HomeMy WebLinkAbout031-281-10731- 281- Mg—"wt. 10 7
Tom Hall
W 7th St., @ inters. of Nevada Ave.,
Oroville (PLAN 2)
contr: Deer Creek Const., Chico
Permit #6687-78B,P,E MI(new single
family)+�0179 "MMLIN
L
031-281-107 PEKIIT#94-2900
.W.
..WTT,T,TAMS, AR.VILLA P..
1465 7TH ST. OROVILLE G
CONT: DAN ECKLEBARGER !7
RESTUCCO/SF I
d 4
r
COUNTY OF BUTTE-.- .DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, C"94i& 95965 - Telephone (91'6) 538-7541
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER 031-28-1-107 ZONIUG BUIL G PERMIT
OWNER ARVILL•A P. WILLIAMS TELEPHONE SO. FT, OCC. BUILDING VALUATION
OWNER'S MAJUNG ADDRESS 1465 7TH ST OROVILLE
2-800-00
CONTRACTOR'S NAME ECKLEBAR ER , DAN TELEPHONE
CONTRACTOR'S MAILING ADDRESS
NO.
CONSTRUCTION LENDER
_
UNKNU`NIV
Fireplace
Total Valuation $
LENDER'S MAILING ADDRESS
Filing Fee=Fee$
Permit Fee
plan Checking
ARCHITECT OR ENGINEER
_
ucENSE NO.
ARCHITECT OR ENGINEER'S MAILING ADDRESS
ADDRESS1465 7TH ST
Energy Plan CPenaltyBUILDING
—'
OROVILLE
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
—
Solar or heat pump water heater
23.00
LOT NO.
SUBDIVISION'S NAME
PAp��,NAp
Water piping
155.00
Each gas water heater or vent
15.00
USE OF STRUCTURE
SF V Duplex ❑ Mobilehome Cl Other
SPECIcv
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home ISIG W
@20.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ` --
Describe Work: RESTUCCO
PERMIT FEE
$
Contractor
ELECTRICAL PERMIT
Filing Fee 20.00
—
Main Service ( BOOV OR LESS
_ 20OA OR LESS I
23.00
—
Main Service I 200A TO IOOOA )
46.00
NEW CONST. I DWELLING OCCUP.
0R AOD Is. 8 ACC. BLD$. I
3.50 sQ-
_.
•-•
CONTRACTORS LICENSE LAW
declare under penalty of perjury (check one)
❑ I am a licensed under provisions of Chapter 9, Division 3 of the BL;siness and
Professions Code and my license is in full force and effect.
License No. Classification
O I, as the owner, or my employees with wages as their sole compensa;. n, Will do
the work, and the structure is not intended or offered for sale. (Sec '7(144)
I, as the owner, am exclusively contracting with licensed contractors. i; ec 7044)
❑ 1 am exempt under Sec. Business and Professions Code
forthis reason
NEW CONST. MULTI -OUTLET )
.NON.RESID. ( BRANCH CIRCUITS
@7.50
18PSINOW GER APPARATUS LEOUTLET CIR. )
Ex. Occup. ( OUTLET OR FIXTURES )
e ai @ i.
Ex. Occup. ( OUFlxeo nPPws. OR
TLETSIRESID.I R I
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23 00 ,
WORKER'S COMPENSATION INSURANCE
I d Clare under penalty of perjury (check one):
This permit is for $100.00 (vacation) or less.
O I have placed on file with the County of Butte Dept. of Development Services,
Building Division a Certificate of Workmen's Compensation Insurance or a
Certificate of Consent to Self -insure.
I shall not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California.
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
such provisions or this permit will be revoked.
I certify that I have read this application and state that the above information is correct.
I agree to comply to all Butte County Ordinances and California State Laws relating to
building construction, and hereby authorize representatives of the County of Butte to
enter upon the above mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte ,igainst all
pliabilities,�judgments, costs, and expenses which may in any way accrue atlainst said
ty of gra ti this permit.
ate
ature of Applicant - ner ❑ Contractor ❑ Agent I
An OSHA permit is required for excavations over 5"0" deep and demolition or
construction of structures over 3 stories in height.
Receipt No. I /IR
WHAT - .-
D.D.SB.D. Ai ASSESS PINK -INSPECTOR
PERMIT FEE $
Contractor
MECHANICAL PERMIT
Heating
Cooling
Hood
Ventilation
Filing Fee 1 20.00
5.50
PERMIT FEE $
Contractor
Mobile Home Installation Fee $
Energy Inspection Fee $
DCC cDNBr. TYPE TOTAL FEE $
HA2. I D. FEES I IMP I FLOOD CDF PARCEL PD ND ISSUE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated,pb?ve for whych fees have been paid.
