HomeMy WebLinkAboutPermit Plumbing 1974-2-8
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. '" ':,.~ >i( " \' f LANE COUN~;,;~I~mNG.'p~RMrt"'OR M'QBILE HQt..-.,USE PERMIT
'~ :'I' ~r.: <f BUILDIN.G ~( ~?... .t.. MH~ 0" " , ,': I" ,,,",' P.ERMIT NO. ~1~
:;PRo"PERTY-, O~('1NER " MAILING'. ADDRESS __
. '..::,,' ,tiGst6\r~r C(j)n$~~yet:it1m CO. . '403t~..HIDJn: S-t,~
... CONTRACTOR MAILING ADD~E~f'
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,:~~lr!l~gfleld p- 0rirgon'
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~.~:I~:'~(,~~i~.~~"t .
,: '" ,Se;n2 .
: 'P~9PERTY LOCATION - INCLUDE POST OFFICE
, , ' . 2:7€J,~ C{Jntsr~lJry St. S~rifl~fJe'ld
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
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"
,.\
,'TWP,
Caf1t,er.l.11ury,.,YHJ tll~(J Lot. 10 . ($h()ck '2
RANGE ,SECTION"
24",t-l J l.'-~
20."EO.l $0 .
1 s-t Add i.t:i0n
jXDz~ :
COD~';:",.
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..
CENSUS TRACT
,'17 "
'o:f'
APPl.
NAME
EXISTING STRUCTURES ON PROPERTY
\1est(j)var CGns'tr'.' CO..
None': ,
. LEGAL ACCESS TO PROPERTY
, ';-C~l'itcar.bu&"y"St~
PROPERTY SiZE - FT.
WIDTH?9 .36 'DEPTH 1 G4 AREA
&, ",
" MAILi'NG
"'ADDRESS
,FOR'MOBILE_HOME PERMITS ONLY,
J '. '
No: of Bedrooms
STRUCT.\JRES TO BE BUILT THIS PERMIT
Connect to Existing Sewage System 0 .
"FYFfE CONSTRUCTION SQ. FT. # BDRMS
. UlrJi3ll-l ng
Frame
1347 @ 12
480 @ 3
G/i)rt:l~Q - UfI(te lIed
M t &Jehecl
"'~',:':':~"J'-'.~, :t.:.-~";;..::~' .... ,o:~'
,91.. - '( f1,:;.:'1
. .
PHONE
747...997'1 .:
PHONE
\
New System' 0'
VALUATION
16~. 1 ~l:,
. _tp,t.~-,
l7;6C4
>,
FEES
PLUMBIN~ INSTALLED BY ,
OWNER D OTHER: NAME \JCJHy"s Plumbii"ll:i
WATER SUPPLY
. ,SEWAGE DISPOSAL' ,
PUBLIC D SEPTIC TANK
5:J' OTHERD
~ 6ft 00
30 ~ 00 '
3Loo,
D OTHER
, ;
BUILDING
WASTE, DISPOSAL
PLUMBING
, PLA~ 'REVIEW
" PARK TRAILER
PUBLIC D
~ ;,":"";,~
, ,TOTAL
~. ~'29..00 "
COUNTY BUILDING &,SANITATION SPECIFICATIONS
DRAIN tl.ELD REQUIRED
lIN. FT 150 TRE~CH WIDTH FT. ,)~
OR SQ. FT.
3~O '
MIN. SEPTIC TANK CAPACITY
WITH DIS'T.BOX: GAl. 9CO
:~~-lt;"\,..fj,.-;,....'" .
, Rodul11<i:lant systGTI' rcqu i.red : CiS' pea r: p let; plen.
. TYPE OF STRUCTURE \.
-' .
,"
Z<;>N.E: .'
PUBLIC -UTIl. EASEMENT
,'. r'
,5~~ '
BLDG, SETBACKS
FRONT. 4G
OCCUPANCY
:, I: &. .J'
_ FT, FROM CTR, OF ROAD. RIGHT OF WAY
SIDE' INT. . 5 SIDE EXT.
