The URL can be used to link to this page

Home My WebLink About047-030-03547-03-35 47-03-35 0 db .0000' 9 A5 -k Wardpt Jai, DNAN HALABI End of pri.rd.,app.1000'off W/S Cana ermit#66-84,k A Exem West,app.k mi.S.of Cana Hwy, equipment storage) Permit # 6-77P,E(u4l.,MH) ELEC. -7q > GAS �i!PPOR'f 8TRUCTURE REQ. COMPACTION TEST REQ. EA P P Permit #1504-7 P, -ft 0j !KI/7*M 7-03-35 Issued wo� COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE I OROVILLE, CALIF.- 534-4541 IT P Y CERTIFICATE OF OCCU ANC This mobilehome has been installed in acco'rdan-c6 with-the� requiremen . t s of the California Administrative Code, Titl� 25, Chaptei 5, �nderj 'y number I -'^IJ qr' for the following location: AF --Z n-1, �15wner 4'- , 't i, rl � � I I �'-'Owner'sAddress Mobileho-me Mfg. 'r_'/-,Md&I Year Insignia No. Serial No. It is hereby certified for occupancy at the above described location and may be occupied. Director,of ublic Works D a t e - 5, By THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED White - Owner, Yellow - Installer, Pink - D.P.W. 9. Electrical A. Is service large enough to provide adequate amperage -to mobilehome (must equal rating of mobilehome with a minimum of 0 amp) and other faciliiies on -lot, i.e., water pumps, garage, cabana, etc.? Yes:ZNO B. Is there proper clearances around panels? Yes /140. G. Is power supply cord,or feeder assembly properly fused? Yes— Zwo D. Is continuity test satisfactory as per the following procedure? Yesj- /N:o De -energize electrical wiring system -of the mobilehome at the pedestal. 2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, have been disconnected. 3. Switch all breakers and switches in the mobilehome to the "on" position. 4. Connect one lead of a test instrument to the mobilehome grounding conductor and apply the other lead to each mobileho'me supply conductor, including neutral. 5. All non-current, carrying metal parts of the mobilehome (alumingm siding, gas line, water line), including fixtures and appliances, shall be tested for continuity from such equipment and the grounding conductor. 6. Upon completion of the above procedure, the power supply cord or feed ' er assembly conductors shall be connected to the site service equipment. A further continuity test shall then be made between the �rounding electrode and the c ' hassis of the .mobilehome. Upon satisfactory completion of theelectrical tests, the lot or site service equipment may be approved for energizing. I 10i Is job card signed by Health Department for water and sanitation? 11. If everything okay, sign off card and tag services. MOBILEHOME DATA Manufacturer and/or Namestyle r1ee661,7 44"o?'704-14- r Lengt Width Vehicle Serial No. State Identification No. Additional Information or Comments: MOBILEliONE INSTALLATION INSPECTION CHECK LIST 1. Is the mobilehome located wi required separation from lot lines and buildings and generally s 9 conform to plot plan? Ye _IN 2. Does the mobilehome have,required clearances above ground? (Sec.5085) Yes 01-INO 3. Are footings and supports properly sized, spaced, and braced as p r approved plans? (Note possible variation at spring shackles.) (Sec. 5082 & 5083) Yes ,r No 4. Is the mobilehome level? (Sec. 5088) Yes C11NO 5. If than a single unit, are crossover connections properly installed? (Sec. 5088) , N Yes:Z 0 6. Water A. Is fle f'ble connector of adequate size and properly installed (1/2" ID min.)