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8203 SW LANGTREE STREET tik 8203 SW LANGTREE STREET _� CITYOFTIFARD CEROCF I OCCUPANCY OF i pCCUAi.:Y COMMUNITY DEVELOPMENT DE,PAIR*i* ON PE.RMIT N. . . . . . . r MST90 -01Ar 1J1253WF-ARIvd. P.O.Box 23397,Tipenl,Oregon972x3(6Q3)8.V4176 DATE. ISSUEDt 11/21/90 S T i E ADDRLS3S3. . . t Bi?0 s ',W L.ANOTRE:k 51 PARCE-l..r PS11M: 11,400 SUBDIVISION. . . . a LANG IkE:E: yy ;7_ONINUv RL.00K. . . . . . . . . . t LOI'. . . . . . . . . . . . . 46 CLAP6 OF' W0RK. a NF W T"Y0E OF' USE:. . . t SF:. O( CUPANCY ORP. tR:3 OCCUPANCY LOADt220 4 )F:NAN I NAME., . . a Ownersw ----_.._. _.,._._.. ......._......____...._._...___w___.._.._ TITAN PROPERTIES PO BOX 6835 AI (111A OR 97007 llt.c nc Mt 6455477 Contractors -_.___ ...... _......_....__..__._.w_._..___ ._____._ TITAN "-'ROPE.RTIES PO BOX 6835 ALOHA OR 97301 Phone ''t 6456471 F'F!, 4. . 1 2`4558 OccoAps.ncy of the above ref-zrenred building it hereby yiveal, and cerci fienq the compliance with the State Of Oregon Specialty C;cake% fo-c the Wl'oaan, occ.aprancy, and oast under which the referenced permit was iiseuRd. r % FIRE DF'•_'PARTMEHT BUILDI O I zmSEG 0k Bu 1,Jn NQ O CIAL POST IN CONSPICUOUS PLACE en nta ea waALU>w INSPECTION NOTICE City of Tigard Building Departwonnt / 1.3125 SR Ball Ble.,. Tigard, Oregon 97223 Inapect:ion Line (Rec-O-Phone)J' 639-4175 Rueinene Phony: G39-41.11 Inepection:F— — -- �---- - )_' Footing Fliq Un,�-lab Mech. Rough-in (Appr)fbdwlk Found. Plbq. Top Out Gas Line FINAL: Post/Beam Struct. Ban. Sewer Framing -Bldg. Poet/Beam Msch. Rain Drain 7neulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Mech. Lata Requested: / _Times _--Alt —PM Addrnas: � �" • • J PeMIt Builder: J ---— THE FOLLOWING CORR1iCTIO4B ARE REQUIRED: 7 Inepectur: (,L / �`-C._ '' Datef�� VAppRoVED DISAPPROVED APPROVED SUSSUCT TO ABOVE Call tor Reinap. 1 INREGTION NOTICE City of Tigard Building Departsvxet 1.3125 SII Ball Blvd. Ti.gar 1, Orejon 9722:1� Inspection Line (Rec-O-phone): 639-4175 [Business Phone: 639-41.11 Inspection: Fo•)tinq Plbg. Underalab Mech. Hough-in Appr/Sdwlk Found. Plhq. Top Out Cas Line FINALt Post/Beam Struct. San. Sewer Framing eld Post/Beam Mech. Rain Drain Insulation -Ply. ch`)q. Underfloor Water Lint Gyp. lid. Mach, j ate RequeetedCs__�L ��y� TiaMt AM _PN Addreoe;-- O Parigit g THE FOLLOW111r. 03RRECTIONS AR REQUIREDs -6 (f - _ - - Insps,ctors- -- Datst_z�- _ kPPRayso DIf1APPROVED _-- APPROVED BUBJSCT TO ABOVE Call For Ralnap. INSPECTION NOTICE Gitr of Tigard Building Department P.O. Box 23397 Tigard. Oregon 97223 Phone. 639,175 Type of Inspection _f"f� /— -- - -- --------.