642 HEMLOCK WAY.PDFIIIIIIIIIIIIII
11491
642 HEMLOCK WAY
The City of Edmonds
QWNER f /-'t/
HOUSE No - ----- -----------
13ACEFILL WORK ORDER ISSUED
SEWFAI, WORK ORDER ISSUED .....
APPLICATION
for
SIDE SEVVM PFJ&BM
OUTSIDE [:] INSIDE El REPAIRS E]
........... CONTRACTOR.
STREET
AVENUE LOT -1
NAME ADD . .....
M
CA-RD No . ..........................
BASEMENT No . ..........................
----------
. ... .... LA)CK No . ................................. .............
ty
J�15
Date ............... DEPOSIT, ............................... . ............ Approved:
................ DATE ......
----------------------- ........ ------------- --------------------- --------------
M
PUBLIC WORKS DEPARDO CHECKLIST
BUILDING -PER= REVIEW
re ro M*
tire
ir =�
Street Right -of -Way Existing C5
�REQD
Z
Access Easements Existing k)
M: REQD
04
Utility Easement ExiSting_h) 0 Nlc,—
_�EQD
W
Lot Per Subdivision Plat
Assessor Map_____�.,
Site Plan Checked for Accuracy
Z
Underground 14iring Reqd.
Check Accuracy of Legal Description
PVk
.Z
Review by_ A-41N�
Date
Existing Water Main Size
Wa Main Required
Service Required
Hydrant Size
P�
Hydrant Reqd PerFire Co
Size —
Detector Check Met qd.
Cross Co-nnec Inspection
Fire tnr-nt Conirtents
XA%
Water Meter Charge Reqd.
Review by
Date
,,-,Septic
Tank Design Approved
Date
ic Tank Permit Reqd.
T Pe
ank rmit Reqd.
Permit No.
an t
S Sanit Sewer Availability
ewe Availabj i'�7
Proj.
Drawing
File No.
I 1 j
Side Sewer Aval bility—
S j Co
anitary Sewer CoMnne 'on Fee Reqd.,
:3:.
3_
Review by_ ,,�Date
Op en Ditch Existing-
d.
Culvert Reqd.
Size
c4
Catch Basin Reqd.
:e on Site Plan
0
Shoulder dr m - intain collection on swale op"4:noff�
re
>ai� qd.
Indicate on Site
Soil L ditions and Ground Water Field Checked
Review by
Date
Revised: IvIO-1977
Page 2
t Paving Reqd._
kid-j�utter Reqd.
Sidewalk Reqd.
Curb'Cut for Driveway Reqd-:��
Right -of -Way Cons lon ermit Reqj'.
t
lic
B>ond -for Public Improvements.
m
eet Name Sigmn Reqd.
Other Signing Reqd.
r:j . - —4.
z
0
BY:
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Permit Site Inspection made on
STREET
,ENGINEERING
Special' Requirements listed in mem to Conmunity Development Departnent,
Building Division
BY -,—Date
All item filled in on Building Permit Application
BY Date
Drawings Stamped and Notations Made
BY Date
Approved by Public 'Works Department
Fievised: 1v 10-1977
'Ic W4 �EDMONDS
"V-1C;-
P NT-.ER-4�W
P..jl)jF,
WIP PARTMNT C ct la��l
._l07, when work
ready. fm Insp66tion. (N intspec-
wtions Saturday, I. Sunday or holidays.) 'NO 110
�SDE
'PERMIT
.................
------------
..................................................................................... I ..........................
4 ...... t1tat-Wheeier
- - - --------- ............................ .. co
............
NTRACTOA ...........
PerlwSsi6il'. is. ................ --------------
% ......... . . .......
with CU3�i:S for
owers inAbV*rdanc'e wjth�ap dais, to Rkjp
PlicatiOn on file and goe AIR or C
rning Ordinance& 9NNECT-a side Sewer
TTENTION, IS CA.LLED To THE
FOLLOWINCT:
N6TF,* No. I—Tfie 'o-wners of the propert
be einPl6yed to construct si I may obtain a permit to con I truct sewer inside property line. A
NOTE No. 2—" Obtain full Inform de sewer it, street arm Do notslover licensed Side Sewer contractor must
No. 3-L7Top ation regardin any Portion Of sewer before It has been inspected.
9, Ordinance 11.16,030 and Regulations governing side sewers when you get permit.
of side sewer M I ust have at least 30 Inches coverage at Property line and 12 inches inside property 11m; ml
No benqs, in grade sharper than % Will Lbe permitted.
140�rE No- 4—Ti6ncbes in treet , must he wate
failure. due s ' r r settled and street rest ullnum grade of 2%.
to Imprope work,'whieb may devesurfa'ce of d to Original condition. Contractors s
NOTZ No' 57-�-It is L UWawfUI tO`alter or do an I.OP-within one Year ore responsible for
Of completion. hall be
Purtinances ex Y other work� than I Provided for in the permit, or to do any work On the main sewer o
CePt to insert the Pipe Into the wye. S
r its ap-