By
GOLDENROD. APPLICANT I PERMITEXPIRESON
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, CWorni3.95965 - Telephone (916) 538-7541 _� PERMIT NO.
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER 031-28-1-107
ZONING
BUIL G PERMIT
OWNER ARVILLA P. WILLIAMS
TELEPHONE
SQ. FT, OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS1 /.65 7TH ST OROVILLE
2
CONTRACTOR'S NAME ECKLEBARGER, DAN
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
LENDER'S MAILING ADDRESS
Filing Fee
$ 20.00
Permit Fee
$ 54.00
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee
$
Penalty
$
BUILDING ADDRESS 1465 7TH ST
PERMIT FEE S 7
OROVILLE
PLUMBING PERMIT
Filing Fee 20.00
Each Trap
7.00
Solar or heat pump water heater
23.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Water piping
15.00
Each gas water heater or vent
15.00
USE OF STRUCTURE
SF XK Duplex O Mobilehome O Other
SPECIFY
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home S G W
@20.00
TYPE OF WORK
New O Addition O Remodel ❑ Utilities ElInstallation ❑ OtherxK
Describe Work: RESTUCCO
PERMIT FEE $
Contractor
ELECTRICAL PERMIT Filing Fee 20.00
Main Service ( 600V OR LESS )
200A OR LESS
23.00
Main Service ( 200A TO 1000A )
46.00
NEW CONST. DWELLING OCCUP.
OR ADDNS. ( 8 ACC. BLDS. )
SD.
3.5C FT.
CONTRACTORS LICENSE LAW
declare under penalty of perjury (check one)
❑ I am a licensed under provisions of Chapter 9, Division 3 of the Business and
Professions Code and my license is in full force and effect.
License No. Classification
O I, as the owner, 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)
1, as the owner, am exclusively contracting with licensed contractors. (Sec 7044)
O 1 am exempt under Sec. Business and Professions Code
forthis reason
NEW -CONST. MULTI -OUTLET
•NON RESID. ( CS )
BRANCH IRCUIT
@7.50(
POWER APPARATUS )
& SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES )
BAL @ 1.50
Ex. Occup.FIXED APPLNS. OR
( OUTLETS (RESID.) EA. )
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00.
Misc. Wiring
2300
WORKER'S COMPENSATION INSURANCE
t1d lare under penalty of perjury (check one):
This permit is for $100.00 (valuation) or less.MECHANICAL
1 have placed on file with the County of Butte Dept. of Development Services,
Building Division a Certificate of Workmen's Compensation Insurance or a
Certificate of Consent to Self -insure.
Ishall not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California.
Notice to Applicant: If after making this statement, should you become subject to the
Worker's Compensation provisions of the Labor Code, you must forthwith comply with
such provisions or this permit will be revoked.
PERMIT FEE
$
Contractor
PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE
$
Contractor
1 certify that I have read this application and state that the above information is correct.
1 agree to comply to all Butte County Ordinances and California State Laws relating to
building construction, and hereby authorize representatives of the County of Butte to
enter upon the above mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against all
liabilities, judgments, costs, and expenses which may in any way accrue against said
yopse of gra ti this permit.
ate
pignatuu�reofApplicant ner O Contractor O Agent
An OSHA permit is required for excavations over 5"0" deep and demolition or
construction of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST. TYPE
TOTAL FEE $
HAZ.
D. FEES
IMP
FLOOD
CDr-
PARCEL PO
HD
ISSUE
This permit is hereby issued under
of the Butte County Code and/or
indicated b ve for wh h fees ha
PERMIT EXPIRES ON Q
the applicable provisions
Resolutions to do work
been paid.
Date (J
Ma tel
' fy `�
Receipt No. I J i , L(/
WHITE-D.D.S.-B.D. A ARY• SSESSO PINK -INSPECTOR GOLDENROD•APPLICANT
6687-78B,P,E,M
C-1 PERMIT NO.
�f
PERMIT EXPIRES
OWNER
1 Tom Hall
Deer Creek Const., Chico
t
CONTR.
LOCATION (A.P. 31-281-105 port. )
W/S 7th St.,@i ters.of Nevada Ave., Oro.
R
Temp. Power Pole
Called PG&E
Temp. Elea Serv.
Called PG&E Cu i
Temp. Gas Serv.
