HomeMy WebLinkAbout017-280-008TO: Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
E - H. WE ONLY
R62 Plan Atli�h.d
Raw Ran Attached
Sam to G.D.
/6,;5.P,j2A!q A.- k� � W 9-4-4 Vz 4Y6 ---44 0,19
Owner Location AP#
Plan Approved for: Sewage Disposal>e Water Supply: Public.,�<_ Private Well
Clearance for _.dwalllwk. Other Y^
Hold final for;
Final clearance O.K. for:
NOTE:'
Environmental Health Specialist
8/96
3- 2,2 -e, I.,
Date
O`VNER-BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your sigoaum.
Please complete and return this information at your earliest opportunity to avoid unnecessary delay
in processing and issuing your building permit. No building permit will be issued until this
verification is received.
1. I personally plan to provide the major labor and materials for construction of the proposed
property im rovement : YES NO
2. I HAVE HAVE NOT 0 signed an application for a building permit for the proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
NAME:
ADDRESS: CITY:
P NE: CONTRACTOR'S LICENSE NO.
4. I plant rovide portions of this work, but I have hired the following person to coordinate,
supervise, d provide the major work:
NAItiIE:
ADDRESS: N111, CITY:
PHOrT: CONTRACTOR'S LICENSE NO.
5. I will provide some of the wo but I have contracted (hired) the following persons to provide
the work indicated:
NAME ADDRES PHONE TYPE OF WORK
SIGNED:
PROPERTYOWNER:
SOCIAL SECURITY i ER*_ �
DATE: 2 S 0 Z
NOTE: This Owner -Builder Verification is required by Section 198.31 and 19832 of tie
California Health and Safety Code. This verification must be contpkMd turd
returned to our office before we are permitted to issue the permit
OVER
TO: Building Department
FROM Environmental Health
SUBJECT: Sanitation Clearance
E.H. USE ONLY
Pat Plan ArImchad VFC—!Q'
FIGuy Man A"c�ajl=
Sent to S.D. V/e77---7= I
f /f -
. &XUI-
VI 121,/Vl t2ocl Q i� 0 1
Owner Location AP#
Plan Approved for: Sewage Disposal Water, �qpply: Public Private Well
Clearance for dwelling. Other cze4d' 41 a/-) 12e C Q 046
Hold final for:
Final cl
NOTE:
"I FII�w 4146�
u::;4
Mai a a 016L,
�r.' —Izz-'-�' Date
Iffirie n-ta-I —H—e-al�t—h S p- el c j a s t
8/96
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