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066-520-001 00-2296
ARNOLD, PAUL .
13880 NIMSHLW RD , MAGALIA
CONTR: N/A ,4/4,F7e /0 -/q -C
POWER FOR LOT DEVELOPMENT, WELL
IN
9,1
NOTES
_p RESIDENTIAL
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04-,066-520-001 ,00-2296
PERMIT NO. _ `
"ARN%D,�PAUL ;
13880 NIMSHEW RD,. MAGALIA r ,
IRCONTR:,N/A?&ti
POWER FOR LOT DEVELOPMENT+ WELL
SPECIAL CONDITIONS
CHECKED
BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
OFFICE COPY //• ,�%
Address
JOB FINALED (D e)
Signature
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04-,066-520-001 ,00-2296
PERMIT NO. _ `
"ARN%D,�PAUL ;
13880 NIMSHEW RD,. MAGALIA r ,
IRCONTR:,N/A?&ti
POWER FOR LOT DEVELOPMENT+ WELL
SPECIAL CONDITIONS
CHECKED
BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
OFFICE COPY //• ,�%
Address
JOB FINALED (D e)
Signature
t
,/ = OK
0 = Not OK
- = NotAppliCable
• =' Not Ready.
MOBILE.HOMES
-
Date MOBILE HOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
Siding; Nailing -Veneer -Stucco -Mesh
2. Soils; Special MH Support Sketch
10.
3. Sewer; Location -Test -Fall -C/O -Concrete
Date
4. Water; Location -Test -Easement Needed (Sketch)
Card B-1 Date Card B-1
5. Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
12.
6. Gas; Location -Test -Wrap;-/ /" L'ft.
/ P Nat. or / /"L"ft./ PLPG
Date
7. Well Clearance 8 Disconnect
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- Bea ms- Rftrs.-Connectors
Shthg.-Frg-Bracing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Electric
8.
Utility Clearance
9.
Siding; Nailing -Veneer -Stucco -Mesh
10.
Roof; Shthg-Roofing
Date
11.
Card B-1 Date Card B-1
Date
12.
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
Card B-1 Date Card B-1
2.
Footings; Size -Spacing -Marriage Line
Card B-1 Date Card B-1
3.
Gas; MH Test -Demand -Valve -Connector
FINAL (Plans) OK except #'s
4.
Electricity; MH Test -Crossovers -Breakers -Clearances
Setbacks -Easements
5.
Drain; MH Test -Fall -Flex Connector
Soils; Compaction -Structure Stability
6.
Water; MH Test -Regulator -Connector
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
7.
Water and Sewer Connected -C/O to Grade -HD Approval
Elec.; Receptacles and Lighting, Distance-GFI
8.
Gas and Electricity Tagged
Elec.; Pool Lighting; 15 Volts-GFI
9.
Tie Downs -Type -Installation Cert.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
10.
Exits; Insp.-Sketch •
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
11.
Cert. of Occupancy
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes- Enclosure s- Pane lboards-Ins. to Main in Conduit
12.
Permanent Foundation Only; License Decal
Health Department Approval
10.
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- Bea ms- 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- Enclosure s- Pane lboards-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
J = OK
0 = Not OK
- = Not Applicable =Not Ready
RESIDENTIAL (:
Date
FRAMING (Continued)
Underfloor (Plans) OK except #'s
46.
1.
Zoning -Setbacks -Easements -Flood -Slope
47.
2.
Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
48.
3.
Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth
49.
4.
Ftg., Porches & Decks; Soils -Steel-/ /" Ftg. Depth
50.
5.
Stemwalls, Main; Steel-Blockouts-Wrapped
51.
6.
Stemwalls, Garage; Steel-Blockouts-Wrapped
52.
6a.
Hold Downs and Special Anchors
53.
7.
Slab, Steel -Wrapped
54.
8.
Piers -Fireplace Ftg.-Steel
55.
9.
D.W.V.; Fall -Fitting -Test -2 Way C/0 -Sewer Test
56.
10.
UF, Gas Pipe; Size Anchors - Yard Gas Piping; Size Test
57.
11.
Water Pipe; Test -Anchors -Regulator -Service Test
58.
12.
Electric Underground
59.
13.
Plenums & Ducts; Clearance -Material -Support -Ins.