? (Sec. .5566) Yesy, No_ B. Test Does water piping withstand working pressure or 50 lbs. air test? Yes V"'No C. Backflow - If coach is not Stat of'California approved, does station have backflow device and pressure -relief valve? Yes 0 7. Wastes and Drains - A. Is connection made with Schedule 40 DWV and have flex connectors at each end? YesvX140 B. Does it have minimum per foot slope and is it properly supported? Yes r'-'No— C. Are'any leaks detected in drainage system after running 3,7gallons of water through each fixture including washing machine standpipe? Yes NoP11-11, D. If co*li is not State of Californiaapproved, does station have required trap and vent? Yes --&NO 8. Gas P ipiN nd Gas Vents A. C c :r Is mobilehome connected to the ga�spply with an approved 3/4" minimum onn or 'L e co mobileho nnector not more than 6 ft. 1p Note: All piping is to be at least as large as t e mobilehome gas line Ril'et wit ut reductions other than the mobilehome connector. es No B. Test OK as pe I !ng procedure?,,,Yes_ No 0� �lves. r 'io 1. Open all ap-1 an7c connector,,#'*a 2. -Shut off appliand bur 3. Air test with mmano 0 6oz.-maximum 8 >.) ca drop. t""and'plilot valves. to 10"-14" water column, or test with slope gauge (minimum brated in tenth pound increments. Test for 10.min. without W 4. Connect 9Xs meter to mobileh h connector, turn on gas, test connections with soapy wAer. OU C. Are all appliance vents properly installedT*�,Yes No. -DCIATES McCAIN ASSL (916) 891-1865. CHICO, CALIF. 959426 492 RIO LINDO AVENUE CONSULTING ENGINEERS SURVEYORS May 16, 1978 Butte County Department of Public Works 7 County Center Drive Oroville, California 95965 RE,: BCAP 47-03-35.' future mobile home site for Mrs. Jan Ward Gentlemen: During the week from May 11 ' to May 16, 1978,' we observed the placement of import fill material at' the referenced site and conducted a series of in-place.density tests. The. material, imported from Valley -Rock Products in.Orland, appeared to be -Class II Aggregate Base. It was easily placed and it compacted very well., The average relative density was 97.0% with 96% being the lowest value. If we may be of further assistance on this matter, feel'free to contact this office at your conven-, ience, Very truly' youl�s, McCAIN ASSOCIATES Ps e 7ph YE 2Ha s s e 1 ,.JEH:db cc: 'Jan Ward Rt 4, Box 470 Chico, CA - TO: '.Building Department .FROM: Environmental Health RE: Sewage and/or.Water Clearanc'e cava- kkos+ W 3 -35 OWNER LOCATION A? NU14BER Has been approved for: SDEVIAGE DISP T, WATER SUPPLY: CL r z ita�fdn -V Date' M 0 -77 116a 6116-77P:IE FtRM IT NO. & PERMIT EXPIRES v 4v v W Jack Ward ,OWNER CONTR. owner LOCATION (A.P 47-03-35 End of pri.rd.,1000'off WIS Cana West,app.i4 mi. S.of Cana Hwy Temp. Power Pofe I Called PG&E Temp. Elec. Serv. Called PG&E Temp. Gas Serv. V, Called PG&E 0 EB INALED (Dat '0 tSignature) 'dOdATY OF BUTT-fE '7z*t1E PARTMENT OF PUBLIC WORKS BUILDING INSPECTIdN RECIORD BUILDING BUILDING (Cont'd) PLUMBING, Seflqack Fhwall SoIJ Piping Forrn\ Parhets 1?9 Floor MaIkBIdg. Rest rn Finish loor Fo ings WindowA 3rd F\oor SteAa I I Sidino \ Topout \ �1-ab Roof SheaAJng Water PiAg Piers Roofing Sewer Garage Fdn. Vents Fixtures Footinas Stemwa I I Garage Vents Insulation Water Htr. Heaters Slab Prov. for phjslcal handicaDDe Appliances Carport Footing Slab Patio Footinqs of ex. FAEA.ACE Gas Piping & Test Temp. Gas Sanitation Final ECT Reinf. Steev I Final I Fixtures Bond EIe4 *IRE SPRINKLEN Motors I Frarnino / Test Water Htr./ Stucco Mesl Heati Prinish I DujAs I erlor Lath I Vintilation oor Closer \1,*Inal MOBILEHOME UTILITIES ------------------ Elec. Service Water Piping Tzk Sewer MORILEdOME