HomeMy WebLinkAboutPermit Building 1973-3-28
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LANE COUNty BUI~DING PERMIT OR MOBILE
BUILDING D MH -D
MAILING ADDRESS
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Hb~E1{JSE PER~IT Y:';f''1~~01'3''1
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PERMIT NO, 48&c";~ ->
PHONE
PROPERTY OWNER
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CO NfRACTOR
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MAILING ADDfESS " .
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'P'HONE.
PROPERTY LOCATION - INCLUDE POST OFFICE
2732 8urt inClton
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
Canterburv vnnaoe.. istAdd.. B. L L. -B-2
TWP , RANGE .11): SECTlo.N.
11
3
24 r 4, I
TAX Lo.T NO..
# 610/9
CODE .,
CENSUS TRACT
APPL.
NAME
&
MAILING
l,~.
20.. EIiH 1;0
EXISTING STRUCTURES ON PROPERTY
M~stovcr Constr~ CO.
I~one
LEGAL ACCESS TO PROPERTY
Bu r.1 t naton
PROPERTY SIZE - FT,
2589 t~. 35th PI.
ADDRESS S~)f i naf ie 1 d. 0 r .
FOR MOBilE HOME PERMITS ONLY
No.. of Bedroo.ms
STRUCTURES TO. BE BUILT THIS PERMIT
WI[)TH
, DEPTH
AREA
,.') Co.nnect to. Existing Sewage System 0
TYPE Co.NSTRUCTlo.N SQ. FT. # BDRMS
New System 0
VALUATlo.N
,l}t'Je.1l i na
Hood
! s85 @) I 2 3
i c}. 020
<<DClraCll'i:i co iilU:. '" QIS !led.
Cove.red porch
1)06 @ 3.'i0
72 @ 2
I . 77 U
llW
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SEWAGE DISPOSAL
PUBLIC D SEPTIC TANK D
BUILDING. '1;.
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
OTHERD.
77.0n
'n.nn
1':t.t:n
FEES
. PLUMBING INSTALLED BY
OWNER D OTHER: NAME
WATER SUPPLY
PUBLIC D
D OTHER
TOTAL
t
130.50
. COUNTY BUilDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED
L1N, FT 150 !m TRENCH. WIDTH FT, ..3
OR SQ, FT,
450
MIN, SEPTIC TANK CAPACITY
WITH DIST, BOX: GAL.
goo
Roof and footinadrains to str12et.
TYPE OF STRUCTURE
OCCUPANCY
ZONE
PUBLIC UTll. EASEMENT
i;M t 8- .J
BLDG. SETBACKS _ FT. FROM CTR. OF ROAD RIGHT.OF WAY
USE CLASSIFICATION
FRONT
45
REAR
7
SIDE INT, 5 SIDE EXT,
AUTHORIZED SIGNATURE - DATE
./sl' 005S bv Harbt'!lRloh
DATE
John t~ulckshan~~ n.s.
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BLDG, PERMIT - WH ITE
OFFICE COpy - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOlDENROD
Constructio.n to.. co.mply with uniform building co.de and co.unty regulatio.ns
co.vering plumbing and sewage disposal. . All buildings require a certificate
, of occupancy b~fore being o.ccupied,
(See Statement. on Reverse Side)
(POST THIS PERMIT ON MAIN, BLDG. AT. SITE)
LANE COUNTY, BLDG, & SAN, DIV., COURT HOUSE, EUGENE, OREGON 97401
FORM # C55 .13
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No. I/J:L~
T / 7 R 03s:; L/ TAX LOT
e~'~US T~ACT ~o :'-~/5c- 'WdJ/
A'~fu;t ~~;~/~.
NAM~~.~B~/
ADDRESS
BUILDING SITE EVALUATION
.. ~ Building Permit Appl ication
1(; Site Inspection
LANE COUNTY PLANNING DEPARTMENT
NO
PHONE
DATE _ r.;>~ ::2s~ 7.,3.
NAME
DATE
() Pre-Permit Investigation
I.
Zoning Ordinance Compliance
(Zone t.C: \ )
Subdivision Ordinance Compl' ance
NOT
app I icab I e
() ()
( )
( )
( )
( )
YES
3.
