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8215 SW LANGTREE STREET 00 N F-' Ul C" 8215 SW LANGTREE STREET - .� eel el► see � ass �►a ea esl 7INSPECCION NOTICE / OS C4"y of Tigard Building Dapartnen / �(C 13 .25 SII Bay` Blvd. Tigard, Oregon 7223 Ll Inspection Lino (Rec-O sone)- 639-4175 Rusineee ones Inspect ion s Footing Plbg. • deralab Mach. Rour .-in Appr/S Found. Plbg. up Out Gas Line FIN Poet/Beam Struct. San. Sewer Framing §-Bldg.Poet/Beam Hoch. Rain Drain InsulationPlbg. Underfloor Watnr Lis.^ Gyp. Rd. ch. Dat.r Requestedt 1 L� _Timet / AM CPM Addreac•_ {� C, Permit it %�/J 7,J Builders THE FOLLOWING CORRECTIONS ARE REQUIRED- Inspector: Date / -'_411_- APPROVED _ - 01SAPPROVRD - APPROVED SUBJECT TO ASOV-. call For Rainap. n uir s tan s nae ew -,r W 1 �1�8PBt:1 Lam_Ii�CE Cit} of Tigard Bvlidfny Departaenk 1 ;25 all Ball Blvd. Tlqard, Oregon 97233 f Inspection Line (Rec-O-Phan* 639-4175 Business Phane. 4171 Inspections - -- footing Plbg.�4` ralab Mech. Rough-in Appr/Rdwlk Found. Plbg. Top Out Gas Line FINAL: Post/Beam Struct. San. Sewer Framing -Bldy' Post/Beam Mach. Rain Drain Insulation -Plumb. Plbg. Underfloor Nater Line Gyp. Bd. -Neth. Date Recnjested e t� ✓ Addresai L� -` Z - Permit is��.�� Builder•. THE FOLLOWING OORRECq,IONS ARE REQUIRED: Inspector'':``_ f- -� �f-��`�` _ Dates�Ll- ✓✓ APPROVRD DISAPPROVED APPPOVED SUBJECT TO ABOVE Call For Reinsp. ,. ION . I Ng ECi:ONICPK :Iitp of Tigard Wilding Dapar"gent 13.25 SM Ball Blvd. Tigard, Or'r+9on 9741Ph. Inspection Lire (Rec-O-Phone): 639-4175 Business L7i Inapact ion t___ --- -- — �— tooting PlIY4. underelab Mect,. Rough-in Appr/Sdwlk Lound. Plhg. Top Out Gas Line PINAL: post/Beam fitruct. Sen. Sower Framing / -Bldg. Post/Beam Mech. Rain Drain Insulation -Plumb. Pll�g. Underfloor Nater/Line^^ Gyp. Bd. -Mach. PM Date. Requested:_ — / p� Pe::mit t: Address: Builder:_ T11E FOLLOWING CORRECTIONS ARE REQUIRED: Date: Inspectors__ ? APPROVED __ DISAPPROVED APPROVED SUBJECT TO AHOVE —1-15a1 T r Rsinap. I NS P1GCT IQN�IO�,�CF_. City of Tigard Building DepartA—t 13125 SO Ball Blvd. Tigard, Orogon 97223 Inspection Lina (Rec-o-Phone)s 639-4175 Buninean Phos -417 Inspections_.-___. _-- Footing Plbg. Underelab Mech. Rough-in Appr/S(wlk Pound. Plbg. Top Out rtes 1,J110 FINALS Pnet/BAam Struct. San. Sewer Framing �oltiq. Post/Beam Mach. Rein Drain Innulation - Plbg. Underfloor Water Lina Gyp. Rd. Date Requested:_y( - Times _ AN _PM Addreaa:-- ev- Ga• Permit Builder: THE FOLLOWING CORRECTIONS ARE REQUIRPDs Inspector:__ Deter_-��_L -( APPROVED __jDISAPPROVZr) APPROVED SUBJECT TO ABOVE For Reinap. NEW �i�1PEQTI0l1 �cmz_CE �� Cit•. of Tigard Building Department 1.3125 5A Bell Blvd. Tigard, Oregon 97223 l Iaspection Line (Roc-O-Phone): 639-4175 Rusiness Phone: 639-4171 Inspect ions____ _ --- Footing _looting Plbg. Underslab Hach. Rough-in Appr/Sdwlk Pound. Plbg. 1,3p Out One Line PINALt Post/Ream Struct. San. Sewer Framing -Bldg. Post/Bbam Hoch. Rain Drain Insulation / -Plumb. Plbg. Underfloor Watery Lined Gyp. Bd. -Mech. Data Requested: /J �� 7 G Times ��11 C � Address% r�T /T{ may d c_ Permit 0&`G��S - Builders 1 THE 1001.1,0WIP 3 CORRECTIONS ARE i SQUIRED: Inspector: Datet1.