-. ------- - Date Perluested--2-t-P?/- ,�Time_ A.M. r }._P.M. AddressCZ/L J S?LIJ f�/dry�2 v—_�� _� Permit #-2(_( -6� Owner - �'1/ Lot -7 Builder / /r� 'Y Tl►? following Building Code deficiencies are required to be corrected: Presented to _ •� Approved inspector __._ ❑ Disapproved Date CALL IPOR REINSPECTION L7 YE1 D No r•- Citp of Tlgazd Fa.11ding Departaentj 13125 SW gull BiM. Tigard, Ozngon 97 23 Inspection Line (Rac-O-Phone)s 639-4175 Busineae Ph 39-417]. Inspection-. Footing Plbg. Undersilab Mach. Rough-in A r pp /Sdwlk Found. Plbg. Top Out Gas Line PINALt PO•;t./Beam Struct• San. Sewer Franing -Bldg. Mecn• Rain Drain Insulat-lon '_-- -Plumb. - Plbg. Undr,rfl.00r Water Line Gyp. Bd. -Mach. Date Requested: �� —f� AM Address: Builder:— THE FOLLOWING CORRECTIONS ARE RSQUIREDr Inspector: ,a ------- _ Date:-��— i1PPROVRO DISAPPROVRD APPROVED SUBJECT TO APANg —Call For Reintp. "„iSPECTION-p—CUO r- / tea._•+... cl�_T or Tigard Building ceparta:ent ,-1..-- 1.3125 SR Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O--Phons): 639-4175 Business Phone: 639-4171 Inepe,:tion:_ - ------ ------- ----- -- Footing Plbg. Underelab Mech. Rough-in Appr/Sdw1k Found. Plbg. rop Out Can Line FIKAI: Poet/Beam Struct. San. Sewer Framing -Bldg. Post/Beam Mach. Rain Drain Insulation �-Pl - D Plbg. Unddrrloor Water Line Gyp. Bd. -Meeh. Date Regveetedt �i _�L'J _ Time! ,( All —2LPK Addreae: ftrOit #I Huildt:r: rHE FOLLOWING CORRECTIONS ARE REQUIRED: C. Inspector:.__ Date:- 4-APPRO"IND DISAPPROVED APPROVED SUBJECT TO ABOVE -_Call For Relnnd. i INSPECTION NOTICE City of Tigard Building Department P.G. Box 2339? Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested �U – `Q — Ti412k-6A.M..._.__...._P.M. Address Permit Owner__— Lot # Builder _�_ ----- -- --- The following Building Code deficiencies are required to be corrected: 01 G� ' TLS d r^ 1.<itt.� J 1 a Presented to ' ( /approved Insp-etor ` ( /- _ DisapproeeJ fate --- --- CALL FOR REINSPECTION 0 YES ONO I WEPECTION NOTICE (� City of Tigard Building Department ` P.O. Box 2?397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection .-- r Date Requested—_ 1 ,. Time .M._ `P,PWI. Address_ �' Permit # t��—�G�22P1J J.7 i Owner.___ Lot Builder _— The following Buildinq Cocc deficiencies we required to be corrected: ------------- ------ -- - r- Presented to f -'Approved Inspector — --- I _, Uisapp►oved i Date - CALL FOR REINSPECTION YES L-1 NO INSPECTION NOTICE City of Tigard Building Departri P.O. Box 23397 Tigard, Oregon 97223 �� Phone: 639-4175 Type of Inspection 4 /47,.