4.
Required Access
( )
( )
( )
( )
(~~~
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( )
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2.
Building Site (Area, Width,
Frontage, Setback)
Other (see comments)
5.
COMM ENTS :
BU I LD I'NG INSPECTION SECTION NOT NO YES NAME DATE
app I icab I e ( ))1
6. P 1 ansSubm i tted ( )
7. Soi I Stabil ity (footings) t><{ ( ) ( )
11 "
8. Flood Plain 2): ( ) ( )
>/~ ~ '1 .,.51 ~#/.3
9. Ot he r (see Comments) ( k ( ) ( ) , <- ,.(1 ~
/
COMMENTS:
SANITATION SECTION NOT NO YES NAME DATE
app 1 icab I e yf
10. Sewage Disposal ( ) ()
11. Usable Area ( ) ( ) (4 Q(VhU~ .~bf) ~
pi .. t.. , -
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12. Water Supply ( ) ( )
13. o t he r (see Comments) ( , ( ) ( )
COMMENTS:
TO APPLICANT:
Your B~ilding Permit / Sb~ ~n~e:t~
(y,..-fan be approved. f;2~. 7~
() Cannot be approved at t 'is time as indicated on item NO. above.
. Quest ions and further informat ion on items] through 5 contact the Lane-
COUNTY PLANNING DEPARTMENT. Questions and further information on items 6
through 13 contact the Lane County Buildinq and Sanitation Division;
() Will be held in this office until you can resolve the problems Jndicated.
() Is being returned. .
() Your building permit appl ication fee is being returned under separate cover.
U\NE COUNTY PLANN I NG DEPARTMENT
ITe; Sixth !\venue East. Ell~lelle. Oreqon 97401
l'llONl' \1".'-1 \ II I XI. n I
LANE COUNTY BUILDING & SANITATION DIVISION
135 Sixth Avenue East, Eugene,Oregon 97401
PHONE: 342-1311 . EXl. 411
p ~llari..un J.'J.cl(;;,dJL1
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.~HA FbRM NO, 2573. At'. /o-#G~PARTMENT OF HOUSING'ANLJ U'R'SAN DEVELOPMENT. Form AP'pr;~~d .-
, eY, 10/70 "'1J... NO. ~ FEDERAL HOUSING ADMINISTRATION Budget Bureou No. 63-R0296
Of";\;: ..r,.-/~::.J.:::t- ~,:?.. ___ .L_ HEALTH AUTHORITY APPROVAL
'D\I..\.E~ No. ~ WATER SUPPL Y AND SEWAGE DISPOSAL SYSTEM
O~'\: I _____ PART I -TO BE COMPLETED BY FHA
InsurlniP&tj.j~
Portland, Oregon
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WESTOVER CONSTRUCTION COo
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Mortgagee - Name, Address and Zip Code
I 40035~735
FIRST NATIONAL BANK OF OREGON
Real Estate Loan Division
P. O. Box 1786
Eugene, Oregon
Mortgagor or Sponsor:
97401
Property Address:
278: Bu::1ington Street .': .'-: ;",:~,:,I'\1 'l!:,r, -L ........
Sprmgheld, Oregon 97477 -~~," I r,_,..LI,1 Or.? I
Subdivision:
L
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FIRST ADDITION TO CANTERBURY VILLAGE
Block 1
Lot No.
12
TpTA~ t1V.~BER
.L'V'Nr. TTIDIS.. RFOR('I.oMS R....:r.HS
BASEMENT
Qg. New Installation
Can Attic or other Area be made into additional
bedrooms? (If yes. how many?)
DYes [FJ No
SYSTEM DESIGNED FOR
1
3
2 DYes QNo
WATER SUPPLY BY:
[Jg Pu blic Sy stem
SEWAGE DISPOSAL BY:
o Public System
o Community System
o Individual
No. of
Bedrooms
Garbage Disposal
o Community System
Qgqndividual
3
DYes
D No.