�/ APPROVED DISAPPROVED _` APPROVED SUBJECT TO ABOVE __Call For Reinsp. INSPEMON NOTICE rr II City of Tigard Building Department K� P.O. Box 23397 Tigard, Oregon 97223 /� Phone: 639-4175 Type of Inspection '��" ) Date Requested Tim� .M. P.M. Address , `� _. C' igi, Permit .11I Owner / Lot # Builder The following Building Code deficiencies are regWred to be corrected: ------- --- Presented to �'� 9-0proved Inspector '`` •/ Disapproved Date _-• CALL FOR REINSPECTION ❑ YLta 19--M �ierww INSPECTION NOTICE rr� City of Tigard Building Department P 0. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 t Type of Inspection Date Requested�� Tim M. P.M. Address _ / C6 �rr' Permit 5 Owner Lot t_.. _ -- -- --- Builder t-�-r'� - - _ .. ----------- The following Building Code deficiencies are required to be corrected: Presented to /,i-Approved Inspector 1134apprnved Date _� — CALL FOR REINSPECTION ❑ YES ❑ NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection- Date nspection Date Requested �Z'.�1-- Time �,�!/. A.M.___ P.M. Address } r}�J� '^�' —r�'�.� — — Permitk�/� Owner — _ - -- _ Lot #--- Builder -!C '� ---- ---- ------ The following building Code deficiencies are required to bp corrected: Presented to ___ _ -- Proved Inspector Disapproved Date �— CALL FOR REINSPECTION El YES ❑ NO INSPECTION NO', ICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of In rpection Date Requested �u 71me A.M. y-- P.M. Address d�� `� c, Permit i Owner — - ----- Lot #-- i BuilderThe following Building Code deficiencies are required to be corrected: ✓tom �` � �` Presented to / —. ❑ A oved Inspertor _ C �.__ Diapptoved Date CALLAlIE2 EINSPECTION 5 0 No ■w nr Jnr s� w. w w .w INSPECTION NOTICE City of Tiqard Building Departrne•it A— P O Box 71397 Tigard, Oregon 97223 Phone: 639-4175 Type or Inspection G _ .M.-__.�—P.M. Date Requested_ _- T.K.e _ Address __��.Z—�yy� 1 Permit Owner ---- -- -�? Lot # - ---- — - Builder The following Building Code def;rioncies are required to be corrected: Presented to Approved Inspector __ _ �. � Disapproved Date CALL FOR REINSPECTION L� YE! 0 NO paINSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 / Tigard, Oregon 97223 Phone: 639.4175 r j �. ��. Type of Inspection - - — Date Requested ~�� Time ___y___ A.M. _—P.M. Address Permit #yG�-"GSs Owner_—_ _ ------ Lot #—_-- BuilderThe followinq Building Code deficiencies are required to he corrected: Presented to _- -- Approved Inspector _- -___-__ _] Disapproved Date A L FOR 6INVVECTION U YEs Ll No rir pier wa mer � .. � sv .an INSPECTInN NOTICE City of Tigard Building Department P.O. Box 23397 ,– Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection _ �" �' G �►-1 _ Date Requested.�L.�J Time _ A.M. P.M. Address ? i Permit # Owner _ _ Lot # BuilderThe following Building Code deficiencies are required to be corrected: � E. �9zVavll / 7"/6 /tom t i Presented to Approved Inspector _ —__ CTursapprov id Date CALL FOR RE VRPECTION L,YFS 0 NO i 1 INSPECTION NOTICE ' City of Tigard Buildin4 Department P O. Box 23397 Tigard, Oregon 97222 Phone: 639-417`, Type of Inspection Data Requested "� �`�rf1D Time A.M. �- P.M. Address F,)/: ir✓iC�1 cG7L-��-L�- ._ _ Permit #7�) r_. Owner _ _ Lot # ajG�Lct.