�_ Z__ Date Requested Z �" o J=�� Time A.M. _ �` -P.M. Address .9.2 UJ L (���2 _. Permit Owner_ —/- rte_ _ _ Lot # Builder The followinq Building Cade deficiencies a e requ'xed to be corrected: Presented to proved —i Inspector ❑ Disapproved Date CAL FOR RE114CTION VES ❑ NO INSPECTION NOTICE City of Tigard Building Department P.O Box 23397 Tiqard, Oregon 97223 Phone: 639-4175 Type of Inspection - ;j Tltnr A.M.^ P.M. Da to Requested_ ._ �b' � - --�- Address __- +..�.:u Permit -- Lot # ------- -- Owner - Builder The follovw.ng Building Code defic:ienciet are required to be corrected: Approved Presented to Disapproved Inspector Date --- CALL FOR REINSPECTION ❑ YES 1�1 NO x. sits .sss rw: � wn W, INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 —y-�. Phone: 639-4175 Type of Inspection Date Requested ___, Q L _, Tim - A.M._______-P.M. Address ---- aa_�- � �- --- Perrift l Owner —. Lot # Builder— -Z 4!L.- - The fol'w.ing Building Code deficiencies are required to be corrected: camAL Presented to Approved Inspector ___ Disapproved Date ---�"`—_—`-- - CALL FOR REINSPF,CTION 171 YES Ll NO ,a P"r NO. 5 2.5 4 CITY nF TIGAPD RECEIP-r or PAYMENT PECE I CHECK AMOUNT 25 NAME ivrAN FROPERTIC'.S CASH AMOUNT 0.(.,)C) ADDRESS Po BOX 68,35, PAYMENT DATE GLIDDTVISION R�,'--'INGF, FEE ALOHA, 0P 7 7(1)()*7-- PUIRFOjE C)F PAYMENT AMOUNT PATV F-,i,IRPOSE OF FAYMEtIT AMOUNT PAID 1-1 ISCELL-ANECIUS `15.QCI TOTAL AMOUNT PAID INSPECTION NOTICE. City of Tigard Building Department P.O. Box 23397 Ti. vd, Oregon 97223 Phone: 639-4175 Type of Insnectimi Date Requested.__rC_ ` _/�_ Tims A.M. PA. Address Permit 0 Owner Lot # RuilderThe following Building Code deficiencies are required to he corrected: - I f i Presented to Approved Inspector �'�' _ �j Disapproved Date .�—t,`-- — CALL FOR RE t iSPECTION C] YEt L] NO nii ASI � et � R/ 7a � 1A 4 I INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 ,l -- ---- ------- --- Type of inspection ' lTime---- A.M. ---P.M. Date Requested—_- L►---�� Address i/ Lot # Owner — f guilder The ----��— The following Building Code deficiencies are required to be corrected: ___.--- ---- -- Approved Presented to J [_ Disapproved Inspeclof Date " CALL FOR REINSPECTION VES O NO i__... ..._ i C,TT`e Of: rIGART.) — RECEIPT OF PAYMENT RECEIPT NO. 190-703160 CHECK AMOUNT a 25.0f) NAME n KEN WATTS PLUMDIN(i CASH AMOUNT n 0.01) ADDRESS x PO BOX 230925 PAYh.17NT DATE n 09'126/90 TIGARD. OR 97223-- I3.2(')2; SW' L.ANGTREE F'UF'C'OSE OF PAYMENT AMOUNT PAID PURPOSE Or PAYMENT AMOUN r PAI�I1�/'" I REINSPECTION FEF I TOTAL_. AMOUNT PAID _ ...r•, 25.00 INSPECTION NOTICE City of Tigard Building Department P 0. Box 23397 Tigard, Oregon 97223 , Phone: 639-4175 / f� Type of Inspection 2 —_ Date Requested .