9532 SW SATTLER STREET t �► 1+
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CERTIFICATE OF
CITYOFTIGARD OCCUPANCY
CIIYOFT ARD 1:'jER14TT #. . . . . . . . MST!0---030k,1
COMMUNITY DEVELOPMENT DEPAMP-r 0 RHO GO#H4
13126 SW HWI BNd P.O.Sm 23W,TOW,O"qDn OY22� m
r)A'rE- 17-,EWED: 031 .14/91
GITE ADDRESS. . . r 95&� T-,W GAT7LER ST PARCI—Lc 2,5111CA-1120111
SUBDIVISION. . . . : LAKESIDE PLACE ZONINGs R-7 Pr)
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . s3
CLASS OF WORK. ANEW
TYPE OF USE. . . :SF
OCCUPANCY GRP. :R3
C1(.X'LJP.'nNr,Y LOAD:0-.20 4
T(`--"NANT NAMF"..
Remarks
Ownpr,-
MCLV1ill WAYMIRG
10845 SW DOVER CT
OR 97224
(-Ahmie 5@36396742
�wcantra�rturs'
MELVIN WAYMIPE
10045 SW DOVER CT
FIGARD OR 970"24
Phone #: '5036396741:2
Rp�j 4. . : 35976
Occupancy of the above referenced building is hereby given, &.tal certifips
the compliAnce with the State Of Oregon Specialty Codes For the group,
OCCUPWICY1 an(I ume under which the referenced permit was ipsttecj.
F1 RE DE PARTOWNT [-.D I I N YSL31/�r'Ir 0 R
1ALJ WD J NG 0 - I C I At..
POST IN CONSPTCUOUS PLACE
INSPECTION_NOTICE
City of Tigard Building Department
13125 SM Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O- one): 639-4175 Business Phone: 639--41.71
Inspections
FootingP Underalab Mech. Rough-in (Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater. Linney Gyp. Bd. -Hoch.
Date Requented:_,� / _-Time: AM PM
Address: .�... -� Permit #:
Ruilder:_
THE FOLIAMING OO CTIONS ARE REQUIRED:
J
-�° . t° •(/Dr /ice
Inspectors / � Date:_ __[!?
_4APPROVED DISAPPROVED �APPROVEn SUBJECT TO ABOVE
Call Tor Reinsp.
M
INSPECTION NOTICE f
City of Tigard Building Department
13125 SW Ball Blvd. Tiqard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Busineae Phone: 639-4171
Inspection: �— -- —
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALt
Poet/Beam strnrt. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb
Plbg. Underfloor Water Line Gyp. Bd. �-�Kech
Date Requesteds `7 Timet AM
Permit is�L�
r�-
Builder: y �
THE FOLLOWING qj�JMCTIONS ARE REQUIRED:
Inspector: --�._---_--_--— Dater
APPROVED DISAPPROVED _ ^_ APPR(rrED SUBJECT TO ABOVE
Cell For Reinep.
Ms PB-LT1ON NOTICE ( '
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639 .0171
Inapectios.;_—� --
Footing Plbg. Underslah Mech. Rough-in A/Sdwl.k
Found. Plbg. Top Out Gas Line ` FINALNAL=__iu
Post/Beam Struet. San. Sewer Framing -bldg.
Moat/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Meeh.
Date Requented: _—Tlsne: AM _PN
,7
Addrenes`?,5- f,f __" Permit 1: 91
Builders
THE FO1,1.oWING CORRECTIONS ARE RFQttIPFD:
Inepectors
APPROVED DISAPPROVED APPROVED SU
--- BJISC'I' TO ABIIVE
`Call For Reinap.
ff w w w
�NSPE�O�t NOTICE
Lit:y of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 9722.3
Inspection Line (Rec-O-Phone): 639-4175 Buai.nesn PhoD639-4171
Inapection:
Tooting Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas line FINAL:
Poet/Beam Struct. San. Serer. Frawinq -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Pl:smb.
Pibg. Underfloor Water Line Gyp. ed. -Hoch.
