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HomeMy WebLinkAboutPermit Plumbing 1973-8-5 , I r ";. ~.:.......... .... ./. . ,( ( ,({; ,;(1 /iry ~// I . t.l'<UY/\ ---- (,~~~.../;:, /; ; L4';1Y,,>;Y~'" LANE COUNTY" buiLDING PERMIT OR MOBILE HOMl.. BUILDING "1m MH D .- ~.;;- MAILING ADDRESS ~ ,. ,; , .' ~- ;~) I .-. ! ~ r.' " 1 . PROPERTY OWNER ~~f;':;;c:U. C'4f. CONTRACTOR /49'E) - 7,';) JSE PERMIT v PERMIT NO. 1P;,S)G=J73 PHONE '? MAILING ADDRESS PHONE ~ ~<2f"JG 7l~1"'997n <,I" " PROPERTY LOCATION - INCLUDE POST OFFICE 21{j~r Gmdu il\:1\(Q!1 PROPERTY LEGAL DESCRIPTION - METES, BOUNDS H :1 2.4,/1/ lo'G n @1 OC~~ r TAX LOT NO. tt 3tfc:lD t ,. i' ----- ~ontorDU~~ V~ViCD0 TWP RANGE ~t r$-rc. AddUOf3 SECTION CODE CENSUS TRACT APPl. NAME 2~o[iDo ~ ~W EXISTING STRUCTURES ON PROPERTY & MAILING ADDRESS ~)GJdQgfOQ~(j, O~@g~ FOR MOBILE HOME PERMITS ONLY No. of Bedrooms 2StJS} fJ0rrch 3~~&-o P U'w.(;:O' ~j@JlilO -LEGAL ACCESS TO PROPERTY .,..... ,f- S\Ert1 ~IO ~gfc~fFV AVG. PROPERTY SIZE - FT. Ucm'E:ovor. ([:(ID\lsft. WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System D TYPE CONSTRUCTION SQ. FT. # BDRMS New System D VALUATION lii.:'on ion NoUe~ GorCl~Jo nmc. GJ\C 1;;_ C:rDlIS y ~60 (J ~2 n~j) 0Ujiy Ol 3) TIGp!J20 ~ u ~!~~~?JL -~i\ "{i<1'/J"'.-"= b v d t< bs'\CoTI 1 S.D.~. H~ ~"nl':r.~~iUlg fhttur~s SEWAGE DISPOSAL PUBLIC 0 SEPTIC TANK [!IJ BUILDING <l: WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER PLUMBING INSTALLED BY OTHERD G@.OO 20.@@- 313.~O FEES OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC /]]; o OTHER TOTAL t ~2U 50 COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED UN. FT 22; TRENCH WIDTH FT. 2 OR SQ. FT. r~~@ MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAl. s@~ ~G~Y arDi~5 to S~?QO~. '\. . TYPE OF STRUCTURE 511 BLDG. SETBACKS ~_ FT. OCCUPANCY C. J ZONE Ctl PUBLIC UTll. EASEMENT FRONT ~51 FROM CTR. OF ROAD RIGHT OF WAY SIDE INT. 51 SIDE EXT. AUTHORIZED SIGNATURE - DATE 1310$5 fJY we n !3Gil USE CLASSIFICATION REAR 7 f Isl .fl.[;" Jc~~~~] C rlJ i c~~sl.,c:'i[t, L1. 5. DATE O=:;J<>tJ 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 COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 97401 FORM it C55-13 BUILOING!SITE EVALUATION ~. L T /'1 R t}~ .~L/' TAX, un i~ ~ j ~#T J:it:~/ /;if~ ~LICANT : /J.~~"~-- ~Q.. NN1E '- ~~.. , I~ -Y~ ADDRES~ (!. _ ; .~/ . . (.h1LLt.lf'. PHONE 7h / DATE ~.30_/73 '. ;fdLi . f Building Permit Appl ica~ion () Site Inspec~ion () Pre-Permit Investigation' No/f/90- 73 LANE COUNTY PLANNING DEPARTMENT J. Zoni ng ,Ord i nance Comp 1 i ance . (Zone 1? \ ) Subdivision Or~inance Com~ iance NOT app I i cab I e () () () () () () () () () () NO 2. 3. 4. Required Access Building Site (Area, Width, Frontage, Setback) Other (see comments)' 5. COMMENTS: , BUILDING I NSPECTI ON SECTION NOT NO YES NAME DATE app I icab I e (v(/ ~J P6/73 6. Plans Subm i tted ( ) () I 7. Soi I Stab i lit Y (foot i ngs) (v)' ( ) ( ) 8. Flood Plain (v( ( ) ( ) 9. o t he r (see Corrment s) (~y ( ) ( ) COMMENTS: \ SANITATION SECTION 10. Sewage Disposal II. l,Jsable Area 12. Wa te r Supply 13. o t he r (see Comments) COMMENTS: NOT apD I icab I e () ( ) ( ) () () ( ) ( ) () NO YES NAME DATE .