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10205 SW KATHERINE STREET-1 10205 SW KA'T'HERINE STREET r- w W CC H U7 LTJ Z a w x :r Ln un A F Delete selected item ObMASTER :MST90-0133: FROJECT:GREENBURG HEIGHTS n0: STATUS:I : UPD:01/29/91: :NRS: PEFMI'PTEE:ROBIt. SLYTER PRIM. . :MST90-0133: ° SITE iDDRESS:30205 SW KATHERINE ST Ob CAS3 HISTORY S$$ii$g$$fi$fi$gab$$L$$h&$€.Req/Sent&Schd/Dua$End/Doiie&iByist:at9b$C A707 Wtr Proofing Bsm't Walls A710 Post/Beam Insp A713 -rawl Drain A717 PLM/Underfloor 05/15/90 MS PASS ° A718 Ftng Drain Bsm't Walls A720 Mechanical lt:ap 01/09/91 KS N/A A722 Plumb Top Out 05/18/90 MS PASS ° A725 Framing Insp 06/20/90 KS DIS A726 Framing cREINSP> 06/27/90 KS APP ° .4730 Fireplace Insp 06/05/90 KS APP ° A735 Gas Line Insp 01/09/91 KS N/A A740 Insulation Insp 06/ 7/90 KS APP ° A745 Gyp Board Insp 07/02/90 KS APP A755 Rain drain Insp ° A760 Water Line Insp / / INSP -c1T1Q1 N9TICE City of Ticzrd Ruilding Department 1.3125 RW Hall Rivd. Tigard, Oregon 57223 Inepeatio.) Line (Rec-O-Phones 639-4175 Buslneee Phone: 639-4171 Inepectiodt Footing / Plbg. Underslab hrch. Appr/Sdwlk Found. r/� Plbg. Top Out Gas Line FINALS Post/Beam Struct. San. Sewer Framing Bldg. Pust/Beam Hoch. Rain Drain Insulation -Plumb. P1'ag. Underfloor Water Line Gyp. Bd. ( - h. Date Requested;_ � � q� Timet AN PM Addreea:/�_„_ f���`�~ �r��� i ++sr.�i ]T•� Permit s Pillder: _ THE FOLLOWING CORRECTIONS ARE REQUIREDt 'nepector: -JC�e r -- - — — Date:1f e:_-A PROVED D;SAPPROVED APPROVF- SUBJECT TO ABOVE ` Call For Reinsp. �. e. s ■w .. M .. MEN ..� erg j)ISPE(.TIOM NOTICE, ��'' City of Tigard Building Departinent 13125 SW Ball. Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone)a 639-4175 Business Phone! 639-4171 Inspections ----- --- ---------- Footing Plbg. Underslrb Mach. Pough-in Appr/Sdwlk Pound. Plbg. Top Out Cam Line FINAL: Post/Beam Struct. itan. Sewer Framing -Bldg. Post/Beam Mach. Rain Drain InsulationPlumb. Plbg. Underfloor Water Line Gyp. Bd. -Mach. Dabs Regssested:_T_ Timet —AM PM Address: Builder: TRC FOLLOWING CORRECTIONS ARE REQUIREDs tl __— 'f � - d Inspectors _— _�—_.__----- -- — Dates Z_ APPROv2D DISAPPROVED — u APPROVED SUBJECT To ABOVE _—Call For Reinap. wr wr w� s e: ■r wi ss e� Noveml)er 26, 1990 COREGON TIGARD .. -.n Slyter lu-J5 Sw Katherine Ti_,ard, OR 9;223 Res 10205 SW Katherine Permit 4MST90-0133 Dear Robin Slyter, The last inspection conducted on the above project was a gyp hoard on July 2, 1990. The next required inspection will be a final. Please advise the Building Division of the statue of this project as soon as possible no the file may be kept current. Please note that any permit without activity for over 180 days becomes void. If you need additional time to .:omplete the project, plenne contact this department so that an extension can be discussed. Sincerely, Brad Roast B-Alding Official Notice.l 13125 SW Nall Blvd.,P.O.Box 23397,Tigard,Oregon 97223 (503)639-4171 ------ INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 7 Type of Inspection �Y `� wZA� e01 --- Date Requested_ � Tirrlit_�ezft.M.