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Home My WebLink About2092 TRUESDELL LN; ; CB162821; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 08-05-2016 Pool Permit Permit No: CB162821 Job Address: Permit Type: Parcel No: Valuation: Reference #: PC #: Project Title: Applicant: Building Inspection Request Line (760) 602-2725 2092 TRUESDELL LN CBAD POOL 1671802500 Lot#: 0 $23,202.00 Construction Type: NEW SORLIE: 450 SF POOL SPA pOOL AND SPA 450 SF Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 07/21/2016 JMA 08/05/2016 08/05/2016 MATT SORLIE SORLIE MATTHEW&TAYLOR STACY C 619-884-3891 Building Permit Add'I Building Permit Fee Plan Check Add'I Plan Check Fee Electrical Fee Plumbing Fee Strong Motion Fee Green Bldg Standards (SB1473) Fee Renewal Fee Add'I Renewal Fee Other Building Fee Additional Fees TOTAL PERMIT FEES 2092 TRUESDELL LN CARLSBAD CA 92008 $238.77 $0.00 $167.14 $0.00 $0.00 $0.00 $3.02 $1.00 $0.00 $0.00 $0.00 $0.00 $409.93 Total Fees: $409.93 Total Payments To Date: $409.93 Balance Due: Inspector: Clearance: $0.00 NOTICE: Please take NOTICE that approval of your project includes the 'Imposition' of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any • • • • Tl i ·1 • r w i h • . . . . City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 08-05-201 6 Storm Water Pollution Prevention Plan (SWPPP) Permit Permit No:SW160325 Job Address: Permit Type: Parcel No: Reference #: CB#: Project Title: Applicant: 2092 TRUESDELL LN CBAD SWPPP 1671802500 CB162821 SORLIE: 450 SF POOL Lot#: 0 Owner: Status: Applied: Entered By: Issued: Inspect Area: Tier: Priority: ISSUED 07/21/2016 JMA 08/05/2016 1 L MATT SORLIE SORLIE MATTHEW&TAYLOR STACY C 619-884-3891 Emergency Contact: MATT SORLIE 619-884-3891 SWPPP Plan Check SWPPP Inspections Additional Fees TOTAL PERMIT FEES Total Fees: $108.00 2092 TRUESDELL LN CARLSBAD CA 92008 $49.00 $59.00 $0.00 $108.00 Total Payments To Date: $108.00 Balance Due: FINAL APPROVAL wm: -;/io;f 1 CLFAR.ANCE __ _ SIGNATUKI: ~ , $0.00 1 p · c·cicyof Carlsbad Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 76M02-2719 Fax: 760-602-8558 email: bulldlng@carlsbadca.gov www.carlsbadca.gov JOB ADDRESS Tr -e \\ Ln- SUITE#/SPACE#/UNIT# Est. Value Plan Ck. Deposit Date SWPP -00 PHASE# # OF UNITS # BEDROOMS # BATHROOMS CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) sed A1 /J -II-t 77S <o EXISTING USE PROPOSED USE GARAGE {SF) PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS YES □# __ NOD YES D NOD YES D NOD OWNER NAM Sor ( LY'!. a.act TruJ£deL/ Ln · STATE ZIP CITYa.r\ S.°\?&\..d STATE ZIP c.4-c}O()q CA q;;o FAX PHONE eBL/-,s 8Cf ( FAX ((014 ( COM EMc~r i ~ D n. -e,s 0 ha +tn ,t;\ i l ' C.0Vv\ CONTRACTOR BUS. NAME l ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE FAX PHONE FAX EMAIL EMAIL STATE LIC. # STATE LIC.# CLASS CITY BUS. LIC.# (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code} or that he is exempt therefrom, and the basis for the alleged exemption. Any 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}) . • Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: D I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. D I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Co. ______________________ Policy No. _____________ _ Expiration Date _________ _ This section need not be completed if the permit is for one hundred dollars ($100) or less,. D Certificate of Exemption: 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. WARNING: Failure