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12416 SW MORNING HILL DRIVE I 12416 SW MORNING HILL DRIVE _ INSPECTION_40TICI City of Tigard Build'ng Department P.O. Box 23397 Tigard, Oregon 97223 ` Phone: 639-4175 Type of ( pection Date Requested - / �y A.M. P.M. Address_ �� � c Poo mit Owner_ J ____-�_ Lot Builder The following Building Code deficiencies are required to be corrected: Presented to ._ _ �pprovad Inspector 1� `Y1�a^✓`°` L� Disapi*oved Date CALL FOR REIMPECTION YES10 i j iig +� sw !NSPECTION NOTICE City of Tigard Building Department P O Box 23391 ' Tigard, Oregon 972'23 ` Phon a: 639-4175 w Type of Inspection .-_- ,k=`- �- Date Requested� � Time. A.M. P�.M�- Address Z!!?__ -�?�.-� ermit Owner ,.- Lot Builder •- .,. �r=. ------- i The following Buildit Code deficiencies ave required to be corrected: Presented to - pproved r� Inspector _.._-_____ _.-,_ ❑ Disapproved Date — CALL FOR REINSPECTION F] YES 0 NO a� ns .� .r est •w aw eae r� i CITY C)F TIFA RD is (]i:CUFCER NC OF Y CRYAFIWARD PERMIT N. . . . . . . a MST90-0076 COMMUNrTY DEVELOPMENT DI tTor 4mm 13126 SW HWI Blvd. P.O.Box 23997.'fig&M,Oregon 97 W ) Ki DA'I L IIiSUE::D i 09/07/90 .%.1: T-H ADDkESS. . . a 12416 .5W MORNINU HILI.. DR VARCLLs 2 104AR 12000 S)LIHDIVISION. . . . a MORNING HILL. 146 Z()NINI.;a R P5 trl_.00K. . . . . . . . . . s LOT. . . . . . . . . . . . . : 149 ('.:L-ASS OF WORK. aNE:.W TYPE Of" USE. . . vSF CICICUPANCY ORP. CR3 OCCUPANCY L.OAD a PPO 4 r,'*:NAN'T NAME::. . . e �.Mflla'r`ECIR 6 Ownerro - -.._....._...... .._.._... ._.-._.-_....._.. w.._. _ __. __ V. E. ANDERSON INC '361 3 SW REAVERTON HIGHWAY HF.:AVURTON OR 9.7005 I,hone Or 297-7666 ('can trar:t cera ...._ ....__..._.__..... DAN E ANDERSON MEADOWBROOK DEVE LOPMF::NT 9363 SW BE.AVER1ON--H'.Ll. '%DAI-E: HWY. BEAVE:RTON OR 97006••-0090 Phone 0% 303- 297-- '/666 ' Reg #. . % -463,64 Occupancy of the waove rofwreanced building to '`wrgb-v' giuMrl, -%M1 r:rtifiv% the compliance with the State Of Orsogon Specialt/ CL,de!a for the gr(it l��, :occupancy, and US0 under whi,t�h the referenced perm$t WAs iunsuwd. FIRE DEPARTMENT � ' UIl_DINd INSPECTOR BUII..D 0 UFF3 �. L POST IN CONSPICUOUS PLACE INSPECTION NOTICE: City of Tigard Building Department P.O Box 23.', 7 Tigard, Oregon 97223 / Phone: 639-4175 Type of Inspection ti.1 t� -_ ----.---- --- ---- Date Requested g' _ 9 U _ Time __.—._ A.M. �—;P.M. Address 1 2 -4- 1 QP liylLd���1_g���i �- �-- _- Permit #qV 00 7 Owner- �- �_�_- Lot Builder GLf - Th(-. `.,iiovvinp Building Code deficiencies are required to be co,rected: Presented to ___ -____,_ _V '! Approved Inspector �7 C� __._�_- Disapproved Date CALL FOR REINSPECTION 71 YES 0 NO CERTIFICATE OF � � TIFA .