-E_1_ AddressU _ Permit Owner_ A Lot Builder,_- - — The following Building Code deficiencies are required to be corrected: (•�`� % Suet t!lC E D"7Z�'Z�TC- ,� 'IeL�G�_"�T� 6c 1n,lSi t`�[�� _. e Presented to _ ___ i �Approved Inspector _ �� Oisapprovpd Date. CALL FOR REINSPECTION 0 YES L) NO mom asst w: ssB i� w WAIIFW INSPECTION NOTICE City of Tigard Building bepartiner.t P O Box 23397 Tiqard, Orpgon 97223 Phone. 639-4175 Type of Inspection ��-Ti t ZZ/ / — Date Requested _(�� �` f � Time--- A.M. 7 VA Address __._..L �•-� _-_-___ ` ��- Permit *�__ Owner __ _---- —.-- ___ Lot #--- Builder _Builder The following Building Code deficiencies are required to be corrected: Presented toApproved -- Inspector - _ ❑ Disapproved Date CALL FOR REINSPECTION YES ❑ NO ■sr wr w e. e, � ewr �. � wr INSPECTION NOTICE City of Tigard Building Department \ P.O. Box 23397 Tigard, Oregon 97223 Phone: 6394175 T,ye of Inspection _ Fireplaces_ —..._ -- Date Requested /5/90 _ — Time__.._-hX A.M._ P.M. Address --._ 10205 SW KatheFine St. Permit #_ 90— 133-- Owner_ �_�—_ Lot # _� Builder —'PLL Construction The following Building Code deficiencies are required to be corrected: j�K'yy'rl� - t3�OC� IIj Presented to _ Approved Inspector / ❑ Disapproved Date CALL FOR RFUNSFE'CTION [J YES 0 NO INSPECTION NOTICE City of Tigard Building Department P.U. Box 23397 Tigard, Oregon 97223 Phone: 6394175 Type of Inspection Date Requested— _ Time —_ A.M. °.M. Address ��2_ ?�tt�� Permit Owner_ _____ Lot # Builder-L-L The following Building Code deficiencies are required to he corrected: 1 CAVi Presented to _ V I Approvad Inspector = __. _ Ll r+isapproved Date CALL FOR REINSPECTION C7 YEs C] NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oreg m 97223 Phone: 639-4175 Type of Inspection __ 7'* ---- Date Requwed - a'� _27� -nme '�+`� A.M.__ P.M. Address �U.�:DS SW X-:-f7�tE�1� Iwo J7`. Perim• #M-t Owner -_--_ Lot Builder 2�L` C-0)— The -0)The following Building Code deficiencies are required to be corrected: Presrnted to Approved Inspectorr�, Disapproved Date - CALL FOR REIMSPF_CTION YES L_1 NO INSPECTION NOTICE City of Tigard Building Department i P.O. Box 23397 j J Tigard, Oregon 9-223 Phone: 639-4175 r����/, — Type of Inspection —----- _..