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HomeMy WebLinkAbout068-410-006I .. ■ VIL BUTTE COUNTY DEPARTMENT,OFDEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP043618 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under Issued Date: 05/11/2005 APN: 068-410-006-000 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. Site Address: 15 FOXRIDGE RD ORO License Class : License Number: Map Index: Date: Contractor: Description: NSF (2456) GAR (576) COV (1484) OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 12m exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code:' Any city or county which requires a Owner: WALL, THOMOTHY & DIANE L permit to construct, alter, improve, demolish, or repair any structure, prior g5 OAKVALE AVE to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of OROVILLE, CA the Contractor's State License Law (Chapter 9 commencing with Section 95966 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any (530) 533-1548 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 Applicant: WALL, THOMOTHY & DIANE L Code: The Contractors' State License Law does not apply to an 95 OAKVALE AVE owner of property who builds or -improves thereon, and who does such work himself or herself or through his or her own employees, OROVILLE, CA provided that such improvements are not intended or offered for 95966 sale. If however, the building or improvements are sold within one 533-1548 year of completion, the owner -builder will have the burden of (530 ) proving that he or she did not build or improve for the purpose of sale.). 1, 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 Contractor: not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). O I am Exempt under ArticliMe ss andProfessions Code Date: � 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: GLAZEWSKI, FRANK is issued. Engineer: ❑ 1 have and will maintain workers' compensation insurance, as 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 Total Square Ft: .4516 S.F. Policy#: Valuation: $197,208.00 Census Code: I 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 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. Date: Applicant: C 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 ofJii r7 't�y pd Z Roo—AL -zl364 B'S 4rV49.�D/' ( O compensation, damages as provided for in Section 3706 of the Labor 1 code, interest, and attorney's fees. ^ �-44101GG `S1 27:2 CONSTRUCTION LENDING AGENCY This permit is hereby issued under the applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolu .o s to cle work indicated abo for ich fees have been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) Name: Date: PERMIT EXPIRES ON: v �l Address: ( to 4 1 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 18827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. O 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 duly 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 any offici form or document of Butte County. I hereby 8uthorize representatives of Butte County to enter upon the above mentioned property for inspection purpos ` Print Name: Ck, Signature: Date: ��C% �- Owner O Contractor 0 Agent for Owner O Agent for Contractor �u a i I I � •� 1 �i 1 BUTTE COUNTY� PERMIT DEPARTMENT OF DEVELOPMENT SERVICES N BUILDING PERMIT APPLICATION gq AND SUBMITTAL REQUIREMENTS 3f „e 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CI -ICO: (530) 891-2834 B OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION BI /A 1 "PLEASE PRINT CLEARLY" . f, 9 - 0 OWNER J Last Nam Name Address s �� Cityr/Y y Sta City Phony - Fax E-mail For office use on CONTRACTOR Name �e Address 7 o Z;�Q ,e woo,Q City ""NEW State Zip 7 —Phone 6-S —Fax. E-mail Lic. # Class For office use on ARCHITECT/ENGINEER Name Type Const. Address 7 o Z;�Q ,e woo,Q City ""NEW Sta 9 73 Phon 6-S Fax E-mail State License Number For office use on APPLICANT NAME Name Type Const. Address �✓ City ""NEW St Zip Phone i Address Fax ` E-mail For office use on Zoning Flood Zone SRA , No Occ. I Type Const. Subdivision Name Map Book Page ""NEW OZONE W... �j Date Approved: —Nam Address For office use on Zoning Flood Zone SRA , No Occ. I Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: LOCATION YV Property Address is -os City ag,2�vi ile Cross Street WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY —Nam Address Descriptio Scope of Work: dr Sq. Footage ructure Built without Permits posed Change of Occupancy te previous use): OVER FOR SUBMITTAL REQUIREMENTS 11 K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. F_ by: " Amount: U 11 Re ipt # oo Date) c�/O alrim Sheriff SMIP k t )Of' Total REV 7-27-04 � s--- 3G -/y l SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INIC ❑ 1. ,Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! 