:AUTHORIZED SIGNATURE - DATE
.7
USE CLASSIFicATION .'~
REAR
:., '-,
:...../~IJ;E. Boss\,by c. HCli"b~ugh
i
" .tol'iln. S~k
:.',
, 0
2..8""7~
DATE
. off:
, BL'oG. 'PERMIT -WHITE
:', . OFFICE coiN- WHITE
:." COUNTY ,TAX ~ PINK
. ,PLUMBING - GANARY ,
'"., BUILDING":' GREEN ,
SANitATION -'- GOLDENROD
Constructioh to comply with uniform building code and county regulations:
covering plumbing and s'ewage. disposal. .AII buil9ings require 'a certificate
of occupancY,before. being occupied.
(See Statement on Reverse Side)
"'; t.,
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,'(PPST T~IS PERMIT ,O~ MAIN BLDG. AT ,SITE)
. ; ;' , . . . . ~. :. .
;", LAN(<;:OUNTY, BLDG, &:SA,N~,DIV.; CO\JRT HOUSE! ~UGENE, OREGON 97401
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.~h~M # C, ~5 -. 13,
c" ,". ,"" J '
of:
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".~:......-:...{~
, :j
BUILDlNG ~ITE ~VALUATION
. ~.
\.I,
~~/,HV
9f-7V
1'7\, 3 2/1
T Itt",:'it'i#, "iii' S '1
CHtSU.1~"RACT
IV- IIdJ. COJ1/e"b'lrV
APPLI CANT: .... J I'
NN~ E WfJfmllt'r
ADDRESS
TAX LOT.
ViiI, L-ID 13-2..
(811,-1 CO.
~ Building Permit Appl ication No.
() Site Inspection
() Pre-Permit Investigation
PHONE
DATE
/-~ '1-71/'
1.
Zoning Ordinance Compl iance
(Zone_d? - L)
Subdivision Ordinance Compl iance
NOT
app I icab I e
() ()
( )
( )
( )
( )
NO
YES NAME
DATE
LANE COUNTY PLANNING DEPARTMENT
3.
4.
Required Access
( )
( )
( )
( )
(~
(~-
( .....r
("y/ ~ ~~--'~~~
( )
2.
Building Site (Area, Width,
Frontage, Setback)
Other (see comments)
5.
COMMENTS:
BU I to I'NG I NSPECTI ON SECTION NOT NO YES NAME DATE
app I i cab I e ,
, ,
6. Plans Subm i tted ( ) ( ) ((
~
7. Soi I Stabil ity (footings) (.1) ( ) ( )
t
8. Flood Plain e) ( ) ( )
Ot he r (see Comments) jr ( ) ( ) "1 f'f .} /1 "
9. (,J "':it " '''---r;l/~/':-k,,-.'''''1' ,ii;;~""-
; ~/~ - ~" "". -\:" "Jf - _ '.
".
COMMENTS: I
SANITATION SECTION NOT NO YES )lltO DATE
app I icab I e V 2/ 7 /-J (,1
10. Sewage Disposal ( ) ( )
II. Usable Area ( ) ( ) (/
12. Water Supply ( ) ( ) (/
13. Ot he r (see Comments) ( , ( ) ( )
." -... ~.."..._--..
--.... - . . .
COMMENTS:
TO APPLICANT:
( )
( )
( )
Building Permit / Site Inspection:
Can be approved.
Cannot be approved at this time as indicated on item NO. above.
Questions and further information on items I 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.
Wil I be held in this office until you can resolve the problems indicated.
Is being returned.
Your building permit appl ication fee is being returned under separate cover.
Your
1)-7 ef )if
( )
LANE COUNTY PLANNING DEPARTMENT
135 Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342-1311 EXT. 231
LANE COUNTY BUILDING & SANITATION DIVISION
135 Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342-1311 EXT. 411
C55-28
~
- '
... "
........../"'...,;,
PRrED SUBSURFACE SEWAGE. DISPOSAL "'-'~TEM
Ins......iler: Complete top part ~f. to~ ,0 ~
signature and submit both coples with
application.