__z��k��1�- 9` L Date Requested P.M. Address IL. Permit ;tweet Lot Builder -- —The following Duilding Code deficiencies are required to be corrected: r _ f - A q r R r i i Presented to __ ❑ Approved Inspector binpproved Date CALL FOR REINSPECTION tTr fES CJ NO s ew .■� s� ess esw as wr sse sssa �. +.r INSPECTION NOTICE City of Tigard Building Departme P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested._ _ Time `_ M. _P.M. rr. Address "26.5— ' Permit K/4T Owner Lot # �— Builder-,, The following Buildin4 Code deficiencies are required to be corrected: �� '�'�R 01t'r[�.r f�%r�.S.��11►L'_�._:.:�"''� .-G.n� rt/�Gc� '�. fir.�;,�,,,� .�,,-��,�r-�..�,rr.� (�C��✓e��:;G �'��L[.. Presented to �' 1`Approved Inspector Disapproved Date •fid— CALL FOR REINSPECTION (_1 YES 1=1 NO � MASTER PERMITC17YOFTIVARD PERI1I T #. . . . . . . « MST90-013: COMIAUNITY DEVELOPMENTS DE�PAPT f Lwf1Y04190m DATEPRIMISSUPERMED: #. « M5T00-0133 �!f.�r� �_ DATE: I55(JE:D« 04/17/' 0 19125 SW Hall Blvd. P.O.Brnc 23397,Tigard,,Orepon 97223(603)839.1175 a T':-F11M1:u.'...i'i ;a. 1.0205 SW KATH ::R1NE ST. — PARCE:L« 151:35CC;--02?00 SUBDIVISION. . . » « GRLENBUURG HEIGHTS ADDT.T10N ZONING: R--4.5 BLOCK. . . . . . . . . . « LOT. . . . . . . . . . . . . . 11 BUILDING) ._._..._.._....._._.._._.._..__.....__........_._.___.___.___..._._..._.....w._.. ... RLI:SSUE'. DWELLIHO UNITS-. 1 BASEMENT'. . . . . . . . «0 sf CLASS 01" WORK. «ADD BE.DRMS« 1 BAT'HS: 1 GARAGE. . . . . . . . . . «0 'sf TYPE OF USE. . . «SF" FLOOR AREAS•-••-•-• -..........._....... REQUIRED TYPE OF CONST. :5N F`IRST. . . . «6413 <.3f• LEF'T. . «0 ft RIGHT. «0 ft OCCUPANCY GRF•'. «R3 SECOND. . . «0 sf FRONT. «0 ft REAR. . «0 STORIES. . .. » .. . . «0 THIRD. . . . -.0 Sf REQUIRED __4...__.._.__...._._....__._.___.._....._.. HEIGHT. . . » . ,. . . . lc ft TOTAL•---____._.«6ti4f3 S f SMOKE DETECTORS. «Y F_L UOR LOAD. . . . c40 psf VALUE. . . . . $« 19300 PARKING SPAC:ES. . 90 Rema•rk.si« _._............._.___._..__ __...._.._.._..__ ._.___..._._____._�._.. PLUMBING SINKS. . . . . . « . . . «0 F=LOOR DRAINS. . . . «0 BA(.KFL.OW PREVN•TRS. . «0 LAVATURILS. . . . . t.2 WATER HEATERS. . . «0 TRAPS. . . . . . . . . . . . . . «0 TUB/SH'OWE'RS. . . . « 1 LAUNDRY T'RAYS. . . «0 CATCH BASINS. . . . . . . «0 WATER CLOESETS. . « 1 SEWER LINE: (ft) . «0 GREASE TRAPS. — . . . . «0 DISH6IASHE.RS. . . . ...0 WA1f":R LINE. (ft) . «0 OTHER FIXTURES. . . . . «0 GARBAGE DISP. . . «0 RAIN GRAIN (ft) . .0 WASIIIIG MACH. . . -. J. SF' RAIN DRAINS. . « i. ........._......._._._._._....__................. MECHANICAL _ _._...._..._._._.._......_... _.. __._.. _ -- - _- F'E E S ......._..... _.._.......... . . .... FUEL 'TYPES - " --_.__.____.. UNIT H'TRS. . «0 type+ ammmt by date reept: VENTS . . . . . «0 EIPRT $ 134. 