~ . ' 9{ ~,~ 'C)>}7'5 q- ( ) TO APPLICANT:' ( ) ( ) ( ) Bu i I d i ngPerm i t / Site I nSp'e5y.~n: Can be approved. t- J -7~ . . .. Cannot be approved at this time as indi~atedon item NO; abov~. Quest ions and further informat ion on items I through 5 contact the Lane- COUNTY PLANNING DEPARTMENT. . Questions and further information on items 6 through 13 contact the Lane Count~ Bu11dinq and Sanitation Division. Will be held in this office until you c.an re.solve the problems indicated. Is being returned. . Yo~r building permit ~ppl ication fee is being returned under separate cuver. Your P1 LANE COUNTY PLI\NN I NG DEPARTMENT 135' Sl;cth Avenue East, Eugene, Or~9on 97401 rl10N E:' 342.. 13 I I F-l< I. 231 LANE COUNTY BUILDING & SANITATION DIVISION 135" Sixth '~"enue East, E1Igenc. Olegon 97ljOi PIK'Nr: 342- I J II [Xl. li V, . .,- .-..-.-.......-.... ................ . . .. .... . . ... .....a......._.._ ._.,'_"_' __'___' M<;<;_'Js:l .....T.' ,"",.-. \ :::', :.. 'r;:" : .~' .:~, d.', "'. .:--" '';'.1 I' . ~ ;~, 'j. ., .. . 'r; ;- 0' . {'Jf\) l1~~h)~1-~\?~) . Date' t~\:t?r0QC Oil ;;~U?15J Perm it No. ,t2.1l,S:;C~', CURB CUT PER M I. T IN THE BOARD OF COUNTYCOMMISSIONIERS OF LANE COUNTY WHEREAS, the attached application has been fully considered by the Board of County Com- missioners of Lane County, and it is the opinion and ;udgment 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 .. fr:JQO~(j\'70~ @;;)GO~i20IG~t0 or constructing the following facility: for placing, building . ' . &"g~;vw':"':l;q y:,-~"-'i'1~15 \:1i1~rt C!..;,i8n:Ib c.:~o tj}o;!,~ ',/1."\,. '" .f, "'"'.... Z:J iJ(;..'o.) U~21> .E"mf5'\?,@S1\ upon the right-of-way of County Road No. Ll2@}9 , Mile Post0o~~<j ~>,:.:;{,\:.;. f.)zlr2:/, in strict conformity to the exhibits attached hereto, and subiect to all terms, conditions, agreements, stipulations and provisions contained in the appl ication and permit, the Rules and Regulations Gov- erning Facilities to be Permitted upon County Road Rights-of-Way, as set forth by the Lane Man- ual 50.190(2) any amendments thereto, and any other applicable regulations, law or ordinance. l\.o(~ [',:'22l Q;:'~uQ;OI$~~1J '\j'IJ,~21L~fJ l}r~Ao "-', r" ~, ~ : '-..1 (,...;) Special Provisions: 1. Driveway will be constructed in accordance with the attached driveway approach specifica- tions (Drawing M98-50). 2,. Permittee will be responsible for the immediate removal of all mud, dirt and debris from the roadway and right of way caused by his operation, leaving the roadway and area in a neat, acceptable condition. This permit is revocable at any time, and will be strictly adhered to and no work other than that specifically mentioned above is hereby authorized. This permit shall be void unless the work herein contemplated shall have been completed be- fore Lj\$:;rtlO\S. @ , 19"iJrJ Expires , 19 Inspected and Approved Date " . Approved by Board of County Commissioners By By .' . Director of Public Works WHITE - OFFICE FILE GREEN:.... RESIDENT ENGINEER . PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE -BUILDING & SANITATION DEPT. YElLOW _ REAL ESTATE c98-79 r' - ,~ ", .' ".,. ~.,'" '.