PART II. - TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DE PARTMENT INS PECTOR'S SKETCH
B.P. 484-73
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It i~r;n;""~ Q St.a.tp n C0unty LoC~l Deoartment of Hf'Alth th.ai.ib.i" in~11f11 ;1'f1tpr-sl~prly sv~tem
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It is the opinion of the D State ~ County D Local Department of Health that this individual sewage-disposal system
with proper maintenance:
[XX Can be expected to function satisfactorily, and 0 Cannot be expected to function satisfactorily
is not likely to creat n ins nitary condition~
DA TE Slct-:- URE R TITLE
5-10-73 , Rt HARO, K_ Y:I. '_ .RVIS ING SAN ITARIAN
NOTE: The health authority should complete the appropriate opnion statement above and affix date, signature and title in the
spaces provided.
Use of the above grid for Health o.tment Inspector's sketch as well as use of th.k of this form is at the opinion of the
hea Ith a uthori ty.
PART III.
FOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
I have reviewed the foregoing and the pertinent Fl-IA Compliance Inspection Report, and recommend that the
Individual water-supply system be considered 0 Acceptable D Not Acceptable
Sewage disposal be considered 0 Acceptable. D Not Acceptable.
DATE
SIGNA TUR E
o CflIEF ARCHITECT
o DEPUTY FOR Ciil EF ARCflITECT
j
HEAL ~'ji AU".:-'iORITY AP PROV AL
INDIVIDUAl. WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA FORM NO. 2573
Re\'. 10/70
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REPORT.Of INSPIECTlON-INDIV8DUALSEWAGEmD!SPOSAL ~YSTEM
PRIMARY TREATMENT wnsists of ~ Septic tank, 0 Cesspool.
50ptk Tank:
Distance from well,
Total liquid capaciry
Inside length, ? C;
CC!IIIlIpool:
Distance from: Well,
feel. Material,
1000
CQncrete
,Io:allons, Capacity i~let compartment
4. C; leel. Liquid depth, 4 C;
Number of compartments
ft:el. Inside width
gallons.
feet,
feet; foundation,
- feet; nearest lot line at 0 front, 0 side, 0 rear,
fc'et. Liquid capacity, gallons, Linin,lo: material
o Seepage pits, Other
feet,
Inside diameter, feet. Dcpth
SECONDARY TREATMENT consists of !?;l Tile disposal field.
TlkI.DI.po.al flold:
Distance from: Wdl. NO
Total length of tile lines,
Trench width 36
Length of each line, 75 -' 75
Type of tilter material: tJ Gravel. 0 Broken stone.
Depth of filter material beneath tile h
IJ-ElL feet; foundation, to feet; nearest lot line at 0 frone, ~ side, f9 rear,~ 0
1 50 feet. Number of lines, 2 Distance between lines, 7.5
inches. Total effenive absorption area in bonom of trenches 450
~ . 4 .
feet. Depth, top of tile to finish gradf'
Other
feet,
feet,
~quare feet,
inches.
inches,
Depth of filter material over til..
2
inches.
SeGpage Pit.:
Number of pits__, . Outside diameter feet. Depth, feel. Lining material
Distance from: Well, feet; building foundation feet; nearest lot line at 0 front, 0 side, 0 rear
In.pectlon made by: 0 State. l&J County, 0 Local Health Authoriry.
feet.
Inspected b}
.John Cru i ckshank. &....s..
Sanitarian
(TITLE)
Date of inspenion _.5~1d1.
,19_
REPORT OF INSPECTION-INDIVIDUAL WATER-SUPPLY SYSTEM
Distance to nearest public water main, _, feet, Size of main inches.
Individual wells 0 at(: 0 are not customary in neighh9rhood.
Give most recent ((:cord of failure of wells in immediate vicinity to furnish adequate supply of water
Properties in nei,lo:hborhood 0 are 0 are not being developed with both individual water. supply and sewa,lo:e.disposal. systems,
Lot size: feet wide, feet deep. Dwelling set back from front property line, feet,
InJividual water supply from: 0 DrilleJ well. 0 Driven well. 0 Dug well, 0 Bored well,
DI.tance of wall from:
Bu ildinJo: foundation,
cast iron sewcr
foet;
nearest lot line at 0 front, 0 side, 0 rear,
feet; septic tank, feet; disposal
feet; other sources or possible pollution
field,
feet,
feer,
feet;
seepage pi'
Well con.tructlon:
feet; tile sewer,
feet; cess pool
Diameter inches. Total depth, feet, Type of casing Deprh of casing, feet.
