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Home My WebLink About025-090-067+ i ,�- NOTES RESIDENTIAL 0 090-06' 04-1368 a SWANSON, DEAN WILEY WAY$,, a,r' Cont: OWNER NEW SINGLE FAMILYiGAWCOV t f r �i x• . i SPECIAL CONDITIONS CHECKED - BY SRA ' FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY Iz USE PERMIT CONDITIONS + ` SUB -STANDARD HOUSING LETTER gfflCE copy o' t Address G AS Meter By Date � -ELECTRIC �1 Meter By D e��—. i ' JOB FINALED (Date) It e Signature V= OK 0 = Not OK = Not Applicable = Not Ready Date RESIDENTIAL (Single & Duplex) loor (Plans) OK except #'s F ain; Soils-Elec. Grnd.-/ f 4" Ftg. Depth tg. ge; Soils-Steel-Elec. Grnd.-/ ;Z Ftg. Depth t orches & Decks; Soils -Steel-/ P' Ftg. Depth Stemw IIs, Main; Ste el-Blockouts- Wrapped /6. St walls, Garage; Steel-Blockouts-Wrapped H Downsand Special Anchors 8. PjpK--Fireplace Ftg.-Steel D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF, Gas Pipe; Size Anchors - Yard Gas Piping; Size Test 11. Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Criooies 15. Access & Ventilation 16. Ins lation Date Card B-1 Date Card B-1 Date _ r/ Card B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s 17. Water Htr.; Vent -Access -Combustion Air Baffle ater Pipe; Test & Anchor -Nail Protection W.V.; Test Fittings & Anchor -Nail Protection hower Pan; Test, First Floor -Tub Access / 1. Tub & Shower, Second Floor -Tub Access 22. Gas Pipe; Sixe & Anchors Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s xfure & Transformer Clearance -Ins. Protection 24.•-.Fy�. Receptacles Spacing -Lights & Switches at Doors Siz Boxes & No. of Conductors Stapled omex Installed Close to Edge of Studs & C.J. 27. uip. Ground made up w/Meeh Fasteners -Bond Gas & Water %94pliance Circuits in Kitchen & Conductor Size GFI 2 . Su ed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga Cu or AI ange Circle / / ga Cu or AI.Oven Circ. / / ga Cu or AI r Insulated Neutral Q Yes Q No 1. S ce-Riser Conductors & Ground Main Disconnect Equi Clearances Panels-Motors-Mech. Equip. 33. Wrhes Closet Light -Shower Light -Spa Light 3 *T. -Smoke Detector Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s A.C. Ducts Insulation & Support 36. et Fan, Exhaust above insulation 305'condensate Drain & Overflow, Size & Grade IW,Fu2ace-Vent Access -Comb. Air -Return Air Vent 115 outlet 3 Attic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s orT-Sills Proper Materials & Anchors 41, alts Studs -Nailing Spacing & Braces -Plates -Sound n Bearing Walls over Girders & Floor Nailing /3' Stop in Walls (rat proof) 4. F' a Stops, Furred Ceilings -Stairs -Chasers -Tubs eaders & Beams -Size & Bearing Date FRAMING (Continued) Hangers -Post Caps -Anchors -Connectors 47 ling. Joist-Rftr. Ties-Purlin-Roff Brac.-Truss-Shting.-Rfng. 8. F' place Ties or Type A Flue -Fireplace Throat Clearance tUc r Access; Size & Romex Protection -Draft Stop -Ins. Battles Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 51. rage Fire Protection Framing �. 52._*(rperty Line Firewall & Openings oors-One 3' -Check Garage 3rd Story, 2 Exits Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 55. Plywoqd. on Roof Overhang -Attic Vents -Rafter Outriggers 56. g -Nailing Veneer St esh-Drip Screed -Fd. Vents-Underflr. Access 5 . Glazing Area -Glass Protection -Skylights -Plastic 59.4511Tear Walls; Nailing -Bolts 60. Brace Interior/Exterior Wall Panels 61. Insulation -Walls -Ceilings 62. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card 8-1 Date Card B-1 Date FINAL (Plans) OK except #'s 6/ Ext. Steps -Door & Sidelight Protection -Landings Smoke Detector 2V Furnace Vents -clearance -Comb, Air-Conne/rtor- In Garage; Above Floor -Ducts -Meth. Prot,6Ction Bedroom Exiting Z_ 7. &. *.I. & Bath Fixtures & Tub Acce f Elec. Trim & Subpanel, Breaker Sizes & Labels �St irs & Rails Fireplace or Stove, Clearance- " arth 7 Elec. Outlets at Wood Panel t. & Ext. 2. Kit. Fixt. & Appliance; ro d- rGap-Cooking Clearance 7 Elec. Outlets & Receptacles at Kit. Counter 7 Garage Fire Door; Swing -Landing -Closure --76--A.C. Duct in Garage -Damper 70,"Wir. Htr.; Vts-Clea rance-Comb. Air Connector-P.R.V. e A in Garagbove Floor-Mech. Protection i,tji�; Plb., 4 1 & Mech. Equip. Listed for Location Elec. Receptacles in Garage (F.F.I.)-Romex Protection Insulation -Foam -Looked in Attic Guard Rails & Deck Construction -Post Caps 441.'Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor Q Yes 8?.<I1owing Instld./Drive DYes J NoMalks: s J No/Planters J Yes o 83. Stucco Brown -Finish 8;;7 A.C. Unit Disconnect, Electrical -Plumbing 8 ents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings ter Well, Disconnect, Electrical, Plumbing Exterior Elec. Trim, G.F.I. Receptacle -Underground 88 A Ventilation Throughout House 89. glass Protection 90.111corrections from Previous Inspections s Test -Meters Tagged, Gas -Electric 92! ater & Sewer Connected -C/O to Grade -HD Approval ergy Compliance Certificate -Other Certificates 9 Address Posted Date o r Card B-1 Date Card B-1 Date Card B-1 ate Card B-1 Date Card B-1 Date Card B-1 Comments at Final: ✓ = OK 0 = Not OK - = Not Applicable * = Not Ready MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s Zoning Requirements -Setbacks -Easements 1. Zoning Requirements -Setbacks -Easements Footings; Soils -Size -Depth -Spacing -Connectors -Steel 2. Soils; Special MH Support Sketch Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 3. Sewer; Location -Test -Fall -C/O -Concrete Wood Awn.; Posts-Beams-Rftrs.-Connectors Shthg.-Frg-Bracing 4. Water; Location -Test -Easement Needed (Sketch) Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete Carports; Windows -Doors 6. Gas; Location -Test -Wrap;-/ /" L'ft. / /'Nat. or / /"L"ft./ PLPG Electric 7. Well Clearance & Disconnect Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 8. Utility Clearance Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 1. 4. Electricity; MH Test -Crossovers -Breakers -Clearances 2. 5. Drain; MH Test -Fall -Flex Connector 3. 6. Water; MH Test -Regulator -Connector 4. 7. Water and Sewer Connected -C/O to Grade -HD Approval 5. 8. Gas and Electricity Tagged 6. 9. Tie Downs -Type -Installation Cert. 7. 10. Exits; Insp.-Sketch 8. 11. Cert. of Occupancy 9. 12. Permanent Foundation Only; License Decal Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs.-Connectors Shthg.-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes- Enclosures- Panelboards-Ins. to Main in Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 r.�.�.T..,i,,,y...v,J.,,,�� .' �� ,;•�4e„�,�i,�./W�t�S.�,.nor'.�,�`�^-�.'v�,Yr°�`"`"+jYlsr..�..^+T.+^`.i[+�.w.+p`w.;s*or�.L,�"tiv= CERTIFICATION OF INSULATION WHITE - Builder Copy, GREEN - Builder Copy, YELLOW - Customer Copy, PINK - Attic Copy, GOLD - File Copy ADDRESS OR TRACT SACRAMENTO BUILDING CONTRACTORS 1309 MELODY ROAD, MARYSVILLE, CA 95901 LIC#202026 605 S. AUBURN STREET, GRASS VALLEY, CA 95945 LIC#202026 �j ` r /'� , V ` ❑ 3881 BENATAR WAY, SUITE A, CHICO, CA 95928 LIC#202026 ❑ 8924 AIRPORT ROAD, REDDING, CA 96002 LIC #202026 DATE INSULATION COMPLETED ( square feet) ( square feet) ( square feet) TYPE OF INSULATION TYPE OF INSULATION TYPE OF INSULATION MATERIAL MATERIAL MATERIAL FIBERGLASS FIBERGLASS FIBERGLASS FORM BATTS FORM BATTS'& BLOW FORM BATTS MANUFACTURER'S PRODUCT I.D. MANUFACTURER'S PRODUCT I.D. MANUFACTURER'S PRODUCT I.D. MANUFACTURER MANUFACTURER MANUFACTURER CT OCF KN CT OCF KN CT OCF KN BAGS R -VALUE APPLIED R -VALUE APPLIED MIN. INSTALLED WEIGHT PER R -VALUE APPLIED INSTALLEDTHICKNESS INSTALLED THICKNESS SOUAREFOOT INSTALLED THICKNESS e) I q ,.w , z, -e >+> KNBE WALLS IF R -VALUE IS OTHER THAN WALLS ABOVE MATERIAL FORM R -VALUE MANUFACTURER FIBERGLASS BATTS CT OCF KN AIR INFILTRATION SEALANT MATERIAL MANUFACTURER FOAM HILTI HANDY FOAM THIS IS TO CERTIFY THAT INSULATION AND/OR SEALANT HAS BEEN INSTALLED IN CONFORMANCE WITH APPLICABLE CODES, MATERIAL STANDfp,D . ND EGULATIONS IGNATU - NSU TIjNfOO S TIL m MCM j DAT 11 1 SIGNATURE - GEN AL CONTRACTOR TOLE t DATE REMARKS WHITE - Builder Copy, GREEN - Builder Copy, YELLOW - Customer Copy, PINK - Attic Copy, GOLD - File Copy ..i,�... �";.^.. -.'w ,•--r: '%" /�'4� 'v±.I'!''1�`r'�/Y�r—.ti„-:, •N•-,�Y ,� i itt ''it �aA�r'!•� Y-"t'li+.,,�n �'+*+( ,.4. ..+1Y .f� _ esr�k>. .1, F' `!"( �"Y^. �. !. +d,�, �'� �'7ct'4-�`WA'YA�T1• A'� tYY*t"^uG.w+a�-�'�."aa�"sn��.