Date Requesteddy(
�s Z V ! 6 ____ rimes --/---AM PM
Address. L1,� __ 1Ao PermLt 1e _
Builder:. ti,
THE FOLLOWING CORRECTIONS ARE REQUIREDI
Inspectors nate:._—
G DISAPPROVED APPRoVRD SUBJECT TO ABOVE
Call For Reinep.
w w w MI w w Aff w
INSPECTION NOTICE
city of Tigard Building Department 1 ��
13125 SN Ball Blvd. Tigard, Oregon 97223
Innpect.ion Line (Rec-O-Phone): 639-4175 Business Phoney 639\4 71
Inspection:.^—. —_ ------ -----
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
i
Found. Plbg. Top Out Gas Line FINAL-
Post/Beam Street. San. Sewer Framinq -Bldg.
Post/Beam Much. Rain Drain Insulation i -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Meeh.
Date Requestedt 0 Tim° _L___AM PM
r
Addrneet Permit f:
Builders
THE FOLLONINQ CORRECTIONS ARE REQUIRF.Dt
Inspectors
APPROVED DTSAPPROVRD APPROVRD SUBJECT TO A@OVC
Cell For Reinep.
® � W t
1NSPECTiON NOTICE
City of Tigard Bul.l.ding Departr•rnt
13125 SW Bail Bled. Tigard, Oregon 97223 1l/
Inspection Line (Rec-o-Phone)e 639-4175 8usinese Phone: 6 ~�
Inspect i un: ZUL&y/
!Doting Plbg. Underalab Mach. Rough-in Appr./Sdwlk
Found. Plbg. 'rop out Gas Line FINAL:
Post/Beam Struct. Sen. Sewer. Framing -Bldg.
Post/Beam Mach. Rain Draiu Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. y, -Mach.
Date Requested:�� �- �Z1 _Time: hU_i___" _PM
Address: 7 Permit i:�
Builder: /,/J
THE FOLLOWING CORRE IONS MR REQUIRED:
Inspect Date:
APPROVED DISAPPROVED APPROVED SUBJECT 1'O ABOVE
__Call For Reinsp.
INSPECTION NariCE
City of Tigard Building Departaent /
131-25 SW Hall Blvd. Tigard, Oxvgon 97223
Inspection Linc (Rea-O-Ph e): 639-4175 Business Phone: 39-4171
i
Inspection:
Footing B1bq. nder.slab Mech. Rough-in Appr/Sdwlk
Found. Mg. Top taut Gan Line FINAL:
Poet./Ream Struct. Ban. Sewer Framing -Bldg.
Post/Ream Mach. Rain Drain Insulation -Plumb.
Plbg, Underfloor Water Line Gyp. DV. -Mech.
Date Requestedf�/
Address:. _ L.r� Permit 1:;'z
Builder:
THE FOLLOWING OGRRE ONS ARE REQUIRED:
Tnepect/or:-----T��a. ---- ------- - Date:
APPROVED _— DISAPPROVRD _ r Ai'PROV6D sUBJRCT TO ABOVE
!lF--- Call For Reinap.
v
iNiM9T.ION NOTICE I
City of Tigard Building Department
13125 Sr Balt Blvd. Tigard, Oregon 97223
It,r ection Line (Rec-o-Phone): 6.39-4175 Buninesn Ph—, 639-4171
Inspection: s �_
Footing Plbg. Under a].ab ch. Rough-in Appr/Sdwlk
Found. ry t Gas Lyne FINAL:
Poet/Beam Struct. San. Sewer Framing ,, -Bldg.
PoPt/Beam Mech. Rain Dratn Insulation -Plumb.
Plbq. Underfloor Water Line Gyp. Bd. -Mach.
Data Requentedt - 1 Timet AM PM
l _
Address: J (_ Permit It 'C1yu
Builder:
THE FOLLOWING OO CTIONS ARE REQUIRED:
inspector --- -- Dete: / ) —
v
APPROVED DISAPPROVED _ APPROVED SU13JRCT To ABOVE
—Call Fnr Reinep.
]:NSYECTION NOTICE
City of. Tigard Building Det 'n'-
13125 SW Ball Blvd. Tigard, Oregon 97223 -,
Inspection Line (Rec-O-Fhone)t 639-4175 Boniness Phone '639-4171
Inspectiont_
Footing Plbg. Cnderelab Nech. Rottgh-in, Appr/Sdwlk
Found. Plbg. Top Out tie Line FINAL:
Post/Beam St-nict. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain insulation -Plumb.