0 +� 5.2. yC,*lete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxesl ❑ 4. Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. •, �, ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. 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 must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). 3 San' tationand�ite-pJariapproyal fromtbe_En_AronmentaLHealihDepadment Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Forma ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530)538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 4 Butte County Department of Development Services YVONNE CHRISTOPHER, DIRECTOR 7 County Center Drive 00 Oroville, CA 95965 (530) 538.7601 Telephone (530) 538-7785 Facsimile WILLDAN Scott Rutherford (530) 538-7160 s rutherfo rd @buttecounty.net Plans Transmittal For Review Per Contract 12/29/2004 Applicant: Wall, Timothy Permit 04-3618 Project Type: NSF/Gar/Cov, APN: 068-4107006 100%. 70% Plan Check Fees $1,272.18 $ 890.53 $ 1,272.18 $ 890.53 FWILLDAN Fee $ 890.53 Copies Attached: Qty Chk Application Site Plan Review FEMA Elevation Certificate -Building Plans Truss Calculations • Energy Calculations Structural Calculations Residential Plan Review Guide Residential Construction Requirements Other Other TO FROM: SUBJECT: DATE: WILLDAN Scott Rutherford (530) 538-7160 s rutherfo rd @buttecounty.net Plans Transmittal For Review Per Contract 12/29/2004 Applicant: Wall, Timothy Permit 04-3618 Project Type: NSF/Gar/Cov, APN: 068-4107006 100%. 70% Plan Check Fees $1,272.18 $ 890.53 $ 1,272.18 $ 890.53 FWILLDAN Fee $ 890.53 Copies Attached: Qty Chk Application Site Plan Review FEMA Elevation Certificate -Building Plans Truss Calculations • Energy Calculations Structural Calculations Residential Plan Review Guide Residential Construction Requirements Other Other COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISIONvY 7 County Center Drive, Oroville,-CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers............................................................................................ ❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........ ❑ 20. Erosion Control Plan Required: ....................................................................... 21. Fees as shown on the attached Schedule of Fees Due Sheet .............................. f oS ❑ 22. City of Chico Plumbing permit........................................................................ 23. California Department of Fore try plan approval p paid. Sent by: :.......... SF t z •x9.04- ❑� 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check:_ .S �0 -. -c; ❑ 25. Contact Land Development about _ Improvements, _ Drainage ......................... -9 26. NPDES Form............................................................................................. 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for required....... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 30. Worker's Compensation Carrier and Policy Number .......................................... r 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) .....................¢ 32. Letter of Signature authorization......................................:............................. 33. Recorded copy of Agricultural Acknowledgment Statement ................................. j ❑ 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. $ ❑ 38. Other: ❑ 39. Other: When issued Telephone and hold for pickup. I have been informed of the above items and requirements for o aining a building permit. J Applicant: % Date: 1. Index permit application for the ab ve items numbered: Plan Check Letter > 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: -)Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: Date: Plans approved by: \ Date: Structural reviewed by: Date: Structural approved by: Date: Note transfer by>( Date:. d Yellow: Building Division OWNER: Ci ASSESSOR PARCEL NUMBER Do� I � Proposed Building Use: ✓ Counter Technician: Date: Items required in order to appl§ for a permit. All boxes .MUST be checked OR marked NA in order t0oo pply. 