Approximate depth (0 pumping level of water in well, feet, Approximate yield, gallons per minute.
Sealed watertight to depth of feet,
Exterior spac.e around casing sealed with: 0 Cement groul. 0 Puddled clay. 0 Ordinary backfill,
Well cover: 0 Conlfete. 0 Wood, 0 Metal. Openings in well cover watertight: 0 Yes, 0 No,
Pump: 0 Shallow well. 0 Deep well. Length of drop pipe, feet, Pump capacity, gallons per minut~,
L.ocated in: 0 Basement, 0 Pumproom off basement. 0 Pumphouse above ground, 0 Pump pit,
Pumproom properly drained: 0 Yes, 0 No, Pump mO\,lnti!lg watertight: 0 Yes. 0 No.
Type of storage: 0 Pressure, 0 Graviry, Capacity, gallons..
Has bacterioloJ.(ical examination of water been made? 0 Yes, 0 No. If answer "is "yes," give dare 19_
Qualiry of water 0 is 0 is not satisfactory for human consumption.
Installation 0 does 0 does not comply with approved exhibits, if any.
Inspection mAde by: 0 State, 0 County, 0 uKal Health Authority,
Inspected by
Date of inspection
19_
(TITlE)
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GPO 900.682
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Date
No.
.~$!t..?$
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PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
WHEREAS, the attached application has been fully considered by the Board of
County Commissioners of Lane County, and it is the opinion and judgment of the Board
that the said application should be granted, and that a permit should be issued, now,
therefore, it is hereby
ORDERED, that a permit be and is hereby issued to
for the placing, building
and constructing of the following facility:
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upon the right-of-way of County Road No. , in strict conformity to the exhibits
attached thereto, and subject to all terms, conditions, agreements, stipulations and pro-
visions contained in the application and permit, the Rules and Regulations Governing
Facilities to be Permitted upon County Road Rights-of-Way, dated March 31, 1960 and
any amendments thereto, and any other applicable regulation, law or ordinance.
Special Provisions:
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This permit is revocable at any time, and will be strictly adhered to and no work
other than that specifically mentioned above is hereby authorized.
This permit shall be void unless the work herein contemplated shall have been
completed before
, 19
Expires
, 19
Inspected and Approved
Approved by Board of Commissioners
By
Date
By
Director of Public Works
WHITE - OFFICE FILE PINK ~"RMITTEE ORANGE - BUILDING & SANITATION DEPT.
GREEN - RESIDENT ENGINEER BLUE 6.D SUPERVISOR YELLOW - SURVEYOR
08-52
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APPLICATIDN FOR 'FACILI. ~ PERMIT
IN THE BOA,RDOF COUNTY COMMISSIONERS OF LANE COUNTY
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Your applicant,
hereby makes application under Rules and Regulations Governing Facilities to be Per-
mitted Upon County Road Rights-of-Way, to construct the following facility:
Upon the right-of-way of County Road No. "J ; , at the following location:
I~I: ! - . ~'. .
as shown on the exhibits which are attached hereto, in strict 'c.onformity to the. state-
ments of the exact nature and amount of work to be done, and to the description of the
facilities contained in said exhibits. Your applicant will be the beneficial owner of the
facility as constructed, or otherwise primarily liable and responsible to members of the
public for its proper maintenance, repair, operation and use. Your applicant accepts all
terms, conditions, agreements, stipulations and provisions, in Rules and Regulations
Governing Facilities to be Permitted Upon County Road Rights-of-Way, dated March 31,
1960, and any amendments thereto, and any other applicable regulation, law or ord'inance.
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Signature
Address
WHITE. OFFICE FILE
GREEN. RESIDENT ENGINEER
PINK. PERMITTEE
BLUE. ROAD SUPERVISOR
ORANGE. BUILDING AND SANITATION DEPT.
YELLOW. SURVEYOR
Phone No.