to secure workers' compensation coverage Is unlawful, and shall subject an emptoyerto criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, damages as provided for In Section 3706 of the Labor code, interest and attorney's fees. ~ CONTRACTOR SIGNATURE □AGENT DATE I hereby affirm /hat I am exempt from Contractor's 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 (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale}. □ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). D I am exempt under Section _____ Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property Improvement. □ Yes □ No 2. I (have I have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name address I phone I contractors' license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name/ address/ phone I contractors' license number): 5. I will provide some of the work, but I have contracted (hired} the following persons to provide the work indicated (include name I address I phone / type of work}: ~ PROPERTY OWNER SIGNATURE __p~ [3AGENT DATE 7 ;~/)le, Is the appJicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? D Yes D No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ Yes □ No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □ Yes □ No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I certify that I ha~ read the application and state that the above information ls correct and that the Information on the plans isaa:urate. I agree to complywith all City ordinances and State laws relating to buildlngconstruction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for nspec1ion purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA penmtt is nequired for excavations wer 5'0' deep and demolition or construction of structures wer 3 stories in height EXPIRATION: Every penmit issued by the Building Official under the provisions of this Code shall expire by limitation and become nuR and void n the building or work authorized by such penmit is not commenced 'MIilin 180 days from the date of such pemlit orn the building or work authorized by such penmtt is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 106.4.4 Unnorm Building Code) . .J!S APPLICANT'S SIGNATURE DATE Permit Type: BLDG-Residential Application Date: 07/21/2016 Owner: COOWNER MATTHEW AND TAYLOR SORLIE Work Class: Pool Issue Date: 08/05/2016 Subdivision: Status. Closed -Finaled Expiration Date: 07/26/2017 Address: 2092 Truesdell Ln Carlsbad, CA 92008 IVR Number: 715931 Scheduled Actual Date Start Date Inspection Type Inspection No. Inspection Status Primary Inspector Re inspection Complete 11/14/2016 11/14/2016 BLDG-51 000980-2016 Passed Andy Krogh Complete Excav/Steel/Bonding /Fence(Pools) Checklist Item COMMENTS Passed BLDG-Building Deficiency Eco bond Yes 01/27/2017 01/27/2017 BLDG-55 011643-2017 Passed Andy Krogh Complete Fence/Preplaster 03/30/2017 03/30/2017 BLDG-Final 018247-2017 Passed Andy Krogh Complete Inspection Checklist Item COMMENTS Passed BLDG-Plumbing Final Yes BLDG-Structural Final Yes BLDG-Electrical Final Yes March 30, 2017 Page 1 of 1 Inspection History: 08/23/2016: 23-BLDG-Gas/Test/Repairs Approval Completed By AEK; 08/23/2016: 51-BLDG -Excav/Steel/Bonding/Fence Approval Completed By AEK; 08/23/2016: 52-BLDG -Underground Plumbing Approval Completed By AEK 'fl I «t~ ~ CITY OF CARLSBAD PLAN CHECK REVIEW TRANSMITTAL Community & Economic Development Department 1635 Faraday Avenue Carlsbad CA 92008 www.carlsbadca.gov DATE: 08-02-2016 PROJECT NAME: SORLIE RESIDENCE POOL/SPA PROJECT ID: CB16-2821 APN: 167-180-25-00 PLAN CHECK NO: SET#: 1 ADDRESS: 2092 TRUSDELL LN. VALUATION/SCOPE OF WORK: $23.202 ✓ This plan check review is complete and has been APPROVED by the ENGINEERING Division. By: CG 8/2/16 A Finai Inspection by the Division is required Yes ✓ No This plan check review is NOT COMPLETE. Items missing or incorrect are listed on the attached checklist. Please resubmit amended plans as required. NOTE: ONLY ITEMS THAT NEED CORRECTION/CLARIFICATION ARE MARKED X. Plan Check Comments have been sent to: CARRIEJONES@HOTMAIL.COM You may also have corrections from one or more of the divisions listed below. Approval from these divisions may be required prior to the Issuance of a building permit. Resubmitted plans should Include corrections from all divisions. For questions or clarifications on the attached checklist please contact the following reviewer as marked: PLANNING ENGINEERING FIRE PREVENTION 760-602-461.0 760-602-2750 780-602-4665 Chris Sexton ✓ Chris Glassen Greg Ryan 760-602-4624 760-602-2784 760-602-4663 Chris.S~xtQn~i;sirls!2s!d!.s!,gQv ChristQgbec.~lassea~i;arls!2at!i;a.gQv ~ regQD'.. B)'.a n~i;si r!s !2agi;a .gQv Gina Ruiz Linda Ontiveros Cindy Wong 760-602-4675 760-602-2773 760-602-4662 ~i□a.Buiz@carls!2at!i;a,gQv Li□ds!,Q□ti~ecos~i;arl~bagi;a.gQv C)'.ntbiii!,WQn~i;l;!rlsbl;!di;a.gov Dominic Fieri 760-602-4664 Qomi □ic,Eieri~i;s1rl1z!2s!i;!!.a,gQ~ Remarks: E-37 Any outstanding issues will be marked with a11 [X] Make the necessan1 corrections for compliance witlr applicable codes and standards. Submit corrected plans and/or specifications to tlte 811ilrling division for re-submittal to tl,e Engineering divisions. Items that conform to permit requirements are marked witlr [ZJ 1. SITE PLAN Provide a fully dimensioned site plan drawn to scale. Show: D r ✓ I North arrow D ✓l Existing & proposed structures D ✓ ] Property line dimensions D t___ Easements Show on site plan: L___J ✓ Drainage patterns D L_ Existing & proposed slopes D L l Existing topography D ,-J Retaining Walls (location and height) D f ✓ Indicate what will happen with soil excavated from pool area. Include on title sheet: ~ ✓ Site address D ✓ J Assessor's parcel number D I ✓ Legal description/lot number D L Grading: Quantities of Cut 1 Fill Import Export 7 D C Project does not comply with the following engineering conditions of approval for project no: D C _J Conditions were complies with by: LOT NO.39 MAP NO. 5520 REF. NO. Date: REV 6/2012 ,f 1 2. GRADING PERMIT REQUIREMENTS The conditions that require a grading permit are found in Section 11.06.030 of the Municipal Code. D CJ Inadequate information available on site plan to make a determination on grading requirements. Include accurate grading quantities in cubic yards (cut, fill, import, export and remedial). This information must be included on the plans. If no grading is proposed write: "NO GRADING" D C • Grading Permit required. NOTE: The grading permit must be issued and rough grading approval obtained prior to issuance of a building permit. A separate grading plan prepared a registered civil engineer must be submitted together with the completed application form attached. □CJ C T No grading permit required. 