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. 4. Engineered truss details and layouts in duplicate. No faxes! 5. Letter 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. ❑ 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. ❑ 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 must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ •11. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner 0 14. Hazardous Material Form Sanitation and site plan approval fromahe-Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. . 0C15. 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers............................................................................................ ❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........ ❑ 20. Erosion Control Plan Required: ....................................................................... 21. Fees as shown on the attached Schedule of Fees Due Sheet .............................. f oS ❑ 22. City of Chico Plumbing permit........................................................................ 23. California Department of Fore try plan approval p paid. Sent by: :.......... SF t z •x9.04- ❑� 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check:_ .S �0 -. -c; ❑ 25. Contact Land Development about _ Improvements, _ Drainage ......................... -9 26. NPDES Form............................................................................................. 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for required....... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 30. Worker's Compensation Carrier and Policy Number .......................................... r 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) .....................¢ 32. Letter of Signature authorization......................................:............................. 33. Recorded copy of Agricultural Acknowledgment Statement ................................. j ❑ 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. $ ❑ 38. Other: ❑ 39. Other: When issued Telephone and hold for pickup. I have been informed of the above items and requirements for o aining a building permit. J Applicant: % Date: 1. Index permit application for the ab ve items numbered: Plan Check Letter > 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: -)Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: Date: Plans approved by: \ Date: Structural reviewed by: Date: Structural approved by: Date: Note transfer by>( Date:. d Yellow: Building Division E.H. USE ONLY Plot Plan Attached ✓ - Floor Plan Ansched r Sant to ®.D. ! TO:' Building Department ; FROM: Environmental Health SUBJECT: Sanitation Clearance Owner ocation 'AP# Plan Approved for: Sewage Disposal ✓ Water Supply: Public Priv7Z?CfiP Well Clearance for ✓ dwelling. Other 3 0315.6z�lle - 164ej6 � e•cJ ea � Hold final for: Final clearance O:K. for: NOTE: Environmental Health 8/96 ist a Date ' r COUNTY OF BUTTE ; DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION ' 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 TELEPHONE (5.30)538-7541 SCHEDULE OF RECEIPT OF FEES �l Q� OWNER l A.P. # VCS PROPR SED BUILDING USE ' + DATE . RECENT # DATE REC. 1. BUILDING PERMIT FEES ` �j r, � `I --- Balance Due ..................... $ ('" 'ZT 30gS- os ' --- Additional Fees Due........... $ --- Revised Plan Checking Fee.... 3$ _ 2. SCHOOL DISTRICT FEES 3Q)'f (paid at School District Office) (form available after Plan Check) 3. r SHERIFF FEES (paid at Building Division) Re360:00 _$ w i Commercial (sq. ftg.).:... X $0.03 = $ Sq.Ftg. 4. URBAN AREA FEES (paid at Building Division) Residential (per tint)..... X $ # Units Amt. Commercial (Sq. Ftg.).... X = $ Sq. Ftg. 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 A E r$89.#0 (paid at Building Division) a� . 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. Commercial (sq. ft X Sq. Ftg. Amt. X30 S , 10. OTHE_ t.time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. These fees may be changed during th Ian checking process. /� APPLICANT olCDATE � . - 0 . 