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HomeMy WebLinkAbout03-2267 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 MOBILE HOME SET-UP 2267 Permit Number: 2267 Permit Type: MOBILE HOME Class of Work: MOBILE HOME SET-UP Proposed Use: MOBILE HOME SUBDIVISION Square Feet: Est. Value: Improv. Cost: Date Issued: 8/01/2003 Total Fees: 1,372.50 Amount Paid: 1,372,50 Date Paid: 7/31/2003 -------work Desc: MOBILE HOME SET UP Address: 6031 RIDGEWAY DR ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: ZEPHYR RIDGE Parcel Number: Name: MACPHERSON WILLIAM Address: 6031 RIDEWAY DR ZEPHYRHILLS, FL. 33542 Phone: JORDAN (INDIVIDUAL) JORDAN (INDIVIDUAL) BAHR'S PROPANE GAS & NC, INC. I EHO I MOBILE HOME SET-UP .. MOBILE HOME MECHANICAL .. WATER METER RES 3/4" NE 60,00 WATER CONNECTION MOBILE HC 35,00 MOBILE HOME PLUMBING 180,00 209,50 40,00 I 'd }yr1 (JJ I q/ 0 '3 ~ Nfl .~\'d~~~.1,. ~ !.~ 'j\~ I ~__ . I _._.___ REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Thirty-five dollars ($35.00) shall be made for each trip for each trade: (a) Wrong address (b) Condemned work resulting from faulty construction (c) Repairs or corrections not made when inspection called (d) Work not ready for inspection when called (e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible C--o 9 - t- 03 _.J!1e p~'tl1lent of i.llspect!9..!!.!ees sball be made b~fore Ciny further permits will Ee issued t9 the person ollming sam~.__ Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances .".--.--------------------- . .~-.,,-----.-"ff;;.-- ~, ~e.(, ...... NO OCCUPANCY BEFORE C.O. ~ ONTRACTO SIGNATURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER Lo+ o'%' of ~"'+D P '5, 'R i d~ e. fA)aJ.(1->}Q.(' € Ze-p~r- 1<,'cl3€ /"" (~H-a(.-d.I- OJ:fa -lJOOOO-0570) "'PI ad D [Pi- 6'6 " <:::l '" 35' ,Vfr ~. I,' r'I <. c;..f. Ie I- 5 ( !')' r (o.ce. ~.:~ ~ E ~ ~ -- ....-.Q Q ~ 'ff 4. I <- > Q ~ ')l., o ~ '89 " ALL WORKSHALLCOMPL YW11l-I ALL PREY AlLlNGCODES, FLORIDA BUUDING CODE,NATlONAL ELECfRlCCODEM"I ~ CITY OFZEPHYRl ULLS o:mlNAl' = V (}-<-\ ;:J ~ --~ -.... ~-.. \ ~ ~ ~ 3 ~ -:.gJ r::x-- " .,,,"-- ''\, JUL~28-2003 07:24 AM HR 4- ~ 1 ~ , ~-J 2t~ 'J ~ \() ~ '11 ~. <3 >(~ (,':) " -- . 1 I ,.:j I 2 I I <ll ! , , ':f~, q I '~j ~ I I '~ \f) --- ~ :n ~ (~ ~ ~ \,,) ...... "- ~ ~ f.-~ ...... -.: ~ ~ iQ ~ <t ~1 ~j{ 8 , , -J. . '.,..- - III ; ~ Ills ~ !i: I~~ lB- ID -~ '_101 , . :I It' III Sir , . '", I ~ I ~ ~~ ~ I - v I .~ . ..... ....... ..... ...... . -... ...... ~ ~-t-{ ~\\' 'f' 7791410 ~ d ~ q ,,\() ~ - ~=rl-- " .W- I~~~~ a:) ~ \'" ~ J' ~ nl c~r ~. ::; ....!l. ~ )l~~ <:l ~ n~: 5 , .... oC ,:~~ < ~ ~ .., ., ~ '2 ~ k ~ - r& P.04 Pocket ....troll:'.... T.t X / ~()t7 X /)'co _I X /~ca X,,150C7 , ~mll. .. X L.:~ 00 T tilt locI'" X /?CO nil Site Rounded Down to IS CJ CJ PSF u-.d ...,....: fj/JAl..t4~ '. ..-" ~ " t<\ ~ I ~, ~~ ~x. ~" ' ~.~ /) V ...'J ~ v1 ~ ~) ~ ,~ ~ ... 4... .n5 ..:- ~ sn ~ \') A..::><..~ 4,-r6 ~ <<:::::::> -, .... ),f") t- ~ -, -- o::;~ -------... "- ~ ~ .