*�� �� Time-- A.M.— x P.M. Address __ ��-��� -fir i Lt, Permit Owner____ { _ —_ Lot #. Builder The following Building Code deficiencies are requ; ed to be corrected: J lPres-- Olt- Presented ented to _ _ roved Inspector _._——.---- --____-- _ isapproved Date -- L CALL FOR RE;INSPF,C7701V YES i--I NO INSPECTION NOTICE City of Tigard Building [department P.O Box 23397 Tigatd, Oregon 97223 t Phone: 639-4.75 �f Tyt r of Inspection -- -- --- � n _ - -------, -- ----- -- Date Requested A.M. P.M. Address —_ c� C' �__ ~' _—_ Permit C Owner— ------ -- -- Lot BuilderThe following Building Code deficiencies are required to be corrected: Presented to __ ____-.r___..—_ I Approved Inspector ________�__ '- — ___— Disapproved Date CALL FOR REINSPECTION j YES ❑ NO INSPECTION NOTICE City of Tigard Building Department P.%') Box 23397 Tigard, Oregon 97223 Phone/639-4175 Type of I nspeetion Date Requested�- /—� Time A.M.-4—P.M. Addwerm :4c ____ �- /L e�_ Pit Owner_._—__ -- Loc Builder The following Building Code deficiencies are required to be corrected: i Presented to _ —_ _.._ Approved Inspector Disapproved DatR ! -_ — CALL FOR REINSPECTION 4 YES 1-1 NO �sesssteses� INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested_ Ti — A.M. P.M. Address --------- .2- Permit Owner Lot Builder The following Building Code deficiencies are required to he corrected: M6 rY Z d i Presented to CI Approved ell Inspector _ sapproved Date CALL FOR REINSPECTION F -1 YES NO INSPECTION NOTICE �Ir, City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 > l� Type of Inspection Date Re uested_ q _ ..:��-� Tirri � A.M. P.M. Address . — _ � G�3 � �__ Permit Owner �vw' Lot #------�-.-� BuilderThe following Building Code deficiencies are required to be corrected: Presented to Inspector ��=� f_ C� Disapproved Date •Z=- -- - ---- -- - CALL FOR REINSPECTION U YE8 ❑ NO MAS'T'ER P E R M I'r 1 +:RMIT #. . . . . . . .. MS'T'90 010 L'. C�TMOFTIGARD �WYOFTIMRD PRIM. PERMTT N. - IIS'1*90-0100 COMMUNITY DEVELOPMENT DEPA"Em 0611190N DA'T*E ISSW-'.D-. 05/31/90 13125 SW Hell BW. P.O.Box 23397,Tigiud,OrogDn WtM(603)669 41 M 7�7 PAPUA-: 2S1.12CC;--J.J.40('1 (lDL)RI:-:'SS. 8203 SW LANG'TREE S*1 IJBDIVISION. . . . L.A Iq G'T*R E L. ZONING: . . . . . . . . a L O'T. . . . . . . . . . . 946 .................. BUILDING 1::.* 1.SS IJ ED 8 9 2 P.2 2 DWELLING UNI1*ri: 1 ElASEVIEN'T'. . 90 sof 1 0136 OF WORK. UNE.W BEDRMF):3 BA141S g 3 GARAGE. . . . " 400 s-f YI::'E OF USE. . a SF FLOOR AREAS...... REQUIRED S .1BACKS I Yl:�'E OF CCNS'T*. 51,1 F,3'.F,S'1'. . 1 s f L E FJ. . -'5 ft 8101-11'.. 5 ft C)CCLIPANCY GRP. aR3 SE.-COND. . . 640 of FRONT" 120 ft REAR. . 