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) �UTTF 0 �i, 0 o o 0 o 0 0 \\ AcOLJNIys ECIC WORD. Department of Public Works C® Ll . n t ,,y :® f B u t t -e J. Michael Crump, Director LAND DEVELOPMENT DIVISION Storm Water Management Program 7 County Center Drive Oroville, CA 95965 " . (530) 538-7266 (FAX) 538-7171 Nati®nal Pollutant Discharge Elimination System (NPDES) Phase ll Construction Storm Water Perth and Storm Water Pollution Prevention Plan (SWPPP) Acknowledgement LLESS THAN 9 ACRE Project Description: ; Project Location and/or Parcel Number: ---- By signing below, I, the project owner/owner's agent, certify that this project WILL NOT DISTURB 1. acre or more.of land and that I, therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site build -outs of less than one acre but when' combined with subsequent phases total more than one acre of disturbed soil will require a Construction Storm. Water Permit from the State of California Regional Water Quality Control Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from -the State of California Regional Water Quality Control Board for a project that disturbs one acre or more of land may result in revocation of grading and/or other permits or other. sanctions provided by law. Signed: Title: Date: Less than I Acre NPDES & SWPPP Compliance Certification Butte CountyStorm Water Management Program Revised 5/24/04. F n &a .DER'VEit R IW1vEa 1 xr xx �+.i_.� �t.ru r• .. err, 't.Y.. Attention Property Owner: An "owner -builder" building permit has been applied for in your name an&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. a . 1. I personally plan to provide the major labor and material for construction of this proposed property improvement: YES [ )0] NO 2. I HAVE [ ] HAVE NOT [ ] signed an application for a building permit for the proposed work. 3: 1 have contracted with the following person (firm) to provide the proposed construction: NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the"work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: PHONE: ' ° CONTRACTOR'S LICENSE NO: 5.. I will provide some of the work but I have -contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE' TYPE OF WORK 012& SIGNED: PROPERTY OWNER:- DATE: WNER: DATE: / L — 2-1-- D NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. Rev'd 11/4/2004 Butte County Department of Development Services ADMINISTRATION * BUILDING * GIS * PLANNING 7 County Center Drive Oroville, CA 95965 (530) 538-7541 Telephone (530) 538.2140 Facsimile , OWNER BI �ILDE� NFIO._�:..�:.�.�, ON Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be 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 to 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. If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government 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. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact 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 structure'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 permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. ' Please complete and return the enclosed owner -builder. verification from so that we can confirm that you are aware of these matters. The building permit -will not be issued until the verification is returned. N Mic el C. Vieirl, C.B.O. Ma ager, Building Inspection NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. ` INI 011 III 1.11111 2 NIM IIII I IIII LIII Qi10 AND WHEN RECORDED MAIL TO: Recorded I REC FEE 7,00 BUTTE COUNTY BUILDING DIVISION Official Records I COPIES 2.00 7 COUNTY CENTER DRIVE County Of t i OROVILLE, CA 95965 BUTTE I CANDACE J. r KUBBS - I Recorder I ROSEMMY DICKSON 1 Assistant I Kathy 01:28RM 09 -Feb -8005 I Pagel of i 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: P4 cel d; ttJ-ps ! 