~ "'$'".. .~u. :':{~;'~:~~~:: '~'>';~:;~i2:;'.{,..,~~t:;1;;"-~,;':;\,:,:7" :.~ :"~' :',;;,- ..' . :~. ;;.;;. .' .." " . ... '. ~ " .. 1: : ,,~ , >:;,. '.' ' . '. " '~7'~:'~_:.~i~.~.'~'~':' ~': ~:,-? .~ > DJI'LD'i'~G;"'P~~;M;T'~R' :~ott~t~~~~~I:-'USE PERMf; / ~it}~; ,:' ;l3~~'" MH .0.'" PERMIT NO. l~""Y~ . MAllINGADDRE5,S' ,PHONE t.: /: \ ',..1 ., i ,i '" / \:' ,/-:.-: : \.....-PROPERT.Y OWNER .t, , 'r ' " LAN~ CO~Nfy BUILDING [ill }'. :.~. C~ffm,.~fhr41t . CONTRACTOR 1 . (" " . . MAILING ADDRESS ''; "l"7;"~1" PHONE 1Umm PROPERTY lOCATION - INCLUDE POST .OFFICE . . 2'164 rnMt" 1 tnaton 'PROPERTY lEGAL DESCRiPTION --:- MEJES, 1l0UNDS tSfltorbMt<1l' VIUO(1JO . ,fJ.~5l'i: Adclthm 'Lot ,lllHook 1 T)NP' f':/"^,,NGE_, SECT,ION TAX LOT NO" ,,' f: C:OOE CENSUS TR'ACT B7 :; :i4 APPl. ,'" . NAME & ,p' 2()..aw<\>B~O EXISTING STRUCTURES ON PROPERTY tr.fl!;}S~f!)\)tSIP Censt Ii- f'~" , ~~IOO('Jl -lEGAL ACCESS TO PROPERTY "~urmlB~9~~ Av@. PROPERTY ..SIZE - FJ:. WIDTH' " ,Ii!. ~ . MAILING 2S8.9.f4oU"th 35th Pl&t':e , ADDRESS' " SPr,i'R9flli!lia~, (if'$mon , : FOR MOBILE HOME PERMITS ,ONLY, No, of. Bedrooms' '. STRUCTURES TO BE BUILT THIS PERMIT DEPTH ARE~' . I'" 4 Sewage Sys.tem' 0' '.' SQ, FT. ',' . # BDRMS , ' New System 0 . VALUATION .' " 'I.i. . ~l Htl~) MlijIh,. . ' , Gor<119G .~~<;. ~tt~" D05&l?llD $..~.~. H.l P'l fSil~lng F ht~ur@1S <;:onnect fo Existing TYPE,CONSTRUCTION Frai1t$ 836S (>>u an> ~ @J l~.,1ia~, .' , u~~. .:-',' ~---l1;fftt.~ ' ''''~ '. ~-.; .!- ," ~'~E'WAGE. DISPOSAL . . PUBLIC 0 SEPTIC TANK 0J ',' BU'ILDING ~. ,WASTE DISPOSAL " PLUMBING PLAN REVIEW :,,'t, ,:", PARK TRAilER , OTHERD '00.00 , '20..0@' .~ ~:3.50 FEES PLUMBING INSTAllED BY OWNER tJ, OTHER: NAME WATER 'SUPPLY PUBLIC I]]~' bOTHER , ',' " " TOTAL ~' l~' .5d) COUNTY' BUILDING.& SANITATION SPECIFICATIONS ; MIN;' SEPTIC, TANK CAPACITY ~ .. ... . WITH DIST. BOX: GAL JOO DRAIN FiElD REQUIRED 22$ " lIN. FT TRENCH, WIDTH FT. 2 OR ~Q. FT. ~$O ft@010ral~s tl:o street. . .~ .... ./ " '::TYPE OF STRUCTURE i ',' S~j OCCUPANCY 8 & ..6 ,ZONE M PUBLIC UTIL EASEMENT >c:"j.. ~;, f, . BLDG. SETBACKS'n FT.' FROM CTR, OF ROAD RIGHT OF WAY FR()NT' ~S" SIDE INT. ,5. SIQE EXT. AUTHORIZED SIGNATURE - DATE Isl.J. Er"$~tll ,by .r,.c.aHGiMf 'REAR l' USE CLASSIFICATION \', .( " DATE 3..$"';13, ..'. , ' " '. ;"\i::-("<'i,,!J~ Con;tructionto comply with uniform building"code- o.~c! county reg,y'!,8hons.;i~ covering plumbing and sewage disposal. AU buildi,ngsre.quire a cerfifi.cj~JE?:~: of occupancy before being occupied. ' ,::':.~-t~j;~;:\1J< , , ;'(See Sta'teme'nton R,everse Side) , , ""~~;~;~~:;: ~.." :...., Johr! 'CfuICklJh~[ltD ~~ s. BlDG, PERMll- WHITE 'OF"FICE COPY - WHITE :f' . 'COUNTY TAX - PINK 'PLUMBING - CANARY BUILDING - GREEN . SANITATION - GOlDENROD I,,'. , . (POST THIS PERMIT 'ON MAIN BLDG. AT SITE) . LANE COUNTY, BLDG. & SAN. DIV" .COURT ,tIOUSE, EUGENE, OREGON 97401' '. '..;,~., FORM..it",r.CjCj ;:-:1::C ,: .,';-.'..,.< .:1:.. .. -s; LAO~I LOOR PLUMBING GROUNDWORK ApPROVED I XI 01 SAPPROVED REMARKS qAS PIPING GROUNDWORK ApPROVED I I DISAPPROVED I REMARKS ROUGH PLUMBING ApPROV,ED !