60.
14.
Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
61.
15.
Access & Ventilation
62.
16.
Insulation
Date
Date
Card B-1 Date Card B-1
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
PLUMBING (Permit) OK except #'s
63.
17.
Water Htr.; Vent -Access -Combustion Air Baffle
64.
18.
Water Pipe; Test & Anchor -Nail Protection
65.
19.
D.W.V.; Test Fittings & Anchor -Nail Protection
66.
20.
Shower Pan; Test, First Floor -Tub Access
67.
21.
Test Tub & Shower, Second Floor -Tub Access
68.
22.
Gas Pipe; Sixe & Anchors
69.
Stairs & Rails
Date
Fireplace or Stove, Clearance -Hearth
Card B-1 Date Card B-1
Date
Elec. Outlets at Wood Panel, Int. & Ext.
Card B-1 Date Card B-1
Date
Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance
ELECTRICAL (Permit) OK except #'s
73.
23.
Fixture & Transformer Clearance -Ins. Protection
74.
24.
Elec. Receptacles Spacing -Lights & Switches at Doors
75.
25.
Size Boxes & No. of Conductors Stapled
76.
26.
Romex Installed Close to Edge of Studs & C.J.
77.
27.
Equip. Ground made up w/Mech Fasteners -Bond Gas & Water
78.
28.
2 Appliance Circuits in Kitchen & Conductor Size GFI
79.
29.
Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga Cu or AI
80.
30.
Range Circle / / ga Cu or AI -Oven Circ. / / ga Cu or At
Insulated Neutral Q Yes O No
81.
31.
Service -Riser Conductors & Ground Main Disconnect
32.
Equip. Clearances Panels-Motors-Mech. Equip.
82.
33.
Clothes Closet Light -Shower Light -Spa Light
83.
34.
Smoke Detector
84.
A.C. Unit Disconnect, Electrical -Plumbing
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
Exterior Elec. Trim, G.F.I. Receptacle -Underground
35.
A.C. Ducts Insulation & Support
Ventilation Throughout House
36.
Vent Fan, Exhaust above insulation
Glass Protection
37.
Condensate Drain & Overflow, Size & Grade
Corrections from Previous Inspections
38.
Furnace -Vent Access -Comb. Air -Return Air Vent 115 outlet
Gas Test -Meters Tagged, Gas -Electric
39.
Attic Access & Platform if Furnace in Attic
Water & Sewer Connected -C/O to Grade -HD Approval
93.
Energy Compliance Certificate -Other Certificates
94.
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
FRAMING (Permit) OK except #'s
Card B-1 Date Card B-1
40.
Sits Proper Materials & Anchors
Comments at Final:
41.
Walls Studs -Nailing Spacing & Braces -Plates -Sound
42.
Bearing Walls over Girders & Floor Nailing
43.
Draft Stop in Walls (rat proof)
44.
Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
45.
Headers & Beams -Size & Bearing
;Ingle & Duplex)
Date
FRAMING (Continued)
46.
Hangers -Post Caps -Anchors -Connectors
47.
Cling. Joist-Rttr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rfng.
48.
Fireplace Ties or Type A Flue -Fireplace Throat Clearance
49.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
50.
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
51.
Garage Fire Protection Framing
52.
Property Line Firewall & Openings
53.
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
54.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
55.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
56.
Siding -Nailing Veneer
57.
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
58.
Glazing Area -Glass Protection -Skylights -Plastic
59.
Shear 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 B-1 Date Card B-1
Date
FINAL (Plans) OK except #'s
63.
Ext. Steps -Door & Sidelight Protection -Landings
64.
Smoke Detector
65.
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor -Ducts -Mach. Protection
66.
Bedroom Exiting
67.
G.F.I. & Bath Fixtures & Tub Access -Spa
68.
Elec. Trim & Subpanel, Breaker Sizes & Labels
69.
Stairs & Rails
70.
Fireplace or Stove, Clearance -Hearth
71.
Elec. Outlets at Wood Panel, Int. & Ext.
72.
Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance
73.
Elec. Outlets & Receptacles at Kit. Counter
74.
Garage Fire Door; Swing -Landing -Closure
75.
A.C. Duct in Garage -Damper
76.
Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
77.
