArylaa
Contractor: Washington Natural Gas
Mailing Address: 1122 75 St 8W Everett
State License #: 98203
Contact: Mariamne Kingsbury
Phone: 356-7500 X7596
Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. C] Commercial [j Subdivision El City Projecit Utility (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family 0 Single Family E] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes (IINo) G. Size of Cut: x H. Chargt�_$
P
APA ANT TO READ -AN tIf.N
INDEMNITY. Applicant understands and by his signature to this application, agrees to h6ld tf,lty ofE�monds harmlZ frovViojuhietdamagea, or
tt it"
claims of any kind or description whatsoever, foreseen or unforeseen, that maybe mad�`ag,,, ia the City ofE4dmond.',_a —'Y-01f 84;wtmentsor
employees, including or not limited to the defense ofany legalproceedings including de�fnse,� attorney fees by M� nti thispermit.
.9njofgra
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THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved -material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all t* e for inspection purposes.
Signature: _&&,W1z Date: 5-10-96
lKractor W�ent;/
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR`CITY USE ONLY.
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION' FEE/FUND Ill:
SPECIAL CONDITIONS: Wo A ce (.V1 RESTORA . TION FEE:
-PERMIT FEE:
COMMENTS:
DATE: .
RECEIPT FEE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comment . s:
Diastram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
[I YES
Date:
Date:
El NO
ww� M IVw%" 8 i�
NaturMGw
AVohg*xjtcn EnergvCorrp"
0
10 1 '\ F�," 60 A14 \AJ
C) F, q (.0 IS E) -92-,
N� 0 C�)j T' lc�->
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariawne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
Key:
-W- Water
Watermain depth -�G- Gas
-SS-, Sever
e, ;!,�Vater hydrant
gas main 0 Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett. Washington 98203, (206) 355-3331
ISL A 2-- fte F1 M
NaturM Gm
AVWhj*xjtanEr-WCcnpWV
13!' 60 A\I \A/
CIO 1 1�3 �:-) -92,
t-3 0 C-)j T' '��>
Watermain depth
gas main
0
Addendum to: -City of Edmonds,
Right of,Way ,
Permit Application
Submitted by: Marlawne Kingsbury
Engineering Aide
Washington Natural Gas
135 -7500 X75�0
'0
Key:
-w- Water
-G- Gas
-SS- Sever
-e- Water hydrant
0 Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett. Washington 98203, (206) 355-3331
%A 2--monn
NaturMGw
AVArJ*KjIcnEnergvCcmpaw
0
C 60 A'V \AJ
C-),A T
Addendum to: City of Edmonds
Right of,Way
Permit Application
Submitted by: Kariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
a
Key:,
-W- Water
Watermain depth -G- Gas
ISS- Sewer
gas main Water hydrant
0 Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
STREff FILE
PUBLIC: uoRKs DEPARTmENr CHEWST -�2 11n /
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BUILDING PERMIT REVIEW T-4
(address)
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Street Right -of -Way Existing
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Access Easements Existin
Utility Easement Existing___�
REQEL_
Int Per Subdivision Plat -je . Assessor Map
Site Plan Checked for Accuracy—A�K,
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Underground Wiring Reqd.
0
Check Accuracy of Legal Descriptilan C)
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Review by
Date_ j,5--)8(-)
Existing Water Main Size DI
Water Main Required IYZA
Service Line Required
Hydrant Size Exist'
Hydrant Reqd Per Fire Code
Size
Detector Check Meter Reqd. AVLA
Cross Connection Inspection
Fire Department Comments
'dater Meter Charge Reqd.
Review by.
Date 2'e>
Septic Tank Design Approved
Date Q
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availabili tYUS:!g
Pr 03 L- 1'--s
Dra:wing No L i r)
File o.
Side Sewer Availability LA C-a"
k"I'L gail.- r-> 4n U,�
Sanitary Sewer Connection Fee Reqd.
:3:
Review by_ SE?::� a 0�— 5SN=
Date-2-0,
0 W
% —d5XQa
Open Ditch Existing__,j��...Reqd.