�'' CERTIFICATION, OF INSULATION WHITE - Builder Copy, GREEN - Builder Copy, YELLOW - Customer Copy, PINK - Attic Copy, GOLD - File Copy ADDRESS OR TRACT SACRAMENTO BUILDING CONTRACTORS �I 1309 MELODY ROAD, MARYSVILLE, CA 95901 LIC#202026 605 S. AUBURN STREET, GRASS VALLEY, CA 95945 LIC#202026 01 3881 BENATAR WAY, SUITE A, CHICO, CA 95928 LIC#202026 ❑ 8924 AIRPORT ROAD, REDDING, CA 96002 LIC #202026 DATE INSULATION COMPLETED It ( square feet) ( f square feet) ( square feet) TYPE OF INSULATION TYPE OF IN TYPE OF INSULATION MATERIAL MATERIAL MATERIAL FIBERGLASS FIBERGLASS FIBERGLASS FORM BATTS FORM BATTS & BLOW FORM BAITS MANUFACTURER'S PRODUCT I.D. MANUFACTURER'S PRODUCT I.D. MANUFACTURER'S PRODUCT I.D. MANUFACTURER MANUFACTURER MANUFACTURER CT OCF KN CT OCF 'KN v' CT OCF KN BAGS R -VALUE APPLIED R -VALUE APPLIED MIN.INSTALLED WEIGHT PER R -VALUE APPLIED INSTALLED THICKNESS INSTALLED THICKNESS SQUAREFOOT INSTALLED THICKNESS ci KNEE WALLS IF R -VALUE IS OTHER THAN WALLS ABOVE MATERIAL FORM R -VALUE MANUFACTURER FIBERGLASS BATTS CT OCF KN AIR INFILTRATION SEALANT MATERIAL MANUFACTURER _T FOAM :::] v HILTI HANDY FOAM C� THIS IS TO CERTIFY THAT INSULATION AND/OR SEALANT HAS. -BEEN INSTALLED IN CONFORMANCE WITH APPLICABLE CODES, MATEOil_ STANDARDS �AND REGULATIONS t ' SIG"ATU INSU�,TIONtON{f�RAG�TO%R� "ti 1.1 TITLE Tj t jLY-04-PA DATL IC 1�S i•k �w11" SIGNATURE "GENERAL CONTRACTOR `v TYLE ' -*J DATE REMARKS y .f WHITE - Builder Copy, GREEN - Builder Copy, YELLOW - Customer Copy, PINK - Attic Copy, GOLD - File Copy �' 11-16-1994 • PROPOSED LAMP REPLACEMENT AND -,LABOR SAVI1GS FOR 3M SILVERLUX FLUORESCEtT REFLECTOR RETROFIT --�"=---------------------------------- ----- CUSTOMER NAME AND BUILDING LOCATION ALDERSON CONV. 4-81 STRIPS 2L -2L 2L -75W TO 2L -32W T 8S ELEC. BALLASTS ONL REPORT #2 ALT. 2 PROPOSED LAMP REPLACEMENT S VINGS LAMPS ANN L NUMBER OF REMOVED PER OPERAT NG FIXTURES FIXTURE HOURS 4 X 1 X 2600 • 3M SILVERLU REFLECTOR DEALER ;ALIFORNIA U- RITE ENERGY MANAGEMENT 6' BUTTE HOUSE ROAD TE A BA CITY 95993 1 AVERAGE LAMP LIFE HOURS 1 = 12000 ANNUAL LAMPS SAVED LAMP COST (EACH) ANNUAL LAMP REPLA MENT COST SAVI S PROPOSED LAMP REPLACEMENT BOR COST SAVINGS LAMP ANNUAL LAMP REPLACEMENT LAMPS REPLACEMENT LABOR COST SAVED RATE PER HOUR ------ ----------- ----------- 1 X 1 X $20.00 j 6 ANNUAL LAMPS SAVED 1 1 $3.50 $3 AL LAMP R LACEMENT LA R SAVINGS. $3 TOTAL PROPOSED LAMP REPLACEMENT AND LABOR COST SAVINGS ------------------------------------------------------ • ANNUAL LAMP REPLACEMENT COST SAVINGS $3 ANNUAL LAMP REPLACEMENT LABOR COST SAVINGS $3 TOTAL COST SAVINGS FOR LAMPS $6 INSTALATION CERTIFICATE T CF -6R • "-'7 13le;-s- 1368 Site Address Permit Number An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required; however, use of this form to provide the information is optional.) After completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at occupancy, per Section 10-103(B.). HVAC SYSTEMS; CEC Certified Mfr Name # of Efficiency Duct Duct or Cooling Heating Equipment Type (pkg) & Model Number Identical (APUE, etc) location Piping Equip. CEC Certified Mtr Name # of Efficiency Duct Duct or Heating Heating Type (pkg) & Model Number Identical (AFUE, etc) location Piping Loading Capacity Heat pump System (>CF -IR value) (attic, etc) R -value (Btu/hr) Btu/br) Split PG8JAA066110 1 80.0 ATTIC 4.2 115,000 94,000 Cooling Equipment Equip. CEC Certified Mfr Name # of Efficiency Duct Duct or Cooling Cooling Type (pkg) & Model Number Identical (APUE, etc) location Piping Loading Capacity Heat pump System (>CF -IR value) (attic, etc) R -value (Btu/hr) Btu/hr) SPLIT PAIOJA060 1 10.0 SEER ATTIC 4.2 60,000 56,000 • 1. read greater than or equal to. I, the undersigned, verify that equipment listed above is 1) is the actual equipment installed, 2) equivalent to or more efficient than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices (form the Appliance Efficiency Regulations or Part 6), where applica0 0 & ble. Universal Heating and A/C Sign ure, to Installing Subcontractor (Co Name) OR General Contractor (Co. Name) OR Owner • TOO 'd WeES:80 VO/LL/80 StSSSEESS6 Ott 9NIlti3H IVSa3(�INn BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.netWds PERMIT NO. BP041368 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 07/16/2004 APN' 026-090-067-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: .151 W1,C.l&J JA)a,• Date: Contractor. Map Index: 0 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: NSF (2463) GAR (810) COV (716) Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior Owner'• SWANSON DEAN A & EFFIE E to its issuance, also requires the applicant for such permit to file a p0 BOX 435 signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section PENRYN, CA 7000) of Division 