�s]:L Builder The following Bu;lding Code deficiencies are required to be corrected: i Presented to -_ lt)- _— —_ -- ❑ Approved Inspector _ J 104ijisapproved Date .40 CALL F NSPECTION 8 1-1NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-41-75 Type of Inspection Date Requested_ / ��L-31L— –i—_Time A.M. P.M. c 6 Address S .�L 2� C e�-� – Permit Owner_ 77 Lot #__ Builder The following Building Code deficlenrles are required to be corrected: /l___L�.i.�'.11'L��_�l:d.�_.11��LT .yro'✓E_.�__��`L��' _ - � 1 Prnsented to r A proved Inspector __ �– �� Disapproved Date CALL FOR REINSPECTION V YES 0IVO � ssst sssr sssr INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 /tom, Phoney 639-4175 Type of In pection � Or � / Date Regdes G _— -- Time— A.M.--P.M. / r #. Address ermit Owner Lot Builder. -The following Building Code deficiencies are required to be corrected: Presented to - ___-- Approtfed Inspector . Disapproved Date -- CALL FOR REINSPECTION I-] YES I-1 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregcn 97223 Phone: 639-4175 Type of Inspection Date R1: guested_ L Time__ A.M. P.M. Address Permit Owner _ Lot #__ Builder The following Building Code deficiencies are required to be corrected: 12 oe Presented to _ V L Approved Inspector _ _ ❑ Disapprovpd Date CALL OR RE NSPECTION ❑ YES 0 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 ' Phone: 639-4175 Type of Inspection _ -C _ Date Requested_ � - � — � Time_ X A.M.--P.M Address _�� `� Permit #, 45 Owner_ � Lot # r L Builder _00=_ ___ A1C The following Building Code deficiencies are required to he corrected: a �0-11 Presented to A iproved Inspector ------ �D sapproved Date _ - �� — - -- CALL FOR REINSPECTION YES ❑ NO INSPECTION NOTICE C;ty of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date requested-'S -3- -- Time A.M. >K P.M. Address fja1ZS-- L/ Permit #. _QC2 93-- O%-vner Lot Builder The following Building Code deficiencies are required to be corrected: Af Presented to Approved Inspector Li Disapproved Date CALL FOR REINSPECTION F-1 YES F-] NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection -- ---- - ----_» _�—__ Date Requested__7 - / __— ____— Time A.M. P.M. Address .�"��_._� r��____.__—_. __.-- Permit Owner--- - --- -- Lot # —_--- Builder The following Building Code deficiencies are required to be corrected: Presented to Approved Inspector _ .. —l- -.�- - --- — _� Disapproved - Date ----- ('A I,L FOR REINSPECTION ❑ YES 111 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection _-_ ,241ag--e, it- , Date Requested. r _ Time "'' A.M. _P.M. Address � ._r2j-1-Y t, Permit Owner Lot # Builder The following Building i;ode deficiencies are required to be corrected: �� Presented to Approved Inspector ��_. - isepproved Date CALL �FOR�' SPECTION YES NO INSPECTION NOTICE City of Tigard Building Department P.O Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested 77� ` Time_ _— A.M..