'2
(Exhibit No.1)
Pr~erty Addr,ss " -
1'~.47/m/LlL/2(/ Ykd a4~J
Baths Basement / Water S~ply
2- ' Yes_ No~ ~ Communi ty
Permit No.
Qc/-7tf
" Installer's Nam7JJ _ / /2
~~ ~, ('/J
No. Living Units Bedrooms
/
Septic Tank:
Ft. from well
Inside Dimensions:
Length Width
Publi~other-List___
Steel
Ft.
Concrete ~ . No. compartments
Diameter
Depth
Gal. Capacity 100&
Tile Disposal Field: ,
Distribqtion BoX: Yes if:.- No
APPl;~a:t I~~k~~)' . ~ /~~)
· ~() 3c..1 ~~
:,~k,
Length of Lines"':: F"f.'" , ., 'Trench' ... 'Total sq.
1. 2. f3') 4. 5. 6. Widthz,..,. ft. 400
Plot ~~ CSee instructions~ :
r I
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,L. ;...-t-- l. I ~o..~~r_-,:, i/!>t..v - . ", - '....
t~:J: i!(6I~~= ~~~~']l~~~~f~~~~~~~~~~_? .0.
__J=_:::_~:~~==~~~~I=_ _
,... ii ----. ------- .. .5 --~ .::-- -{ ~fi(;-;2 L;;;('" "1%'f ~--"" tZ ~'~ :......"..--.. .. ...,...-. :
I - .------ -L-f_/--lO--:':tM --;--:-;;:;':--;-- ------1
."-~i~~=e .5"~2T~~..;~ -J
. ~ "" "..:.
Of}
Other Distribution - Type
Address
Feet from
Well
Lot Line
Front Side /0 Rear 10
Ft. between Filter ~ilter-"nePthEilt~r Depth
lines zr , TypeJl<.; )ilL m~e,... in., tltg~ g- in.
t
Foundation
10.
Mailing
t~_t._._ .
I
" .... ...,- .,...'...,...._~ "...._.~
.... ...'.u
Date
Eor ~tarian Use Only:
~ Approved: System Installation Conforms to DEQ Rules for Subsurface Sewage Disposal
o Disapproved: Does not Conform to DEQ Rules
Remarks:
for Subsurface se~a~" ~sposal
Date:Lf/~1 7l(
\ ht~~iqnatur.
State of Oregon d
Department of Environmental Quality
Interim Form #2
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LANE COUNT
BUILDING ~~
..UILDING" PERMIT OR MOBILE
MH 0
MAILING ADDRESS
[~~)S~J ttJno Dc.
MAILING ADDRESS
'HOIV,c USE PERMIT
" PERMIT NO. S"~.:./):J
(l
,.
PROPE,RTY OWNER
t~0:~C0~:~~?
W:-'::'Cl~~8t k:1 (';;:';4"
(,1""" n, "', (,):;f niJ,... llC"\
.....-j/'v._4il.'uJ'" vU '-e
G[f~:l nt.';~'J
'-'
PHONE
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(jc'JIj:::J',i'.)// 'J ,
PHONE
CONTRACTOR
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(z,....~
t..r......."'...-
.....;.1. ..".~, ,._
'./". i~
PROPERTY' LOCATION - INCLUDE POSf;;OF'FICE
(",~'11~f') t;'r~'Z?,hR':'c.J'~ (,'1 (I '('r~r,f":;,-':'0~r"!JA
. ~(J.....t'A-\;....~:';.J'~~JV ;...-'..... V il v~,),~ ~)vn;- Ulj'~:':}f lfV'VQ
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
eL~\1~()[~~~%'V tJO u.~\,'{j:; ~,\)~~ 'va DU(~)(;~ 8
TY"P RANGE ,SECTION
"l.l,"
1l D~~'L:cDv~Cc::.)
TAX LOT NO, .' CODE
CENSUS TRACT
,L;:}.?OD U 59
EXISTING STRUCTURE'S ON PROPERTY
-r~~J
LE?A~ A~CESS" TO PRO;'ERTY ~
eL~C(j'~~fV ..;;ll'itb
PROPERTY SIZE - FT.