3 of the Business and Professions Code) or that he or 95663-0435 she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an Applicant: SWANSON DEAN A & EFFIE E owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, Contractor: and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ I am Exempt under Article 3 of B ines d Professions Code Dater 146-2 1 Owner: License #' WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: MATTHEW MCKISSON ARCHITECT is issued. ❑ 1 have and will maintain workers' compensation insurance, as Engineer: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Policy#: Total Square Ft: 3989 S.F. Valuation: $190,991.00 I certify that in the performance of the work for which this permit is Census Code' issued, I shall not employ any person in any manner so as to • become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 7 l6` d Date: Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor L�®s 6G?0 15q -Zs �$/� 3/Def code, interest, and attorney's fees. • 40& Tei ► 1,57-q6. zz CONSTRUCTION LENDING AGENCY This permit is hefeby issued under the applicable provisions of the Butte County Coda an(vor I hereby affirm that there is a construction lending agency for the Resolutions to dJ work i dicarl ted above for which fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) 7 1 G , O Name: By: Date: % • / 4o - O Address: PERMIT RES ON: Date ❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the ly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of 'o cial fo or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purpos Print Name: NZ�- /4 i ��/` ,J Signature: Date: finer 13 Contractor ❑ Agent for Owner 0 Agent for Contractor I have been inform f thea a items and requirements for obtaining a building permit. Applicant: ,d^ Date: l3 O 1. Index permit ap&aiion for the above items numbered: _y Plan Check Letter„-, 2. Additional items required Contractor, designer owner as advised of the above data p , ❑ mail, O counter, bDate: Contractor, designer, er, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, bM.Date: Date: Plans reviewed by: Date: Plans approved by: Structural reviewed by: Date: Structural approved by: JJW Date: Note transfer by:Date: 7 tS a Yellow: Building Division 'COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION G� 1 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET ,^ Q /\ r 1 'ASSESSOR OWNER: PARCEL NUMBER V� Proposed Building Use: Counter Technician: Date: ✓ i ✓' Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order o ply. 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. . 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with"wet signature on plans AND 2 sets of stamped and. signed calculations. D 4. Engineered truss details and layouts in duplicate. No faxes! 5. Lefler from Engineer or Architect for truss design review. 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. O 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. 0 9. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these 1 must be stamped and wet -signed by the engineer. O 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate O 11. Site plan and business license approval from the City of Biggs . 0 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner O 14. Hazardous Material Form eTD 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. 0 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) O17. Fire Sprinklers........................................................................................... 18. Agricultural.Buffer clr and site plan apr from the Ag Commissioner Sent by� 01 19. Soils Report and/or Engineered Foundation required ........................................... ❑ 20. Erosion Control Plan Required..................................................................... �. 0' 21. Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 22. City of Chico Plumbing permit........................................................................ `❑ 23. California Department of Forestr plan approval ❑ paid. Sent by: ............. �i 24. Planning approval (A) User (B)Parking: (C) Parcel Check: 0 25. Contact Land Development about _ Improvements, _ Drainage ......................... _26.. NPDES Form............................................................................................. RY-r 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for required.......fi ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 30. Worker's Compensation Carrier and Policy Number .......................................... %] 31. Owner -Builder Verification (Given to owner, _Mailed to owner) ..................... O 32. Letter of Signature authorization.................................................................... 