INSTALLATION -------------- Support Water Piping f-- - Drainage '9 C--� DATE ��REMARKS OR CORRECTIONS v 7 Servigie T,Irno. Pole finderground / Permanent 'Final Elec. Pedestal Gas Piping Elec. Continuity Gas Piping _ (NOTE: An entry must be made on this form each time you visit the job site.) To e K W -Ir NOTE:—All Mate.rials, & Workmanship Shall Be ' in Accordance - with Rcccqni7c,d Good Practices and of a quality prescribed for the Specified use in the Uniform Building, Plumbing & Machanical Codes and the National Electrical Code. This set of plans and specifications MUST be kept on.the job at all times and it is unlaw.fui to make any changes or allerations on same withoul written permisson from ihe Department of Public The.Mg- Setbc Works, County of Butte. side property I ceriterline of A4 q,um of a 2 ft. E out of all ease Sept: 1c s. stem and location ai=v- 9:Ei'dt to be as p er 0.. A permil will be requir( Butf& ounty Health Del3t. Re t�t� quire ts. inst e mob 20" All utilityp;, connections shall. bk f lo�ated wit i n 4 ft. outside the rear fl � hird secti of the mobile home on the left oad) side of the mobile home, 6 Aco V. A I e C ' It -3 A 7'� No te th;!,, *0164 yloe 0 set P "V40:1. Ve:_A;!'eo e�64 / /. -cc ti�".OA home 6-o) P50e 9///, a se & f A We s ia eo a BUTTE COUNTY BUILDING DEPARTME 47 me, APPROVEn W� IV I iall be 5*t. from the ::nd 50 ft. from the,. cl, permitting a mOxi- overhang but entirely fh I e =rA a V, WIA Z-0 4 -3 PL A -r 0 F (o Ft),S j��P 7 e p- EA D UNA —lip E L a j N > reZ— VA o U 7- -;-0 t'001117 -y S, 7-7 vl�OFESSI W. ex BUTTE COUNTY L BUILDING DEPARTMEN7 OF MW APPROVED COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7,County Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT authorize representat'i les of the County of Butte to enter upon the no r ze 'e above-mentioned pr y for in ction purposes. x Date Sig4_(ure -of �errn_itee or Agent 7 q_L� o. eceipt No. White-D.P.W. - Yellow -Assessor - Pink -Inspector - Golden rod-Appli cant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated abo e f which fees have been paid. 7�_.W5tECTdR 20: PUBLIC WORKS B BUILDING Owner SQ. FT. OCC. BUILDING VALUATION Mailing Address Rt 4— Zey-4-7 6 Telephone No 0:3 6 Contractor Mailing Address Fireplace Total Valuation Telephone No. Permit Fee Building Address y Plan Checking Fee &/or Penalty 71111 Permit Fee $ PLUMBING No. - @ FEE lb Q-Zlen� PERMIT FILING FEE $3.00 Each Trao 1.50 0A1 CZ Repair drainage or vent piping 1.50 A. P. No. Lf 1 Zo ing & Planning Water piping 1.50 Each gas water heater or vent 1.50 Pop ds%eIZI;�Fire Dept. I Fi re Zone — Use Permit Gas piping system 1 - 5 outlets 1.50 EOA Parking Plans I Parcel Declaration I Parcel Map 1 60' R/W I Improvements Each additional outlet .30 Building sewer 5.00 B d _-J A41'al Plans Ap4,Z-v-a_1_"' Lawn sprinkler system 2.00 —orcel NEWFJ % ADDITION UTILITIES OTHER Permit Fee $ 1$ —77:7 ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 600V OR LESSESS 5.00 100 AMP OR L Single Family Duplex E] Mobil Home E�� Others Main service EA. ADD -L 100 Amp 2.50 OVER 600V Main service 100 AMP OR LESS 25.00 Main service EA. ADD -L 100 AMP 1.00 NEW CONST DWELLING "'. ') 20sq ft OR ADDNS. - ( ACC. BLDGSO.0 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 style of: NEW CONSTP_ _T .0..RES,., (MULTI.OUTLF BRANCH CIRCUITS) 2.50eal NEW CONSTR. (POWER APPARATUS & N ON. RESID. SINGLE OUTLET CIR. 50 @ 2F4 Ex. Occuo(OUTLETS OR FIXTIIRES BALOI� --- . --- --- J FIXED APPLNS. OR Ex. Occup.(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15. 