HomeMy WebLinkAboutPermit Mechanical 1984-8-30
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j I FOR OFFICE USE ONLY
Lane County'- AUZh rization for: ,--. '// v/I
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,rd/e ,~~ I ~~ DTWO Copies of ~lans '
- D Three Copies of Plot Plans
TOWNSHIP /7 I RANGE/) .2 SnIO'/,/ /, / ::?~~T;fl--' DMech/Plumbing Checklist
C/~ eX' /,7, (,/ p-) D Legal Interest Document
S:JBDIVISION/PARTITION (if applicable) LOT/PARCEL BLOCK 0 Plan Check Info Sheet'
~~'/ dfi2_, /' /. . // ~/' ~ ~/~7PROPOSED,USE O~ PROPERTY ,
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STRUC~~L~RTY V S{j;'Y--' / d Dcommercia_l D/ublic
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~2SC~ PRO 0 ~~ ~PE6 ' - iJ/.J "'/ - - ~ - DECLARED $ VALUE "
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= ~F 1>EDROOMS ' I-~ OF, STORI ~ I # OF;t7)!L; WATER SUPPLY (~/L- ~~~~
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I HAVE CAREFULLY EXAMINED THE COMPLETED APPLIC~N FOR PERMIT, and do hereby certify that all information hereon is true and correct, and that I
.have the following legal interest,in the property:~ner of record; []contract purchaser; []authorized agent with evidence of authority attached,
I f~rther certify that any and all work performed shall be done in accordance with the Ordinances of Lane County and the Laws of the State of Oregon
pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I fur-
ther certify that registrat~on with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exempt~on
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NAME (please print) (' ./ SIGNA'PtJRE DATE
READ THIS SECTION CAREFULLY. YOU~ ~UTHORIZATION HAS BEEN BASED ON THE FOLLOWING CONDITIONS~ J ~
o PLANNING/ZONING: zone-.L1~~ Partition # Parcel # Parcel Size ~g
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Date:
~--6c:J-JY Pr--
o SANITATION: S. 1. #
Installation
Specifications:
Gallon
Tank
Lineal Feet
of Drainfield
Installation Record Issued? DYes 0 No
Maximum Depth
of Trenches
B. P. #
COMNENTS:
~LANS EXAMINATION: Type
l\ - COMNENTS:
Date:
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Group
Use '~~/.J
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Date:
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TOTAL VALUATION $
CONSTRUCTION AUTHORIZED BY THIS PERMIT
1_ r? DescriPti~
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Sq. Ft.
Fixed Feel
Unit Cost
Floodplain Fee
Subsurface Fees
Building J;ee
1-18ch/Plrnbg Fee
Plans Check Fee
State Surcharge
DEQ Surcharge
TOTAL FEE
$
$
$
$
$
$
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PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE (per ORS 456.8b5(l)) DATE
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061, C 14-25
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
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holder and shall require satisraccl.HY CUl11l-''':<::.c-.L",=,n-'''''':=~_'__
meet the requirements for sa tisfactorycciriipletion wi thin a -reasonable' .time consITt:utes-a-vro-
lation of QRS 454.605 to 454.745 and this rule.
Setbacks .. Subsurface Sewage Disposal
From:
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Septic Tank
10'
10 '.
5 I.
50 '
Drainfield
10'
. 10.1
10'
.100'
Interior property lines
Edge of road ~ight-of-way .
Buird~ng foundation
Wells, . other water sources.
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