/\ I DISAPPRO'VED REMARKS ROUGH GAS PIP I.NG ApPROVED I / 01 SAPPROVED __ I REMARKS FINAL PLUMBING ApPROVED ~..-rl DISAPPROVED-I REMARKS _ FINAL GAS PIPING ApPROVED I j 0 I SAPPROVED I REMARKS CERTIFICATE OF OCCUPANCY " ... "; I DATE 1-/0-73 I I DATE I DATE 7- ,)?-?J I I DATE I D~HI/- t- J J . / DATE READY TO ISSUE I ,/ NOT READY TO ISSUE / 1 . DA TE ~- "-" REMARKS ~. ''''1 ' . \'NSPECTOR INSPECTOR, \) d/~ 't/ I",,'no: . :41~. f INSPECTOR IN""~ 1I I N,SPECTOR -':."" INSPECTOR ~ . .... ""., " , '; ,I 1 ".... . t.'~' ;~ :7";;'': .!. ", . ~ ,. , i,:~ - ~,'!:; )::'" " ...... \ .' ,::PR,OP~RTY OWNER ftt~a(~"'::\.. ,~j~ , CONTRACTOR ",,_." ~ .: . ~~ ~':- ...~~j~4~~j.~~Jc_:~~iJ!;.. ,'PROPERTrCO-CATION - IN'CLUbE P;~'W:OFFiCE:; ,<;)"jj!G.l\ n~;@lIR'l!'MIl~~' PROPERTY lEGAl bEStRi~Ti<:!N'~ METES, "'J ";. . ", ' , . ~r1nfl't'1l!1l':\'t~gmr Mn Untrf") fw,(', .'" RANGE., BOUNDS ,"'!:'~~;f:J:,P;*'~ii. '..... ILD-'I,r~.:.PERMI~l;(),R MOBllE~:HO ''':MH'f~t~i;~h~,,~':<(f:r'; ',: ,:.'~I'\', ' , MAILING ADDRESS'" ' ,'<, <. . ( " . ,,:.'~~;L;~:'j,,~' ," " ~ :~'i!i~;J~'. SE P~RMit PERMITN:O. n~~~}}~l " PHONE ", :.. . ~:r-~~:~ -:, .." ,4.~.'t:,., ~ '-'1 //lJu:r, ...., . ;. ,...~.... . MAILING, ADDR'ESS,:.' . . , -; ~ \'.o.Jil~.) ,\. . ,-~\t~'-_. , , I' PHONE " r' ,,~w~g.i:J;vn " ~.~.., " -' <::-~~='..; . ......... . ~.' '1, , ' .. ' 171i frflfC .~1c11t 'M t@~;Ut1U ~~ ~. SECTION ' TAX LOT NO, CENSUS TRACT STRUCTURES TO BE: BUILT THIS PERMIT _ _ .', -t , \;p.~~, n'- ,,_ " -' '" _ i. -' ~;~_ .;, .' ,',R:-~t'1U h6~(1 t:.'ct.lan(', ' ,~'~:~OftQ'i;ci..tMiJ3; 'tl~at:~ '. ", .. . .......". '~'\', ,'I.,' - ~,'. - ..t.. ~........, " OnsaoU,D '3.;04$... " '~~.;,~ 'l'r(i{ t>~r''';0.'!lfl~t:ll :!1.Bt1'ftMWCD ' '-" ~ <"'~ ..;:. ..~ f" ~, " ..11':\1 v . ",...; ',' " )4 P PL NA'ME, & MAiLING' PlCiltn ~*,l" '" MOOfi.ft.i~t~Nf1R _ '.. m.'\;\ : .~' ~i{i ~t)mQ ',j'j(\~ht~! !LltreJ , ADl;lRESS, RD1fr.n~';fD()n41" iJP.0~t't, ,FOR MOBILE HOMCfERMITS QNLY 'No. of ,Bedrooms . '" ':", '~ SEWi1GE DISP,OSAl '\PUBLIC d BU.llDING'" '., ' . WASTE 'DISPOSAL t. i PLU,~BING" ' ':., PL4-N REVIEW '- {, . . . ;:" PA~'.5.-JRAILER ' 1, "TenAL SEPTIC:TANK I1EI 4{';" ~ _:~.; .,;..:.:-" .1 ~. , ' :-.,,~ ~ , MIN. ,SEPTIC TANK <;APACIIY : :WITH' DIST. BOX: Glc, . ; , ~, \ t;@G " ," '\.~~~;' €J~Qq~O ~~,,~~\~, ',.\ \ l ~ . 't "..;,,_~~,~~.:~l '':J~~E:OF STRUCTUR~ ' I.; .~ , B,LD,G, SETBACKS ~RONT, 't~~o .;,J', .... l. CODE ::-:~ . '1J~~ -',:' ':~~' y. I;f;; j ~~')'"'~~ \1~1U . 0 .:r-\,.;.I~ iJ,~),l ,~. PROPERTY , t ,1. , < , f'-. EXISTING STRUCTURESpO~ :.'. - . .. ")1-~"';~~' ~i:Q" . 'I,' ~ LEGfL ACCESS ,TO' PROPERTY [J~WD'$a h';l\;;ird;@I\)IAV~" P~OPERTY SIZEk:T' FT: , " iWIDTH DEPTH '0" ,.:: .',~AREA ,~~.7 ,. ~S:e\.Va~g'e, ;S)'~tem D.... New Syste,rn. 0' ," SQ~ FT,: # BDRM.~ VALUATi'ON ll.;)(b.~r '~@, U~; ~D~ ' , ~J~;()~ne .:"~~' O',~, ',.' .~~t?c~' " ~\ ~ ,.' 7-~/p'i?J--'-' ,,,,'- ,{'"\ "'... \ '~V'j, -"\. v-, .~\ '. ~ '.~~;, 1i . . ,/ ,,',,=-.'.t.. \' , ~}'. of .. ') "';'\"'~-': ".,.~ 1,>\ .... : c'onned 't(),.}EXi~,t.!~g TY,PE CONSTRUCT\~N 4f(?Ot;1;l, " " '.. i-~- ~.\_~ ~ , ' , '" "', '.,' '\ ';:-J \ ....~ \,;, , ....... .