Culvert Reqd. 47,e
A/ Size A�,
P4
Catch Basin Reqd. t,
Jndie�ie on Site Plan , rtp ,
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Shoulder drainage maintain collection on
swale open runoff 9.5,Rj Z,7—
ad &12 7Y
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Manhole reqd.
Indicate on Site Plan
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Soil Conditions and Ground Water Field Checked k, -,e -
Review by, Z7
,7,4 A 5-
Date ;�r c,
Revised: 1vlO-1977
Page 2
Street Paving Reqd. 'Pe / v ov-7-,, S
7
Curb and Gutter Reqd. A/
Sidewalk Reqd. A,�f-
Curb Cut for Driveway Reqd. A- 0.
r4 Right -of -Way Construction Permit Reqd. -e -s
Bond Reqd. for Public Irrprovenents �e 5
Street Name Sign Reqd. A/ C.>
Other Signing Reqd.
Pre Permit Site Inspection made on
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BY: MER
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En
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ENGINEERING
Special Requirements listed in memo to Conm-mity Development Department,
Building Division
BY Date
c> All items filled in on Building Permit Application
P4 BY Date
P4 Drawixi"s"'Stanped and Notations Made
BY— Date
Approved-by.Publ'ic'Works Department
Revised: 1v 10-1977
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BUILDING DIVISI�ON Applicant Fill
USE T
ZONE ER
Inside Heavy Lines
PERMIT APPLICATION
ION
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ADDRESS kVS \A4
NAME JOR NAME OF BUSI SS)
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LEGAL DESCRIPTIOWT—SUBDIVISION
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SHORT SUB No.
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING F-
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PROPOSED
OF RIGHT OF WAY
CITY
ELEPHON NUMBER
I/ __ YE x � �
U
NAME
RDEFICIENCY
W
U
Ct
ADDRESS
A)
PUBLIC IMPROVEMENTS REQUIRED
DRAINAGE IMPROVEMENTS REQUIRED 0
DRAINAGE PLAN REQUIRED 0
UNDERGROUND WIRING REQUIRED
10,
CONNECTION TO SANITARY SEWER
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CITY
TELEPHONE NUMBER
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NAME
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SEPTIC TANK PERMIT REQ'D 0 NO.
ELEVATION OF PROPERTY CORNERS
FOOTINGS REO'D
ADDRESS
CITY
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TELEPHONE NUMBER
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SEE ENGINEERING MEMO DAT7.
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STATIL LICENSE NUMBER
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CITY LICENSE NUMBER
CHECKED BY
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Legal Description of Property (Show Below or Attach Four Copies)
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- BUILDING 11 SUPPLY SIZE
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REMARKS
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SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADS NO.
SHORELINE
jRCMARKS
VARIANCE OR CU _r�7A�REVIEW
BY
DATE
YARDS LOT
COVERA E
GAS
NEW El RESIDENTIAL LINE
IF�
FRONT SIDE REA
FIRE ZONE
OF CONSTRUCTION
HEIGHT
MADD NON-hESIDENTIAL SIGN
El DEMOLISH RETAINING
WALL
ALTER EXCAVATE FENCE
F-10R FILL F7— X—rrl
D REPAIR PRE -MOVE swim
El INSP. POOL
ITYPE ICODE
SPECIAL INSPECTOR
REQUIRED
0 YES 11
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
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NUMBER OF' STORIES JNUMBER
OF
DWELLING
UNITS C_
REMARKS
NATURE OF WORK TO 13E DONE
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PLAN CHECK FEE
VALUATION
FEE
PLOT PLAN
SBUILDING
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PLUMBING
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MECHANICAL
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FENCE
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SIGN
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"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indcrmlify, dc�fend and hold ha rmless
tile Citv of Edmonds, Washington, its officials, employees, and
agents from any and all claims for damages of whatever nature,
arising directly or indirectly from the issuance of this permit. Issu-
RETAINING WALL
SWIMMING POOL
-
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ance of this permit shall not be deemed to modify, waive or reduce
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all% requirement of any city ordinance nor limit in any way tile
( itv',-z qbNitv in enfnrce. inv nrdinnn(-,-� or—i-inn."