0 License No. Classification Misc. Wiring 6.25 I I 1 am xempt from the Contractors License Laws of the State of Cali fornia. Permit Fee $ MECHANICAL N01 FEE WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions ot Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. EI have placed on file with the County of Butte a certificate of l Workmen's Compensation Insurance. rV1 I certify that in the performance of the work for which fis /1-0-1 permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of Cal ifornia. PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee 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 relating to building construction, and hereby Land Development Fee TOTAL PERMIT FEE authorize representat'i les of the County of Butte to enter upon the no r ze 'e above-mentioned pr y for in ction purposes. x Date Sig4_(ure -of �errn_itee or Agent 7 q_L� o. eceipt No. White-D.P.W. - Yellow -Assessor - Pink -Inspector - Golden rod-Appli cant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated abo e f which fees have been paid. 7�_.W5tECTdR 20: PUBLIC WORKS B % MOB I1:EH0MESUPPGi' T DATA If otherthan single wide, Mobilehome Mfr. a,//,. Ives furnish Setup Model No. fV-.Zf,4-,3 Year /,57 7,F Width (ft.) Box Length (ft.). Tagalong,or Expando Siz f t . x f t . (SHOW SUPPORT DETAILS BELOW) On all mobilehomes manufactured after October 7, 197 3,, furnish manufacturer's installation manual and structural setup sheets (if not on file with the County of Butte). All center supports measured from front.of mobilehome unless otherwise specified. Footings (check one) Single 1. Wood either pressure treated oi A A- foundation grade. (ft.)(in.) (in.) (in.) 2. Other (specify) Center support Center support locations* footing sizes Supports . (check one) (in.) 1. Concrete block. x 2.'Other (specify) - (in.) (in.) f dwo (ft.) (in.) (in.) (in.) X (in.) (in.) *If ce ' nter piers are other than drawn above, draw in -locations, spacing, and dimensions. Tagalong or Expando, show support details. 12- x 2(( -- Typical Support in.)'(in.) Footing -Size Max. Pier Spacing (f t.) (in.) // I -- Max. Overhang (f t.) (in.) 'BUTTE COUNTY BUILDING DEPARTMPNI APPROVER BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 1. owner's name: service? --------------------------------------------------- Yes No 2. Installer's name: t (Amps) 9. What 3. Is the site currently under pe t? Yes No 7— (If yes, furnish permit number &A OR 10. Wh a.'t is the Isthe site an existing site? Yes No 777 11. What is the (If yes, furnish two (2) plot plans.) tank to the mobilehome? (ft.) 4. Will the mobilehome be located at least 5 ft. away from septic tank and leach fields and 1-2. clear of all setbacks and easements? Yes No mobilehome.gas demand? ----------------------- (BTU) (If noi clarify A �0 - 5. What is the mobilehome electrical rating? ------------- Amps 6. What is the mobilehome site service rating? ------------------ 040 Amps 7. What is the mobilehome site circuit break er rating? ------------- Amps 8. Is there any other -electric load -to be served by the mobilehome (This information not required if pipe length less than 6_ft. on natural gas or less than 50 ft. on LPG.) site service? --------------------------------------------------- Yes No (If yes, identify the load and size- .