~: >; . '\ .:,.~;~~.~~:. , \ " \\~\_T.,,-'_ ~ '\ ,': ,\,,:,~:,>,,:' . '.;.::..,-:..... . , !~ , .. "to ~', '':~'" . " \ ""'. 1".- ;'\ " ~ :.i;!~).. 'f :- ~;.,- _: PLUMBING INSTAllED BY .f , , !.1 , 0THERD "1ll:~U~5 ., tf@. ~Pl "i1~. Lh~ , OWNER 0,' OTHER: NAME WATER SUPPLY' :...~ ~- FEES , , o OTHER \ (--..... . , ~~?<\: ~ " PUBLIC QlI I- ' ! ~ ...., \j; j~-" .1 ' . ....; ,. , . .. !, ,HHL~ ' '.. COUNTY BUILDING & SANIlATlON SPEClFIO\TloNS' BRAIN FiElD REQUIRED " lIN. FT 2<2~t , 'TREI..lCH WIDTH n: . \~(~ .!"~' \ ~~... \ ,>it "'. " '\ ~.""" 'Xl \". \'" ~, . " ~ .~t~~\\l~~\~~~~: \'. , . "\ ' ,~~ r~l) .' 'OR SQ. FT., "," j , , " , ~ :..... L -'\o~ -....... ..;........ ~""\-~: \ \.) \. ...... .... '~~~."-~"'fP:., '....~II , .-' -, ,! OCCUPAI'-!CY n (;; J', ZONE, bin PUBLIC 'UTll. EASEMENT i j., ",," _ FT, FRqM CTR, OF ROAD RIGHT OF WAY' ~lJ , ; DATe' . OcJffto21.~/ REAR, .;. (. 11'/ ", USE 'CLASSIFICATION !~I SIDE -INT. SIDE EXT. AUTHORIZED SIGNATl:JRE- DATE J..tr. g:t)$f}!;;V ~nC~ ~)Q@,V'l\JlU q;;~OtDQ.,"U~e C~ 0 S,~ " .....,t" ": .. ". ,,(See\ Statem~nt ,on: ,ReY~r~.: 'Si~e) '" :.-,;~, '<:'" ),.,-...1). \i': \,\;'~\"'\ i . "'''''..',r'\>''\'1~.~ ~.~~. '" ~ ~., . ~~ '. ',<.. . \..\.......l::~~ - \\ .~ .~~::.~ .'$';:'~:,,':-'-;':\.~ ~") ..~ ),"J,_;,.~<" <; ~\:~~:.'tY'.\ ~.'" ~ :'~)':~~~:)'\':~\." ~__.,;"" .~ , ". >".J \ '.:~~ ',,' '. (POSTTH(S PERMIT ,ON MAI~ BLDG.. AT S.ITE) , \ '. .', "t ' H, ". ~~. ';'!'", .' LANE COUNTY,' BLDG: ~~At;I" DIV.j:, COU.RT"):l/;iuSE" EUGENE, OREGON 97401 ~,. ;" ,_ ,,;."/''''~'~ oF- ..... ...;, .~. <' ~ ....\,~ ~';-.t":^r.;':..f:' ',<.~' .~).;' ',' .",..! ., jBLDG, PERMIT:'- WHITE" iOFFICE COpy - WHITE .ICOUNTY TAX - PINK , I PLUMBINGi- CANARY ! B'UILDING - GREEN i SANITATION- GOLDENROD ", I ' .! \,\:' }~ , o,j , \;.I :,.., 1 ."'," ~.~.~.t.-1~ ;t\C~5t~~: '1;3' " .'~ 1 'F J... ~ ,. . _ ~ Cons,tructi'on. . to comr.lywith :!-,nifor~ building code and county regulations covering pty,~~~':l,~i. a>,\~,:\s~..~~ge ,disposal. AU bupdit.1gs, requir~ a certificate' , ,of occupancy before""Belng 'occupied. '''i,.. ",,'~ '< '!~ SITE INSPECTION ApPROVED / / DISAPPROVED / / DATE: INSPECTOR REMARKS FOUNDATION IN~ION ApPROVED / V / DISAPPROVED / / DATE (,.(J ~ ? J INSPECTOR ;/ REMARKS FRAMING INSPECTION APPROVED' /~ 01 SAPPROVED / / DATE '7-/ ~ -t/7 . I NSPECTOR ~ REMARKS,.,A'.4v \?~ <j'- / J .- ? '3 I - LATH OR SHEETROCK INSPECTION ApPROVED / / DISAPPROVED / / DATE I'NS P ECTOR REMARKS FINAL INSPECTIO~' /~ ApPROVED / t:r DI:1PPROVED / / /lATE I O-t:l1 ~ 711 NSPECTORlb( REMARKS~~ / ()" 10" 7'7 tI( , - CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE / / DATE INSPECTOR REMARKS /1 f) '/~1 A_~'; II' fI.J./A"I/ ~ /'-- / Ifr~~73~21tf 0~ .,,?o~3 tl~ ~, :' ..~~>trI~~' ,C";.:. : .". ': ~:,~"'.' 1 ',' . \~ . . ~':t ,.' -, -. :-~- V;;.'-::~ -"--V-.':"'~t~~"-:''':;::~.~_:~~~~r:,:'.~;'t~~~:~~';~. ~'::;/:i:'-':~~' ': . - " ,4, v..' '''','. ~;r: . ~,' ~~;~."l:~-':.tj~;"",-: , ''''j , ;j~.~J .I. '",'.' ",: ;~i"-~' ,.;..", jf l)' ,.' . t .~/ "',f . ,.,,~' . I./,_~ '~~"-~'~r "':~;'l~;..~..~I~.:& jflff~. '_1':1\ ~ ", i.<< ' ." ~ '~.~\".'I... ':".: ~~ "1 "- .: . ~ .