3. MISCELLANEOUS PERMITS NOTE ON PLANS [ = INDICATES ALL EQUIMPENT ✓_] RIGHT-OF-WAY PERMIT is required to do work in city right-of-way and/or private work adjacent to the public right-of-way. AND MATERIALS I TO BE KEPT OUT OF PUBLIC RIGHT-OF-WAY E-37 A.separate right-of-way issued by the engineering division is required for the following: =:J C Please complete attached right-of-way application form and return to the engineering department together with the requirements on the attached right-of-way checklist, at the time of resubmittal. Right-of-way permit and pool permit will be issued simultaneously. REV 6/2012 «,~ ~ CITY OF CARLSBAD PLANNING DIVISION BUILDING PLAN CHECK APPROVAL P-29 DATE: 7/25/2016 PROJECT NAME: POOL AND SPA PROJECT ID: Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.11:0v PLAN CHECK NO: CB162821 SET#: 1 ADDRESS: 2092 TRUESDELL LN APN: [gl This plan check review is complete and has been APPROVED by the PLANNING Division. By: VERONICA MORONES A Final Inspection by the PLANNING Division is required □ Yes ~ No You may also have corrections from one or more of the divisions listed below. Approval from these divisions may be required prior to the issuance of a building permit. Resubmitted plans should include corrections from all divisions. D This plan check review is NOT COMPLETE. Items missing or incorrect are listed on the attached checklist. Please resubmit amended plans as required. Plan Check APPROVAL has been sent to: carrlejones@hotmail.com For questions or clarifications on the attached checklist please contact the following reviewer as marked: PLANNING ENGINEERING FIRE PREVENTION 760-602-4610 760-602-2750 760-602-4665 □ Chris Sexton □ Chris Glassen □ Greg Ryan 760-602-4624 760-602-2784 760-602-4663 Chris.Sext2n@carlsbadca.gov Christogher.Glass~n~!;;s!rl§bs!dCa.gQv ~r~gQQ'..Rlls!D~!.s!tlSbs!Q!;s!.gQll □ Gina Ruiz □ ValRay Marshall □ Cindy Wong 760-602-4675 760-602-27 41 760-602-4662 Gina.Ruiz~carl~!;!ad!;s!.g0ll Va1Rs!ll-Ms!rshall@carlllbadca.gov Cl£nthia.Wong@i;s1rll2bai;!i;i;!.gQll ~ Veronica Morones □ Linda Ontiveros □ Dominic Fieri 760-602-4619 760-602-2773 760-602-4664 V~ronii;s1.M2r2nes~carlll!:!adi;a.gov Lindi;!.Ontiveroll~carls!;!adcs1.gov Dominii;.Fi~ri~carlsbadi;s1.g2v Remarks: POOL AND SPA FOR 450 SQ FT. NO SLOPES. STORM WATER POLLUTION PREVENTION NOTES 1. ALL NECESSARY EQUIPMENT AND MATERIALS SHALL BE AVAILABLE ON SITE TO FACILITATE RAPID INSTALLATION OF EROSION AND SEDIMENT CONTROL BMPs WHEN RAIN IS EMINENT. 2. THE OWNER/CONTRACTOR SHALL RESTORE ALL EROSION CONTROL DEVICES TO WORKING ORDER TO THE SATISFACTION OF THE CITY INSPECTOR AFTER EACH RUN-OFF PRODUCING RAINFALL. 3. THE OWNER/CONTRACTOR SHALL INSTALL ADDITIONAL EROSION CONTROL MEASURES AS MAY BE REQUIRED BY THE CITY INSPECTOR DUE TO INCOMPLETE GRADING OPERATIONS OR UNFORESEEN CIRCUMSTANCES WHICH MAY ARISE. 4. ALL REMOVABLE PROTECTIVE DEVICES SHALL BE IN PLACE AT THE END OF EACH WORKING DAY WHEN THE FIVE (5) DAY RAIN PROBABILITY FORECAST EXCEEDS FORTY PECENT ( 40%). SILT AND OTHER DEBRIS SHALL BE REMOVED AFTER EACH RAINFALL. 5. ALL GRAVEL BAGS SHALL CONTAIN 3/4 INCH MINIMUM AGGREGATE. • 6. ADEQUATE EROSION AND SEDIMENT CONTROL AND PERIMETER PROTECTION BEST MANAGEMENT PRACTICE MEASURES MUST BE INSTALLED AND MAINTAINED. ~ 7. THE CITY INSPECTOR SHALL HAVE THE AUTHOR! , TO ALTER THIS PLAN DURING OR BEFORE CONSTRUCTION A·· NEEDED TO ENSURE COMPLIANCE WITH CITY STORM,~-· R QUALITY REGULATIONS. • · OWNER'S CERTIFICATE: I UNDERSTAND AND ACKNOWLEDGE THAT I MUST: (1) IMPLEMENT BEST MANAGEMENT PRACTICES (BMPS) DURING CONSTRUCTION ACTIVITIES TO THE MAXIMUM EXTENT PRACTICABLE TO AVOID THE MOBILIZATION OF POLLUTANTS SUCH AS SEDIMENT AND TO AVOID THE EXPOSURE OF STORM WATER