(Load) (Amps) 9. What is the mobilehome site gas pipe size? ------ �f &A 10. Wh a.'t is the type gas service? ---- --------------------- Natural LPG 11. What is the gas pipe length from meter.or tank to the mobilehome? (ft.) 1-2. What is the mobilehome.gas demand? ----------------------- (BTU) (This information not required if pipe length less than 6_ft. on natural gas or less than 50 ft. on LPG.) COUNTY OF -.,BUTTE Department of Publ ' ic Works 7 County Center Drive broville ----- 534-4541 ELECTRICAL INFORMATION FOR DE -RATING MOBILEHOMES Owner j'a e /(, -A— 141a�r� Location CaIVI? I L53 AMPS De-r.1te Mobilehome to .................. aU. TTE.CQUNTY. Mobilehome Installation Permit No. FILL IN INFORMATION FOR ITEMS 1 THRU 10 Watts 1. Width x Box Length 4 D x 3 X0 2. 2 Kitchen Appliance Circuits ................. 3,000 3. 1 Laundry Circuit ............................ 1,500 4. Ovens .......................... ............. 'F,- go 0 5. Cook Stove Top ............................... 6. Hot Wa ter Heater ............................. 7. Dishwasher &,Disposal ........................ 8,. Clothes Dryer ......... * ....................... 9. Other (specify, etc.) i.e., motors, exhaust fans, Sub -total - Watts ..... First,10,000 watts @ 100% ................... * ........ 10,000 Remaining 7/460 watts @ 40% ................. ; ...... 10. Air Conditioner watts @100%.. = Largd'si Demand Central Heat.System watts @ 65%.. = TOTAL DEMAND WATTS REQUIRED ............. 3,5-1 23 "Demand Watts Required" 230 ........ ............ I L53 AMPS De-r.1te Mobilehome to .................. aU. TTE.CQUNTY. AMPS BUILDING DEPARTMENT APPROVED McCAIN ASSOCIATES (916) 891-1865 492 RIO LINDO AVENUE CHICO, CALIF. 95926 CONSULTiNG ENGINEtRS SURVEYORS SNAL I May 16, 1978 Butte County Department of Public Works 7 County Center Drive Or6ville,,California 95965 RE: BCAP 47-03-35, future mobile home site for Mrs. Jan Ward Gentlemen: During the week from May 11 to May 16, 1978, we observed the placement of import fill material at the.referenced site and conducted a series of in-place density tests. The. material, imported from Valley Rock Products� in Orland, appeared to be Class II Aggregate Base. It was easily placed and it compacted very well. The average relative density was 97.0% with 96% being the lowest value. If we may be of further assistance on this ma:Eter, feel free to contact this office at your conven- ience. Very truly yours, McCAIN ASSOCIAT S '0 #Xfl� I Mseph E. Hassell JEH: db cc: Jan Ward Rt 4, Box 470 Chico, CA - I cp ow COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — -0rovi 1.1e, California 95965 Telephone: 534-4541 //47 APPLICATION AND PERMIT 4 BUILDING 4 %Now Owner W nxA SQ. FT. OCC. BUILDING VALUATION Mailing Address U0 Tel ephon e No. 9—Fireplace Contractor. -Total Valuation Mai I ing Address Permit Fee PlanChecking Fee&/orPenalty Telephone No. alllb Permit Fee $ Building Address PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 A0 TIK W I S 0, C -4A, a S &v fp rtx Each Trap 1.50 14—tt) I li 8 L4 Repair drainage or vent piping 1.50 Water.piping ". 0 — ganint V-44ficatiOn "04 Each gas water heater or vent 1.50 � 7— C)3 -- 3 S�_ A. P. No. A — 7/7-1 Zo Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F�� FireDept.1 FireZone Use Permit Building sewer 5.00 EQA P.��ring LA-lans rcel I Dec2aration Parcel Map 60' R/W I Improvements Lawn sprinkler system 2.00 P I a In s R e c'd Parcel Af'opooroval 1`12ELApproval Permit Fee $ �V3,60 NEW ADDITIONE] UTILITIES 9;K OTHERE] ELECTRICAL No.1 @ FEE PERMIT FILING FEE $3.00 Main service 15200V OR LESS 100 AMP OR LESS 5.00 SO() Main service EA. ADD -L 100 AMP 2. Single Family E:] Duplex E] Mobi I Home Others[] Main service OVER 600V 100 AMP OR LESS 25.00 Main service EA. ADD -L 100 AMP 1.00 NEW CONST. DWELLING OCCUR. OR ADDNS. ACC.5LDGS. 120sq ft NEW CONSTR. MULTI -OUTLET NON&R-ESID. ( BRANCH CIRCUITS) 12.50ea NEW CONSTR. WEIR APPARATUS &I NON -RES I D. (SPIOGLE OUTLET CIR. J_ 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 style of: )+,T. Yj t-^ 1,00 I Ex. OCCUP(OUTLETS OR FIXTURES) 50 @ 25o BAL @ 100 FIXED APPLNS OR Ex. Occup.