~ " .,';: ',', . ',' ; . .' " . ',' ! M:..,:"'t~:,'i;:',>: "'i ',.AP:PLICATIDN'" J;OlR., FA,CILII .,PER'MI-r'/ -;"~, .: ".:..' . ,-. .'..'.'.,- ..',", ,,'.'.,. (~~', ': ' ."- "':':'I:,~~ . ' . , ,.,',.. :" , 'IN THE' 'BO~:BJ.;?~~1PF :eO~N~ ,C:OMM.lSS.ONER~ OF~~,\:lANE C~UNTY;+i~i':i';'''~;, . , . ;?~I>. '-"~" ~.' - .,- ";'~':~~.:., """!.' <' ", '".; ." ,Your applicant,' ,'" :./ >~{>~;,:i~'_~'.'~ ;,,~, / ~~ /':>4:~,;,.;t >.~.f:)'," , / '~.; "J/" . . _/t' ,.-' _ .' . ~r"" . "'''. .'.. ! " hereby' makes applicationunder.Rules. and .Regulations Governing Facilities to, be Per- . rhitt~d Upon Cou~ty': R~ad Ri9ht~~~-Way:'toco~stroct :t~~following fadlity: . ,.,c,,;. ,/ {" (,/ . 1,' ...... i! .. ~., ,/"" . .4 "',- !~. '>:.~~r:i:L\. 4. 1't.--": , 'I",' .::~ ..',r~L ~.~ _ . ~ /:. ( ... ". .~.... . _.... ... <"",.~,. .... _ .,':._., . ~:;> '~... ':;,,..(, , :' :':;;, 'iI,i> . ::.;;:i;)C;~ -".--,.,;. ,Upon theright~of-way.of ~o~nty Road No./:::'.t:i.c; , "at the'followir~g location: '~,., r;';~ :f'~'<'''' . . ',' ~/. t/f.':",>^t:>i,r. : .', t,.-;\-, :~....;,;~(. .:.::;-"'":;,-"'/';{.~:~;:: .<;'L ". /~/ ,J:" ,...):, i/ ,>. '. ':' 1::- /' ,';". ..' f . . ;:..._,,-:-.T. I . ~ ' ..~/. . ',' J.' ..': . a~' ~ho~~.on t~e: exhibits which 'are attached heret~, in' strict Gor,lformity to ~he,st~t~ '.,. "'nients of the'exa"'ct"f1ature and amount of.work t6,.be'done, and to the description'o,fthe' ,"'"'" .. . .. ~. . . ,facilities contained in said. .exhib.its. YourappHcarif:w'i,n,'b~ the benefic,i.al oviiner. ~f' ~he ,~., " ','.~.:..;.. facili~y, as:'constr~cted, or otherwise primar!ly liable~~nd r~sponsibl'e. to' members of.'the . ,..~ ...,' " ' ' . -, ~"" .' ,- : " ,,;':..,' .... '-'., .. . . ' ; 1 ,. ," .' ',' . ""'. ' ",' .' -',. . . ":publlc for its proper maintenarice',repair; operation and use'. Vourapplicant accepts,all '., .:'c' , i . . . . ' . . . . .. . . . . ~-' I: . t<.~. . . . . .' .' . .... terms,'conditions, agreements, stipulations ,and provisions';, in Rules and Regulations' . ...., GOv~r~';ng F.aciliti~s to be,permittedl\jpon' cou'~rY'R~ad ~ights~of-Way, dated !\'1ar~h ;3', ::'>~~:' , . . :' . ~ . .~~;~. . ~ . . . ,,4, '.' 1960; an~.l~riy-ainEmdments thereto', and any other applicabl'e regulation" law or ordinanpe., ' " :"\.'. '; ", :' >;,' .~ : . .",' . { I' ':", J'.., . .' ";.,, " i ~. . ~',. " , Ie " . .-01 1/ ~ ". . .. ,i'. . ".': _." . ft;"'~ "(t. '.",k~. " f: "'..' ", c.~J(.Y //",,:.. y.. . . ~ . [.'j~~"(~."'''' . ~'~, ~~ , '.' / " t"1 ',.,.,A., '.. ""', ' ,r,.,j", ,""-:l' l,."<t(..., ....-~d , I . . . . ", . ~ : ," ,'.' " :.;~'Il~ t~/7-3 ~'. ~ : ~. .' . , ; 'I' .. .. ! ' -.' . ' "1 ~ ;"... _ ,'" " ., ',-i. ' ,J'::~ -,,' '. . ," r ^."~~,,. I ,'. '~~ftl t';' t . " ,~:.It.." ";: ' . -'.1 - .L_, .~' "'.. ...Jwp.J~:.tt..,,<<<~)o~t7'''''~lt..,-t:''-.' ,-"". '" , .,' .,.' "",.,..., . . , . ! ,'. ~ '..' I., : :~: ; :1 ' . <, .~. '. ~ " :,~; ~.itiv~ , ',:.i:;;f" 'd:t~~--- .~'t'*,,:~'jJ" . . . . . Adaress" . I . It' . oct. , "":',,, It . ~'jr ~ ,r,'5 ji', " ~1#.I~ ;\;.ll:" ~ .-<< ; t jl.-t ,.."..... .)~ t"'ol!.~'~rlr1. ..;t(,~...#~...~ .)::;....;1. j i~'~ y.