23 • PIT > Date " 6 '" t06_ State of California } County of •� ) On D _ OF- 0-5- ; before me, personally appeared T �nf� �'• Gr/,a // personally known to me (or proved to me on tfie 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. �. Signature Seal: RICHARD FEUERSTEIN A.P. #00- q1,0 -00� y , Commission #1299529 n v Notary Public - California Butte Countyy My Comm. Exp. APR. 13, 2005 School District A.P. Number Property Owner Property Location/A Subdivision BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building) •t Building Department No. Jurisdiction:./ =City County Lot No. .............................. :... ................................... Residential Development/Q Q Q Q Sq. Footage No of Living Mobile Home Addition/ 'Supplemental to (Group R) Units Installation Conversion Permit # *(No foundation Inspection) ...................................................................................................... Deed Restricted Sq. Footage �r (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) Commercial/Industrial Q Q Sq. Footage New Addition (Including Exterior Roofed Areas) Building Department Representative Date ,District Identification No. -10 ,1'1 School District certifies that w o_.1 (Applicant) (Street Address) (Phone Number) 0�J:ll� ra C( ";9 1114 (City) (State) (Zip Code) has complied with the requirements of Resolution No. representing .(. S b square feet. F_ School District 0 '� ._pyc _ i by payment of $ 15 S D l `E 2926 ^i FULL MITIGATION = Paid by Check # Remarks: Date NoVee: You may protest the Imposition of the fess identified above by submitting a written protest to the District, In compliance with Government cods Section 66020(a), within 90 days from the data fees are paid. Failure to submit a timely written protest will'prohibit you from challenging the Imposition of the fess In any court action. N. subsequent to the School District Representative signing thio Butte County Schools Impact Fes Certification Form, the School District Is notified by the applicable Local Planning Agency that this project Is being revlewed under the Caltfornia Environmental Qual ty Act (CEQA), this project may be subject to additional school fees to fully mftlpa a.Its Impact on the school district's schools. by White (applicant), Yellow (building department), mink (school district) feeform.As (10/03)dmm SITE PLAN REVIEW APPLICATION Date: . 6/4 K, 3 240, AP# jq l Yl Permit Number (if 'applicable) Bin Number x APPLICANT INFORMATION Parcel Size: . Owners Name:''"` Owners Address: Telephone No.. Situs Address: (, ae, Proposed Use: Residential' New Single Family Residential. ❑ Single Family Addition ❑ . Single Family Remodel ❑ Mobile Home - ❑ Residential Accessory Y ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) _ ❑ Temporary Travel -Trailer - F] Multi -family Non-residential ❑ New Commercial ' ❑ Commercial Addition ❑ Commercial Remodel _ ❑ New Industrial . ❑ Industrial Addition ❑ Industrial Remodel , Other ❑ Septic ❑ Well ' ❑ Agricultural Exempt Building ❑ Agricultural Buffer Form ❑' Applicable ❑ N/A ❑ _Other: , Brief Explanation (if necessary): - DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) Approved ❑ Conditionally Approved' ❑ Resolve Problems Prior to Approval AA VI Site Pl Stamped A roved By , _ Date ALL ITEMS CHECKED APPLY TO THE PROPERTY 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 attached) • Flood Zone: X • Flood Panel No.: Index Date: ❑ 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: CL 09 ) Applicable Building Setbacks: ❑ Setbacks drawn on site Plan. M CDF approval needed for encroachments into SRA setbacks. Page 2 of 5 Zoning Code Streets & Highways Fire Prevention Subdivision Map Front ! I Side 30 Side Street Rear -30 ` Height Waterway N/A N/A N/A ❑ Setbacks drawn on site Plan. M CDF approval needed for encroachments into SRA setbacks. Page 2 of 5 Applicable Development Fees: Standard Fees Amount Formula Fire e ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87 ❑ Chico Urban Area — Road ❑ Thermalito Drainage Area Thermalito Urban Area ❑ Other -----------------------------------=------------------------------------------------------------------------------------- Subdivision Map Special Fees ❑ Water Tender` 5 ' ❑ Road Improvement F ❑ North Oroville Aiea ❑ Other (per map) 'Check 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: Legal Access Provided: ❑ No -❑ Yes Deed of Reference: Legal Access Required, ❑ No ❑ Yes Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name: Complies with County Standards for Deed Creation: F1 No ❑ Yes Comments: ❑ Parcel Deemed to be legal s ❑ Verify Legal Parcel ❑ Verify Legal Access 0 Provide Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a. Merger !' ❑ Obtain a Lot Line Adjustment t ❑ Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23). ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements a ----------------------------------------------------------------------------------------------------------------------------- Page 3 of 5, yawcst e Lh6e�641�1 P6 bl6 g4fe"- 10 S� l Subdivision Map/Parcel Map: Map Date of Recording: cfiu,-g—; [-I, ( k Lot: 1Z ❑ Use Permit/Minor Use Permit Permit Number: Book: 1-23 Page: ,� �t 7 Date of Approval: Parcel Map/Subdivision Map/Use Permit Conditions ❑ Comply with the following Conditions of Approval: ❑ Meet the Fire Safe Regulations of Butte County and P.R.C. 4290 r Q ❑ 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 whichcan 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. Page 4of5 4 _ Ci Summary of Specific Requirements: This information provided in this summary is based on the application information and on the best available data at the time of review. CALarrys\Building Permit Site Plan Reviewl.doc } c f Page 5 of 5 Butte County Department of Development Services 3T DIRECTOR o r�a p p . 7 County Center Drive o 0 Oroville, CA 95965 0-- q.'o (530) 538-7601 Telephone (530) 538.7785 Facsimile ADMINISTRATION.* BUILDING * GIS * PLANNING March 4, 2005 Timothy Wall 95.Oakvale Avenue r Oroville, CA 95966 ` Subject: Building Permit — 04-3618 (New Single Family); APN: 068-360-141 Dear Mr. Wall: The Butte County Department of Development Services, Plannin ivision, has reviewed the submitted application. The home site location on this parcel has en determined by the map that created the property. The exact condition reads: "Locat omesites as far as possible from • natural drainage swales on-site and utilize standard a ion control measures and construction techniques to minimize erosion potential. Your homesite must be located in a rdance with the approved map, and utilize standard erosion control measures (Availab at Website: www.cabmphandbooks.com). Please adjust and resubmit your site plan to the D artment of Development Services, Planning Division. Should you have any stions please feel free to call Chris Tolley, Assistant Planner, between the hours of 8:00 a. and 4:00 p.m. Monday through Friday at (530) 538-7603. Sincer ly, e en Streeter anning Manager 9 eq S%� Put; 6p Accws LO ",j in dm& "r couno 0! f Lo. "n final Soo is fn 1 C2 S•... _-:. '_ . P: -c'.. C me Final Ln MreeL CnCMWnWnZ PeMiC and CWSLMMZ Munrin pro vidAg a"quace sight discave W LK ].titers Road iay any del:'.n�-,nt taxes or cur: c::•. L.a.xes as re A13 hfeet the req-,:-' re.ments 'o.f.the Buicre Count), Fire ..S ol O.W.iD. 4. --h D„ con.. 15 Pro'. },.`.field f: -n- tzk around ei:-. or :00 ft. of on setbac:: 16 Sh Che uphil 'M% o Uro-:`.1.ditch on hIi setback on side onparcul 2. On - S 1: - E- E. -IC 2-2 SL,ri:lard erosi.cjn control, measures and constru techniques to minimize erosion potentialX 120 -he -I ineamert-_- described in tbe,seljimjc- hizards evalaiio by J. f,,_-h.-J:e on the final map and desigi-"6t. '- ,60t—bailding'.set Ati from the lineament. ,t. n, 4 na as -Stru s A '4f21j:-Tlh_ci: a note on-thijfi' ' 1' map stat All. , '4' , , ' ­ - - �il . - , to be constructed to uniform �!uilding t 'a"fi da' axinum lateral groan: acceleration 68 sty 1'd ijl E."wM �on of anchored or braced to meet', the"same'stan'dar o homes shal Aj l be exempt From this requ 22 Place a note 0:1 the final map stating: cons on permit i.chi.n 100 ft. of Li._ Palermo canal with6ut"prior. Inspection "and D '. roval o- the Oro,.--'-!.;,,: Wyandotte irrigation District %}<j 41, ' 23 Deed to Or ov 1 e WN.an c.o L r. e Irrigation aiiiftssemento it the Palermo canal .encompassing from thefV ,top',o ths(cut to•theoe of the berm including any associated facilities aniaciess roidi. ire ngmitigatibn measure is requi dit" e'iollowi -A U rata share installation Pa' it pro e towards"ins"t' ftraffic signals ligignghyay ;ind Oakvale Avenue. P. WALL, 17 o•: i d. d oc;:m r, o n f rom Oroville Wyandott6 D :.ng thi!L are willing and able t0,' Pa:-Ccl L il'.S*, :­­'. "development of parcel 2 C r, M r. Q < 1 c water supply." 1. 0:,. ar 19 L-lr----c homc-si­es as ;nr Fts possible from natural, drainage avale's On - S 1: - E- E. -IC 2-2 SL,ri:lard erosi.cjn control, measures and constru techniques to minimize erosion potentialX 120 -he -I ineamert-_- described in tbe,seljimjc- hizards evalaiio by J. f,,_-h.