3 0 ft 1'0 R 1'.E S. . . . . . » :0 "THIRD.. 0 s f R 1::*CT U I R ED........ 1: 1 G H'I*. .. . . . . . . :20 ft 'T*0 I'A L---------- : 1.391 s f SVIOKE DE'TEUTORS. :Y UL)R I JAD. 40 -f V01 A-W- - $2 65622 PARK I NG SPACES. . DO 1 e ni a-r k s i ............ PLUVIBINU ...... NYS. . . . . . . . . . a 'L Fl,-.00R DRAINS. . . . a0 B A CK F L.0 W P-1 R 1:�:V N'r R S., 0 i1V0'T*ORlk.S. . . . . N 3 WATE:.' HEATERS. . . ^ :1 'T'RAPS. 0 1 (.)H/S H 0 W 1:1'.R S. 2 LAUNDRY 'T TOYS. . . :0 CA'r C.1-4 UA 111'1i. 0 WO*T'E:-'R CLOSETS. 3 SF.WER LINE ('ft) . .O GREASE 1)1 SHWASHE.Rs. . . . C1 W A'14.*R I-INE:: (f t) - - 1014 OTHER F'I X1'(JRES. ::0 UOR130GE DISK!. . . '.I RAIN DRAIN 4ft) . W WOSHING IIACH. . . J. GF' RAIN D R Al N S. . a I MECHANICAL FE E'S 1::.*L, 'T*Y P L S UN11' HI'RS. . 10 type amak.kilt 1)y (J'Ate -r e C:p t (-)S/ VENTS . . . . . DO PAYVI $ 40.. 00 JLH 03/1.2/90 107776 111OX 114:11.11,10 14 TIJ Vl':.:'.Nl* FANS.. . -3 B F,R'T $ 3:31. . 00 t URN ( :LOOK . . DI HOODS. . . . . . a F4F-*'L.0 $ 40. 00 I URN )-1.0OK . . nO W 0 a 1)11310 V E,3. .0 B 5 P(11 $ 1(1. 51") F 1 0 0 R FAJ R N. . . . ..0 CLO DRYERS. : 1 S'T'DC $ 600. 00 3HP"O UTHER UN1'1'S*.O 913) . DC 1- 2150.00 GAS "CW1*LE'TS: I r:,ARK 250,. 00 OW)le-r: ....... ..................... -— III RJ' $ 3 6. 0 0 1 AN F-1 R 0 PE R T I E S m r:,L C 9. 00 1..t(.')X 6835 11!'.5 1:1(11 11. (30 PPRI, $ 1.;32. 55 0 01.014) OR 97007 1:115)P C", $ 6. 63 0: 64'55477 POYM $ J.6;33. 48 JLH 05/28/90 aeto-r". lJ()N PROPERTIES P(:) PDX (.)81-:I"*,.,j 01.0110 OR 971607 Pl-ic)iie N.- 64 5647'7 #. . o 30558 1.673. 48 1'01'AL This permit is issued subject to the regulations contained in the REQUIRED :"NSPEXTIONS Tigard Municipal Code, State of Ore. Specialty Codes and all other Foat/fal.tvid Ivisp PIt.tnib 'T'Op OUt applicable laws. All work, will bf- done in accordance with A,proved Wt-r P-rc)of iiiq Psni F-ram:iiig Ti-isp plans. This permit will expire if work is not started within 180 Flast/Flealrn TrIsp Fi .,eplare Irisp days of issuance, or if mirk is susCrawl D-raill Gas I.J.17e 111sp IIII/Lti-vislak) Ivisp Illst.kl'-atiall Irlsp rinitt.ee 1:)j.41.1att.tre!:: L.M/Uvi(ip-rfloc)r Gyp riciard I'visp trig D-rAJ.vi Psni" t Frain d-rain Ii-isp Ilya me0lal-lical. 11-1sp Water I i ri e :Crisp Call fo-r ivispec:tiavi 639---41*75 wn � w tri r! e. mlm! I SEWF_Ft COMNE:C HON -� CITYOFTIGrARD PERMIT T CItYO�T�AIRD I�'F:.F;Irl 1'T' M. . , » , . . : S W Fi'J 0--0.1 1:l COMMUNITY DEVELOPMENT DEPARTMENT 0 gem I TRIM. PERMIT 0. . MST90•-01.02 13125 sw fwt Blvd. P.O.Box 23967,Ttpnd,OrWm (r i,(Me?"e 1.;5 _ DOTE :ISSUEDa 05/3_1/90 _ S 111- (il)l)kl: S a. » . a 8203 SW L.WNGTREL S'T