PSbg. Underfloor Nater Line Gyp. Bd. -Mach.
Date Requested:_ 7 9nj _I.imeI AM _-PN
Address• Permit #:e/Q -,0_500
r
Hui.'dert
THE FOLLOWING CORRZCJrONB ARE REQUIRED:
inspector- - Dates /Z, �
APPROVED DISAPPROVED APPROVED SUDJECT TO ABOVE
Call For Reinnp.
�I
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397 /
Tigard, Oregon 97223 C
Phone: 639-4175
Type of Inspection zzzv •�"�
Date 'Requested 7ime A.M._ P.M.
Address __ C� S-- _ Permit
Owner _. Lot #
Builder —
The following Building Code deficiencies are required to be corrected:
Presented to — — } Approved
Inspector _._._. —y —_�__-- Disapproved
Date
CALL FOR REINSPECTI0.1V
P YES ❑ NO
� hill'
INSPECTION NOTICE
City of Tiy Building Department ^
P.O.O Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection ---
Date Requested ! Time A.M. P.M.
61 z3c2.6
Address 3�' � C� ----- Permit #1S1
Owner _ Lot #
Builder _--_—_— —
The following Building Code deficiencies are required to be corrected:
Presented to -_,^Approved
Inspector `'�� __ Dizapproved
Date �—
CALL FOR REINSPECTION
[1 YES ❑ NO
XWXwilllm"
INSPECTION NOTICE �y��
City of Tigard Building Department
P O Box 23397
Tigard, Oregor, 97223
Phone: 639-4175
Type of Inspection zJ&a I C- --
Date Requested /C" z 7'f li' Time_-JSt.A.M. P.M.
Z ' 3S3
Address `i � -�-�-- ,,..r'"f��(4 a �—___ Permit
Owner __ ------_--_ —. Lot #_
Builder L(J`GC�farL'i��
The following Building Code deficiencies are required to be corrected:
PresPrited to _--_.-,-�— —_�,iTV Approved
Inspector _ - - -._.__. -... .._-. Disapproved
Date
FALL FOR REINSPECTION
❑ YES El NO
i
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397 1L
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection - — :�`�
Date Requested ! -1Q ' P.M,
4
Addresse A.M.�— h
Permit
Owner -_-__
-- Lot #
Builder __(
The following Build,1/4 Code deficiencies are required to be corrected:
Presented to 1 Approved
Inspector
� _ Disapproved
;-, pprove
Date
CALL FOR REINSPECTION
M YES 0 NO
III PS)*1 E R E.R III I.'I
CITYOF TIG RD (r11YOFTt16ARD 1'.:,f-_'R III 11* It.. .. .. . ., -, M S 1*9 01 ---03 0 0
COMMUNITY DEVELOPMENT DEPARTMENT R I III F,E R III'.1 T' 0 M S T 9 00 3 0 @
13126 SW Hall Blvd. P.O.BaA 4397,Tigaiti,Omgon 97223 16031639 4176
:1,0 0'*.'-i/9 0
'T
�'I Tl*�_. (4 D 1)R E S S. 9 5 3 2 1514 SATI'Ll]-'R b 2S1i1CA--1_SP#'
LAI-O'SID11 1:1 (alL"-_ ZON I NG
W. OCK. . . ILOT,. 33
................................. ......... BUI I DING
R1::1:SSUE.* DWELLING UNT. TS: 1 W)SEME111'T 5f
C."L.(.1 S S OF W 0 R K. -NEW BEDRMS...3 DOTHS.-3 G(.)RoC;E. . . . . . . . . . ..492
I YPE OF* USE. . .. -SF FLOOR A)REOS RI-1Q .TIRED5I:':'.'TE4ACKS --
T'Y F,E UF' CON(31 . ::�N V I Ps 1'. .. ^ c1.007 f 1.-E FT. . -. 7 ft RIGHT. 5 f.,
1)(`C:L)P0N(,Y GRP.. aR3 SEC,01%11). 803 r,f F'R 0 N'T.. x:30 ft' REAR. 99 '11 L
'0R T ES., . .. ., - - - «P T H 1:R D. . . . ^0 f R E(1 U I R E D
G H 1 -.20 -f t; 1'(.)'T 0 L 8:10 S-f SMOKE DETEL-TORS. -Y
1, OOR I D., 40 1:) f VAI...UE::. . . .. 921.1.6 PARKING S P r.,:S.. 0
H K . . .. .. . . . . . . . 1 I':I OOR DIWIINS.. .0 P A C'K F1...0 W P'P 1:�V N FR': 0
:4 WATER HE(ITERS. MAPS. 0
T(J F1/S 110 W E RS,, -.3 DRY I RAYS. CATCH K4STNS.