� OF r►!d OCCUPANCY NRP cirry T RD PERMIT N. . . . . . . a M81-90-0078 COMMUNITY DEVELOPMENT DEP#fJ4 (T PRIM. PERMIT P. : MST90 -AOlti 13126 SW Hail Blvd. P.O.Box 23397,T1pid.Onpon 97223(503)639-4176 DATE: I S S UE D z 06/27/90 i altE= ADDRESS. . . a 12416 SW MORNING MILL DR PARC;EI.a 28104AFt--].P000 SUDDIVISION. . , . a MORNING HILI_ 06 IONINGa R-••25 Pt.OC:K. . . . . . . . . . a LO1.. . . . . . . . . . . . . a149 (A OF WORK. 1 NEW I '(PL: OFF USE:. . . a af:. OCCUPANCY OPP. a R 3 C)t:C: JF-'ANC:Y LOAD 12L.@ 4 T L NaN i' NAME::. . . 1 kemarkswe 30 Day Iemporalry Occupancy Uwnerc _ .__..._.._ .... �._._� _.. _.__...._. ._m._...._..._......_.. D. E. ANGE.RSON INC. 9363 SW PE:AVE 81104 HIGHWAY PE.AVERTON OR 91005 Phoney Ns cont•rar_tore D. E. ANDERSON INC: 9363 SW BE=AVERTON HIGHWAY DF.AVER TON OR 97505 0hor►e Na 297-7666 Rep b. , a 46 344 Occupancy of the above; r•r ferwrscesed buildinp is hereby pivAn, and certifies the compliance with the ;tate+ Of Ors!•gon Specialty LoelNs for the p•roup, occupancy, and u,:e under which the roferencod permit was issued. FIRE DEPARTMENT -- - - BUILDING INA06 I+l)1'1_DI?SQ FFICI _ POST IN CONSPICUOUS PLF4(_.F_ j f jy c�J 1 4SPECTION NOTICE City of Tigard Building Department P.O. Box 2339.7 Tigard. Oregon 97223 Phone: 639-4175 Type of Inspection �r �llJ L Time__ �A.M. _P.M. Date Requested Address1 -fC.�° .Permit Owner yy �� Lot # __ Builder �QGz`� z!'n��-� The following Building Code deficiencies are required to be corrected: N4 I n c'l•Lc17z..ec�e..� SE2vie� �/1.yeC.,, �Ns,��ior�._ /-1-r1.S /dPF'r'e .cso 1=i.vi�L �/J' UE} ts/�<t.. ���rTAeT rnesi�c7"v�� '5..�—��==tet' ���—�� sTG('� �->•�II/aS.:r� �,t.rr-L'�rL�''!1 is Qir.14 Gv9Li-- ,a Z3L&A,) �z`___.�l�•�3•�•/ �ft'l�taii!�, /tf0% 'T7o� �-f�!S t"i GL•c.5" ____ A r-`'Fji?a IA,t n_ /2 z r Presented to _ _ proved Inspector ____.___ ❑ Disapproved Date CALL F)R REINSPECTION No INSPECTION NOTICE -� City of Tigard Building Departmenth�- P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection �___ �L7 �t1411 � Date Requested Time A.M. f P.M. Address1,-��, �/�-�Z�'LGs -�� PermitF6� Owner Lot #_ Builder The following Building Code deficiencies are required to he corrected: Presented to _ ,Approved Inspector Disapproved Date — CALL FOR REINSPECTION ❑ YES 0 NO INSPECTION NOTICE City of Tigard Building Depaihnent P.O. Box 23397 Tigard, Oregon 97223 Phone: 639--44175 Type of Inspection _� U 1F- L� Date Requested 7~ !.'D _ Time A.M.._ P.M. Address -Permit #.1.LL_ e� Owner " _ Lot # Builder The following Building Code deficiencies