33. Recorded copy of Agricultural Acknowledgment Statement ................................. 8'- Z-0 34. Manufactured home utility clearance............................................................... ❑ '35. Existing violations and/or expired permits......................................................... ❑ 36. Deed Restriction......................................................................................... ❑ 37. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ 0 38. Other: ❑ 39. Other: -I 11 When issued Telephone and hold for pickup. I have been inform f thea a items and requirements for obtaining a building permit. Applicant: ,d^ Date: l3 O 1. Index permit ap&aiion for the above items numbered: _y Plan Check Letter„-, 2. Additional items required Contractor, designer owner as advised of the above data p , ❑ mail, O counter, bDate: Contractor, designer, er, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, bM.Date: Date: Plans reviewed by: Date: Plans approved by: Structural reviewed by: Date: Structural approved by: JJW Date: Note transfer by:Date: 7 tS a Yellow: Building Division ,r COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (530)538-7541 SCHEDULE OF RECEIPT OF FEES �l OWNER ( � n' A.P. # 6'D_-5 6C) 6,- PROP SED BUILDING USE DATE 1 3) U RECEIPT # DATE REC. 1. BUILDING PERMIT FEES c --- Balance Due ..................... $ �'�% O ( 7 �P 64-- --- Additional Fees Due........... $ )3. Revised Plan Checking Fee.... -Y . SCHOOL DISTRICT FEES paid at School District Office) (form availab e a er lan Check) SHERIFF FEES (paid at Buil ing Division) Residential............ X $360.00 =$ Units Commercial (sq. ftg.)..... X $0.03 = $ _ Sq.Ftg. 4. URBAN AREA FEES (paid at Building Division) Residential (per unit)..... X = $ _ # Units Amt. Commercial (Sq. Ftg.).... X = $ _ Sq. Fig. Amt. 5. RECREATION DISTRICT FEES (paid at Recreation District Office) (form available after Plan Check) 6. THERMALITO DRAINAGE DISTRICT FEES $510.00 (paid at Building Division) 7. SRA FIRE INSPECTION AND PLAN CHECK FEE $89.00 (paid at Building Division) 8. WATER TENDER FEES BATTALION # $200.00 (paid at Building Division) 9. NORTH CHICO SPECIFIC PLAN (paid at Building Division) Residential Zone X = $ Zone # Units Amt. I.-1�-6¢ 64 - ommercial (sq. ftg.) ......... X = $ Sq. Ftg. Amt. 10. OTHER At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. These fees maybe changed during_tkte'lan Cheng process. APPLICANT DATE Pursuant to Government Code Section 66020, you are hereby notified that items, 2, 3, 4, 5, 6, 8, 9, and 10 above may have been imposed on your project. You have 90 days from the date of approval of the project or from the imposition of the above mentioned items during which you may protest. The requirements for a protest are specified in Government Code Section 66020(a). Original -Building Division Yellow -Applicant Pink -Owner (rev. 2/2003) BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (ne form per Building) School District Building Deparbrient No. Jurisdiction: County A.P. Number I --6a6-- 6 (a, M.ty Property Owner Property Location/Address Subdivision Lot No:— ............................................................. ...................................... Residential Development Q Q 4 Footage aq. ,59— No of lPing Mobile Home *Supplemental to (Group R) Units Installation = Conversion Permit # *(No foundation Inspection) ............................................................. ;7................................