Called PG&E
JOB
FINALED
(Date)
(Signature)
COUNTY OF BUTTE -,DEPARTMENT OF PUBLIC WORKS—'
BUILDING INSPECTION RECORD
B ILDI G
BUILDING (Cont'd)
PLUMBING
`
Setback / 7
- Firewall .�L�.-4
Soil Pipin
't"'
Forms
Parapets
1st.Floor..
-
Main Bldg.
Restroom Finish
2nd Floor
-
Footings A
Windows - %
a 3rd Floor
StemwalI
Siding
To out
Slab
Roof Sheathing -
Water Piping
Roofing
Sewer
Garage
Fdn. Vents '-.='�� -_
-- Fixtures
Footings 1- -
StemwaI l
Garage Vents
Insulation
Water Htr.
Heaters
0 O - .
Slab L-
Carport
Po
Footings
Slab
Prov. for physically
handica ed
Conformance of ex.
structure ""---
Final C,
Appliances
Gas Piping &Test Z
Tem . Gas - JO
Sanitation "---1
Patl
FIREPLACE
Final
S�'3
Footings
Footing
ELECTRICAL
Masonry Wal
Throat -
Rou h
Relnf. Steel
Final ✓
Fixtures~
Bond Beam -----FIRE
SIPFUNKLERS
Motors
Framln-q
Test
Water Htr.
Stuc
Final
Subpanels
-
Mesh
MECH L
Grd. Fault Prot. E�-
Scratch '
Heating
Service
Brown Cooling Temp. Pole
Finish Ducts - Under round
Interior Lath Ventilation Permanent 5"�►�
Door Closer Final — Final - , Nj
MOBILEHOME UTILITIES ------------------ Elec. Service Elec. Pedestal
Water Piping Sewer Gas Piping
OBILEHOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity
Water Piping Drainage Gas Piping
P 9
DATE REMARKS' OR CORRECTIONS
I ,j`�-
% . jj
21
(21AR.
�
(NOTE: An entry must be made on this form each time you visit the job -site.)
aA��-
A -ML-" tQ6 00 aMo
I
RES IDENT IAL
ENERGY CONSERVATION STANDARDS
CONSTRUCTION COMPLIANCE CERTIFICATE
f
THIS IS TO CERTIFY THAT ENERGY CONSERVATION REQUIREMENTS HAVE BEEN
INSTALLED IN CONFO�T
/ HT RRENT ENERGY CONSERVATION REGULATIONS
AT
(location)
BUILDING PERMIT NO.,�, 78 A;P. NO.
THE FOLLOWING HAVE BEEN INSTALLED AS PER APPROVED PLANS:
(Check each item or write N/A if not applicable)
INSULATION:
Slab Edge li .
Fdn. Walls
Floors
Walls l
Ceiling/Roof
Ducts
Circulating Pipes
APPROVED HEATER'
APPROVED WTR.HTR.
zt;;-`
GLAZING:
Single Glazed
Special (Insulated
CERT. & LABELED WDS.
& SLIDING DRS.
WEATHERSTRIPPED.DRS,
BACK DAMPERED FANS
INTERMITTENT IGNITION DEVICES Zl/ ±
CERT. APPLIANCES ALA
I DECLARE THAT ALL REQUIRED ITEMS AS NOTED ABOVE HAVE BEEN INSTALLED
IN ACCORDANCE WITH THE ENERGY CONSERVATION REQUIREMENTS AND AGREE TO
THE COMPLETENESS OF THIS CERTIFICATE AS SUBMITTED.
Insulation Applicator Name
Signature of (please print)
z
Insulation Applicator
State Contractors
Lice No.
No.,
General Contractor/Owner Name .e�5ff9�L
1
Signature of
General Contractor/Owner
print)
sDate
Sta a Contractors
License No...��
THIS CERTIFICATE MUST BE ON FILE WITH THE BUILDING DEPARTMENT PRIOR TO
REQUESTING FINAL INSPECTION AND SHALL BE POSTED IN A CONSPICUOUS LOCATION
WITHIN THE DWELLING.