— -P.M. Address _. ' Permit # l Y�} Owner_ _. Lot Builder ' The following Bui'ding Code deficiencies are required to be corrected: Presented to _ _ __ _ __- —� Approved Inspector _ —_ Disapproved Date CALL FOR REINSPECTION ❑ YES U NO 1- F INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection _— 1 Time A.M. P.M. Date Requested Permit G — Address ___O�.f�-- Lot #`_ Owner _--_-- —` Builder —The following Building Code deficiencies are required to be corrected: - -- - ----—--._—.�. pproved Presented to --f— � _��— Disapproved s Inspector �, \ Date '— CALL FOR REINSPECTION ❑ YES f l NO y CITYOFTIGrARDMASTER PERMIT CETYOFTI�ARD PERM I T H. . . . . . . s II ST` 0 0095 COMMUNITY DEVELOPMENT DEPARTMENT anon« PRIM. PERMIT #. c MST90--OO95 13126 SW Hall Blvd. P.U.Box 23397.T4prd,Oregon 97$M(6W)P?974176 DATE ISSU Ds 05/14/90 faITE A1)1)Rw SS. « . s 8215 SW L.ANGTRE:E S T PARC:E:1.. : 29112(',C:--11300 SUBDIVISION. . . . s L.ANGTREE: ZONING: i+1...OGK. . . . . . . . . . I LOT. . . . . . .. . . . . . . s 4:.) __._.__....._..__. __. .._...._..__.._..._....._._......- BUILDING k,L'I S S U E:MST90-••0008 DWELLING UN I TS: 1 PA':iE:NI:-H I . . . . . . . . so s f CLASS OF WORN.. :NEW BE;DRMS s.3 LATHS s 3 GARAGE TYPE' OF USE:. . . s SF FLOOR ARE AS- - REQUIRED SETI,ACV.r_..-....___...._._..__ .... TYPE: OF CONST. -".JN F� IRS1'. . » . :1;.'i1 sof• LF=.FT. . :5 ft RIGHT. :5 ( t, OCCUPANCY GRP. sR:3 SECOND. . . :640 S FRONT. -.20 ft REAR. . :3O f•t; STORIES— . . . . . s0 THIRD. . . . :0 la RIwI1(JIRk`D_.__.._.._.__.». .._._.. »..._..__.._.... .. HI-IGH'T.. . . . . . . . ..20 ft TOTAL------__.__......11,3':).1. s-f SMOKE DETECTORS. aY 1=I.AJOR LOOD. . . . .40 pt;f VAL..lJE. . . . . 1G s 6 36 2 c`'.. PARKING SPACE::S. . s 0 Remar-P.1a s . ..............._.......-.._ ___._..-...._..__-...._._-_._........_.-_.-....._._. PLUMBING SINKS. . . . . . . . . . si FLOOR DRAINS. . . . ..0 BACKFLOW PREVNTRS. . 10 I...AVAT'ORIES. . . . . s 3 WATER HEATI: RS. . . s 1. 'TRAP'S. . . . . . . . . . . . . . 10 TIDE+/SHOWERS. . . . ..P LAUNDRY TRAYS. . . :0 CATCH HA5INS. . . . . . . sO WATER CLOSE TS. . s3 SLWER LINE (ft) . :0 GREASE 1RAPS« » . . . . . CO DISHWASHERS. . . » s 1. WATER LI:NE (ft) . : 100 O rHER F'IX T'URE::S. . . . . sO (3ARBAGC DISP'. . . : .1. RAIN DRAIN (ft) . :O WASHING MAC;H. . . a J. SF RAIN DRAINS. . ". 1 ME::CHANICAI.. FE:E:S F--UEL TYP'E5- __. __....._....__.. UNIT IATRS. . sO type amnt.tnt by date reept /()AS/ / / VENTS « . . . « s 0 P'AYM $ 40. 00 JLH 03/09/90 107703 MAX INPUT s O D T U VEN T F'AN . . -.3 BPRT $ ;3;31. „ 00 FURN ( 1O0K . ., : 1. HOODS. . . . . . S1 BPLC $ 40. 00 1:URN . . :0 WOODSTOVES. 10 B5P(; 16 1f:1. ':i"i 1 / FLOOR F'URN. . . . :0 CLO DRYER S.. : 1 :yTD(I q 600. 00 BOl:l.../C;I7 r'' ( 3HP s 0 0TH1:R (.1N I Ts-0 SSDC; $ GAS OUTLETSs J PARK $ 250. 00 Owrte•r.s .__..____... _.._..._....._._.._..._...._.__ ._.._.._._........._._......_......_.... PIF'RT $ 136.(40 I I TAM PROPERTIES Mr''LC $ 9. 00 i (.) BOX 6835 115PC 1; 1.. 80 PPRT $ 1132. 50 0 I ()HA OR 97007 P PC $ 6.63 ( hone bs 64554.77 PAYM $ 1633. 48 JLH 05/14/90 (:(•)n t:r a c:t o-r s _......_......__.... ....._._...__...._._..... – ........._.........._._.._._. TT TAN PROPERTIES PO BOX 6835 AL.(.)HA OR 9!007 !::'hrctne! N: 6456477 Req H. . : 3O55E1 $ 1.6'73. 