are required to be corrected: AJ i Z 41 _ Presented to Approved 1 Inspector ' y "— ' ❑ Disapproved Date U CA U FOR KEINSPECT'ION VA1 1^ A ® YES 1:_1 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 17 Type of Inspection Date Requested Time__2� A.M. __P.M. Address ermit c. Owner Lot Builder The following Building Code deficiencies are required ta be corrected: OQL-LI-Z-714- IA Presented to -- roved Inspector Disapproved Date CALL FOR REINSPECTION YES NO INSPECTION NOTICE C�*1, City of Tigard Building Department �lf y P.O. Box 23397 JTigard, Oregon 97223 ] � 0,41 Phone: 639-4175 r Type of I pection _�___ A.M.__. P.M. Date Requested Time— --� -- Address .� -' 1� �%L ' Permit #C�— Owner _ _. L�: #_---- r BuilderThe following following Building Code deficiencie3 are required to be corrected: Presanted toroved Inspector � �- �.— _� [.� Disapproved DateCALL VOR REINSPF.C2'ION I YES L7 NO i - INSPECTION NOTICE r !ter City of Tigard Building Department P O Box, 23397 Tigard, Oregon 97223 Phone 639-41775 Type of Inspection 't'�fr.'6"•--6.e�--- -- — -- Date Requested_— '� Time A.M. _P.M. Address ��-Ll�____t�GL� - Permit i Owner . __ Lot. BuilderThe following following Building Code deficiencies are required to be corrected: Presented to ❑ A roved Inspector _ Ditepproved Date CALL FOR EINSPECTION YES [- NU INSPECTION NOTICE �1 City of Tigard Building Department P.O. Box 2.3397 Tigard, Oregon 97223 Phone: 639-4175 Type •-)f Inspection Date Requested Time— A.M.-P.M. Address # Owner- _�.__�_____. —......— Lot ---� Builder— The uilder—The following Building Code deficiencies are required to bp corrected: Presemed to ---- - -- _-_ Approved Inspector , ' _..___._.�_ i Disapproved �JatP, CALL FOR REINSPECTION [J YES 0 NO W 1W I INSPECTION NOTICE City of Tigard Buildirg Department r P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 T ype of Inspection Date Requested _ �c• - G _ Time A 4._ P.M.M^'��.�/ Address _ 77�7/J _ _�� Permit #0. LJ_ s Owner Lot # Builder The following Building Code deficiencies are required to be corrected: Presented to _ _X Approved Inspector , L I Disapproved Date -- CALL FOR REINSPECTION ❑ YES ❑ 140 INSPECTION NOTICE f /� City of Tigard Building Department P.O. Box 23397 6 �/ 1 igard, Oregon 97223 F!)one: 639-4175 Type of Inspection -- - h. Date Requested ALTime L— — ..� _ P.M. — � ��- � A.M. �— Address ��}L _T-T //�-� , Permit Owner_..__ ,o _— Lot # — Builder The following Building Code deficiencies are required to be corrected: Presented to __ ❑ Approved Inspector Disapproved Date _? — el -- -- CALL F R F.EINSPECTION �] YES f�1 NO sssr a � �. r .