50 / f MAX I:NT-`(J1'«0 k+TU VENT F'ANS. . -0 BPLC $ (37. 4;3 F'(.)RN ( 10bK . . ::0 HOODS. . . . . . «0 FIRE' $ 0. 00 FURN )=100K . . ;N WOODSTOVE.S. «0 B5PC. $ G. 73 / f FLUOR F URN. . . . .0 CLO DRYERS. :0 PPR•T• $ 52. 50 BOIL/CMT' ( 3F P,-.0 OTHER UNITS«0 Ic'Sf'(:' $ 2.63 GAS OUTLETS«0 PAYM $ 283. 79 J LIA 04/171/90 RUPIN SI.YTLR SW KATHERINE. Si' 'T I'! 3RD OR 97223 P V.C.n e #« Cmit•ractar. TLL C'UNSTRUC TION TRACY l_IVING5'TGN 11.1.00 SW 95T1•I :I:GARD UR 97283 f'h c,ne #-. 639-•J.1 G y $ 283. 79 TOTAL This permit ;s isFu?d subject '.o the regulations contained in the •• .... - .- RECIUIRED INSPECTIONS -- Tigard Municipal Code, State of Ore. Specialty Codes and all other Faat/faUnd Insp PIUmb )Crp OUt applicable laws. All work will be tion in accordance with approved Wtr P-roofing Bsm Framinq Insp plans. TMs persit will expire if woo is not started within IAN Fast/Beam Insp Fireplaces Insp days if issuance, or if work is susp-nded for wore than 1 days. Crawl Drain Gas Line Insp Plm/i.mdslab Iiisp InsUlati. )1.1 Insp Fle•'•mi.tt:ee` Signaturi—. V&4AA PLM/Underfloor Haar Gyp Board Insp F'tny Drain Bsm't Rain drain Insp 1:Si s u e d B y» _.�_._ m__..... .. _ _.....w__...__ _ ..__... M e+r�h a n i c a I. T n s p Water Line Insp Calc for insapec:tian ...• 639­4175 CITY OF Tlb�.'Wrl RECEIPT OF Fiwmu-"rrr, HlEi,'KlPr No. 0 00':.64 28:7. 79 NAME r ROBIN R'"-LYTEF% CASH AMOUNT ADDRESS 3 102075 5W V.ATHEPINE PAYMENT LIATE : S WEID I V I'. l ON g C')R 2 10205 SW �. A T HC-P I NF FLIFFOSE OF PAYMENT AMOUNT FA 1.D PURPOSE OF Poymw AHOUNT F A I b BUILDING PE PMI 134.50 PLUMBIN(6 P('F:MtT tj 1.450 GI . BUILD PEF-111T TAX 5% 9. t, F,LAN CHEC.1 FE::E TOTAL AMOUNt PAID w�c a p m N A C IZ �n ru m i i!1 O N N •� 4 —� w iO-bO-O to N N i o `] e01 ✓ � L O Q�0 n • en to N N I W m - wmrn INteenn d = a W CD > E y m i • W t m m tD m m 0 J w /\ l7 ti Nw n n w Qi R1 m O q to M N N In A2 Z I W O O o m '» CD I . I . •- Irl N CV m ♦ W INV G\`tel•• Q r, � u- S � 3 !/•ry t`'^ ... u� �� cv to /CD r.Ca o � u `- ry �._.- % C v L C S I:. w u to � MIThS a n n '141, c�r5s ui 0 0 0 2-�r✓A €� .. rNi 0: � i�Fpyp„F E ayaA 6�i.✓&Y&��I7��,�$N��c•S O "n O I 1 1 C7 r o Oo�,aU 000 3 bU LO _ N Z N a u u z z 0 0000 ;ao » Ln u 0 Z N a D. Om eC• :�ua3 'w� Ln D: V1 O o •C o<:a & Ln � �€j C� •iC''tY SE`Fr'- pis Imija - i m.i to sa�t'E%F-�.fsfYa� Irl ;"••€ Ee b o _ �$ e N tri 7 I u, C7 In W 7- ID v ♦ to N h n u \ W u W t/l 1 m Ln mtn N O� Lt N W aC ^ n O Z . u .mut eJ r-� N o coW .� in W u C n r, N .