&.- ~ J tt j r=j ~ I J'~ I ~ ... : I ~ 'I ! ...~ ~.. I e1 .. I 1 , , rb I , ~i , I c:p , , . ~ , . , tp . . ... . ~ , . I , ~ , , ~ , I I tp , . ... I ~f ~,1 : I ."1 ~-T~'/I" r-Jfr 66--r.'/11 t.- n Jto i 1:11 rH .---...----= ---cp- I -:T~ ="'=.~ r; i : r '. j II : I I '4w'9 I I I ..~ II ! '! 1.4 I' i : i ... j II : I ..,~ II I I r II : [~ II ~~~( :i, I z ~I~! I ";oJ I 8 " ,~ !; r.tJ Ii! I' .. I l.. ,I _'~ QC 'I ~ W I ! ~ i j t;l ~ ~ I: I I " ..I I,' ': ~ I /. r , r. , i *. I' tb =ll ' r ~. ri' X j i 0-' . I ....., 18' 'I' ~' b. I I ... In I , I , I , I I . , . . I I , , , , I I , i * , , , , !: ~ . . I: I ; : I I:f:\ I I I . ~11 i ~ i - ~ !I~ j ; i T i i 1:11 , . . . . . ! , ' -~ , , , ! ,! tt " 1 . . ~-~l- _ I ...._ '_""" I. .. , I ~ ----r- ." ...,... I .~=~==::S'"'=~::==~ == , , t? , ...., ..... ----..... 0;[ .of ..... i>- ;; ~ ~ w ..... C5 t.J .. ~ ~ ..l. CLI !Q !:::! ~ >- f! >- c. -J' >- 3 lr ell: W ii: lir i ilJ --'I: h 11 1= I ~ t,~ lif . iI ! ~ r f!i A i!: M . i . ~ 51 I l!l I~ eo .. ='i i i :~ it I !- ~M I ~, i~ ~ e; ~I i ~ S ~ bi ~8 Ii i ii ~I . 04 = I ,~ .. ~ !!J ~i ~... ij ! i~ I: i! Ij i II I~ ,~ - ~a ~'I , . . , . ~_._.... _... ..._~" ......."... _.... UN~'. JUN ~U ~r'ruu l au:.\.IU1~ I ~ ,~nUnl&aeClJ r IO"WIDIlHOII- at..... MDM&$ 21" . .'WlJ!:" HOur sa" WIDE HOMES PIIW PW ..... pw' 1_ .... u.lI ...., ..... ...., LaM PWuM PIlI' ..... .... .... PW ..... PIIr &..- ..... ~ .- (LM) IMin8 (u..) (LM) m 1"=-= :=r (UIe) (1M) (.....,) ~~, r) (u..) ~ 20 PSF .... 21) 40 PSF 3D"': 3O~l&P PSF 30 'SF ~PSF lIIIIn Roof .... Roof I...... ...., ..., Roaf Rou' .... Roof IIoof Root --- ZOne Zone zone %oM zone :z..ne zone ZaI~1II Zone %AM Zone Zone (Pl.) 4 181t .2CMKJ 21n "11'00 ii ZMKl 238 25110 "2IM Jt -I 3320 ~ 22'n II Wnf -2tIIO 3180 2tII 33l!Hl ~ 4150 ~6 J 272C .. e 3830 3154 1Ol~) 441 m - 7 31n .,0 .3BDI 4180 "'7 4110 l8l11J ~ l!181 - 4130 4S4O 4770 511 4720 . ~ 18 S8l IOC B 3130 9 408U ~ ~ li= =:\i 5370 575 :i~ iNf IU :J3l r75C ~C 10 V 1 :. 5170 I38D ~)O l44: 701 'SO( I30C ...1IODi ,. !5IJ7 aa r;;o 34 870 750 830 . .... . - . TABLE 2 PIER LOADING UNDER MAIN I-BEAMS DOUBLE-WIDE HOME~!J I'E$: _ Table 4 for minimum footing alz.. baaed on pier loads and allOlNl.ble IliCllI bMrlng capac:ltie.. The footing sizes and ... ~ are minimums reqund 10r ~ applicable condition.. The footing shall not be amaller than the pier it IUPPOrts If 144 8quare InchM. 1\e maximum spacing of aupportl II not to ~ ,0 feet. Yhere It II impractical to maintain 1paCing, such .. in the axle ..rea, tt111 average of the distance to each adjacent IUPPOrt may be UMd to determint eupport ..-qulrements: for exalTlple: If 'the dletanee. to the adjacent supports were j'.q and 8'-0". the average epacirlQ woWd be 1'-(;f. ~ I l PlerC 'M .ve~ spadng tor pier B WCM.i1d be (6 + 8) /2.7 ft., thereto,re tier B wouki be dlllgned tor 7 ft. pier ipIldng.' " ~ntrated Ioada at marriage ILrul (1M Table 3). .