48 TOTAL This permit is issued subject to the regulat!c.is contained 2r the -- -- -- REQUIRED INSPECTIONS --- --- Tilard Municipal Code, State of Ore. Specialty Codes and all other Font/found Insp Plt.tmb Top Out applicable laws. All work will be done in accordance with approved Wtr P'roofinq Ersm F•ralminq Insp plans. lhts permit will expire if worF is not started within 188 Post/Beam :Insp F. i-rep+:l.,ar_e Insp days of issuance, or if work is suspended for morn than 180 days. C-rawl Drain Gas Line Insp Plm/urtdsl.ab Insp Tnsulati.on Insp Permittee signature: '... '-.._._........ PLM/Underfloor Gyp Board Insp Ftnq Drain Bsm' t Rain drain Insp l a s u e d B y s __. ...... Mechanic.-al Insp W:%ter Line Insp Call. far inispec:ti.ctn 639-4175 I � SEW[:.R CONNEC'I ION CITY OFTIOrARD rCITYOF416MIRD PER1111' I7:1E.RM1J* 0. . . . . . . . 1,;14R'90 0103 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SIN HWI BOW. P O.Box 23397,Tip rd OreW 97Paq#03),15P,4176 DATE ISSUED: 05/14/90 SITZ' 8215 $;W I GT PARCEL.: 2S112C0 1 1 GUM. )ISION. . . . .. I 0NGTRL1*.' Z(JNTNG: BI-OCK . . . . . . . . . . ..4 Iti .................. ............................ 1*11NANT NAME. . . ., . : U(3A NO— swou . . . .. - 40673 F–r.X F t.)R L. IJ N 11`13. Cl..W3)G OF WORK., .. . .-I,IF.--W Dwf"A 1-1'.N G kJ 11 YT 13 1 TYPE OF USE. . . . . I SF NC). OF: 1'AJ1L..I)J'NGE;.- 1. TW31'01-1- TYPE. . . . a BLISWR 111PE'AW SIJRF:*A(.'I:':'. Own e-r: ................... FELLS 1"IJAN PROPERTT1"S ty T)e A III C)tA I I t by date -r e PO BOX 6830J PRM1 $ 1250. 00 1,Iq CP ti 35. 00 ALOHA OR 97007 P,A Y 11 1AM5.00 JI._W 05/12/90 Phone 0: 645?547Y Cc)vi t-r A c t a r T*1 TO N 1.1 R 0 1..#ERJ I F.G PO E:OX 6835 OL.UHA OR 97007 r7llic)l1e W. 6456477 $ 1.285- 00 TOTAL_ q REPIAIRED INSPECTIONS This Applicant agrees to comply with all the rules and regulations Sewer lrissect ic)ii ...... of the Unified Sewage Agency. The permit expires 120 days frop Case Firialed the date issued. The total amount paid will be forfeited if the .......................... ............ ....................... permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If ti-e 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 installer shall PUT01ASe ......................... ......... -------- a "Tap and Side Sewer" Permit and the Ajenq will ins ll a lateral. ............. r)e-11 nO. t,t P e S j.q 1-1 A t U VP ------- ....................... 1 S St U e d D y II ......... ........... ....... .......------------- --------- call fc)r jriF-[)ec,tJ.nvi 95 39-•41 5) CITY OF 1-163(lRD -- FECEIPT nF F-,AYMENT PECEIPI rJG- s 90-2007: CjjF 48 W10UNT 2;,,8. CASH AMOUNT 0. 00 NAME t TITAN PROPEPTIES PW(MENI' DATE 1';i 90 ALA)RESS s (W FAD 1 V!S I ON op 97700-7- PUPPOSE OF FAYMP-IT ()MOUNT rFilf) F-UPPOSE OF PAWFN'r AMOUN't PAID r4l PEPM (30 PLUMBING PEF Ooq--j JLD I Nr 24. P8 ST.. b U I L D P F-!',.' MECHANICAL PE SWR90-0 103 1250.Ou PLAN (,HF-r-V FE 00 +MEP U:,A 600- 00 5. (Jo STREET SDG SEWER INSPECT DRAIN SDC no -4 F-M -S SDC 450.00 T 137 AL At'll U14 Z918. 