TO CONSTRUCTION RELATED POLLUTANTS; AND (2) ADHERE TO, AND AT ALL TIMES, COMPLY WITH THIS CITY APPROVED TIER 1 CONSTRUCTION SWPPP THROUGHOUT THE DURATION OF THE CONSTRUCTION ACTIVITIES UNTIL THE CONSTRUCTION WORK IS COMPLETE AND APPROVED BY THE CITY OF CARLSBAD. D~111'd 'Ja1€-5 . OWNER(S)/OWNER'S AGENT NAME (PRINT) i E-29 7h//J6 r1ilif STORM WATER COMPLIANCE FQRM TIER 1 CONSTRUCTION SWPPP E-29 CBl0-2-§Zl • SW_lli_-3~ BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE Erosion Controi BMPs Sediment Control BMPs Tracking Control BMPs Non-Storm Water I Waste Management and Materials Management BMPs Pollution Control BMPs Best Management Practice* (BMP) Description ➔ CASQA Designation ➔ Construction Activity "' ..... 0 ~ -0 "' Ii O> C Ql .£ Oc, .c "'3:: (J Q) (/) "5 ~ Q) ..... ::. 0 O> X Q) 0 ..... -0 .C C 0 0 ....,,_ ~ L. 0 Q) 0 I.. c., WO I I I r---1 co I °' <.) u u w w w II) C -~ 0 Cl) 0. 0 (/) ~ l u w -0 C 0 E o, 0. a; .5 o m a. I.. Q) ... I ] ·E ~ 0 m Q) t-E "' o, ~oi u c 25 'ls ciS (/) .£ oi ID Q) .:£ Cle'. -..... § _g LL. .§ (J L. ~ ~ ::::, -0 ~ ~ ~ ~ ~ _::;g § (/) (/) u LL. c., (/) > (/) I I I I I ~,r01-sl-1LD 1<0 w w w w w (/) (/) (/) (/) (/) I l r---I co w w (/) (/) C •o C I.. 0 O:.:; E~ I.. ..... 0 0 ...., I.. (/)Q_ 0 I w (/) C C 0 0 :;::: :;::: (J (J ::::, ::::, L. L. ..... ...., "'"' "' C u, C 0 Ql 0 u L. u O> -ow -0 >, Q)......___ Q) 0 ~gi ~3: ·-Q) ·--0 ..0 L. ..0 0 l?cr>..So V1E V1Clc'. I l ~,N ~ ~ C 0 :.:; 0 > L. Q) "' C 0"' u Q) (J L..:;:; Q) (J ...., 0 0 L. s:a_ ~ I (/) z --,- C ...., 0 ..... :.:; C C Q) -0 O> 0 E C Q) -0 C O> 0 E C '6 ·;:: .9-Q) 0 L. C '-::::, >, O> ·;:: 0-L. 0 C I.. ~ E (.'.) w C Q) a Q) 0 ...., -0 "' -0 cii "' ::. C Q) C Cc 3:: C 0 ::::, Q) ..... Q) 0 Q) > :g E 0 0 O> Q) (j):;:; Q) <I> C ~~ 0 ·a. 1..-3:: Q) :0 a.. e cO u·c L. 0 ·;:: .:£ O> ·-I.. 0 ·-0 Q) L. Q) (J +-' -0 0 ?; ~ ...., .c Q) ...., 0 +-' 0 := C •-C 0 Q) -o...., 0 en a.o oo 0..0 Q_ >u ::. (/) ::. (/) u (/)~ .., r---co N .., v LD I I I I I I I I (/) (/) (/) ::. ::. ::. ::. ~ z z z 3: s= 3: 3: /Soil Disturbance -,< g/Excavation =:,---t-+.~t-7t--+---+-t--+--t~X7"f--t--t--i-::-+, --t,--t.--.t---1 'x X Al I I I X Stockpilinq Drillinq/Bori~ Concrete/ A~alt Sawcutting XI Concrete Flatwork Paving >< ~IX 2!_lx-x- Conduit/Pipe Installation Ix I Stucco/Mortar Work fx'I Waste Disposal X. lklfilc:iging/Lay Down Area ~ "x )(.IX ~ x Equipment Maintenance ano Fuelinq X >< X 1 Hazardous Substance Us~Storaqe Dewatering Site Access Across Dirt Other (list}: Instructions: 1. Check the box to the left of all applicable construction activity (first column) expected to occur during construction. 2. Located along the top of the BMP Table is a list of BMP's with it's corresponding California Stormwater Qual ity Association (CASQA) designation number. Choose one or more BMPs you intend to use during construction from the list. Check the box where the chosen activity _row intersects with the BMP column. 3. Refer to the CASQA construction handbook for information and details of the chosen BMPs and how to apply them to the project. PROJECT INFORMATION Site Address: 201 :z_ Tn,\. -esd e 11 l-\1\ . Assessor's Parcel Number: / G, 7-/ 80 "2'5-oo Emergency Conta;it Name: gN. ~~Or"l\°e 24 Hour Phone: ___________ _ Construction Threat to Storm Water Quality (Check Box) □ MEDIUM ffig LOW Q) ...., "' 0 3::...., C "' Q) :::i E 0 Q) -0 O> 5 0 NC 0 0 :c::. (0 I ::. 3: Q) ...., "' O+' S:: C Q) Q) E ...., Q) Q) o,, b o CC O 0 u::. co I ::. 3: Page 1 of 1 REV 02/16