Plb., Elec. & Mech. Equip. Listed for Location
78.
Elec. Receptacles in Garage (F.F.I.)-Romex Protection
79.
Insulation -Foam -Looked in Attic
80.
Guard Rails & Deck Construction -Post Caps
81.
Fdn. VBents & Crawl- Hole Door Drainage & Wood -Earth
Clearance Looked under Floor O Yes
82.
Following Insild./Drive ❑ Yes 0 No/Walks ❑ Yes D No/Planters Yes ❑ No
83.
Stucco Brown -Finish
84.
A.C. Unit Disconnect, Electrical -Plumbing
85.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
86.
Water Well, Disconnect, Electrical, Plumbing
87.
Exterior Elec. Trim, G.F.I. Receptacle -Underground
88.
Ventilation Throughout House
89.
Glass Protection
90.
Corrections from Previous Inspections
91.
Gas Test -Meters Tagged, Gas -Electric
92.
Water & Sewer Connected -C/O to Grade -HD Approval
93.
Energy Compliance Certificate -Other Certificates
94.
Address Posted
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Comments at Final:
,r COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 ERM NO.
(Rev."2/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMB
ZONING
BUILDING PERMIT
OWNER
tEUEPH
SO. FT. OCC. BUILDING VALUATION
.OWNERS ILING ADODRESS J 5
CONTRACTOR'S ME
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
—Filing Fee
$ 20.00
Permit Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDING ADDRESS 3 �? 9 A I _
XV� lX� /VI`S/1C 'Nv, 1
Energy Plan Checking Fee
$
$
PERMIT FEE
S
LAT NO.
SUS NAME
BDNIS ION
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
pSolar
SF ❑ Duplex ❑ MobilehomeOther ?nci ?� 1
SPECIFY
Each Trap
7.00
or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work:,
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S G W
@20.00
PERMIT FEE
$
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service 200A OR LESS
23.00 23.00
LICENSED CONTRACTOR'S 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 the Business and Professions Code,
and my license is in full force and effect.6
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ 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.
�'Ilk I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service 200A To 1000A
46.00NEW
CONST. DWELLING OCCUR
OR ADDNS. ( a ACC. BLDS.
so
3.50FT.
NONO IDT' MULTI.OUTI.ET
@7,50
PSINGLE OIfTLET OWER APPARATCIR. US
q
Ex. Occup. OUTLET ORFIXTURES
20 @'.0°
a„L Q ,50
Ex. Occup. oFuTEL R D °ERA�
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wirina
23.00
PA -e-141
23 W 23-60
PERMIT FEE
$
WORKERS' COMPENSATION DECLARATION
1 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 is issued.
❑ 1 have and will maintain workers' compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE
$
Policy Number
.(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
1%,l 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 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
fort with comply wit those provision ..
ryry
X Date .�y
SiaTiTature of Applic It - Owner C ntractor ❑ Agent
An OSHA permit is quired for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee
$
Energy Inspection Fee $
OCC
CONST. TYPE
it
TOTAL FEE w
HAZ.
D. FEES IMP
I FLOOD
CDF
PARCEL
PO
HD
ISSUE
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
By l�
101 191
PERMIT EXPIRES ON
the applicable provisions
Resolutions to do work
been paid.
Date
� GHQ O�
Date
ReceiptNo.Lp
WHITE-D.D.S.•B.D. CANARY -AS ESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
.-..�„7„ a-+,.-1�+-,ri��..i.�ii�`,..►=�'��.. �,`�`.�"(�Q�,. fir' ��`-�,.�3i.��rla �•�'i i�"'"L?.•�►'`^�•".•�•%�e''�.ti +Y 1�.: -YP:•
COUNTY OF BUTTE -"DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
. 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (530) 538-7541
-
PE"IT"PLICA TION DATA SHEET
OWNER: Pa U& GAA&& -,QA ASSESSOR PARCEL NUMBER:
Proposed Building,Use: _ Building Inspector: Date: q - a 0. O -o
At time permit application, I was ad ' ed the following data must be submitted prior to permit processing and/or issuance:
ecL . P&:, Date Received By
All items have been submitted. --- ----------------------------------- ------------ -----------------------------------
❑2. Plot plans, 3/4 sets, signed by the preparer of plans. --- -------------------------------------------------------
03. Complete plans; 3/4 sets, signed by the preparer of plans . -----------------------------------------------------
04. Engineered plans ,"3/4 sets, with wet signature on plans. All engineering must be shown on plans. --------
❑ 5. Engineered truss details and layout in duplicate (required prior to plan review) No faxes! ------------------
❑ 6. Energy Design Compliance and supporting documentation. ----------------------------------------------------
❑ 7. Statement of Intent for Non -Heated and A/C Buildings.---------------------------------------------------------
❑ 8. Hazardous Material Form. ------------------------------------------------------------------------------------------
❑ 9. Manufactured Home data and installation instructions including Tie Down Specifications -------------------
0 10. Fees of $ -------------------------------------------------------------------------------------
❑ 11. Impact fees as shown on the attached schedule.----------------------------------------------------------------.