W()J,E,FI [_L 0 S E:,T*S -.3 9 F W E R L.T.III L (f t) .. -.0 UREASE *TRAr-`S. 0
DI I INF: (f t) . . 100
:RS., W WT E R . 1 0 T'H F.R F1 X H i R 1'-- 0
C., R Ei P 6 E D I S F). . . RATI-1 DRAIN (ft) . 10
41 )14 1'.14 L7 III r.)I'IA. 13F, RAI 11 DRAINS.. .
III ECI-441,11Cf4l... F'EES --
............. ATRS. . -0 type Anic)unt I)y date -r er lit
Ur L U N 11' 1 1.00. 001 JLH 08/31/90 204:30,#
/(:,AS/ VLNTS . . . . .. .0 PPYM $
1,1(.)X J'NP(J1 -0 P T 1.) V V.N I V'ANS. ., ::4 DDR T $ 41.2. 00
1:7URN ' < 100K HOODS. . . . . . .. J. 14 P L(, $ 267. 80
1:-[.3RN -0 W 0 0 1)F-.1)1,0 v E S. 0 B5171C 1, 20. 60
FA OOR F URN. '.(1) (1.0 DRYERS. I C.31 1)C $ 6001, 00
3 1-4 P-0 UNI'TS-0IS D C $ 375. 00
GAS OUTLETS): .l. PARK $ 250- 00
NELVIN WOYMIRL P L C11 9. 7 t'j
110845 SW DOVER C,T 1 . 95
PPR*1' $ 'I.4 7. 50
1 1C.30RD C)R 97224 17115 P C $ 7. :38
Pfiane #9 5036396742 POYM $ 2030- 98 JL.H [0/05/90
1,11--..L-VIN WOYMIRE
,H,1W.J SW DOVER [ T
1 ' 24
[WIRD OR 97R
Or. '5036371674i.2
35976 .............
2130. 98
This permit is issued subject to the reoulations contained in the REPUIRED I N S P F.(,T T'0 N 1.3)
Tillird Municipal Code. State of Ore. Specialty Codes and all other P o ci t/ f c)t.t n d I n s 1:) 11 a c,h a n i c.,a k I ri s P
applicable laws. All work will be done in accordance with approved wt.r r'rc)afiviq Bsni P I u ni b 1nN, Out
plans. This permit will expire if work is not eta ted
ta,ted W,th I n 180 St-ruet F'-raniinq Insp
days of issuance, or if work, is sus !d for or than 180 days. F`C)tz apet/rienl ml-lArl F i r e P 1.A e e 11.1 S P
C-rawl, P-raill Gas Lirle Ivisl:)
ol j.t t e e 15 1 q ii iA t,vt v Pl.ni/ttvid!;Iab Triql-.) Tnsuiaticin 11 ;1!)
PLM/Uriderflnn-r Gyp Rc)a-rd Inst:)
ISSUed Dy". ......................................................................................................... FL-viq D-rain FISM' t Rail' d-rail' 1:1-1$P
Cali -for ivispectiavi 63.3 41 /5
�4EWE:R CONNE('.I1ON
CITY"OFTIOARD V,ER In 11'
Cff
COMMUNrTY DEVELOPMENT DEPARTMENT VO—FTWA a. SWR90--0353
13125 SW Heil Blvd. P.O.Box 23397,Tigard,Orogor.97223(503)639-4175 H. III:)T'.`)0 0 3 0 0
A 14 L il 1 R Z LA W
r4 R E 1�3 3 2 SW b 0 1 '1 L E R ".31,
L.AKESIDE ZONING:
L::Iqf)NT 1,1411E.
LJSA NO. 42396 F.'mrURE LINYTS.
Cl (ISS 01:7,
Iq[ W 1)W LA.-I T N G (J N I''Y* :;. . .