PARCEL- 21311.2('C 1.1400 SUNDIVTSION. . . . a LANGTREE ZCININGa I?I..0C,K.. . . . . . . . . . I LOT. . . . . . . . . . . . . a46 'T'I:::NAN'T' NA11E. .. . .. . USA NU. . . . . . . .. . . a 40690 FIX'TIJFF. UNITS. . . a (::I..,AISS OF' WC)RK. . ,. :HL::W DWELLING (JN1:TS» . - I TYPE OF USE:. . » . .. < F N(7. OF" T4CJ11..1)IN(3Sa 1 1NfiT'Ai._L 'i'YF'Ic . » » a I+USW 1:111='F. "'ERV a(JI�F"AC1=:„ » a a�sf Remarks: (:l w it e r a -— -_.. _ .____.__._,._..�__._.__._.._....__. ......_.._......._.____._.. .........___ ____............ F:EJ--.S T'1:TAN PROPERTIES type amo++nt by ed ate rec�pt; PC) E+UX 6835 PRM'T' $ 1.250. 00 1:NS1' $ 3;5.00 AI...OHA OR 9700? PAYM $ 1u?85. 00 JLFT 05/28/90 Phone #: 645547? C.aiitrae tar a ............... _._.._.._.......____.._.....__..__.._..._.._...__.._._...._......_._. CONTRACTOR HOT ON F;.I_E: f'I r.ttir. ►F $ 1285. 00 TOTAL __.._._._._. REUCJIRED :1NSPE(.;TZUNS ...._..... _.._._.. This Applicant agrees to comply with all the rules and regulations Sewer 1111Sper..t IOn of t4 Unified Sewage Agency. The permit expires 120 days from Carse F'inaled the date issued. the total atount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect � feet in all dirertions from the distance given. If not so located, the installer shall purchase a "lap and Side Sewer" permit and tl.,� Age cy will inst 11 a lateral. _ _. ..__._.._._._.._ t'ermittve ;3 i.grtature» ....._................... __....____ C;aII for inspection G39--417`x" CY. TY OF TIGAPI) PECLIPT (IF POYMEN,r RECEIPT NO. i 913-2012t.,9 CHECK APIOUtiIT 1 2918.48 NAME IlTAN PRUPERT IEci CASH AMOUNT 0. CIO PAYMENT DATE 1/9 0 SLIPIDIVISTCIN 14EAVERTON, OR 9"7007— R,2TY-1,' SW I—ANOTRFE FIJFFO, F OF PAYMENT AMOUNT PA IV rIJF,,F,OFjF— OF PAYMENT A110111N'T P0410 BUILDING PFPM M5T90-0102, -11 .00 PLUMC INB PERM 11,1 . 50 MECHANICAL PE 36.00 E-T. BUILD PER 24.98 Pl—AN CHEChFE 9.00 FEWER USA MST90-01.0,: 1.,..50.00 GEWFR INSPECT 33.00 SI)C e;00.001 ;TOF,,Pl DRAIN SDC 7150. 00 PAPt, S SDC 0.00 TOTAL AMOUNT F'AID 29,18. 48 aapr � a>• � r�r � � rs C17YOFTIGARD My 0 PLAN CHECK APPLICATION COMMUNITY DEVELOPMENT r)EPARTMENT 'r"�OM PLAN CHECK N �2 13125 S W Nall Blvd-P.O Boa 27397,Tigard,Orag 97227,(5W)639-4175 PERMIT DATE ISSUED— )(JOB [ RESS: ` - — R P'� _ — TAX MAP/LOT I -/.2CC- SUB: C- SUB: A-� LO-1 . _ — LAND USC: _..---- ---- VALUVION: OWN FR SPECIAL NOTES NAME `Jt_� _ _ REISSUE OF: MST- U-ays 4�- ADDR[SS: LAST RLISSUE: _ —7zFLOOD PLAIN/ — � SENSIIIVE LAND: PHONE: _— APPROVALS REQUIRED CONTRACTOR — — PLANNING: - NAMC!