_.. Commercial/industrial New Addition rk� to, Building Department Deed Restricted Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) District Identification No. School District certifies that (Street Address) (City) has complied with the requirements of Resolution No. representing . square feet. Paid by Check # 1 CE2, Remarks: (State) Sq. Footage (including Exterior Roofed Areas) Date (Applicant) (Mone Number) (Zip Code) by payment of $ AB 2926 A $ FULL MITIGATION $ (:3L4 Date Nodes: You may protest the Imposition of the too Identified above by submitting a wrtftn protest to the District, In compliance with Govenu writ Code Section 66020(a). wffldn 90 days from the data fen are 0M. Failure to submit a timely wften protist will'prohlbit you from challenging the Imposition of the fen In any court actkwL If, subsequent to the School District Representative signing this Butte County Schools Impact Fee certification Form, the School Distrid Is notified by the applicable Local Planning Agency that this project le being rwle wd under the California Envinnunantid QuWlty Act (CEQAh this project moy be subject to additional school fen to fidly mitigatelts Impact on the school dWbkft schools. . . White (applicant), Yellow (building department), Pink (school district) foefwm.xls (10/03)dm,m 2 O.B.-1 OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. 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. I personally plan to provide the major labor and materials for construction of the proposed property improvement : YES NO ❑ I HAVE 13HAVE NOT/signed an application for a building permit for the proposed work. I have contracted with thi following person (firm) to provide the proposed construction: AME: 'CITY.. PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 5. I will provide some of the work but I have contracted (lured) the following persons to provide the work indicated: _ NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTYOWNER ---------------- S S / DATE: NOTE: This Owner -Builder Yerirtcation is required by Section 19831 and 19832 of the California Health and Safety Coda T71is verification mast be completed and returned to our office before we are permitted to -issue the permit OVER o- •B.-1 I OWNER BUILDER INFORMATION Dear Property Owner. An application fpr a building permit has been submitted in your name listing yourself as the builder of property improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible party ofrecord on such a permit Building permits are not required to 6e signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and tp have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. Ifyou plan to do your own work; with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: 0 Ifyou employ or otherwise engage any persons other than your immediate family, and the work (Including matmials and other costs) is $300 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. 0 If you are an employer, you must register with the State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be Snancial risks far you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and, if You wish, the U.S. Small Business Administration). For more specific information about your obligations under' State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the shvctm a is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building pously �b* that the PreP� owner is providing his or her own labor and material personally. Building permits are n required to be signed by property owners unless they are pmf mmg their own work personally. Information about licensed contractors may be obtained by contracting the Contractors State License Board in your community or at 102014 Street, Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. ly, /�C � Mi 1 C. Vi iia, C.B.O. r, Briding Inspection NOTE: This Owner-Buflder Infortna:fon is required by Seddon 19930 oftke Calrforn a Health and Safely Code OVER National Pollutant Discharge Elimination System (NPDES) Phase II .Construction Storm Water . Permit' and Storm Water Pollution Prevention _Plan (SWPPP) Acknowledgement (LESS THAN 1 ACRE1 Project Title: f c=� By signing below, I, the project owner/owner's agent, certify that I am aware that a construction project that disturbs 1 acre or more of land requires a Construction Storm Water Permit from the State Water Resources Control Board and that it is my responsibility to submit a Notice of Intent (N.O.I.), a Storm Water Pollution Prevention Plan (SWPPP), and a check for $700.00 made payable to the State Water Resources Control Board to obtain such a permit if my project disturbs 1 acre or more of land. I, further, certify that this project will not disturb 1 acre or more of land. I am aware that submitting false and/or inaccurate information may result in revocation of grading and/or other permits or other