E OF 1.)S E. . !3F NO. OF PUlLDINGS- I
T H(3 T L I I YFIE. .. . BUSWR I'll R V GLJRF_A(]E. . . :S f
k k
FEES
ME'LVIN WAYMIRE. type a ni Q Lk 11 t by date -r e I t
1.0845 SW CT PIRP11, 1300. 00
T.NSF' 35..00
1160RD OR 97224 V'A Y M 1.535.00 JLIA 10/05/90
Vlfic)vie W. 5036396742
('.1(JN'T'R0C1 (JR NOT ON F 'r.L.E
1-:1 1-1()I-)e It r 9 1.535. 00 TOTAL.
............ R E()L).1 K 1.-.'1) INSVIECT'IONS
This Applicant agrees to comply with all the rules and regulations Sewer Iiiispecti.0111
of the Unified Sewage Aqenry. The permit expires 120 days from ......................... .......
the date issued. The total amount paid will be forfeited if the ...... ..........
pprait expires. The Agency does not guarantee the accuracy of the .......
side sever laterals. If the sewer is not located at the measurement
given, the installer Shall Prospect 3 feet in all directions from
the distance given. If not so located, the install T Shall PUTChASe
...........
"Tap and Side Sever" Permit and l the Or my I nstall a lateral.
.......... ...........
.......... -------
15SU(ld BY'
Cal.I ft.)-r iricipec,t:inri 4175
i •
ITY OF TIGARD PECEir-r OF roYMENT RECETPT NO. s(70-
C'HEMl: AMOUNT s Z565.r10
CAStl AMOUNT
NAME M[..-.1- WAYMIRE PAYMENT DATE
D D E SUBDIVISION
TIGARD, OR 9 7-2 'M32 r3ATTLER
PUPPOSE OF PAYMENT AMOUNT f:1.)I D pliNfjosu OF PAYMENT AMOUN T PA I D
-[-ta-L-D ING, mf.iTg(l-o:7,00 41.A2. 50 PLUMBING PERM 147. (W.,
MECHANICAL FE 3?.(.,)o ST. BUILD PFP 29.9-1
F-"L.,AN CHECK FE 177. 25 SEWER MIA 1500. 00
"'OWER INSPECT 315.00 STREET SDC boo.CIO
F APK.S SDC 2150.00 STORM DRAIN SDC "75. CIO
-T 01(11- AMOLINT f---A I D :!,565.60
C I 1Y 0 F T I FA RD13125&W.Han Bnra. PLAN DC K APPLIC A7ZON
4,7P.O.Boz 23397 PLAN a pCX l�` �-�q L"
figord Oregon 97223 P_EMUT CI if _/V-5/ yc , O..700
COMMUNITY DEVELOPMENT DEPARTMEI44 (503)639-417,
DATE ISSUID
JOB ADDRESS: 95 4- s w Sattler St, Tigard -- TAX rug'/torr
sui: Lakeside 111aQe I o�
�y�7�,J7. -_- - � ilk: --_
VAILUMON:� __-
�-R SPDCIAL NOTES
NAME: _ Melvin G Waymiru, (ter— _ REJ-���[JE OF: - -
ADDRESS: P,0. Box--2-3 I 1 f4 _ LAST REISSUE: -- -
__ Ticard, OR 9722.3 _ FWOD PLAIN/
_ SENSSrr VE LAND: _ --
IlnNE: 639-6742 _ - -
APPROVALS RDIRl7�
OOt? AC'MR PLANNING: —
NAME:- Melvin G. Waymire, Jr. OCINEERING:
ADmEs : P.O. Box 231].64 FIRE DEPT -
Tigard, OR 97223
PIME: _ 639-6742 _ - 7(TrEMS. REQUIRED
BUIIDERS BQARD if: 35976 EXP DATE: 3/ L I /-9 1 I:rsr/ . ts: -- —
BUS TAX:
ARCH/EM31NEER CAUCU MIONS:
NAME: Ulan Mascord -- _ TRUSS DErAIIS: _ -
ADDRESS: 1515 N.W. 23rc 3 Ave- C01 m: - __--
�._ PQr 1 ari 1 , OR - 97210 -
PHONE: 225-9161
A
PILM: --LLii Waj-t6 11111mh-i n-q - Ham:
PERMIT # AOCT ,1# DISCRIPrICN AMDLNr .AM13UNr PD. BAL. 61E
10-432 00 Building Permit Fees ✓.�1.2 .v u '
10-431 00 Plumbing Permit Fc�
_ 10-431 Ol Mechanical- Permit Fees 4-' : moo 3z �
- 10-230 Ol state Building Tax (5%) L1E,93_
Building � �u
Plumbing 7-.'K
10-433 00 Plans check Fee
Building , 7 So y
Plumbing r
Mediow.ki
o4 5 3 30-202 00 Sewer OTMection /�l
30--444 00 Sewer IngX--tion _ 3 S_
51-448 00 Street System Dev Charge 1p(SDC) 00 _ ter✓
52-,449 00 Parks System Dev Charge (PDC) 19-5'p
31-450 00 Stamm Drainage Svst Dev Chrg (SSDC) L` Z6
10-230 06 Fire
TUTAL.