CITY,OF EDMONDS
PUZLIC WORKS.DEPARW�:*T
�SIDE SEWER PERMIT
FOR INSPECTION CALL
775-2525 Ext. 220
Permit D419 6 6 3 6
Issue Date
LU
IV .. I ; . I ... q
I PERMIT MUST BE POSTED ON JOB SITE *
l.. Address of Construction -Z/02,(�_'— ;,'10'-' �6e- Lu
2.'. Property -Legal Description (include all. easements) E-
3. Famifty Residence
Commercial
4.
5.
6.
Owner and/-or-Buildez 7
Contra-ctor & License No.
Invasion into City Right
way Construction Permit Required - Call Dial Dig
excavation).
Multi -Family No. of Units
Cery,c) C)
(342-5344)
before
E-1 7.,':Cross other private property: Yes No Easement required
U attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
04
a.: Property owners must obtain a permit*to install side sewers on
>1 -:their property. A licensed side sewer contractor must be employed to
construct�:side.sewers.in the public' right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
c 'Com
mercial establishment requires a minimum of a six inch (6")
side sewer line.-
0 d. Side sewers may not be installed closer than thirty inches (30").
ioto any structure.
M e. Side sewer lines must be laid at a minimum g 150)
0 and maximum grade..of 100% (45 0). 0 . Uff 36 Abdis.
E-4 f. 'No turn.in side s8wer greater than 45 (1/8 11
1 jGd,
between cleanout. All 90 turns must be constructep"tE 4
bend) and wye with removable cap. 1- 800 - 562"6478
g. No down spouts, footing drains or floor drains can be connected
side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-�-60" from each plumbing exit line
and at minimum intervals of 1001 along sewer 'line run.
j. Trenches within City right-of-way must be restored to origi nal
conditions. Contractors shall be responsible for right-of-way failure
due to poor ' compaction of fill.
k. Side sewer must be left uncovered until.inspected and approved
by the City.
1. Inspection during-pormal working'hours onlyi,-.Two,(2) working
days notice required.
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.DATE:
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I certify that I have read
-and shall comply With the above
'PERM 0
IT FEE: DISAPPROVED BY: Date:
U14 By: Date:
In CONNECTION CFEE: 2 06) QJZ�_Date: 7/ c
APPROVED By,-
0. r)m Qyl %,i v,:- () �ve
PERMIT -MUST BE P09TED ON JOB SITE
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0011
-�—I'% `7 �C—fl_��—_
W.EASEMENT- NO.. -w!
-NEW (�6NSTRUCTION
-------
--- ----------
. ......
-
REPAIRS
LID NO.' ASMT
OWNER
...........
cl ..........
JOB ADDRESS;��A;VO
. .... ...............
........ . .............
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-'PWW-0001-11175 (RE�.11/78)�,*,'-
CONTRACTO
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--------------------- PERMIT NO.
LEGAL DESCRIPTION: LOT
..... :'BL :NO . .............
..... ............. ocr�
-----------
................
........ ..............................
............................... .................
-------------- ------
NAME OF ADDITION ........
---------------------------------------------------- . .....................
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Approwd:
T'DATE .......... By
..........................
.................... ......
Rw&-igglud
CITY OF EDMONDS
PUBLIC WORKS DEAVENT
SIDE SEWER PERMIT
FOR INSPECTION CA*�;"7
_775-2525 Ext. �220
Permit, N? 6636
Issue Date
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04
E-4
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�PERMIT MUST,BE POSTED ON JOB SI
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1. Address f Construction* --1-
2. Property'Legal Descri-p t I i-on.(indlude all easelmen�s) P
( I ) � _s c> a Lt ) *, 110" W*' -\C
3. Single Famiiy Residencd" , Multi -Family
Commercial
4. Owner z_-Biii1dar-
5. Contractor & Licen.§e') No�.
6. Invasion into City Right-of-W#y'":
way Construction Permit Required
excavation).
