560 12TH AVE N.PDF1111111111
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560 12TH AVE N
7
APPLICATION CARD No . ......................................
for
The City of Edmonds '\\,gt
SIODE SEWER FERYaT llv-� *
STREET FILETSIDE 0 INSIDE g REPAIRS 0 EASEMENT No . ....................................
OWNER ......
------------------- .................................................. CONTRACTOR ....... /'YA.Z-0 ... .......................... ?5� ................... PERMIT No.
HOUSE No . ....... ------------------- STREET
AVENUE LOT No . ....... .......
----- --------- 44AKe. A ......... N .................. -// -------------------------------------------------- BWCK No . ...............................................
NAME ADD - -----------
..................... ......................................... ............................................
40
0
x/l
Date
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .......
SEWER WORK ORDER ISSUED ..........................................
Approved:
...................
.. .... ........ .........................
DANE /4�Z/"�
................
D '.9 4KE -�Z'i."� i':
ull;
CITY OF EDMONDS
C'V][C CENTER — WATER -SEWER DEPARTMENT Can PROsPect 6-11-07 when work
11; ready for inspeemon. (No Msp—
SIDE SEWER PERMIT tims Saturday, Sunday or houda".) N2 1195
ADDRESS .....................
�OWNER ............... byj�q ... ;�gp
qrA .................. ........... ................... CONTRACTOR ..... Ar?�9w—C-on-s.tru.c.ti.on .........................
PernAssion is granted ......... pAgqy0pr
... 9 .......... for ... M ----------------- daYS, to REPAIR or CONNECT a side sewer
V,-; with city Sewers in accordance with aPplication on ffle and
governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
1—The owners of the obtai a permit to construct sewer inside Property line. A licensed Side sewer contractor must
NOTE No. be employed to construct side sewe in sn
Property may r treet 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 Regulati - . -
Ons 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; mlrdmUM grade of 2%.
No bends in grade sharper than 'A will be Pern:dtted.
NOTE No. 4—Trenches in street must be water settled and surface of street restored to Original condition. Contractors shall
faflure due to improper work which may develop within one year of Completion. be responsible for
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 ap-
Purtenances except to insert the Pipe into the wye.
Cr—
T �4 S T FILF:
RE
PIMLIC !'JT'!.,S P!:PT. WIT!, LIST
BUILDING PI'll"UT 1TV117..'
w
Street Pdr1it-oE-L'ay Rxistin-
F
Access Easommits Existing
Utilitv Fiscincim J'--istin- pm!)
Lot Per Subdivision
Plat Assessor 11'ap
-in Mcd:cd for Accuracv
Sitc pl,
Vflcicr-rcund "cod. No
1) "1 t C
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Yxi,,tin'- 1*,'atev '-Iain
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ary Connection YCO FICCIiiii-CO
se, 'r I c
Size
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lell Ditch ]ZOO.u.j.3-CO
Clilvcrt Pec'111 Size
Catc"i Basin !"'criui le(I I Oil
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Nall" 10le requircd
Soil Conditions
Id I.1"iter Field Choc"'Cd
!'�itc Plan
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-- TUte
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Amok
%cclui rcd
Oct Paving, R
Curl) and r R'Comirc(l
sidowalk 110011ired
Web ou t for, Priveway Rcquircd
Pj -I I t - o Constructi cn"I�i t Rumired
Eond Requim r Riblic Im-provcments
c ,\xie Sion Reciiircd
Othcr Signini;
Pre itc Inspcction madc on
ScI"-Cr
r4
Strect
Ellginccrinp'
Special. ]�oc:uirc?"icnts listcd ill meMo to ])"Ilil.ding
Date
m 1-9W-M
A-11. itc;�Is filled in cil 11"'14LI(IJ111g,
P" D"Itc
"Otaticils '!"1(10
"Iral-divs StanvCd an(l
By Rlto—
/�pproNcj by Pul)jic Wor].-'s Pepm ),,-,nt