■ s� ... INSPECTION NOTICE - City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-x175 Type of Inspection �A. . — =—TimeDate Requested_, — P'M' Address _��L---- � �-----T Owner —_.-----__-_ _ Lot # — Builder ti The following Building Code deficiencies are required to be corrected: 17 Presented to Approved Inspector p �� �_ — [J Disapproved Date — CALL FOR REINSPECTION ❑ YEs 0 NO i INSPECTION NOTICE City of Tigard Building Department P.O Box 23397 Tigard, Oregon 97223 Phone: 6639-4175 Type of Inspection �/ Date Requested `� S Ll� Time A.M._LTJ P.M. Address _ ,� ✓ate` Permit Owner ) 4 __ Lot #__ Builder The following Building Code deficiencies are required to be corrected: Presented to _ Approved Inspector _ ____ .� Disapproved Date CALL FOR REINSPECTION Cl YES El NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection —_ %'lYi��'� Date Requested 3 TimeA.M. P.M. Address ___ _IlJd___ �._Time — A.M. # Owner __— —_— Lot # BuilderThe following Building Code deficiencies are required to be corrected: /T L11 a Presented toApproved Inspector __!!_�.. __.�_____— ` � Disapproved Date -------� — --- — CALL FOR REINSPECTION Cl YES ❑ NO i i INSPECTION NOTICE City of Tigard Boding Department P.O. Box 23397 y} Tigard, Oregon 97223 r Phone: 639-4175 Type of Inspection Date Requested____ __ "� ,G _ Time A.M. P.M. Address _ � - -,� 1 �h"�-'�Gi � Permit Owner_ `i.. _ Lot BuilderJ� ti" IL The following Building Code deficiencies are reo-iired to be corrected: II�GLI7 577ZI�WPI»i 'S d G��-� '-�C'CL' T',S,� C'cy,i�1�'Tc i�'L�u1r�.--1� - t-'e'er•iy` Presented to _ Approved Inspectors `' ❑ Disapproved Date CALL FOR REINSPECTION Cl YES ❑ NO - CITY OF TIGA RD CC4r. MASTJ­:R PE.RMIT ji�� AND 1,F:"RMIT #. . . . . . . .. 1.IS'190 -0018 COMMUNITY DEVELOPMENT DEPARTMENT 0114mm PRIM. Pl:';:RMIT 0. : MST90 140'/8 13125 SW HWI BW. P.O.Box 23397,Tigaid,Oregon 97M'") 175 D ­D: 0* /16/90 OTE ISS)UE­ SITE A 1)1)R 1*:,*-":)S. . . 1241.6 SW MORNING HILA.. DR PARCEL..: 26104AH-12000 SUBDIVISIDI-I. .. - 11ORNING HILI IK" ZONING: HI OCK. . . . . . . .. . . .. I-Ol . . . . . .. .. .. . . . . . : 149 BU11..DING REISSUE: DWE:'l I..ING UNITS: I RnSF:'MF:NT. . . . 0 Sf Cl-ASS OF WORK. -.NE*W SEDRMS.-4 BATHS-.3 GARAGE. . . . . . . . . . ..400 S f TYPE OF SF FJ..00F%` RE1.41JIRED TYPE:-* OF CONST. -5N f I F.F T. . : 1.0 ft RTGHT. -5 fix OCCUPANCY GRP. R3 SJ:­.COND. . . :800 S;f FR 0 NT. 2 0 ft REAR. . : 15 ft STORIF::S. . . . .. . . P) TH I R 1). 0 4s•f R E Q U 1'.R E D-- HEIGHT. . . . . . . . ..20 ft TOTAL..