_ ti_ ENGINEERING: ADDRESS: _ _ FIRE DEPT ^— OTHER: PHONE: __— � ITEMS REQUIRED BUILDERS BOARD N: _ _ EXP DATE: :5 ya_ LIST/SUBCONTRACTORS: _ BUS TPX: _ ARCH/ENGINEER CALCULATIONS: NAMC : _ �— _ _ TRUSS DETAILS: ADDRESS: OTHER: COMMENTS: SUBCONTRACTORS: PLUMB: (�� ._ �(� �_— MECH PERMIT N ACCT N DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE 5rfy—v/ 2, 10-432 00 Building Permit Sees _ 10-431 00 Plumbing Permit Fees / 3z 10-431 01 Mechanical Permit Fees 10-230 01 State Building Tax (5%) yja z Building Plumbing Mech p_ 10-433 00 Plans Check Falk Building Plumbing Mech _ 30-202 00 Sewer Connec t i r,n — I C.. f�J 2-5-V 30--444 00 Sewer Inspection 3.1, _ 51-448 00 Street Systom Dev Charge (SDC) 52--444 00 Parks System Dev Charge (PDC) 31-450 00 Storm Drainage Syst Dev Chrg (SSDC) '' �5�_ ��k- 10--230 06 F i re TOTAL 3 yLj�� A11P ,ICAN ;;IGNATURF Received By: _ Date Received: cri/3587P/18P GRADIN(:1FROSION CQN'1'11(21. INFORMATION GENERAL CONTRAC'I'OR NAME& ADDRESS: CA. EEILE NO._ —_u�.,!1l� , =•=� (I PERMI•I'NO.: APPLICANT NAME AND ADDRESS: EXCAVATION CONTRACTOR —rl NAME & ADDRESS: — __ OWNER NAME AND ADDRESS: TELEPHONE NUMBERS: T 1 <I PROPERTY DF.SCRIPTEON: APPLICAN OWNER I _ STREET ADDRE AND CRO STREE' 61.'NI-.RAI-CONTRACTOR:--j_-j-. ' EXCAVATION CONTRACTOR: ^'d - �'►='LL- SITE/JOB: LEGAL DESCRIPTION: 24 HR/AFTER HOURS EMERGENCY TAX LOT NO.: CO ",Cf PE SIS ISI ,TELEPHONE: — 1/4 SECTION SITE SIZE,ACRES; __ --- DISTURBED/WORK.AREA,ACRES: I OCATION& ADDRESS WIIERF SI'OIL.S LEAVING SITE WILL BE TAKEN SITti�RA1NS'):: CIRCLE ONE) (NO PERMITS MAY BE REQIJIRGI)) �ATCH-BASIN DITCH PIPE CREEK —�— - (CIRCLE ONE) VATE PROPERTY --� P UBLIC;RIGHT OF WAY LRC [ SF;•I)IMEN'TA-T ('oNmoi (ESC1 MEASURES K11NIMUNI ESCREQUIREMENTS MINIMUM ESC REQUIREMENTS III IRIN(i CONSTRUCTION: FOLLOWING CONSTRUCTION: SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE STABILIZED CONS'TRI)C-I'IC,N ENTRANCE REMOVE AND RESTORE TEMPORARY ESC PERIMETER RUNOFI-'CONTFtOI. FACILITIES Cl.FARING AND GRADING RESTRICTIC 3 CLEAN AND REMOVE ALL.SILT AND DEBRIS COVER I'RAC-1'ICES ENSURE OPERATION OF PERMANT FACILITIFS CONST'RUCT'ION SEQUENCE OTIIER OIIIER --. — PIAN FOR EROSION CONTROL PREPARED AND SUBMITTrO IN ACCORDANCE WTTH TECHNICAL GUIDANCE HANDBOOK". EROSION CONTROL PLAN DRAWING,AS RF•.QIJIREQ,HAS .'l AN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY PHONE NUMBER, SCHEDULE/STAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEAS(JRES,AND APPLICABLE STANDARD NOTES. I HAVE R"D AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRUCT AND MAI'4TAIN ESC MEASURES AS NECESSARY TO CONTAIN SEDIMENT ON TI IE CONSTRUCTION SITE. //-- {� --- APPI.I NATURE --- OWNER S , ATURE OITICIAL USE ONLY, RECEIPT DATE ACCEPTED Elil; NUMBER �- RECEIVED