-4 a% 06 ui au o i-. m m r1 I O m 0 O 10"�•l/'O m O J U � W W W ♦ ♦ • fV 4 a.rx W to Vt N N N RecSipt # 341 SEWER PERMIT NV 21905 UUnified Sewerage Agency of Washington County CITY OF Tigard DATE 5aBO OWNER : Michael R. Porter PHONE : 639-3633 OWNER 'S ADDRESS: 10205 SW Katherine Street TYPE OF INSTALLATION: BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER TYPE OF OCCUPANCY: D NEW ® SINGLE FAMILY ❑ COMMFRrIAI ® EXIST. (PRIOR TO 7- 1-70 ) [] MULT. RES. ❑ INDUSTRIAL FIXTURE UNITS DWELLING UNIT'S 1 ADDRESS OF STRUCTURE : 10205 _t�aherir�,e �tregt - _ PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY. WHEN CALLING FOR INSPECTION , PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE- HUNDRED AND TWENTY ( 12o ) DAYS. THE AMOUNT PAID WILL. BE FORFEITED SHOULD EXPIRATION OCCUR . FEES: PERMIT FEE s 25.00 CONNECTION CHARGE rmo-nn SIDE SEWER INSTALLATION Penny Liebertz ISSUEJ BY OTHER TOTAL $ 325.00 _ Clys � ��,7 - /80 APPLICANT DATE t iliCi : _.7�p G�n'f3pV kE CR'"�'Pi?.;,� �,'i.L BL=G i FOR rims PE9SEWER PERMIT No ADDRESS OF STRUCTURE 10205 SW Katherine Street 4 _ TAX MAP 151-35C TAX LOT 1105 SYSTEMFann❑ Lt2ac LOT BLOCK OF Greenbury Heights Addition _ DWH 5/.16 80 -- 58Q APPROVED BY DATE IIiED E3Y DATE D. U . 'S 1 REMARKS Pump--& fill existing septic tank per State Code. Minimum 4" pipe required. >RxGM U)f"a c*XXDG(-Ka XXY")9LIXot rx x x c f SEWER PERS/H �- � N�) Em- Unified Sewerage Agency ------���� f�► i PZ'R• of Washington County CITY OF l t 9Gl.R�' DATE etu OWNER : /llttiN.irJC \<- �o P-l`' PHONE : e/3Q— 5613 OWNER ' S ADDRESS : n2�s g Yy `�e GGr TYPE OF INSTALLATION: BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER TYPE OF OCCUPANCY: ❑ NEW ;�) SINGLE FAMILY ❑ COMMERCIAL DOEXIST. (PRIOR TO 7- 1-70 ) ❑ MUL.T. RES. ❑ INDUSTRIAL FIXTURE UNITS DWELLING UNITS ADDRE.-; OF STRUCTURE: : Goye _ PERMIT CONDITIONS : THE APPLICANT AGREF`7 TO C.UNIPLY WITH ALL RULES .AND REGULATIONS 9F THE UNIFIED SEWEf'AGE AGENCY . WHEN CALLING FOR INSPECTION, PLEASE REFER TO THE PERMIT NUMBS,'. THIS APPLICATION EXPIRES IN ONE- HUNDRED AND TWENTY ( 120 ) GA`,a. THE AMOUNT PAID WILL BE FORFEITED SHOULD EXPIRATION OCCUR . FEES : X • � I PERMIT FEE E 3oC� CONNECTION CHARGE SIDE SEWER INSTALLATION v ISSUED BY OTHER va. �- AF'PLIC SDATE ~� �����R P�Ri,��l�' ADDRESS OF STRUCTURE Aa-oe-- - � N° _ TAX MAP ��C _ TAX LOT SYSTEM F414610 LOT BLOCK OF A F P R O E DSU B Y DATE D ISlED �BY DATE n D. U. 1 5 _______1— R E M A R KS IIIIIIII-M-AARK C17YOFTEVARD rma7www PLAN CHLCK APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT(- PLAN C':ECK 13125 S.W.Hall Blvd..P.O.Box 23397,Tigard.Oregon 97223,(Sal)L"4175 PERMIT N - OpTE ISSUED JOB ADDRESS: J l�2 f75 JVJ IC� �✓1 Q__� TAX MAP/LOT LOT : — LAND USL: VALUATION: I yp0�,00 _�... _ OWNER � I SE ECIAL NOTES NAME: _ All�lvs Slti�°�"� (vT�/% — REISSUE OF: _ —_-- ADDRESS: I Ly�lt^_i�� -- LASS REISSUE 9 )z 2.3 FLOW PLAIN/ SENSLI IVE LAND: PHONE' -- APPROVALS REQUIRED CONTRACTOR. PLANNING: NAME: lylv ENGINCERING: -� - ADDRESS: DIRE DEPT `� 72,: OTHER: PHONE: 31 ITEMS REQUIRED BUILDERS BOARDr7: _�„�LI "t EXP DATE: _ LIST%SUBCONTRACTORS: _ BUS TAX: ARCH/ENGINEER CALCULATIONS: _ NAML: _ _ TRUSS DETAILS: !