WIDT~'t9;S.5 . DEPTH bC~)
AREA
u?
0:0
r'!\
","ll
APPl.
NAME
&
MI~ILlNG
ADDRESS '
rr"'-"..;-,....g....,~0'\I-~)l? l~s"
1,.-o....;~_{;,'J~rv~\. ~..-0..Lv\:)U" 1..%.)..
~
:.' "t~-~,-~
:fOR MOBILE,-HOME PERMITS ONLY,"
No; ;;'f Bedrooms
STRUCTURES TO BE BUILT,THIS PERMIT
C2'~~)~ fi '8t:Q
Connect to Existing
'TYPE CONSTRUCTION
~ '
f!u> G1f~
Sewage System 0
SQ, FT, # BDRMS
OTI&jd (J tl2
New System 0
VALUATION
\1/7 t'.(?r\
(! ,,)::;, Ii ,;c;.
GUyCe;) r:; tj~O~'
--
CJ~~ C(:b:;j~ ~ ~ '~\ .. ~~ ~ . ~:2J .0 ;[)
'\ ~.\ ~. '~~
" ~ "-, ". " ... .~ ~~-~\~~\r."'-~,~"" .-'--~
~~\)~~~~~~~,~~)~~,;#\~: .~>~~~~'\.\ ~~)-
~~-~.t. ,~~~~~~,~~~~~~,~~ ~~~
" PLUM~I.NG. .INSi~LLED BY "
O,,lJf}
~----,,,'~'.~--:- ~
'il'il ry,o
("i: t\;..,y-,!
SEWAGE DISPOSAL
PUBLIC, 0
BUILDING
, WASTE 'DISPOSAL
PLUMBING
PLAN ,REVIEW
PARK TRAILER "
.1
SEPTIC TANK -EJ OTHERD
- t l,;;~~<SiJ
"'-\:-( JJO~G:W
\~,' <~.'~U\>€V
",
FEES
OWNER 0 OTHER: NAME t:DG UVG\) C>Dt~j n;;~r!
WATER,SUPPLY
PUBLIC 0
o OTHER
, ~
. -'1\\:)lt~~~~~
'\y\* c~- ~
\} ~ .~'t
MIN. SEPTIC TANK CAPACITY
. {~r.;."',
WITH' DIST. BOX: GAl. ,;,.~
IH ,~~ , P':)
$\I~V"'~
,COUNTY BUILDING & SANITATION
DRAIN FielD REQUIRED
llr,:0
lIN. FT ~v'
SPECIFICATIONS
TOTAL
~1-
TRENCH WID,TH FT. ,;,..
OR SQ. FT.
~C~9
',-
G~::>::::~:y.t~]C:ii&:' 0~'n'C;C:J\ (fC~\,' 3r:::::d.;,:~ GOG> 'BOC~ [>"U,Sr.J~' '"
iY V . V ~~
'~_~.~\" \\vc ~~~~.';\~..wk~~
\ . 'x"~': \
TYPE OF STRUCTURE
i}[j
OCCUPANCY
a 0> r3
ZONE
PUBLIC UTll. EASEMENT
BLDG, SETBACKS u FT, FROM CTR, OF, ROAD RIGHT OF WAY
FRONT ~3 ' SIDE INT. 5 SIDE EXT. Q
AUTHORIZED SIGNATURE - DATE
lrJiJ ~D" n.. G:JOSi W t&.. tc:WCx:WGDJ
USE CLASSIFICATION
REAR
r;
J,D~wLi SG,::;~~
," ~J ('1 '.':\
~r/",'
DATE
~(1~ .
(~; U t.
