Ed Way OVWD Cut & Cap 5.5.208128 228th St. SW
Edmonds, WA 98026
Office: 425-774-7769
Fax: 426-670-1856
Side Sewer Address 2 L t3
Lot No.
OLYMPIC VIEW WATER & SEWER DISTRICT
SIDE SEWER PERMIT
0 &1 +-,Oncj5 W
Block
Plat Name
0
Permit No.
4718
Date 51 + 1 2-0 20
The undersigned hereby agrees to construct the side sewer as above applied for, including, but not limited to, the following stipulations:
1. That all regulations and requirements set forth by Resolution No, 138, of the Olympic View Water & Sewer District, be complied with fully and completely. Resolution No. 138 is, by
this reference, included in its entirety as a part of this side sewer permit application and by the issuance of this permit and acceptance by the owner, or his agent, agree to be bound by its
terms and stipulations in their entirety. (Copy available for review.)
2. The owner hereby agrees to maintain the side sewer constructed under this permit in accordance with rules and regulations of the Olympic View Water & Sewer District, and
further will permit access with entry by authorized representatives of the Olympic View Water & Sewer District on the property described in this permit at any reasonable time for the
purpose of inspection for compliance with all district regulations.
3. The owner is hereby notified that the Olympic View Water & Sewer District sewerage system is for sanitary effluent only and he agrees that he will not at any time connect storm
water drainage from any source to the District's system, this includes, but is not limited to the following: (a) roof downspouts, (b) building footing drains, (c) springs or under -ground water
from any property, (d) any outside ground -water drains.
4. The owner and his contractor hereby agree to accept full responsibility, and to hold Olympic View Water & Sewer District harmless, for any liability, damage and/or costs of any
nature whatsoever which may accrue from prosecution of side sewer work under this permit.
S. The owner and/or his contractor hereby agree to safeguard the work done under this permit in such a manner as to prevent injury and/or damage to the public. Such precautions
shall include the employment of all necessary ditch safeguards such as lanterns, barricades and safe access or egress through the working area.
6. Unless work is to be performed by owner, the owner and/or his agent agree to employ a side sewer contractor, licensed by the State of Washington and covered with adequate
and satisfactory liability insurance, for all work to be prosecuted on public roads, rights of way and private property.
7. The owner and his contractor agree to obtain at no cost or liability to the District all necessary permits for construction work to be accomplished under this permit.
Owner's Name 5o in &i+e-rrl 5C L LC Owner's Signature
(PLEASE PRINT)
Owner's Address and Phone � 07 15,yLe— & urky� Is tZ 1 7n')"11011 r 3
Side Sewer Contractor A�F, h Contractor's Signature
(PLEASE PRINT) -
Contractor's Address and Phone �" V ` s~� `JY�l ''- ',a�C'2-c3'+
Type of Building and Use
Monthly Service Bills To
_`�uf r rem
FOR USE OF OLYMPIC VIEW WATER & SEWER DISTRICT ONLY
Permit Fee and General Facility Fee • oc) Paid S 1 44 LC) 20 C jL-C� �51
I-- � ,
Issued By
Ov 035 (5111)