� 41
1 RW ;# &
XiPi ��:-•r�r�.i
IC SIQWftjRE�.. -- -----
Received By: - Date Received:
of/3587P.WPF
0- "-JM-
GRADIN(:/EROSION CONTMIL, INFORMATION
GENERAL CONTRACTOR. NAME&ADDRESS: CASEFILE NO.: _
Melvin G. Waymire, Jr, PERMITNO.:__
ox 4
__ aya_rCy. cs, ___ — - APPLICANT NAME AND ADDRESS:
EXCAVATION CONTRACTOR Melvin G. Waymrie, Jr. —
NAME& ADDRESS: P.O. Box 231164
Lonnic Endicott DumuLruckina `1 9ard. OR 97223
0 N.W. Moores Val-ley Rd. OWNER NAME AND ADDRESS:
- Y amli i 1.1 . Olt 9 7 1 4 8 -- -
TELFTHONF..NUMBERS: -'
APPLICANT: 639-6742 — PROPERTY DESCRIPTION:
OWNER; STREET ADDRESS AND CROSS STREETA)OCATED
GENERAL CONTRACTOR:_ 639--6742
S .W. Sattler St.
EXCAVATION CONTR ACTOR: 245-7646
SITE/JOB:
LEGAL DESCRIPTION:
24 HR/AFTER HOURS EMERGENCY TAX LOT NO.: 42 - Lakeside .Place
CONTA P -R$ON,TITLE,TELEPHONE: I/4 SECTION:
Melvin G. Waymire, Jr, SITE SIZE,ACRES, 9580 Sq. Ft. _
-- ) S ont_ractnr
_6742 —
DISTURBED/WORK AREA,ACRES: 9580 Sca,Ft,
LOCATION&ADDRESS WHERE SPOILS
LEAVING SITE WILL BE TAKEN SITE RUNOFF DRAWS TO:(CIRCLE ONE)
(NOTE:PERMITS MAY BE REQUIRED) �CATC- H-BASINS DITCH PIPE CREEK
None anticipated
(CIR.C:LE ONE)(PRIVATE PROPERTY
-- PUBLIC RIGHT OF WAY
EROS ION/SEDII`I_ENFATION CONTROL BSC) M- EAS1J.S
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS
DURING CONSTRUCTION: FOLLOWING CONSTRUCTION:
SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE
STABILIZED CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY ESC
PERIMETER RUNOFF CONTROL FACILITIES
CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS
COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES
CONSTRUCTION SEQUENCE OTHER —
OTHER--- -- _
PLAN FOR EROSION CONTROL,PREPARED AND SUBMITTED IN ACCORDANCE WITH TECHNICAL GUIDANCE HANDBOOK".
EROSION CONTROL PLAN DRAWING:,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE INCLUDING EMERGENCY
PHONE NUMBER, SCHEDULFJSTAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND
APPLICABLE STANDARD NOTES.
I HAVE ROAD AND WILL COMPLY WITH THE AAOVE AND WILL CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT ON THE CONSTRUCTION SITE.
OWNER SIGNATURE APPLICANT SIGNATURE
OFFICIAL I ISE ONLY.
RECEIPT DATE ACCEVI I:1?
FF.F. NUMBER RECEIVED B Y