~ II!. ..... . ,;,' ".WHITE ~ OFFICE'FILE ' " " . . I . .,.., .GREEN,.'RESIDENT ENGINEER ":1','..;. ':-P'INK.PE,RMITTEE. ,";''' ,': \ . " ;' .' , ;.,;' BLUE. ROA'o SUPERVISOR , ':. " , , ." " "ORANGE .'BUILDING A~D S~NrrATlON DEPT~ .. _,_" . '. .'.. . '.. ,'.. l l ", .~, ',YELLOW .'SURVEYOR' ' ~ ''. .; " .' , ',' . ". :"....,f..'lf:~J...1 ""j.'.:,.,"<">!" .1 ' ~ 'It.'''' -~' .....~ .~"..~:': ''1" . . Ph'one No ,.' ~ .. 'f: ',Ii' "ri'. ':. ~ . . If< ~,__ . ~. . .'^"_ '; " ': .; ,. . - , /. ..' " ':: : '; ~ '.' . . ~ . '~ , , ;.. .'. ~, .:. . " , .. \ 'I. . ..' : ~. " '. .:,:' ~'1' . J' , '.... ,~. ~''-' . : ,. ,'.' " . ..:' i... ~ ..... ',' ;.,,-" '.. ',' '. .' " '1 f.-. .... ~l's 1Z Ij Bedrooms Baths \:J I INDIVIDUAL SEWAGE D~JPOSA4j SY' .~ RECORD Installer: C6mple~e top part form to signature and return both copies to Lane County Building Sanitation Department. PF'RMIT No. 1#t?--7 ~ ),(j'r:--tJ, Address We-.s7:0VeT Cond: r ,J "2.. r..f1. Feet from ~&8'g N) .}~'l"Y\. Well Foundation 10 S '~e..-t I p\ Lot Line ' .' pn'J' fJQ I ~, ) ~ , ' !...Front Side I tJ Rear I ~ L~PJ:th""1*Lin4es J Ft. ,... T:~nch\i' Tot~~~q.F~.bet~~n Fil11rJtt:l,. ~~~~~r'dePth '~~i~~rl,d.ePtfi..' 1 f ~ 2./..J 3. . 5. 6. WJ.d th it. 7'-' tJ hne s I v TYP1~~ tile ]..- in. til~ hi.lJ... I Sket~ (See, instructions) : .. ?J' j; . pzogefty ~<t4res~.. .1-., / t L./ ~../~9 1 /h., ,~ Basement ~Water ~ply' Yes 0 No ~ PubliC, - Other-List Concrete e( No. Compartments / Gal. Capacity. / €)tf!Jd Tile Disposal Field: ~ Diameter Depth , Distribution Box:Yes ~ No 0 , Other Distribution- Type No. Li ving Uni ts / SeptJ.c TanJe: . Ft. from well Steel 0 InsJ.a.e DunensJ.ons: ~.t. Length Width Applicant"' Name Mailing f.tL. '~., N I <"" 'V.J\A'? n-i 3' , - 1, T t- ... T I J.D_ ) \E',' (Pl fe fl \V1 ~ DII t' I," \.: \1 ,', Jt "'. AU G 29 1973 ] I I I _I T [ I I I 1-- LANE cour~l'I HEALTH UNIl go~ I For Sanitarian Use Only: ~APproved: system Installation o Disapproved: Does Not Conform Remarks: () ..4 , Signaturel\~~' Q/)/z[ lJ~ '..' " 'I -t/' . Conforms to Current stLdardS Date, ~~ to Current Standards dr;l~~/___ ~ , -". J " . .. Date ~ ,- z- J - / q 7 i. Lane County Building & Sanitation ~~~1:.~J / l' Sani tari 's Signa ure Dept. C\ ~~13 C 55 - 11 . .' PERMIT LANE COUNTY Bl .JING PERMIT OR MOBILE HOME TYPE - BUILDING ~' MOBILE HOME DOSCREG':'# MAILING ADDRESS ~ - APPLlCA TION PERMIT # /c/7C1-7-.3 , . :.A?~A..- _ VJ/I /1 /' ' CONTR,Ao/R . ~ ~ /fJ ~ I rJ i;' MAILING ADDRESS L ~~_ PROPERTY lOCATION - INCLUDE POST OFFICE c:2 7 ~ ~ /S-d / jHONE ' /. PHONE /7tC/7-997/. V_ ~// /!:/~ v~ MEfES~ & BO~S~O YES ATTACHED 0 NO PROPERTY LEGAL DESCRIPTION .,----/ ~ /,/ LOT - BLOCK - SUBDIV. ~ / , TWP RANGE l/ SEe. -2<;/ /. /. / / DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY q/~~-~~. --yJ~ , _ - - ~cL /" ~EGAL ACCES~Tt> PROPERTY - RO:-D ~. OR # ~-S f- 9 ~,h~ :<.j ':AI.PJ. ~~ MAILING ~~. - ,- - . PROPERTY IZE-WIDTH DEPTH ADDRESS . FOR MOBIL E PERMIT ONLY Number of Bedrooms sTRynREs TO B~BU~ THI~ PERMIT ... /~///~---- ~ '~4 ~~ -"~~.4-"J ~- , /" - - TAX LOT # C,ODE CENSUS TRACT , ~.o~.L:-D /~-o /7 3 APPLICANT NAME AND AREA .Connect to Existing TYPE ~TRUCTlON . _7A~;A-/7_ Sewage System 0 or New System Req. 0 SQ. FT.Ii3'/2..