Permit#• -
INSULATION CERTIFICATION
�CFS� 7th Ctreet Oroville
Number and Street City County
Lot 1455
Subdivision Lot Number
DESCRIPTION OF INSTALLATION
ROOF
Material
Thickness (inches)
EXTERIOR WALL
Material
Fiberglass
�1 rr
Thickness (inches)
J2
CEILING
Batt or Blanket Type
Fiberglass
6"
Thickness (inches)
Loose Fill Type
Minimum Thickness (inches)
Area Covered (0)
FLOOR,ELEVATED
Material
Thickness (inches)
FLOOR, SLAB
Material
Thickness (inches) _
Width (inches)
FOUNDATION WALL
Material
Thickness (inches) _
HEATING SYSTEM
Make
Model Description
Rated Bonnet Capacit,i
Gas Furnace
Brand Name
Thermal Resistance IR Value)
Brand Name Certainteed
Thermal Resistance (R Value) 11
Brand Name Certainteed
Thermal Resistance (R Value) i9
Brand Name
Number of bags Weight per bag Ib
Thermal Resistance (R Value)
Brand Name
Thermal Resistance (R Value)
Brand Name
Thermal Resistance (R Value)
Brand Name
Thermal Resistance (R Value)
DECLARATION
1 hereby certify that the above insulation was installed in the building at the above location ir. conformance with the
current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24 of the
California Administrative Code).
General Contractor (Builder) License Number
_ Signature and Title Date
Hawkins Insulation Co.. Inc. 215925
Sub -Contractor (Insulation Applicator) License Number
Owner 2/28/79
> Signature and Title Date
• '
CERTIFICATE REVIEWED BY Date
BIN -029 (Building Inspection Ofd)
COUNTY OF BUTTE — .. DEPARTMENT OF PUBLIC WORKS
- •� 7 County Center Drive - Oroville, California 95965 ���✓/ ��
• •. Telephone: 534-4541 0 /-
APPLICATION AND PERMIT
Z. vF. rn — L I VUUIrly UUt— LU GIIl01 UPV11 1110
ve-mentione erty for inspectio yp_o es.
X D ate �� Z!:?> _
Signature of Per [' a ge
or Ant
Receipt No. � ` 35a
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECT F PUBLIC WORKS
BY Date_(Z-- 7- 7P
Iding permit expires Date / v
BUILDING
Owner p
SO. FT. OCC. BUILDING VALUATION
2aO• c0
Mailing Address
J' 0,00-t. Oa
Telephone No.
V.
�� Q-0
Contractor -PC-C (Zrr- U S i-eUGTRO IN
Mailing AddressP.Q. Box -1 77
Fireplace CLA 5 A
500,• 00
Total Valuation
LA R 2
9 ds
T�e J -n (D
Permit Fee I Z 4.00
Building Address Com; XT_
'
Checking Fee &/orPenalty
Permit
Permit Fee
'Z ,00
Z ®C
I M TuwS15 �TTOJ O c -0A -,t>
PLUMBING
No.1
@
I FEE
PERMIT FILING FEE
$3.00
0d
Each Trap $ 1.50 2.Oi7
o'/
�y l(,(��
Repair drainage or vent piping 1.50
3 � "Z 13 lam P
A. P. No. G% Q2 -f
Zoning 8 Plan n
g & P
Water piping
1.50
1 �0
Each gas water heater or vent 1.50 Cr0
Fhog
Fire Dept. Fire Zone
Use Pemi It
Gas piping system 1 - 5 outlets 1.500
,
EOA
Parking
Pian_s
Parcel
I Declaration
P
60' R/W I
Improvements
Each additional outlet .30
Building sewer 5.00 6',&C)
Bldg.ons Recd
ftarcel&El I
PI Approval
Lawn sprinkler system 2.00
NEW G;/- ADDITION ❑ UTILITIES ❑ OTHER ❑
Permit Fee $
(,QrfJ 'Zr
ELECTRICAL
No.
@
FEE
PERMIT FILING FEE
$3.00
3.00
Main service 600V OR LESS
too AMP LESS 5.00
SinSingle Family ^/ Duplex Mobil Home
9 Y Lid' P ❑ ❑ Others ❑
-L
Main service EA. ADD,00 AMP 2.50
Main service OVER 600V
100 AMP OR LESS
25.00
Main service EA. ADD'L 100 AMP 1.00
NEW OR A.D.S. ( LING �
ACCLBLDGS.0 W) 20sgft 5t,+, O
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
s le of:
NEW CONSTR 11 Ll T
NON-RESID ( BRANCH CIRCUITS)
12.50ea
NEW CONSTR. POWER APPARAS 1
NON•RESID. (SINGLE OUTLET CITU8
R.
Ex. OCCUD(OUTLETS OR FIXTIIRES I5 L25
Ex. Occup.(FIXED APPLNSOR
• OUTLETS (RESI.D.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No���j6 Classification �'�
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee
$
y 40
$ 57 1 1L
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL
No.