48, CITY OF T167A RD C-q PLAN CHECK N of PLAN CHECK APPLICATION �'; ria"°" COMMUNITY DEVELOPMENT DEPARTMENT 13125 S W Nall Blvd..P.O.Boa 23397,Tigard,ORgm 97223,4503)8394175. ` PERMIT N 1Yj DATE ISSUED JOB Pl RESS: O oZ� 1 . TAX MAP/LOT �.._� "OB: X1_U 1 : LAND USE: VALUA EION OWNER A SPECIAL NOTE b�9 - 8�q �aKa� ,�► NAME: �''a- - REISSUE OF: ADDRESS: - LAST REISSUE: �__ _ ��__ _ FLOOD PLAIN/ �7 '7 SENSTIIVE LAND: APPROVALS RE UIREU CUN1"RACTOR PLANNING: NAME.: _ ENGINEERING: ADDRESS: _ FIRE DEPT --- --- __-- i OTHER: BUILDERS HOARD A!; EXP GATE: .ITEMS REQUIREDLIST/SUBCONTRACTORS: _ BUS TAX: _ ARCHENGINEER CALCULATIONS: NAME :: TRUSS DETAILS: ADDRESS: _ OTHER: PHONC : COMMENTS: i SUBCONTRACTORS: PI..UMB: MECH: Tf PERMIT M ACCT M DESCRIP' ION AMOUNT AMJUNT PD. SAL. DUE 10 432 00 Building Pe-mit Fees3/ _ _ 10-431 00 Plumbing Permit Fees / fit 10-431 01Mechanical Permit Fees1 `'i- 10-230 01 State Building Taff (5%) Building t= Plumbing Mech 10-433 on Plans %!peck Fee Building _ _,l ✓ Plumbing _ Mech l.k lu I/D3 30--202 00 Sewer Connection _ 30 -444 00 Sewer Inspection 51-448 00 Street System Dev Charge !SDC) -^••�-Yr=— v�,. 52-449 00 P,irks System Dev Charge (PUC) 31--450 00 Storm Drainage Syst Dev Chrg (SSDC) 10-230 06 F i rE TOI AL l RFS: M ,�- APP T(;AN SIGNATURE Received By: _ Date Received: / . crl/3587P/18P T--- - ;ItAI) N • &RQSl0N CQNTRQ) , INFORMAIMCAsr-1:11.1. No . GF;NERAL CONTRACI OR NAME& ADDRESS: !'L•RMIT NO.: r �< o APPLICANT NAME AND ADDRESS: n E T AJ r rl;_UL21 full --- EXCAVATION COKI-RA("l'OR A NAME& ADDRESS: _A _moi 1(�. ►�Z_._ — t� ,RI «'�•,� ; tl�Tl � - OWNER NAME AND ADDRESS: I]*.ITPFIONE NUMBERS: E 4 PROPERTY DESCRIPTION: APPLICANTi ST E'f AD ESS AND ROSS EET ATF Q Q , /[' OWNER: `a [ 71 7 J GENERAL CON'IRACI()R: -- EXCAVATIONCONTRACfOR:_411? SIZE/JOB- LEGAL I)FSCRIP'TION: 24 HR/AF IFR HOURS IiMER%I NCY fAX LOT NO.: - 1/4 SECTION: CONJ'ACIllPIiRSON,TITLETELEPHONE: SITE SIZE.ACRES- _ oISTTIRBED/WORK AREA,ACRES: I OCATION&ADDRESS WIIERE SPOILS SILT FtQt4OFF DRAINS TO:(CIRCLE ONE) LEAVING SITE WILL BEs TAKEN I'CU BASIN DITCH PIPE CREEK (NoI U:PIpMMITS MAYBE RFQUIRF.D) �� --- (CIRCLE ONE) _PRIVATE PROPERTY CPUDLI_ RIC CiFIT OF WAY j:R,QS ( N[SFWMFNTAl1Q QQMLRQ-1 (CSC) MEASURE MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS F)URING CONSTItUC1ION: FOLLOWING CONSIRUC'rloi.• SEDIMENTATION FACILITIES 3TABILI7.E EXPOSED SURFACE STABILIZED CONSTRl1CTIJN ENTRANCE REMOVE AND RESTORE TEMPORARY ESC PFRIMETTR RI INOFF CONTROL FACILITIES CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS COVER PRACTICES ENSURE OPERATION OI'PERMANT FACILITIES CONSTRII(71'10N SEQUENCE OTHER OILIER — - PLAN POR EROSION CONTROL PREPARED AND SUBMITTED IN ACCORDANCE WITH"TECHNICAL GUIDANCE IIANDBOOK% EROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE.INCLIIDINO EMER(}FiNCY PIIONE NUMBER, SCI IEDULFATAGINO I-i)R INr-TALLATIOM AND REMOVAL OF EROSION CONTROL 1AEAS(1RES,AND APPI.lCAt,--STANDARD N(YTES. 1 HAVE R5AD AND WILL COMPLY W O It TIIE CONTAIN VE AND IL THE CONSTRUCTION AND MASNTAM ESC 0 IEASURES AS NECESSARY owNER S , ATTIRE �' ��APPLIA 1NATURE • • • • • • • • • • • • • • • • • • • • • • • • • • •OFI:IC[All1S1:ON[Y • • • • • • • • • • • s • • • • • • • • • • • • • • • RECEIPT D A'IT A('C EI'TT D FTI; NUMBER -- -- RI-AlAVIA) �- BY