# IJoEDROOM\ VALUATION /Uo ~ (3--) .Ie) 3~ f//?'t/ /, 4S--t or / 7) 77.:J- .-- J ,/~~ c.b~E DISPOSAL . PUBLICO SEPTIC TANK~ $ /;"X, tf iJ ' _ ' c2lJ ((:JCJ -3-3~s7J TOTAL J2f,.~ ,/~f PLUM,B,IN,G INSTALLEp BY ~~ OTHER 0 OWNER 0 OTHER~AME FEES WATER SUPPLY PLANS FURNISHED' , FACILjpf PER T ~ PUBLIC 0(' OTHER YES~ NO [j YES ~ NO 0 PLUMBIti6 F~S x: 'S~.T :ruURREE Yl APP~,L1N NTTU> - . DATE Ldr;KfURES"&?I'OO ~~ ~ 7 -..:;?tJ-& CASH 0 s~ / . 'FEE RECEIVED~~ DATE CHECK ~ON~ECTION FEE ~ c: CJ CJ ''f?r 4:e" e;...- 7-:3 (J --Z) PERMIT fI:' / PUBLIC WATER ' . ~ / ~ 7" CONNECTION FEE / ~.sO ./ 'T' 7' 0 -/.3 COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED L1N. FT. :z~ TRENCH WIDTH FT. .:2- OR SQUARE FEET~ /.t~ ;1 / / BLDG. WASTE DIS: PLUMBI,NG PLAN REVIEW PARK TRLR. MIN',SEPTlC TANK CAPACITY 9'00 Rd6f ~ iJJ E;Gao.t WITH DIST. BOX: GAl. TYPE OF STRUCTURE ~V OCCUPANCY , , 1+;T ZONE REAR YARD \ 'rBLjf'rlL. EASEMENT V 1<1 REAR "7 ,A BLDG. INSP. USE CLASSIFICATION Dote ll<,h~ '" I - ","J..//'"~' ~ /_ Dote /{/lL;?f€-o.~ nt-1/ PE ~_~ '/ '., 1 //- to Find Property: COpy 1 - OFFICE COpy 2 -:- JOURNAL COpy 3 - AUDIT Form #' C55-12 .1,' l' ~/ !i;' ,,,,' I ~, "P < .J. .//, -' 1 jV.', ;. III IZ .. rJ:~;'1:}. S Name {/ ?No.LivingUnits. Bedrooms Baths .. / \J ~' Septlc Tank: I Ft. from well Steel CJ j Ins lC1e IJl.mens lons: I:'t. J j Length Width \pplicant" I ,( Name 1 . jM ailing ....,!"-t..ft"'=..~ 1NDIVIDtJAL SEWAGE DI-':;POSl\l. SYS' 'lU~CORD ~nstaller:: Cumplc .:e top part, . _form to signature and return both copies to Lane County Building SilriitCltion Department. , /,.._, / '-./ ~/ ,I, .-- , P',LRM..LLNo_,,-.~....{~-'" " t\q.c1 1'8 S S / / 7 "I. ...t-- . .l.~: t~f\;l-lti'-<-- Public ~ Other-List' \ -.r ,/ " , P.r:ol?2~'ly '/'7' , ... / t. i/ Basement Yes 0 No ~ .\- " / Concrete W' Diameter Depth .I Gal. Capaci ty /Oc.;c>" Tile Disposal Field: ~ Distribution Box :Yes It.l\ tJo c:: Other Distribution- Type No. Compartments ; Address i r ! ~ -j- ~ C' -to ' .'ve...." uJVCrun <.. r- :L,S:X'Cj iv)j :S~:tt, S p~--\\"l{il::.kC F) l~ ,- Length of .Lines -' Ft. .../ Tre'nch Total sq, 7' 0-/"-- \ ;) .. 1, .j 2:(J 3. 4. 5. 6. Width.) ft. ~r (1 Sketqh (See,instructions): 1) Ft.between line s /0 Feet from Well Lot Line Yront Side' '/ Cl Rear 10 Filler~ 2- F.iller deDth .Filler depth '1' c/i] , a!?ove be low J yp ,(.~j."A tllC 'J.-.-- in. tile ~ ~ Foundation ICY l L.c ~ I ) j"f n. 'jcJ. 0--:, ---- ---~\) r-'--"iJ- y, ----Cc..---------------- \)-~J l ~~~ ~ r '_[-I . rJ r fIlL __'_______n_,.. -ot ~ ( / ~{)- L I I I _I ,. I D) , , Ln ~ (:9 i!~ n \'11 r~ r: :;, ir: " ---, "' [ I I I I ~\U G ;) '1 i-J I.,.! 1973 I I I 1-- LANE CUUi'HY HE.i;LTH U!\!II _3 () _.~ . - -), Date N --- 2. )f - / Cj 7 i /' POl' Sanitarian Use Only: ~Approved: System Installation o Disapproved: Does Not Conform Remarks: ~ Jj I Signature ~-,,--(~ t/~ f1 Conforms to Current Standards Date:~~:?CI' ~ to Current Standards ~~___ Lane County Building & Sanitation " Jr" ftjl fi), J2... fl 11.- "YI-n )j...;/{{t. - 1 /1,~ . '. Sanitarij,s si9.na;u:r:e..> Dept.l . L\ --I - 1_.