-J:e on the final map and desigi-"6t. '- ,60t—bailding'.set Ati from the lineament. ,t. n, 4 na as -Stru s A '4f21j:-Tlh_ci: a note on-thijfi' ' 1' map stat All. , '4' , , ' ­ - - �il . - , to be constructed to uniform �!uilding t 'a"fi da' axinum lateral groan: acceleration 68 sty 1'd ijl E."wM �on of anchored or braced to meet', the"same'stan'dar o homes shal Aj l be exempt From this requ 22 Place a note 0:1 the final map stating: cons on permit i.chi.n 100 ft. of Li._ Palermo canal with6ut"prior. Inspection "and D '. roval o- the Oro,.--'-!.;,,: Wyandotte irrigation District %}<j 41, ' 23 Deed to Or ov 1 e WN.an c.o L r. e Irrigation aiiiftssemento it the Palermo canal .encompassing from thefV ,top',o ths(cut to•theoe of the berm including any associated facilities aniaciess roidi. ire ngmitigatibn measure is requi dit" e'iollowi -A U rata share installation Pa' it pro e towards"ins"t' ftraffic signals ligignghyay ;ind Oakvale Avenue. A 0 A WILLDAN Serving Public Agencies t . May 4, 2005 Scott Rutherford Butte County Building Department 7 County Center Drive Oroville, CA 95965 Tel: (530) 538-7169 Fax: (530) 538-2140 117 C Street Marysville, California 95901 530/749.2373 fax 530/749.2199 www.willdan.com COUNTY OF BUTTE PLAN REVIEW Status: APPROVED Willdan Project No: 14353-1314 Jurisdiction Job No: 04-3618 Assessor's Parcel No: 068-410-006 Applicant: Tim Wall Description: Wall's New Single Family Dwelling Dear Mr. Rutherford: Willdan has completed a plan review of submitted plans and documents for the above referenced project and recommends your approval with the conditions noted on the 2nd page of this letter. The revisions were in response to a previous plan review and comments listed in our letter dated February 1, 2005. The plans and documents provided for this review that have been found in compliance with the applicable codes are: * Plans: Two (2) copies sheets A-1, A-3 through A-7, S-2 through S-4 dated 04/01/04, A-2, A-8 S-1, S-5 and S-6 dated 12/20/04, by Frank Glazewski AIA. r * Structural Calculations: Two (2) copies pages 1-78 dated 12/22/04, Two (2) copies pages 1-4 supplemental structural calculations dated 4/22/05, by Frank Galzewski AIA. * Energy Calculations: Two (2) copies dated 12/20/04, by Aaron Klemenok. * Truss Calculations: Two (2) copies dated 12/22/04, by Endeavor Homes. The plans have been stamped with the Willdan approval stamp and dated the date of this letter. According to our previous letters relating to this project, the superseded plans and documents will be discarded within 10 days unless we receive other instructions. On the pages to follow is the identification of the codes and standards applicable to the project, a code analysis, conditions -of -approval and identification of any deferred submittals. APPLICABLE CODES Unless noted otherwise, all comments are based on requirements of the 2001 California Building Standards Code found in the California Code of Regulations; Title 24: • Part 2, known as the California Building Code and abbreviated herein as "CBC." • Part 3, known as the California Electrical Code and abbreviated herein as "CEC." • Part 4, known as the California Mechanical Code and abbreviated herein as "CMC." • Part 5, known as the California.Plumbing Code and abbreviated herein as "CPC." • Part 6, known as the California Energy Code, and Energy Commission Standards, and abbreviated herein as "CECS." CODE ANALYSIS Our plan review revealed the following information regarding the occupancy designation, type of construction, and other pertinent features. This information is consistent with that shown on the plans. Specific Use Type of Occu anc Type of Construction Sprinklers Stories 1" Floor Sq Ft Total Sq Ft z„..a FIRSZi Y ��t1s ri no Dwelling R-3 V -N No 1 2456 2456 Garage U-1 V -N No 1 576 576 Cov. Porch R-3 V -N No 1 1484 1484 CONDITIONS OF APPROVAL 1. Approval is .contingent upon the review, requirements and approval of other. departments and/or agencies that have jurisdiction over this project. 