/ ADDRESS: OTHER: _ PHONE: � - --- COMMENTS: ✓ '0'e Ce,v,6L, C' 4-' SUBCONTRACTORS: PLUMB: MECH: � PERMIT M ACCT N DESCRIPTION / AMOUNT AMOUNT PD. BAL. DUE 10-432 00 Building Permit Fees /3y 5v _ 3 y -' 10-431 00 Plumbing Permit Fees V _ 10-431 01 MFetfthiCal` Pcwmit Fees �s 10-230 01 State Building Tax (5X) Building —�_ 1 q , 3G Plumbiny Mech _ 10-433 00 Plans Check Fee ' ✓' Building Plumbing Mecn _ 30-202 00 Sewer Connection _ — 30-444 00 Sewer Inspection — 51-448 00 Street System Dev Charge (SDC) 52-449 00 Parks System Dev Charge (PDC) 31-450 00 Storm Drainage Syst Dev Chrg (SSDC) _ 10-230 06 Fire TOTAL _ RFC b APPI 1 C T . ICNATUPF Received By: -- Date Received: cn/3587P/18P I I (;IZADING/1:RQ IV_�„ 1'IZUL INFORMA•'lU G CASEI'ILE NO.:---.-- PERMIT NO.: Z APPLICANT NAME AND ADDRESS: EXCAVATION CONTRACTOR �, � ��.�� v� - NA l:& ADDRESS: OWNER NAME AND ADDRESS: lie TELEPHONE NUMBERS: APPLICANT: 'i� <- PROPERTY DESCRIPTION: �- �l �_� .� OWNER;_ a —•- STREET ADDRESS AND TROS STREET/LOCATED GENERAL CONTRACI'OR:_ " EXCAVATION CONTRACTOR: — -- - SITEJ.IOB: ( Z C/ - C' F, b 5 LEGAL DESCRIPTION: 24 HWAFTER HOURS EMERGENCY TAX LOT NO.:_ CONTACT PERSON TrFIfE, III—PHONY: 1 1/4 SECTION: - - C 7ve, ice✓ SITE SIZE,ACRES: DISTURBEDIWORK AREA,ACRES_ LOCATION&ADDRESS WHERE SPOILS LEAVING SITE WILL BE TAKENSITE RUNOFF DRAWS TO:(CIRCI E ONE) (NOTE:�PF.RMrM MAY BE REQUIRED) CATCH-BASIN DITCH PIPE CREEK t n lJ �k l -- (CIRCLE ONEX:'RIVATE PROPEiiv —� UBLIC RiaHT OF WAY EROSION SEDIMENTATION CONTROL (ESQ MEASURES MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS DURING CONSTRUC,'TTON: FOLLOWING CONSTRUCTION: SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE STABILIZED CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY ESC PERIMETER RUNOFF Col'TMOL FACILITIES CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES CONSTRUCTION SEQUENCE OTHER PLAN FOR EROSION CONTROL PREPARED AND SUBMITTED IN ACCORDANCE WMI'TF :HNICAL GUIDMICE HANDBOOK'. EROSION C'ONT'ROL PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE.INCLUDVNG EMF-RGE14C:Y PHONE NUMBER. SCHEDULEISTAGING FOR]INSTALLATION AND REMOVAL OF EROSION CONTROL MF ASORES,AND APPLICABLE STANDARD NOTES. I HAVE READ AND WILL COMPLI'WITH THE ABOVE AND WILL CONSTRUCT AND MAINTAIN FSC MEA:URES AS NECESSARY i 7 TU CONTAIN SEDIMENT ON THE CONSTRUCTION SITE. OWNER SIGNATURE APPLICANT SIGNATURE OFTICIAI.USE ONLY. RECEIPT DATE: ACCEPTED FEE NUMBER RECEIVED BY