-- ---- : 1.91; Sf S)VIOKE".' DE11A.,"TORS. -Y FLOOR I 00D. .. . . :40 f)!:i f VALUE. . . . . $c 8'76 30 PARK I NG SPACES. . :0 PLUMBING SINKS. . . . . . I FL.00R DRAINS. . . . -0 D A CK F I OW PREVNTRS. . :0 LAVATORIES. . . . . :4 WATER I RAPS. . . . .. . . . . . . . . . ..0 rUB/GHOW1_RS. . . . :3 I.-PUNDRY TIRIAYS. . . :0 CATCH BASINS. . . .. .. . . :0 WATER CL,OSF:T5. , -3 SE'WER t..INE (ft) . :0 6 R F-.'O S L TR A V'S. . . . . .. . .0 D 19 H W 0 S 1-4 RS. .. . .. '. 1 W A 11.R I IHE: (ft) . : 1.00 OTHER F I X T U R 0 GARBr-1(3E* D I 13P. . . - I RAIN DRAIN (ft) . .0 WASHING MACH. . . : 1. SF: RAIN DROINS. . gl. M[:1(;HANIC01,. FUEL TYPES-­­--------- UNIT HTRS. . :0 iyr)e aMOU11t 1:)y (Jate rec. /GAS/ V E'.NTS . . . . . ..0 i.,Oyll $ 100. 00 JLJI 02/21/90 107409 MAX INPUI -.0 B11.) VENT F;ANS. . -4 1­,RM1 $ 397. 00 TURN ( 100K . . .- I HOODS:. . . . . . : 1 P1_C K $ 258. 05 TURN )=100K . . -.0 WOODSTOVE'S. .0 5 PC T + 19. 85 FLOOR FORN. . . . .0 CL.0 1)R Y F'R S. I STDC $ 600. 00 14OIL/CMP OTH1­R UNITS 0 SSDC 1; 250. 00 GAS (JUTL_ETS-. 1 PARK $ 250. 00 Owriert INSP t 0. 00 1). E. ANDERSON INC. PRMJ $ :39. 00 9363 ':)W 14F:*:AVERTON 11T(31-AW')Y P 1_C V $ '3. 75P 5FIC,1 $ 1. 95 K.AVE.RTON OR 97005 PRM T $ 147. 50 Phone #-. 297-7666 5PU'l, q; 7. :313 C o n t r a c t ci v 17,A Y 11 J> Ifl.1801 . 48 JA.H 03/16/90 D. E.'. ANDE:'RSON INC.: 9363 SW BEAVF`_R1'[)N 1+161AWY BEAVERT'ON OR 97005 Phone 14- 297 Reg #. . .- 46344 $ 1.980. 48 TnTAI_ This permit is issued subject to the rejulations contained in the REQUIRU.1) INSPECTIONS -- Tigard Municipal Code, St!ta of Ore. Specialty Codes and all other Foot/fat.tiid Irisr) V"i replace Ivicip Applicable laws. All work wile be done in accordance with approved Past/Beam 11-1sp Gas Lirie plans. Th?s permit will expire if w is not started within 180 Crawl Dri-aiii 11.1st.tlation I P days of issuance, or if work is sus ded fothin 188 days. PIM/Midslab liisF) Gyp Board I ii sF) Permittee SignatUrei ro,/Al(A-- MPcJ1a1-)ic!a1 Irlar) WAl-ev I.-irle I lis P PlUnib Tnp OUt Af)pr/9dw1P, Ivisp ISSUed By: r:v a ni i 1-114 1'.1-)S P M P(7 h a vi j.c�a I. F i via 1. Call for irmpeetioi-i --- 639­4175 S EW E R CO N N L C1 ION CITY OFTIFARD PERMIT CffYOFTNRRD i� COMMUNrTY DEVELOPMENT DEPARTMENT 1*1 F.:.R M 17, 111. . . . . . . SWR90-0086 13125 SW HWI Blvd. P.O.Box 23397,TkpM,Oregon 97223(503)63"175 F,R 11. F,E R M 1 1 14. » M S*T 9 0---0 07 8 i 66WED 041Z i 6,190 SITE ADDRESS. . . - l ;.?41.( ',W NORM ING lrl:fl 1. Dfi F-IORCEi 29104AP.--12000 S)(.JF4DIVISION— . . : NORNIN(:; till L. 14 f, ZONING.- BLOCK. . . . . . . . . . . 1 01 149 T'ENAN'T N A 11 F.:'. tJ")A NO. . . . . . . . . . ..40615 F'IX'T'(JRL UNITS. . . LJ-AS!'3 WORK. . . .-NEW DWF.