@
FEE
PERMIT FILING FEE $3.00 '6e00
Heating &0 r00
vo o -p -f-,
Cooling `r 4.00
Ventilation
Hood 2.00 IZ,, 00
Permit Fee $ I3-00
$ 13 •0-C
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relra�ing to building construction, and hereby
Land Development Fee
$ -2"5.ov
TOTAL PERMIT FEE
$22. 4 kc
Z. vF. rn — L I VUUIrly UUt— LU GIIl01 UPV11 1110
ve-mentione erty for inspectio yp_o es.
X D ate �� Z!:?> _
Signature of Per [' a ge
or Ant
Receipt No. � ` 35a
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECT F PUBLIC WORKS
BY Date_(Z-- 7- 7P
Iding permit expires Date / v
RESIDXIdTIAL PLAN CHECKING GUIDE
(S.F., DUPLEX, & MISC..ONLY)
Bldg.
0"vNT ER i�1�/¢G A.P.
A. GE RAL
Zoning requirements
Valuation.
Signature by R.C.E.
(sideyards and parking).
or Architect (if required).
B. PLOT PLAN
Complete parcel -size and dimensions. eAl.
Setbacks, sideyards, easements, etc.
Other buildings or structures.
Grading, fills, drainage.
Permit # 66 0DZ e _ %P
V 3 -WfD/1-1/40
tot'.
C. FLOOR P12-i`i
Complete to scale plan with dimensions. /
Required windows for light and ventilation (Sec. 1405). Z Z
Required windows for second exit'(Sec. 1404)'. d
Allowable glazing for energy requirements (20% max. per State law). Z 3 7
Human impact glass (Sec. 5406).
Required room sizes,. ceiling heights (Sec. 1407).
G.F.C.I.'s in baths and exterior outlets (Sec. 210-8).
"Ci. 2
Light fixtures, switches, receptacles, and exterior receptacles' for maintenance of
mechanical equipment-.
Locations of water heater, heating & cooling equipment,.other electrical or gas
equipment, and plumbing fixtures.
Garagefirewall; door size, and closer (Sec. 503(d)(4)).
' 1 - 3'0" exterior exit door (Sec..3303d).
Fireplace location.
Smoke -detectors (Sec. 1413).
igiX,Foundation plan complete enough to construct building.
Floor construction details complete enough to construct building.
Elevations and wall construction details complete enough to construct building.
Roof construction details complete enough to construct building.
7 Fireplace construction details and calcs if over one-story in height.
t%:;- Sufficient data and details to satisfy energy insulation requirements (State law).
E. MISCELLANEOUS ITa1S TO LOOK OUT FOR
CCX plywood on exposed locations and overhangs..
Stairway details (Sec. 3305).
Guardrail details (Sec. 1716).
Brick or stone veneer (Chapter 30).
*0 Exterior plaster — weep screeds (Sec. 4706 & 4708).
Proper roof pitch for roof .covering (Chapter 32).
i after ties or bearing ridge beam.
arage door or porch header sizes.
�r Ad e o7_. ^ n b in t
Living area over garage - complete 1 -hour separation required. including supporting
walls and posts, etc.
Two (2) exits on three-story dwellings (Sec. 3302).
/r3.2cp
F/
7 THS
w
THERMALITO _IRRIGATION DISTRICT
410 GRAND AVENUE
OROVILLE. CALIFORNIA 95965
TELEPHONE 533-0740
CSA 26 SEWER SERVICE APPLICATION AND CONNECTION PERMIT
'u
Service Address: `' - - •. �`
Owner's Name: ,r -
Date:
Address: �"
Acct. No: -�' 41h
A.P. No.: -5
Phone: - "r
No. Units:
Applicant/Agent:"✓
Agents Proof:
Address:
Fees:
Phone:
Application $
Arrearage
Preliminary Review By - '� �` Date: Z 7 7
CSA 26
Remarks:
SC -OR
1 st mo. S.C.
Other
o
>r�
Total Fees
Collected By:
Date:
/
Field Review By: 1( Date:
r•
Remarks:
US7'14-TiG, O
MONTHLY SERVICE CHARGES WILL COMMENCE AUTOMATICALLY UPON:
❑ Date of TID approval of completed building sewer (early connection).
❑ 30 days after date above, or on date of D.P.W. approval of completed building
sewer, which ever comes
first ("existing construction", prior to Mar. 5, 1974).
❑ 180 days after date above, or on date of D.P.W. approval of completed building
sewer, which ever comes
first ("new construction", after Mar. 5, 1974).
DISTRIBUTION: WHITE - TID, YELLOW - APPLICANT, PINK - DPW, GOLDENROD - DPW to TID
I