-0. M C_
No. of Units I I
LA �IL Q 0 UJ C', 0 16-)
N o ,Y e s (If) Yes-- -Vig�t'70
- Call Dial Dig (342-5344) before
7. Cross other private property: Yes � No L-"'--Easement required -
attach legal description and county easement number.
READ THE FOLLOWT.NG AND SIGN:
a. Property owners must obtain a permit to install side sewers on
their property. A licensed side sewer contractor must be employed to
construct side sewers in the public right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
C. Co-mnercial establishment requires a minimum of a six inch (6")
side sewer line.
_d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
e. Side sewer lines must be laid at a ininimum Ajjdjof 2% (1.150)
and maximum grade of 100% (45 0). 0 C Hou
f. No turn in side sSwer greater than 45 (l wed
between cleanout. All 90 turns must be construcog9waAlp 408
bend) and wye with removable cap. a8OO c�§4�4Z&nected
g. No down spouts, footing drains or floor dr ins
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 1001 along sewer line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k. Side sewer must be left uncovered un inspected and approved
by the City.
1. Inspection during normal workin hours (2) working
days notice re ired.
,qu
DATE: K-n
certify. that I
and shal-I comply With the abOVE
APPLICATION
VMS" for
The City of Edmonds FILE SEDE SEWER PERMIT P"NT EASEMENT No . .........................................
NEW CONSTRUCTION [:] REPAIRS C] (7—D
...... CONTRACTO ... T No. .( .......
OWNER ....... ... .. .. . ... .......... R.K .............................. PERMIT No.
e7w�s ... ................ LEGAL DESCRIPTION: LOT N .......... �p .... .. BLOCK No . ................ ...........................
ADDRESS ... . ... ......... 4. 1 ............................. - ;w 1� A I
- 486 TjV AIE NAME OF ADDIT 'Al . . ... ...........
ION ..... .......................................... . .............
00, L-�) /
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,F'?,
Approved:
DATE ... ........... . By-;.
kPP"ROVED
1967
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 forth o.n these
map(�_). Any person or entity -requesting a
copy should conduct an independent
regarding the information shown on
-fh-e -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
ernp-l-o-yee-s or. officers Shdall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
7
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CITY OF EDMONDS
Call PRospe'et 6-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT [a ready for Inspection. (No Inspec-
tions Saturday, Sunday or holidays.) N 2: 2368
SIDE SEWER PERMIT
ADDRESS ..... * ................................. 401 - 21st Avenue South
..................................................................................................................................................................
Lee Wooley
OWNER............... E-ve.lyn .... Conn.le-y ------------------------------------------ CONTRACTOR ................................................................................
Permission is granted .......... Juae --- 2,6 . . ...... : ....... 19-51, for ........................ days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION 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—Obtain full information regarding Ordinance 11.16.030 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; minimum grade of 2%.
No bends In grade sharper than % will be permitted.
No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
k� failure due to improper work which may develop within one year of completion.
NOTE No. 5—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 appur-
tenances except to insert the pipe into the wye.
(T
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BUILDING DIVISIO
PERMIT APPLICATIC
J, Pt�AE JOR NAME OF BUSINESS)
_L_., \. 4c., *r-, j _L
ij MAILING ADDRESS
USE
Applicant Fill ZONE A
Inside Heavy Lines JOB
ADDRESS
2- 1 ko I
ILEGAL DESCR . IPTION SUBDIVISION S H 0 R T S UBN0___----T-
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TELEPHONE NUMBER
NAME
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TELEPHONE NUMBER
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NAME
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fLe—g.I' Description of Property (Show Below Or Attach Four Co , pies)
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PUBLIC RIGHT OF WAY PER, OFFICIAL STREET MAP
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EXISTING 126-MLIA-111C. Qi
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PROPOSED
DEFICIENCY OF RIGHT OF WAY
PUBLIC IMPROVEMENTS REQUIRED
C1
DRAINAGE IMPROVEMENTS REQUIRED
E]
DRAINAGE PLAN REQUIRED
0
UNDERGROUND WIRING REQUIRED
CONNECTION TO SANITARY SEWER
SEPTIC TANK PERMIT REO'D 0 No.