~ ~ I~~~ the above ,!,able ~. the weight per foot each main I-beam I~I carrying. Multlpty this number by the span , ~r .. ca.. ;rRow to determine tMt requiNd capacity of that pier. 1< .'4' 8'-(1' III 'oil:... 1 I - Pier " Pier 8 11 !_ '~WT-'::':'~~;;:;:""'''''Al..':l:'. ~ ''''.<!,....~~'':III. ",. , .__.,__ ....~.... ~...n_'.. OUNDAno~ AND sup..:>BT REQUIREMENTS ~.Con1liDuecl) TABLE 3 PIER LOADING UNDER CENTERLIUE BEAM DOUBLE-WtDE HOMES II · II ..~. ....... ....... Ph..... (Uaa lLJIlI) ,~, ..... . N' III pep '.... ..... ..... z.- a-.. .."'" 1 1 , 1 . !i04O 1N01U' \) ~. tIIAlIIIIlft......~............ -.. ................... .......!-................. 2)...... 1&... ............. ..... ......................... ........... ... K 3) The __1. A ~........... .....,.... ...,. .a' - ---..... -..................... .......,...' it ;;::;;;.... ___..... ......J . -. PIER OAD AND I noN UNDER SIDE',""AL,l DOORS AND WINDOWS UIII........ ~...... TWIIII-'. .......... . ......-.. ~ A+j ! I 1 ! i A'-; 'IW'- ..... .. ... -....... .-....- .....--- ... ...... ...... .. IN PIer 10.. (&.aSl 4O"F Roof zone 1980 2200 2<420 2e2Cl 1730 1980 2100 2160 2360 NOTa: 1)................. ..,........... I' 11'......,--....... :I) ~_..~._--................-...-.....,.... ~) ................ ............., ~_"I .'~.......... .. ~ eN .........._ ....,.................. -- ~.4L"'...4 .........,. c..-....,..,... WIt your tlOIM ID 1II1l1"...1A..... J - .. .......... ' . 5) See .... 4 .. ......... ...... .... ...... ... .... ............ ... ...... -I -. ., ...--.. _............ ,,............. WIt" ,..... -.... ... .....-..a UIlIlwW.. .12'. '4'.20', 24'. .. - - ~ ....... mey II. '0" lML ............. __ ~.. tt..... _..................... iI 'I'. 'II' .. 3Z' IMft ~.. __1G"' -. 1't,..... ____ _...... _1............................,...-... .. ' -. '.." -~' --~ 09116/00 OI:U PAX I , . \. Ie- ....... 17 ..... __,' .. ~-,' -, MOTU . It .....~ .. T". t, ....... .. .... ..... ... _. '.1111' .... ..... ....., . __ ..... ... "3'1. -'., ...... ... " 47'11I ... ",..... lilt..... ~~......... ............... ... ......... .... _ _ .. AI1'IIIII.... ~., Z) ...... ............,. ____....... ."'. ..., .. _ I." .,4PII....... .......,. 1', 1'1 ...........' 3t A ......... II ........,..... If....- ., . 11.-'-" II........... ........ ~ ........ .... ....., ....... ... ......,"'.... ..., lit ...... 4t 0IIltf ....... -..... ......... . "'"-~ 0IJllMt ~ ., ~ .....'........... .. .. ..... - - . 17' - '~1 _. ....... ..._.."............_.~. I A......., It .......... Jaat ..,..... 1- ~...,.. _... __ ....__ #' r? '" .............................. ........ ..... .... -.......,............. 1 . ......_. ___"h _ .,..................,. .......l " 1M..... ....... ........ 1M __ ........... .............. II ,r, I\~'" ........... ... " 1M ...... ....... ..... .. ....~. tr.! ......,... _ I'M . IL ~ .......................... ,r _........... ." - ..... ............, ~..................... - .....'................... I)..... , ---................ __ ~ T........... II.............. III........ _. ..._~_ ...,.._. I) AI 1M ......- ....... ..... .,A b-. ........, . .......... _..... If....... 'lit..... ..~. "1 "................ II.. ....., _ t. ~ II __..............---. 11tt.e Or III ......,..1................ n Jm ____- ............__........... =_.c::_~ I:CJT Gla ~ Tn.,::._ ca........ ~,.j;:',:=> (::;~.'1iUI~,"'~~~' ,.,..wna ~, WInd '. .ZMj......~..O.,RtI~i'~..:....'O,~ - - Page2CU _r:~ ~ I ..... 'A' ,., .... ..... "1I1~. rl :c,:"_~~~i'''''Ii.,,''',,'l''''' . .,t..1St ...1,_ -. - ...IMI*O ~."' ~. '.-rr iNIItIIM ....... ...... ~), ~ .".,. ... AIw:hon" be....... ...... o.c. . "..., at WINI z..' .... ..... .... III WInd Zone.. ,..,.,., ---- ...... ...., _.~ ~ ~ ,- .. ..... .,.2 ..., PIII:Jt AIIll,..... ---..- ...... 'It'''' ......." _i~lf./MlIlI. --./ ..1 l l:~ .~.,~ ~ NOTI: $"-' .....1.. ana pier ...... for InpleoWkl.. .,e tile _.. .rap angle. .-<l pier heJgIlla lor 21" wilH lOftils, "H max"",ay be ln~r..Nd ~ ~ 12 l!\e llepttl 01 the Il'lllin I-CIMITi ......" rnelIlOd 1 01 lSelaiJ '/I;' iel ..-eel to alladl li.. ~ ""'0 Ille I rnalll ,.....rN. , ",. mimm4ll11 p,,,: I hel8N of 22" .. 1NI1ecl Oft a 10" I.tleatn anll I . '2" _taNI from 1M ~1Ulm ollh. I I I......m lCl ""ialWti ~raoe lI_ nol. /j. !J "'I ~ \, '" 1\/\ " ~~.:J } 'V " .. - - -- 'I' . .. ",- · - - -- " ~~ : i -11 /- ~1 I L,... I ~! f - (T">o , go -il ~~ r ~I ~~ ;J~ ~i .... ~ ~~ i ~ ~ .eod .1.'6J...L .. c!1 ;1 'il "I I I ,.- r-.J I~ I :: I: :\JJ ....., l. r- :. :. , ~I; I ~~II }F~ r1~ ~ ~ - 01 i ~ ..... ~ ~A ~) " (\ \... lJ) .... ~'~.' v....'... r It) ? €", fi-- ~~ ~~~ ~U\ ~~ r-~ ~ .; .... ~S~3~Nt ~H W~ ~r.:~~ ~~~~-.~_~n~ OWNER'S NAME -.t!ltt l!., ph er-s v h LV ,t / (,' Gv W'\ JOB SITE ADDRBSS(1:4'f:'iidOj!/t0~~JS (,uJO.-y .~ dr LEGAL DESCRIPTION: LOT(S) 5' If +O~S? BLOCK 0 PARCEL ID # 03-~V,;-;U-:-O/30'-O[JJOO -05'70 CITY OF ZEPgYRHILLS PERMIT APPLICATION BUILDING DEPARTMENT 5335 Sth STREBT ZEPBYRBILLS, PL 33540 Phone:S13-7S0-0020 Pax:S13-7S0-0021 DATil RECEIVED PLANS REVIEW PBE PHONE CONTAC(jB) 7/1- 'J YI5' SUBDIVISION Zr?f/'l '1 r R./cij € WORK PROPSED: [JNEW CONSTRUCTION (OBTAIN FROM PROPERTY TAX NOTICE) [J ADDITION [J ALTERATION [J DEMOLISH [J REPAIR IStINSTALL [JSIGN [J MOVE PROPOSED USE: [JSGL FAMILY DWELLING [JMULTI-FAMILY [J# OF UNITS it'MOBILE HOME [J OTHER [J COMMERCIAL [J INDUSTRIAL o SWIMMING POOL o RESTAURANT & HEALTH DEPARTMENT APPROVAL DESCRIPTION OF WORK New )1?abJ/~ hDrne '~P/uC'fl men f BUILDING SIZE '3 D X Co 0 SQUARE FOOTAGE jg-OO HEIGHT RESIDENTIAL: COMMERCIAL: ATTACH (2) PLOT PLANS & (-2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. g"BUILDING n( ELECTRICAL ~ynmING ~ECHANICAL PERMITS REQUESTED $ 50. 