(OUTLETS (RESI*D.) EA) 2.00 Temporary service 1 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 I am exempt from the Contractors License Laws of the State of Cal ifornia. Permit Fee $ WORKMEN'S COMPENSATION INSURANCE 1 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. E] I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this LIOIJ 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 Heating Cooling I Ventilation Hood 2.00 Permit Fee $ $ 1 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 relating to building construction, and hereby authorize representa es 'f �'hegcunty of Butte to enter upon the t 0 above-mentionbed p r ty for n tion pucposes. X Date AA V 1/ X Signl�atu"re of Permitee or Agent eceipt No. 17 V031 5_6 ot TOTAL PERMIT F9E 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. DIREC RVLIC WORKS By- A L Date3 -d-q-7(f _�, - % ff --a White-U.F.W. — Yellow -Assessor — Pink -inspector — Goldenrod-Appli cant I nuiiaing permit expires uate �� — 9�� __1 If U� TE - DEPARTMENT OF PUBLIC WORKS Driv C7f!unty �Cente Oroville, California 95965 - Telephone 916/534-4541 7'AYF(ICULTURAL BUILDING EXEMPTION PERMIT 7RMITNO. P Agricultural building is defined as follows: Agricultural building is a structure designed and constructed to housefarm implements, hay, grain, poultry, livestock, or other horticulutral products. This structure shall not be a place of human habitation or a place of employment where agricultural products are processed, treated, or packaged, nor shall it be a place used by the public. ASSESSOR PARCEL NO. ZONING f'(- (i 7-5:-- 14 - OWNER PHONE NO. OWNER'SADDRESS & �s f4 74� z g -0 LOCATIOt4AF BUILDING w1f J g1d, ',G,,;;Z� PlUT 1111ifs 4."�S-r 10�1_— AY, r..,f _'6 ! t r USE OF BUILDING SIZE OF STRUCTORE X 1�, -SQ. FT. TYPE OF CONSTRUCTION: WOOD FRAME — STEEL _Zef��CONCRETE —OTHER (Specify) _T TYPEOFSIDING ROOFCOVERING LOOR TYPE ESTIMATED COST OF CONSTRUCTION $ — Z E FAG Buildings shall comply With the building front, side, and rear yard requirements of the applicable County Ordinances as follows: i REAR FRONT S IDES AG Buildings shall be a minimum of five (5) feet from any septic tank or leach fields. AG Buildings lessthan 1000 sq. ft. in floorareashall be located a minimum of 6 feet from a residence, 10 feet from a.mobilehome, and 23 feet from a commercial building. AG Buildings greaterthan 1000 sq. ft. in floorareashall be located a minimum of 23 feet from a residence and a mobilehome, and 40 feet from a commercial building. I I declare under penalty of perjury that the building will be used as stated above and the proposed use conforms with the AG Building definition. If any change in use or oc9upancy of the building is made, I will contact the Department of Public Works and will obtain any necessary permits, inspections, and approvals to comply with the requirements in effect at that time and before occupancy. Date Signature of Owner ermit Fee - $25.00 The above described AG Bui.lding is exempt from a building permit. cog W4-� --e / e �/ 4- 1W -e te - 4 7 eceiipt No. Director of Public Works By Date 11-6 White - DPW, Yellow - Assessor, Pink -,B. I., Goldenrod - Applicant V .00 00 r PO 'CO Cj?