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PROPERTY OWNER
LANE COUNTY BUILDING PERMIT OR MOBILE
BUILDING 0 MH 0
MAILING ADDRESS
HOME USE PERMIT
PERMIT NO,
PHONE
CONTRACTOR
MAILING ADDRESS
PHONE
PROPERTY LOCATION - INCLUDE POST OFFICE
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
TWP
RANGE
SECTION
TAX LOT NO.
CODE
CENSUS TRACT
APPL
NAME
&
MAILING
ADDRESS
FOR MOBILE HOME PERMITS ONLY
No, of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
EXISTING STRUCTURES ON PROPERTY
LEGAL ACCESS TO PROPERTY
PROPERTY SIZE - FT,
WIDTH
DEPTH
AREA
Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT. # BDRMS
New System 0
VALUATION
'i:
FEES
PLUMBING INSTAllED BY
OWNER D OTHER: NAME
WATER SUPPLY
SEWAGE DISPOSAL
PUBLIC D
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK D
OTHERD
PUBLIC D
D OTHER
TOTAL
~.
MIN, SEPTIC TANK CAPACITY
WITH DIST, BOX: GAL
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FiElD REQUIRED
lIN, FT
'; l'
t~ i
TRENCH WIDTH FT,
OR SQ, FT,
TYPE OF STRUCTURE
OCCUPANCY
ZONE
PUBLIC UTlL EASEMENT
BLDG, SETBACKS _ FT. FROM CTR. OF ROAD RIGHT OF WAY
USE CLASSIFICATION
FRONT
SIDE INT, SIDE EXT,
AUTHORIZED SIGNATURE - DATE
REAR
DATE
d, '.
. ,
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOlDENROD
Construction to comply with uniform building code and county regulations
covering plumbing and sewage disposal. All buildings require a certificate
of occupancy before being occupied,
(See Statement on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COU~!Y, BLDG, & SAN. DIV" COURT HOUSE, EUGENE, ORES;ON 97401
FORM=C55-13
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SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED /
/ DISAPPROVED /
REMARKS
/ DATE
-'L.A.../ U1M,' ,F:; 6 b l- dJ)/)
GAS PIPING GROUNDWORK
..
S'/ll/c ~ ('.1.16-"'7
ApPROVED /
/ DISAPPROVED /
REMARKS
ROUGH PLUMBING
ApPROVED /-,1... / DISAPPROVED I
"
REMARKS
ROUGH GAS PIPING
ApPROVED /
I DISAPPROVED /
CI
REMARKS
FINAL PLUMBING
ApPROVED 1)(' / 01 SAPPROVED /
REMARKS
FINAL GAS PIPING
ApPROVED I
/ DISAPPROVED /
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO JSSUE I
/ DATE
(:> /c..
/ DATE1j~ /1-.V
/ DATE
/ DATE/-/-;?5
/ DATE
/ NOT READY TO ISSUE /
REMARKS
/ DA TE
INSPECTOR
/I'lI,?.J ~{j~
INSPECTOR'
INSPECTOR, ..... 4./
f./
INSPECTOR
INSPECTOR ..-4'l.-./
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INSPECTOR
INSPECTOR
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PROPERTY OWNER
LANE COUNTY BUILDING
BUILDING 0 MH 0
MAILING ADDRESS
PERMIT OR MOBILE' HOME USE PERMIT
PERMIT NO,
. ~.gLi'_] 3
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CONTRACTOR
'~\;lr..~t. ;
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...,~\q .~:. ;':.th )>>1.. Sohh
MAILING ADDRESS 'II
PHONE
741-9" 1 !
PHONE
PROPERTY LOCATION - INCLUDE POST OFFICE
i: ) PlI.-1 j nnlon
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
., ,;t.d.\i"V V!1141(,e. 1st rl\:H t.. i. L. 12
TWP RANGE SECTION
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TAX LOT .NO.
CODE
CENSUS TRACT
J
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C"
01\
\>
:Iv-LOiSe
EXISTING STRUCTURES ON PROPERTY
If, I Ill.
LEGAL ACCESS TO PROPERTY
Bu r j i n y t un
PROPERTY SIZE - FT,
APPl.