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 ,
FOR", # C55 -13
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SITE I NSPECT I ON
ApPROVED 1 1 DISAPPROVED 1 1 DATE
INSPECTOR
REMARKS
FOUNDATION INSPECTION
ApPROVED 1 ~/- DISAPPROVED 1
1 DATE ;<';-/9-71/
INSPECTOR
~-
REMARKS
FRAMING INSPECTION
ApPROVED 1 l/(' DISAPPROVED 1
~JJ:t:#
1
DATri;?J-S - tf -7'11 NSPECTOR e
I
~-I@J/ ~~
-'71/-
LATH OR SHEETROCK INSPECTION
App'om ~~;~o"o /
REM""/.?! ~'7.rtJ Jr'-
/ Dm -;]'-6-JI/ INspmo~ e;
l
3"(p.1l/
FINAL INSPECTI~ _ . . _ ' /}_
ApPROVED 1// 1 DISAPPROVED 1 1 DATEV\f"1L )PjSPECTOR ~
, tJ /(. ~",;U J.At h!A,.", 3'" 1/ "11/11___
~'fJ/.rJ1{ r~.'w"
&J
CERTIFICATE OF OCCUPANCY
READY TO ISSUE 1 1 NOT READY TO ISSUE 1 1 DATE
INSPECTOR
REMARKS
~
- // ~ '
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ql(~l'l 7f/~~ cl76'f-
~
First National Bank of Oregon
(
,~'I'" 'J;)R_ (9~-1</
. FHA FORM NO..2573 /J -- u.s. . \RTMENT OF HOUSING AND
D. ."fu'v. lQ170 .' . r> FEDERAL HOUSING ADMI
BI.LED ~ -tiJi-74Nri: .::LOt) c:J.5 HEALTH AUTHORITY Ai.
DnTE/.' _~_ 74-- 4_ ~ 'I~IVIDUAL WATER, SUPPL Y AND SEW
Pi.... ,r '; rcgr~~',.-f PART I -TO BE COMPLEl
~ '
DEVELOP"
TION
VAL
DISPOSAL SYSTEM L/l,l\lE CO. ('\:\1.
t-- -___.____.___
BY FHA I UIf/ j ,
Form Approved'
Budgel.Bureau No. 63-R0296
Insuring Office
FHA Case No,
,__
r
Hr::Al TH D1V
I I I
-I
5
Mortgagee - Name, Address and Zip Code
..---
I First National Bank of Oregon
Real Estate Loan Division
P.O. Box 1786
Eugene I Oregon
Mortgagor or Sponsor:
n.'1.l'~ ~
1 1
.1_ .L
10'7A
'JI'i
--,
I
WESTOVER CONSTRUCTION COMPANY
Property Address:
1"1"''-
_..........u.\l r ............ J ~.,;;J ............P~:ii\j
97401
2764 Canterbury
Springfield. Oregon
Subdivision:
97477
Lot No.
L
.J
First Addition to Canterbury Village
T TVTNr. lINTT~
T\1TA r. ~V.MRiR
~OOMS BATHS
BASEMENT
o New Installation
10
,~ll( - ::z-
Can Attic or other Area be made into additional
bedrooms? (If yes. how many?)
1
3
l~
o Yes ~ No
DYes [i] No
SYSTEM DESIGNED FOR
WA TER SUPPL Y BY:
~ Public System
SEWAGE DISPOSAL BY:
D public System
D Community System
D Individual
No. of
Bedrooms
Garbage Disposal
D Community System [i] Individual 3
PART II. - TO BE COMPLETED BY HEALTH DEPARTMENT
DYes
[]] No.