sanctions provided by law. Signed: Title: ��✓ Date: S�/i 1 /� Ing r _Vit 1 AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE OROVILLE, CA 95965 2004—X1027395 Recorded Official Records County Of BUTTE CANDACE J. GRUBBS Recorder ROSEMARY DICKSON Assistant 02:19PM 10 -May -2004 REC FEE 10.00 COPIES 2.50 Barbara Page 1 of 2 AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8 of the Butte County Code required this acknowledgment to be recorded prior to issuance of a building permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying; pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has established agricultural purposes and residents within said zones and on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: FLE /9-;11 r e- dr.1,7Lft4At 0ISL2lp7-/o Date <:�> --1- O9 State of California County of N 'e-0 cA0,�- On 1:�) - O PROPS. WN before me, lIns O/\) C « personally appeared ry S Wa-&3 S 0 A) personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal.\ N• HpPKIN .1 Signature Seal: COMM # 1377236N Z • NOTARY PUBLIC -CALIFORNIA O NEVOCT. T COUNTY U 2006 COMM. EXP A.P.# 0115 Order No. BU -214262-3 AM Description The land referred to- herein is situated in the State of California, County of Butte, and is.: described' as follows: LOT 5 IN BLOCK 2; AS SHOWN --ON THAT -CERTAIN- MAP ENTITLED; "RIO -BON T—O-COLONY; BUTTE COUNTY, CALA.", WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON FEBRUARY 1, 1892, IN BOOK 5 OF MAPS, AT PAGE(S) 31. THIS DEED IS MADE AND ACCEPTED UPON THE COVENANTS, CONDITIONS AND RESTRICTIONS AS SET FORTH IN THAT CERTAIN DECLARATION OF RESTRICTIONS RECORDED MAY 5, 1988, UNDER BUTTE COUNTY RECORDER'S SERIAL NO. 88-14035, .BUTTE COUNTY, CALIFORNIA; ALL OF WHICH :ARE INCORPORATED HEREIN BY REFERENCE THERETO WITH THE SAME FORCE AND EFFECT AS THOUGH FULLY SET FORTH HEREIN AT LENGTH AND GRANTEES BY ACCEPTANCE OF THIS DEED APPROVE, ADOPT,.RATIFY AND AGREE TO THE TERMS OF SAID DECLARATION. APN 025-090-067-000 PAZrEl. IT- A NON-EXCLUSIVE RIGHT OF WAY FOR INGRESS AND EGRESS AND PUBLIC UTILITIES AND DRAINAGE FACILITIES OVER THE FOLLOWING -DESCRIBED PROPERTY: A PARCEL OF LAND DESCRIBED AS A CIRCLE OVER LOTS 9, 10, 11 AND 12 IN BLOCK 2, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "RIO BONITO COLONY, BUTTE COUNTY, CALA.", WHICH MAP WAS RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON FEBRUARY 1, 1892, IN BOOK 5 OF MAPS, AT PAGE(S) 31, HAVING A RADIUS OF 50.00 FEET AND A RADIUS POINT LOCATED ON THE'SOUTH LINE OF SAID LOT 11, AT A POINT 34.99 FEET EASTERLY OF THE SOUTHWEST CORNER OF SAID LOT. PARCEL M- A NON-EXCLUSIVE RIGHT OF WAY FOR INGRESS AND EGRESS AND PUBLIC UTILITIES, AND DRAINAGE FACILITIES OVER THE SOUTHERLY 30.00 FEET OF LOTS 1, 3, 7 AND 9 AND THE NORTHERLY 30.00 FEET OF LOTS 2, 4, 6, 8 AND 10 ALL LYING IN BLOCK 2, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "RIO BONITO COLONY, BUTTE COUNTY, CALA.", WHICH MAP WAS RECORDED IN THE. OFFICE OF THE RECORDER- OF TIE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON FEBRUARY 1, 1892, IN BOOK 5 OF MAPS, AT PAGE(S) 31. SITE PL W APPLICATION Date: Z AP# 4� Q Permit Number (if applicable) Bin Number APPLICANT INFORMATION P cel Size: C_-.7 /'- Owners Name: Q Owners Address: %� - �/ Telephone No.: Situs Address: Proposed Use: Residential New Single Fancily Residential . ❑ Single Family Addition ❑ Mobile Home ❑ Residential Accessory ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer ❑ Multi -family Non-residential ❑ New Commercial ❑ CommercialAddition ❑ New Industrial ❑ Industrial Addition Other Septic Agricultural Exempt Building ❑ Other: ❑ Single Family Remodel Ce ❑ Commercial Remodel ❑ Industrial Remodel ❑ Well Agricultural Buffer Form [� Applicable ❑ N/A • aK Brief Explanation (if necessary):r---`. DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) ' a Approved ❑ Conditionally Approved ❑ Resolve Problems Prior to Approval Site Plan Stamped Approved By Date -S-1 0 — O Page 1 of 5 ALL ITEMS CHECKED APPLY TO THE PROPERTY 0 Parcel Is In: ❑ Snow Load Area: ❑ Land Conservation Act Minimum Acreage: ❑ Verify residence can be built per contract ❑ Nitrate Action Plan (See Environmental Health for standards) ❑ Watershed Protection Overlay Zone (See attached standards and requirements) ❑ Expansive Soils (Test for expansive soils and if verified proper foundation design required) ❑ SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: (See at, ac ed) • Flood Zone: • Flood Panel No.: 0 Index Date: U g ❑ Sacramento River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ Feather River Reclamation District (Approval must be obtained from the. California Reclamation Board) ❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements) ❑ Chapman/Mulberry (See attached standards and requirements) ❑ Cohasset Area (See attached standards and requirements) ❑ Grading Zone (See attached handout) Use Requires: ❑ Use Permit ❑ Minor Use Permit ❑ Administrative Permit ❑ Minor Variance ❑ Variance ❑ Detached Building Use Form ❑ Encroachment Permit ❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement Zoning: A 4P - Applicable Building Setbacks: ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments. into SRA setbacks. Page 2 of 5 Zoning Code Streets & Highways Fire Prevention Subdivision Map Front rL. t Side 2 �� Side Street Rear 2 Height rWaterway N/A N/A N/A ❑ Setbacks drawn on site Plan. ❑ CDF approval needed for encroachments. into SRA setbacks. Page 2 of 5 . Applicable Development Fees: Standard Fees Amount Formula ❑ Fire ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87' ❑ Chico Urban Area - Road ❑ Thermalito Drainage Area ❑ Thermalito Urban Area ❑ Other --------------------------7--------------------------------------------------------------------------------------------- Subdivision Map Special Fees ❑ Water Tender ❑ Road Improvement ❑ North Oroville Area ❑ Other (per map) M * Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of the building permit. Parcel Created By Deeds: Date of Creation: -`Z-� - d 1 Legal Access Provided: ❑ No ❑ Yes Deed of Reference: 01 - bD_!� 9 0 8 H Legal Access Required ❑ No ❑ Yes Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name: Complies with County Standards for Deed Creation:❑ No ❑ Yes Comments: ❑ Parcel Deemed to be legal ❑ Verify Legal Parcel ❑ Verify Legal Access ❑ Provide Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a Merger ❑ Obtain a Lot Line Adjustment ❑ Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23). El Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements Page 3 of 5 i! Subdivision Map/Parcel Map: Map Date of Recording: (9 Lot: ❑ Use PermitlMinor Use Permit Permit Number: R S :.. Date of Approval: 1 Page: Parcel Map/Subdivision Map/Use Permit Conditions ❑ Comply with the following Conditions of Approval: ❑ Attached ❑ None ❑ Meet the Fire Safe Regulations of Butte County and P.RC. 4290 ❑ Automatic fire suppression sprinkler systems shall be installed in accordance with the National Fire Protection Association Standard for installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet the Fire Department specifications, serves the parcel. ❑ Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California Clean Air Act of 1988, as amended. ❑ Provide an erosion control plan for building and land disturbance. The Erosion Control Plan must be prepared by a registered civil engineer or other qualified professional and be submitted to and approved by the Department of Public Works. ❑ In lieu of a pressurized water system or water storage tank, payment into the appropriate Battalion Water Tender Fund may be required. ❑ Measures shall be taken to control fugitive dust emissions from all driveway and other civil construction associated with residential development. Approved dust control measures are found in the fugitive dust control plan for the site approved by the Butte County Air Quality Management District, a copy of which can be obtained from the Butte County Department of Development Services, Building Division." ❑ Engineered foundations are required. ❑ Class A roofs are required. ❑ Property owners responsible for road maintenance, and stop sign maintenance. E L Page 4 of 5 ?I 0 I ARAR-OXIAM ZMA-7-71VAll Ovc- 33 0 MAR f Es Aw 18Ar /98DE DvS G. 2GJ liP ev OZ 2,413-.4e. 19"446 * 7/{0 -tip Ail 40-91* 19',Vla "AftW) /�..SS'- E.H. V4UC—N ILY Flat Maw Attached Haar Plan Attacho4d 34m is S.D. I TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance Owner Location AP# Plan Approved for: Sewage Disposal Water Supply: Pu lic Clearance for dwelling. Other Hold final for: Final clearance O.K. for: NOTE: Environmental Health Specialist 8196 Private Well 13-1 Date �oQ ls, ire .y P, UGLUUOJInu. /.f, Uno� a;. n W lbg-r 4 —Lar i INK wmm