000 /~OOOVALUATION OF TOTAL CONSTRUCTION ( I . AMP SERVICE 0 FLORIDA POWER 0 W . R. E . C . $ VALUATION OF MECHANCIAL INSTALLATION o GAS o ROOFING o SPECIALTY o OTHER TYPE OF CONSTRUCTION: 0 BLOCK o FRAME o STEEL [g/t>THER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREAO YES 0 NO BUILDBR ~. SIGNATURE, ~1<Jrtn^'- COMPANY acd-v r TV-CCli1 SoD .f STATE CERT OR REGIST # ::n.f-OOOO<ltJ.J7 CITY PROCESSING # ****************************************************************** BLBCTRICI~ _ SIGNATURE 'i~~ ~ COMPANY J'o~do V\.... STATE CERT OR REGIST CITY PROCESSING # '-1 I.' 1::; t e e..'n- I c. # E Rooo 8''1 ****************************************************************** PLUMBER ~ LfYI.&th-.. COMPANY Jo y- do Y\-l:>/ \A. ~ b I' v\.~ STATE CERT OR REG 1ST # R f:' 00 t..j ;) 3 Cc 8' CITY PROCESSING # SIGNATURE * * * * * ** * * * * * * ** * * * * * * * * ** * * * * * *** * ** * * * * * * ~* * * * f' * *i'* *** A~ ** ,* * * * * *'L ' ""CBANI~ COMPANY \:SCLhr.s Irc.o"cL "c.u~~ U/Vl ST, ATE CERT OR REGIST # c... ~ <!.D LI ~ c, t..( ~ SIGNATURE ~ r r ~ CITY PROCESSING # ***************************************************************** OTHER COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ***************************************************************** CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS The undersigned understands that th:Ls permit may be subject to "deed restrictions" which may be more restrictive than City regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictiJns. B. UNLICENSED CONTRACTORS AND CONTRACTOR RES~ONSIBILITIES If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and l'Jcal regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the City of Zephyrhills Building Department, 813-788-6611. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "Contractor Sections" of this application for which they will be responsible. If you, as the owner signs as the contractor, you are indicating that you, rather than the contractor, are responsible for the work. If th~ contractor wishes you to sign as contractor that may be an indication that he is not properly licensed and is not entitled to permitting privileges in the City of Zephyrhills. C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES D. CONSTRUCTUION LIEN LAW (CHAPTER 113, FLORIDA STATUTES, AS AMENDED) I certify that I, the applicant, have been provided with a copy of "Florida's Construction lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other that the "owner", I cerify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. E. CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning, and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be perfoDned to meet standards of all laws regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that'I understand that the regulations of other governmental agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: *Department of Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment *Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses *Aomy Corps of Engineers-Seawalls, Docks, Navigable Waterways *Department of Health & Rehabilitative Services, Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks *U.S. Environmental Protection Agency-Asbestos abatement I also certify that, if till material is to be used in Flood Zone "A" or "A, etc.", it is understood that a drainage plan addressing a "compensating volume" will be submitted which is prepared by a professional engineer registered in the State of Florida prior to permit issuance. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction, or violations of any code. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of issuance, or if work authorized by the permit is suspended or abandoned for a period of six months after the time the work is commenced. One 90 day extension of time may be allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An approved inspection must be logged during each six month period, or the project will be considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT .WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER /$2,500 IN VALUE DO NOT NEED TO RECORD AND POST ~TICE OF COMMENCEMENT". , ~ Lt J~ ~J-tn~ ~?!f'-o-~ SIGNATURE: OWNER OFf'AGENT' SIGNATURE: CONTRACTOR STATE OF FLORIDA COUNTY OF -Xc, .s C!....0 The foregoing inst~ument was acknowledged BEUQre me this~day of 0lA.'-\ ' ~OD3 by VonV\.~. mOD Y'- _/' (name of person ackn~wledged) Ulwho is personally known to me, or STATE OF FLORIDA COUNTY OF \-'0..) (' 0 Th~ foregoing instrument wasaZknowledged_ Beforhe this ~ay ofJ't.....Lr ,. :;J..O"S by t Il VI VLc... VYl C C ^- _~ (name of person acknowledged) ~ho is personally known to me, or o who has produced (type of identification) and whoD did Ddid not take an oath. .1 /---J. _ _/:J . //}' // . ..A~<.4l2 t!" Signature of person taking acknowledgement o who has produced (type of identification) and who Ddid DUd not take an oath -^~ C2~~ Signature of person taking acknowledgment Name typed, printed 0 . ~~~~'-' f~ "'ClaImI. Erl*wJun 18. :<ee" . n. 0.......... . CC92574~ i ...".."'-:"!!-,....-:z-... .~ " ~-.....~ __......... """"""" ""'1',..,~';.-~' . r ;..:/....,. .~...- . 'f-,VALLf:'E ,",iJ :>f AorIdo , .'.c' j..," 18. 2IXl4 CC9257 -46 >.-...]'..f............:.'" .' . .. . Name typed, printed OIE.st' - ~(;fJ< . \,;x/itl ~i;" r, .,...._"".',-" - I. EP-~9-2003 08: 21 AM ONT~i:At:~'rOF'( .. z: AM'~ . DONNA MC)('JN .X>DR u ,~/STll HR INTERST 7791410 P.01 C~NT~AL P~RM~TT!NO 0, t~GC) r.~OUNTY Ii f.~I..CJRtJ)A X>A TE: II oa/:'i~o/O:$ TIME. :~11T4" f> Ar~e: II ~. OFr :t. rm~UF~ OFr: 1. cs: . X> RL:::(~F.t!t:''''T NUMBR a ()06:.';~5BO L1F"F I Of:. II l)ADF.~ C r. T V ~r.}~B CHECK .. 443Ci' Re:SQUCF!. FIE:e:B P'O~ F~F!.RM! l' ..' a 226' & 226S ~CCN'r :I.:l. :1,14 TOTAL flll,.,OUN1'1I 27" 40 COMPNY Atc~('JUNT ce;:N'rER AMrJLlNT nl::BCRT.PT:r.ON,II:'''Iii:~Mi nA'rA :e.ct~() .~. ;~e!J~OOO .... 2 ~ j,;!;" '10 *......*.(0 mOl_II> WASTe: 1="1::1::: St4l50 .... ~1.>3()()() - 2 ~ 3.:$" '0 .....*** r~OI...ID WAEnE: "EE: I>Fc"'C~ 60 6() :EC:Ei::tVr;::X) By......,. D ~ I--R- 7 7~ -:J' I't +!~ 5 f~ .1 ~ ~s / F~~ ]5'/ () .~ ( /~l>_OO o~ 1(0 ~o ,() .;.~ "" ~~~ I 'd 698S'ON weei aWOH a+e~SJe+ul ~V!I:S €OOZ '6 'des