NAME
&
MAILING
ADDRESS
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WIDTH
DEPTH
AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT. # BDRMS
New System 0
VALUATION
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12
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12 (. ')
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20.'));)
t
OTHERD
j / . liO
;:~ C:. Of;
FEES
PLUMBING INSTALLED BY
OWNER D OTHER: NAME
WATER SUPPLY
SEWAGE DISPOSAL
PUBLIC D
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK D
PUBLIC D
D OTHER
';; ~< . ;;u
. TOTAL
t
I>J.'IU
MIN, SEPTIC TANK CAPACITY
WITH DIST, BOX: GAL
'00
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED
15(\ 'I
UN, FT \J TRENCH WIDTH FT,
J
OR SQ, FT,
!,50
",y:.,; ;I'{;~ foot fng dr~fM to street.
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TYPE OF STRUCTURE
OCCUPANCY
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ZONE
PUBLIC UTIL. EASEMEJH
BLDG. SETBACKS __ FT, FROM CTR. OF ROAD RIGHT OF WAY
USE CLASSIFICATION
I. ..J
REAR
.,
I
FRONT
"
SIDE INT, ;. SIDE EXT,
AUTHORIZED SIGNATURE - DATE
j\)~~\ b\' l10rbaugn
John CnJid~!>h';tHk. "',.S.
DATE
}..'/.&.1'3
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BLDG, PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING -CANARY
BUILDING - GREEN
SANITATION - 90LDENROD
Construction to comply with uniform building code and county regulations
covering plumbing and sewage disposal. All buildings require a certificate
of occupancy before being occupied,
(See Statement on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
FORM:!:i:C55-13
LANE COUNTY, BLDG, & SAN, DIV" COURT HOUSE, EUGENE, OREGON 97401
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SITE INSPECTION
ApPROVED
/ / DISAPPROVED / / DATE
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INSPECTOR
REMARKS
FOUNDATION INSPECTION
I NSPECTOR a
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ApPROVED / ~/ DISAPPROVED /
I DATE t/_I f1".~7 J
REMARKS
FRAMING INSPECTION
ApPROVED / 1/1 01 SAPPROVED / I DATE i/ ~/~.... 7.] INSPECTOR
REMARKS
LATH OR SHEETROCK INSPECTION
ApPROVED /
I DISAPPROVED /
I DATE
INSPECTOR
REMARKS
FINAL INSPECTION
ApPROHO /; 7D" ,"PROV(O / / /1''' ( G -,;l 6'-73. I NJ,'" nOR
REMARKS~~~~f"'J U..- ~12.r"2f-'l) lW-
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CERTIFICATE OF OCCUPANCY
READY TO ISSUE / I NOT READY TO ISSUE / I DATE
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REMARKS
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INSPECTOR
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~INDIVIDUAL SEWAGE DISPOSAL SYSTEM RECORD
Installer: Complete top part of'form to
signature and return both copies to Lane
County Building Sanitation Department.
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I~erls Name~
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PF'RMIT
No. 484-73
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No.Livingupits Bedrooms Baths
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Septic Tank:
Ft. from well Steel 0
Ins~C1e D.unens~ons: .t't.
Length 'J,S- Width ~,J-
!\pplicant
Name
Property Address
2782 Burl inqton
Basement Water Sypply
Yes 0 No ~ Public ~ Other-List
Concrete M
No. Compartments
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Gal. Capaci tYl d" (!J
Tile Disposal Field: -~
Distribution Box:Yes ~ No 0
Other Distribution- Type
(7
Feet trjom /J f
wellNO IA.f~I"-1Foundation I ()
Lot Line
Front Side i () Rear I d
Total sq,Ft.between Fil~r~~ F~ller deDth'F~ller~d eptfi
L1"" , 7 (- above below
it V~ () hnes /Iv Typ A-d,...~ tile "Z-- in. tile il'4
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Depth .,1. J-
Diameter
Westover Constr. Co.
Mailing
2589 N. 35th PI.
Address Springfield, Or.