--Ll ING LIN I'M. . : 1 'T'Y V'E OF' USE. . . . . »SF NO. OF B1JILDIN(3Su1 TYP,E. . . . :BLJGWR IMFT.RV SURFACE. . : R e nia-r P.s>- OW11".r .- FEES 1). E. ANDERGON INC type anic)(.11-It by Y date rec�pt 93613 SW PEAVERI'ON HIGHWAY F:,RM*l $ 1250. 00 Tlqsr:, f 35. 00 14:.0VE RVON OR 97005 [::,(,)Ylq 1- 1.k'.1'5. 00 B(,.,R 03/16/90 Vlllavie #.- 297-76C6 Covit-vac�ta-r-. 1). E:. . ANDERSON INC "),3613 SW BE(IVF--.R'T'ON HIGHWAY BE.AVEWTON OR 9700'-) Fllic)vie #.-. 297--'7666 1.285. 00 TOTAL Reg 46344 .................. REOLlIRVI) INSPECT'IONS This Applicant agrees to comply with all the rules and regulations Sewer li-ispecti(art ............................... of the Unified Sewage Aqency. The permit expires 12@ days from ........ the date issued. The total amount paid will be forfeited if the —------- permit txpires. The Aqency does not 11jarantpe the accuracy Y of the ......... side sewer 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 installer shall purchase a "lip and Side Sewer" Permit and the instill a lateral. .......... V'R T'M i t tee j.il i,i ra k v ..................... ................ ............ ...................... ...... ...........................--.—................ Call fo-r inispection 639-4175 MuLm� CITY OF TIGARD RECEIPT OF PAYMENT REC NOt 001078',*6 CHECK AMOUNT : 7-165.48 NAMEc MEADOWSROOK DCVELOPMENT CASH AMOUNT t .00 Hvi)RESS3 PAYMENT DATE 1 03-16-90 SEAVERTON, OR 9?00 , BLOCK NO/ADDRi 12416 SW MOPNING HILL D PURPOSE OF F-AYMF14T AMOUNT PAID PURPOSE OF PAYMENT (AMOUNT PAID ----------------------------- ----------- RUILDING PERMIT (90--0078) NW 397.00 PLUMPING PERMIT 147.50 MECHANICAL PEPMIT 39.00 STATE BUILD Pr.'PMIT TAX (15%) 29. 1H PLAN CHECK I'VE 167.80 SEWER USA (90-0086) 1 50.00 SEWER fNSPECION 35.00 ST' PARKS SYSTEM VPVELOPME1,17 CH 250.00 s'r8k,'4TDRftj six TOTAL A1101JNT PAIL 16.1.40 CITYOFTIGrARD cmoFiiclRc PLAN CHECK APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT OMo*" PLAIT CHECK N ^:50 R - 1J125 S.W.KA FU d..V.O.Box 23L"r.'n9arit Oregon9T723.(SM)6"4175 PERMIT # n j f j U- Gv / DOE ISSUED JO DRESS:: IP e 4i,4;AX MAP/LOT `;u LOT. LAND USE: `v UAfrON: _ Z 3C' -•�►�----- OWNER SPECIAL NOTES NAME; REISSUE OF: _ ADDRESS: _ LAST REISSUE: FLOOD PLAIN/ • SENSITIVE LAND: PITONS APPROVALS REQUIRED CONTRACTOR PLANNING: _^ NAME: _ ENGINEERING: ADDRESS: FIRE DEPT OTHER: _ PHONE: _ ITEMS REQUIRED BUILDERS BOARp b: _ EXP DATE: LIST/SUBCONTRACTORS: BUS TAX: _ _ A_R_CH/ENGINEER CALCULATIONS: — NAME: __ f TRUSS DETAILS: ADDRESS: _ 0:4- OTHER: PHONE: _ COMMENTS: _ _ -- - - -- SUBCONTRACTORS: PLUMB: '�,Iakze,ti. MECH: PERMIT 9 ACCT b DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE X115tt;r) y(J I'S 10-432 00 Building Permit Fees / 0 2y1 -- 10-431 00 Plumbing Permit Fees v _5a _ •-5v 10-431 01 Mechanical Permit Fees 39,c, 10-230 01 State Building Tax (5%) Building /G. E), yL Plumbing 7,-3,y ✓" Mech 2, 9> r/ � 10-433 00 Plans Check Fee �P��'� Building Plumbing Mech a -y 30-202 00 Sewer Connection `J 2 J JZ 5 o QL c� 4 30-444 00 Sewer Inspection 35 _ .55 _ SLti1� ~ 51-448 00 Street System Dev Charge (SDC) 52-449 00 Parks System Dev Charge (PDC) � � r 5 V _ U 31-450 00 Storm Drainage Syst Dev Chrg (SSDC) ✓ v�� v 10-230 OG Fire TOTAL �G-•`� V _1A�1 _ REC H 16 _�— APPLICANT STGNATURF f Received By: �� Date Received: � ��- / V cn/3587P/18P GRADINGIEROSTON COWMOL. TXVORMATTON GENERA.CONTRACTOR NAME&ADDRESS: CASEFTZ-E NO.: D. I,. ANDLRSON, INC. PERMIrNO.- U2C"ZCGT Roajtorfi�,��-11iIIGrIaln ukw- Rc a v n r tjT rl r n wf'n a'7n n r, APPLU:ANT NAME AND ADDRESS: EXCAVATION CONTRACTOR am NALS A ADDRESS: ui kuuwtL OWNER NAME AND ADDRESS: TELEPHONE NUMLERS: APl7.ICANT: ' b b b PROPERTY DESCRIPTION: ` satoc ADDRESS ANDS S1RINT,, C TED GENFRALCONTRACTOR• same s�4lJ �Q�t�R& IiXCAVAMON CONTRACTOR• SI'IMOB: LEGAL DESCRIPTION: Zt HRJAF'1ER HOURS EMERGENCY TAX LOT NO.L CONTACT PERSON.TITLE.TELEPHONE. IJ14 SECTION: Koi th .Ia�pjnn _ CnnG Foreman SITE SIZE.ACRES: � )d ri-q R n A DISTURBEDIWORK AREA,ACRES• , LOCATION&ADDRESS WHERE SPOILS LEAVING SITE WILL BE TAKEN SITS RUN. FF DRAINS TO:(CIRCLE ONE) ow .•MtMM MAY DR MUD=) TCH-BASIN) DITCH PIPE CREEK none (CIRCLE ONE) PRIVA.TE..PR0P C (MJBUC RIGHT OF WA EROSION/SEDIMENTATION CONTROL (ES0 MEASURES bfI NIMUM ESC REQUIREMEN I S MINIMUM ESC REQUIREMENTS DURING CONSTRUCTION: POLLOWIING CONSTRUCTION: SEDIMl-ENTATION FACILITIES X STABILIZE EXPOSED SURFACE X STABILIZED CONSTRUCTIOP!ENTRANCE REMOVE AND RESTORE TEMPORARY ESC X PERD4ETER RUNOFF CONTROL FACILITIES X CLEARING AND GRADING RESTRICTIONS x CLEAN AND REMOVE ALL SILT AND DEBRIS COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES CONSTRUCTION SEQUENCE OT HER_ OT7�.R PLAN FOR EROSION CONTROL PREPARED AND SUBMITTED IN ACCORDANCE WITH"TBCHMCAL GUIDANCE HANDBOOK-. BROWN CONTROL PLAN DRAWING,AS REQUIRED.HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY PHONE NUMBER SCHEDULEISTAGING FOR INSTALLATION AND REMOVAL OF EROSION CONMOL MEASURES,AND APPLICABLE STANDARD NOTES. I HAVE READ AND WILL.COMPLY WITH THE ABOVE AND WILL CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY TO CONTAIN SEDIMENT ON THE CONSTRUCTION SrM ( PRT'SIULN'I') SaIlIL' OWNER SIGNATURE APPLICANT SIGNATURE C OFFICIAL USE ONLY RECEIPT DATE ACCEPTED FEE NUMBER RECEIVED BY