2. Revisions and/or notes as red -lined on the plans. DEFERRED SUBMITTALS Our plan review reveals no deferred submittals noted at this time. SPECIAL INSPECTION NEEDS Our plan review reveals no special inspection needs pursuant to CBC 1701. Sincerely, Michael LeBeau Ricardo Guzman S.E. . Plans Examiner Plan Check Engineer CC: Alice Mefford, amefford(a),buttecountv.net Frank Glazewski, 1370 Ridgewood Dr. Suite10 Chico, CA 95973 (530) 343-4630 Fax: (530) 893-0532 Page 2 off 1h'i ldan 143 3-1.3:(4.PC2.T' Butte; C«unty 04-3618 Butte County Department ofDevelopment .Ser ces OT. TF YVONNE CHRISTOPHER, DIRECTOR o 7 County Center Drive o ___ .-_ - •. Oroville, CA 95965E (530) 538-7601 Telephone EOvU Nl�� (530) 538-7785 Facsimile 'LQo Building Permit Application���¢/�h��Jf� Acknowled meat . f I' hereby acknowledge that •I' am voluntarily applying for a building permit without pre -approvalfrom the .Butte County Jif Environmental Health Department..-.- I epartment..•.I acknowledge that l have submitted a septic and/or well application to the Butte County Environmental Health Department. I have been informed that the County of Butte has made no determination of whether or not the property on which the proposed, development is to be located is considered to bela; developable lot. r,. ► „ Finally,-! have been informed that no building permit will be issued without the Environmental Health Department clearance, and understand that compliance with Environmental Health requirements is required prior to clearance.' Permittee Name Address q -S c9 t(` 4' Ie— ' f AP Number Permit Number I have read and understand the above acknowledgment: y ' Signature of Permittee Date Z Z� t r ' Acknowledgment form.doc (6/04) Acknowledgment Form Procedure THIS PROCESS IS FOR MOBILE HOMES AND SINGLE FAMILY DWELLINGS ONLY 1. The Single Family Dwelling must be proposed on a lot created by one of.the following: a. A parcel map (TPM) after March 4, 1972. b. A subdivision map (TSM) after July 1, 1949. MOBILE HOME LEGAL LOT WILL BE DETERMINED IN PLANNING REVIEW and does . not need to meet these dates 2. The project must be fully engineered by a California-licensed architect or engineer (See Submittal Documents). 3. ALL applicable Submittal Documents must be completed and included in submission. 4. A separate, concurrent application for this project is made with the Department of Environmental Health (EH). Applicant is responsible for notifying Development Services in writing should EH subsequently deny clearance. EH WILL PROVIDE AN ENVIRONMENTAL HEALTH CLEARANCE WITH AN APPROVED SITE PLAN TO THE APPLICANT 5. Applicant is required to bring the approved EH site plan to Dept. of Dev. Services.. AND WHEN RECORDED MAIL TO: BUTTE COUNTY BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 290105-00080z10 Recorded I REC FEE .7.00 Official Records 1 COPIES 2.00. Count } CANDACE J. GRUBBS f Recorder ROSEMARY DICKSON I ;' ` Assistant I Kathy 01:28PM 09 -Feb -2005 I Rage 1 of 1 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: p� c m rn A -p S 1.23 % �j 'o (o t4,41 <vt cop p©,2A-* Date ?''" '" PROPERTY WNERS: T'm ofd &�),4 2 - State State of California ) County of 'On D - 0-25 before me, lc �Asa< SIJ `1J1� ��✓��C personally appeared personally known tome (or proved to me on tie 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. ; Signature_ Seal: RICHARD FEUERSTEIN VCommission #1299529 � Notary Public - California j pp / ``,, Butte County A.P. # 06 8 �3 L6 ®-1 T1 My Comm. Exp. APR. 13; 2005 R�ma� 068 -Po -tuq TO: FROM: SUBJECT: Building Department ; Environmental Health Sanitation Clearance E. USE ONLY Plot Sten anechoa-. Flow Ian anschad Sant to ®.O. Owner Location AP# Plan Approved for: Sewage Disposa Water Sup y: Publi Private Well Clearance for dwelling. Other Hold final for: Final clearance O.K. for: NOTE: - P,� 0" 4 "-,- / Environmental Health Specialist 8/96 03 Date 'If =-'.t7E of CHEN 0 of °, O' O "O °j2j 1, � 'DINING:ROQM LIVINGR;O.0 i .. 1 i ii V • i 0" 1 - 7- - J—.'97 Q.� cD QD -I► c <C �� ill;^t.. :. ...Y•'.:. '� .. � .... ...... IN 4;o k,[NQ at 42 C n 4 z i 0� c „ r'` Ott . � � •; ��, Q m Im _ov. let N p.00 J a� s:P_•..:;-...--,a,., ,o.e. .:::...._..... .. ...... ...r -'{+.t,.;;brr ,¢t.a.,m ST.'•'� '�o+'s.-:-r;".t.., 4dxww:!e+L c.... _:3:.F,Y..�R3e..m-i: t c., ..- ,...... .. ... . .. .. . e . � � � .� •� II .:�. v6� �wIry � 0.1,Ii12. 91r611IlAle 115 T Tz / Qo.59' I _'28 • .I I 0• UNf/QTGf/E/J AREA 2 Ac G.FS.A / I � I I q• � r• e •7 L•F. S.q� � I I I .�'• � � � I G: F. 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