Length of Lines - Ft. Trench
l7'J"2y1J3. 4. 5. 6. Width 0'
Ske~h (See in~truction~):
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Signature {J }l /1/1l ~J"
Conforms to Current st~dards Date, ~Jf7jLr~
to Current Standards~
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Date 1.-- 27-- It! 1 i
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For sanitarian ule'only:
~APproved: System Installation
o Disapproved: Does Not Conform
Remarks:
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t/ Sanitar~an's~ignature
Lan?unty Building & Sanitation De
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, LANE COUNTY BUILDING PERMIT ,0 R MOBILE HOME USE APPLICATION
i' (tpERMIT TYPE '- BUiLDING ~ MOBILE HOME Dose REG. # PERMIT # <<F~ - 7...:::1
PR~~~~/7~-_ ::..~ ":AI~::DDRE.Ss,,:~.'._a,~: . . ~ .. j:l"ONE
~/A L~ (V__ -L;J-t2, I /1" 3.~ ~~ ) , A7~/ ~
CONTRACTOR . ,. . MAILING ADDRESS .. './. . /P~NE
'7~'7-997/ n
PROPERTY LOCATION -INCLUDE POST OFFICE .
2fJ/:? ~~v/~/:~ 'I. ." ~.
'PROPERTY LEGAL DESCRIP.TION n~c:T.. , / {/< ~/1.. L '/:' 1 / ./2'/ -/ /.' ., . METES & BOUNDS. 0 YES
LOT -BLOCK - SUBDIV. (~. - /..d4" ~ 0 -:- ~ - <><--- ATTACHED JZfNO
TWP RANGE . . .. SEc./. // 1 TAX LOT #. CODE: .: CENSUS TRACT ,/
./7 03 . '".(?L-.. ..,. , ~o .-ed /:50
( DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY, .
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LEG:bACCESS.;;.p ~ROPERTY -", ROAD~AME OR #,
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PROPERTY ~IZE-WIDTp.. DEPTH
APPLICANT
NAME '
AND, ~~~
MAILING . . ,
AREA
ADDRESS
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FOR MOBILE HOME ,PERMIT, ONLY
Number, of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
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'- SEWAGE DISPOSAL
PUBLIC 0 SEPT.!.S...TANK ,kf
BLDG. ~. I'Z rl" FEES
WASTE DIS. ...2...P. P-i:>
,f3;6d
Connect to Existing.
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Sewage System D or New System Req. D
'. .SQ, FT, # BEDROOM}--- VALUf'TION
/5J?.5 (B /d/ (J )/'~O~I!)
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~'h 413. ~ ) '11/
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TOTAL
/3tJ..$o
PUBLIC WATER
CONNECTION FEE
eX: .~
).50
PLUMBING INSTALLED BY
OWNER 0 ' OTHER 0 NAME /
PLANS FURNISHED .. / ... FACILITY PERMIT
YES V NO 0 A YES.M" NO 0
StCH-ATUR:-8f APi' ICANT '
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~CEIVED BY I
tLIdA /
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4P.L/-A3
DATE
PLUMBING
OTHER 0
WATER SUPPLY
PUBLIC )( OTHE~
PLUMBIMG ~EES e!..,3 tJ-(J
,/0 FIXTURES J-o ..~
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CASH 0 S '
CHECK ONNECTION FEE
PLAN REVIEW
PARK TRLR.
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COUNTY BUILDING & SANITATION SPECIFIC,~TIONS
DRAIN FIELD REQUIRED . I
L1N. FT. IS'O TRENCH WIDTH FT, ./..5' OR SQUARE FEET. 6160
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MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAL.
cJYlLi'h~ 'in
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UN'
REAR .Y ARD
PUBLIC UTIL. EASEMENT
.~ . OCCUPANCY
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BLDG, SETBACKS - FT, FRO~CTR, of! ROAD RIGHT OF WAY USE CLASSIFICATION
FRONT .4-e:s . SIDE INT, . S SlL>t tA:, REAR 1 . _. ^-
tteARIAiIA ~ .. . D... PLANNING D... BLD't. l~sP.a5 If r/Jt)., F ....
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~;'e't;on' '0 F;nd .,ope,'( .... . . .... . (/ "(
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!>Y 1 - OFFICE
'If 2 - JOURNAL
\~ - AUDIT
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TYPE OF STRUCTURE
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