❑ 12. California Department of Forestry plan approval/fees. ---------------------------------------------------------
❑ 13. Flood elevation certificate.----------------------------------------------------------------------------------------
❑ 14. Sanitation and plot plan approval Health Department.
❑ 15. City of Chico plumbing permit.---------------------------------------
016..
--------------------------------------
❑16.; Plot plan and business license approval from the City of Biggs. ---------------------------------------.
1 ❑ 17, Planning approval for (A) Use: (B) parking: --------------- ____
❑ 181Uontact Land Development about ❑ Iinprovemenfs;'O Drainage, ❑ Legal Parcel. -----------------
❑`1'O Encroacbment Permit for driveway (construction approval prior to occupancy). ---------------------
020:4)4 -inspection for required Request to Building Inspector on
s -
❑211` Contractor's license information. (Number, Name Style, Classification).
f
022.: Workers' Compensation carrier and policy number. -----------------------
J
❑231 Owner -Builder Verification (Given to owner ❑, Mailed to owner ❑). -.
❑ 24' Letter of signature authorization. --= }--------------------------------=-`___--
❑25 Recorded copy of Agricultural Acknowledgment Statement. -------------
❑26. Letter of intent on building use. ------------
❑27. Manufactured Home utility clearance: -=---
1128. Existing violations and/or expired permits.
029. ❑433 A, ❑Grant Deed, ❑ M.H. Title, ❑ Check to H.C.D $
I
--------------
❑ 3 0. Other: %
When you issue the permit, process as follows Mail to owner, []Mail to contractor.
❑Telephone and hold for pickup at office. .❑1 Deliver with inspectir.
f Applicant: 4� Date:
,Copy of Haz-Mat form sent ❑ Health Department, ❑ Fire Department, ❑ Air Pollutionbate: By:.
Copy of plans sent ❑ Health Department, 11 Fire Department, ❑ Other: %Date: By:
(Date)
1. Index permit application for the above items numbered: s ❑ Plan Check List
2. Additional items required: /
Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date:
Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date:
Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date:
Contractor, designer, owner, was advised of the above required'd_ ata by ❑ phone, ❑ mail, ❑ Building Division counter, by Date:
Plans reviewed by: Date: Plans approved by: Date:
Sets of plans on hold in ❑ Plan Cabinet, ❑ A.P. folder. Note transfer by: Date:
Vallnm !`.,..., _TIP.. o.+..,o..t ..f Tlo..el............♦ r.._.:___ n___u:-- ^'_-' -' -
PRE -INSPECTION REPORT
OWNER: TOLk4 ` DATE: ( coo
LOCATION:
CONTRACTOR: C,cJt� l
A.P. # �0 6
ZONING:
PRE-INSPETION FOR:Pr�
DATE TO INSPECTOR r 6 PERmrr HISTORY -,W NONE AS FOLLOWS:
BUELDING INSPECTOR'S REPORT
Building Description:
Commer+ciaUUsage:
Residential/# of Units:
Currently Occupied
Abandoned/Vacant
Electric:
Yes No Electric currently On Off
Condition of Electric
Gas:
Natural Propane None ✓ Currently On Off
Obvious Problems:
Sanitation:
Plumbing Working
Well Working Potable Water
Obvious SewageProblems
a
Comments:
ACTION RECOMMENDED:
HOLD FOR
Date 1 ��
Sketch buildings on reverse and indicate location on property.