ELEVATION OF PROPERTY CORNERS
0
& FOOTINGS REQ'D
SEE ENGINEERING ME.O -A:Z__1
CHECKED BY
METER SIZE �UPPLY SIZE
REMARKS
1� T_(
SIGN AREA ENV. REVIEW NO.
ALLOWED I PROPOSED ICOMPLETI EXEMPT
REMARKS
VARIANCE OR CU [PLANNING REVIEW BY I DATE
YARDS ILOT COVERAGE
ED. / NEW El RESIDENTIAL GAS
LINE
FRONT
FIRE ZONE
TV
E] ADD NON41ESIDENTIAL SIGN
DEMOLISH RETAINING
WALL
ElALTER EXCAVATE FENCE
OR FILL (_
SPECIAL INSPECTOR
REQUIRED
1:1 YES El NO
PLAN CHECKED BY
REPAIR PRE -MOVE swim
INSP. POOL
REMARKS
z NUMBER OF STORIES
0
OER OF
`D1U11M.LLING laill,
UNITS_
- NATURE OF WORK TO BE DONE
co rz N
PLAN CHECK FEE
PLOT PLAN
SBUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
Ln "Applicant, on behalf of his or her spouse, heirs, assigns and
V)
W
_j successors in interest. agrees to indemnify, defend and hold harmless
E the City of Edmonds, Washington, its officials, employees, and
RETAINING WALL
OL
agents from any and all claims for damages of whatever nature,
1 arising directly or indirectly from the issuance of this permit. Isslu-
al ance of this permit shall not be deemed to modify, waive or reduce
.J an), requirement of any city ordinance nor limit in any way the
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SIDE REARI
NSTRUCTION I CODE 1HEI
AREA OCCUPANCY OCCUPANT
I GROUP I LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
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PUBLIC WRKS DEPAR=AECKLIST
(address) (date)
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Street Rig�it-of-Way Existing -
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Access Easements Existing .,:, A,-
REQD
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Utility Easement Existing.
REQD
Lot Per Subdivision Plat Assessor Map
Site Plan Checked for Accura
Z
Underground Wiring Reqd.
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Check Accuracy of Leal Descriptlon C)
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Review b
Y4
Date
Existing Water Main Size Di
Water Main Required
Service Line Required
Hydrant Size
P�
Hydrant Reqd Per Fire Code
ize
Detector Check 1,1eter Reqd. AIIA
Cross Connection Inspection___2Y4.......
Fire Department ConTmnts
Water �1eter Charge Reqd.
Review by.
Date
Septic Tank Design Approved
Date
Septic Tank Permit Reqd. Ojos..
Permit No. Ij
Sanitary Sewer AvailabilityQ,_,,,, MAt A--
PrOJ L I
Drawing No.
File o. L- t 10 1
Side Sewer Availability LA
"te,
Sanitary Sewer Connection Fee Reqd.
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Review by sp—:4=rca 4
Date
Open Ditch Existing e-
Culvert Reqd. /E /24-��-
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Catch Basin Reqd. P, tt
Indicate on Site Plan_,e,,,,,,,
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Shoulder drainage maintain collection on
swale open runoff
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�lanhole reqd.
Indicate an Site Plan
Soil Conditions and Ground Water Field Checked. j., -,,� 7"-- <,,j
Review by
_pate
Revised: lvlO-1977
HEIM0 TO
FROH;
SUBJECT:
0 40
DATEI: Z - �z q- 000
BuIlding -Division '
Community DevelopmenL Deparment
Engineering Division
Public Works Department
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Af-Ler review of che subject building permi.t: application, %,.,e have
the Collm-.,ing commcnUs:
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