HEALTH DE ?ARTMENT INSPECTOR'S SKETCH
---1===-
L=---
'I -- 11- '---
====---=====----t----:::__
L
'-
I
,---
,-- ---------- ,
I 1- - - _ _ _ _ _ _ _ _ _ _ _ _ - - - -C 1-
~~~~~~:;=:. E== --~j==~~~~;;~~~~~:=t~=~=~:~- ~;::===~~~,~I ~~~=c:
___+______ 1__- ________1 _ ____I ___ ,--
---i----T--f --- ------ L__+_ _1-_-
== = f = :='= - -1= =::: = =::: ::: = = =::: = - - - - - i~ ~ ~:::: - - = = = = = = = = =::: ---
====:::- -- --I::: :::=- I ------ ----- -----
C-- 1-- ----+-- _____:::=:::I~~~~~~===::::::::::::::: ------F=======r-=p===+ - -
-- -----=F---t
F 1=: --=:== ~~F um~ ~=E ~ 1
~~~,~~==~-- ==J~b=1 =mF l~;~~~~ ~::~~~~-==::=r =::~~f't I I~-
It is the opinion of the 0 State D County Local Department of Health that this individual ~ater-supply system
o is 0 is not - satisfa-d6i--y -as-a dom-esHi:-watenupplyfor-t:he--subject-property.- ---..-- -- --:------.--. --'-'"
= ~I- - ~
1---
___-L
----
It is the opinion of the D State D County' 0 Local Department of Health that this individual sewage-disposal system
with proper maintenance: X
D Can be expected to function satisfactorily. and 0 Cannot be expected to function satisfactorily
~s not likely to create an insanitary condition
DA TE SIGNA TURE TITLE
.._ . _ ~~lig...~~RJ. hYt.. ..'
-+,2.-+, J-+ J.{,u;dI\ A. KIRBY R.S. M.P.H. ~upervlslng Sanltarlan
NOTE: The health outhority shoul omplete the oppropria'e opnion statement above and affix date. sIgnature and title in ~,e
spaces provided, '
Use of the above grid for Health Department Inspector's sketch os well as use of the back of this form is at the' opinion of the
hea Ith authority.
PART III.
FOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the
Individual water-supply system be considered D Acceptable 0 Not Acceptable
Sewage disposal be considered 0 Acceptable 0 Not Acceptable.
DATE
SIGNATURE
o CHIEF ARCHITECT
o DEPUTY FOR CHi EF ARCHITECT
I
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA FORM NO. 2573
Rev. 10/70
...
..
Diameter. inches. Total depth, . (eet. Type o( casinp Depth o( casing, (eet,
Approximate depth to pumping level o( water'in well, (eet. Approximate yield. gallons per minute.
Sealed watertight to depth o( [eel.
Exterior spate around casing staled with: 0 Cement groUI. 0 Puddled clay, 0 Ordinary backfill.
Well covtr: 0 Contrete. 0 Wood, 0 Metal. Openings in well cover watertight: 0 Yes. 0 No.
Pump: 0 Shallow well. 0 Deep well. Length o( drop pipe, (eel. Pump capacity. gallons per minute.
Located in: 0 Basement. . 0 Pumproom off basemenl. 0 Pumphouse ahove ground" 0 Pump pit.
Pumproom properly drained: 0 Yes, ,0 No. Pump mounting wattrtight: 0 Yes. 0 No.
Type o( storage: 0 Pressure, 0 Grav"icy. Capacity, gallons.
Has bacteriological examination o( water been made? 0 Yes, 0 No. If answer 'is ,"yes," give date
Quality o( water 0 is 0 is notsatis(actory (or human consumption.
Installation 0 does 0 does not comply with approved exhibits, if any.
Inspec:tion made by: 0 State. 0 County. 0 1.O<.al Health Authority.
Inspected by
I.'
REPORT OF INSPECTION-INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
. PRI~ARY TREATMENT toosists o,xjg Sept it tank.
.' I
.:~;:'
o Cesspool.
Septk Tank:
Distance (rom well,
Total liquid capacity
Inside lengt~'
C...paal:
Distante (rom: Well,
Concrete Number o( compartments
gallons, Capatity inltt compartment,
feel. ' Liquid depth, ftet.
(eet, Material
1000
feel. Inside width
feet; foundation.
~ (eet; nearesl, 1m line al 0 fronl., 0 side, 0 rear,
(eel. .Liquidc'apatilY, _ gallons. Lining material
o Seepage pits. Other
Inside diameler, feel. Depth
SECONDARY TREATMENT consists o,1{o Tile disposal field,
Tile Disposal FI.ld:
feet; (oundation, 10 (eet; nearest lot line at 0 fronl?'1:J side?C[] rear
3' .. S-
feet. Number of lines, . Distance between lines,
inch<;s. ,Total effeqive, absorptio,n area 10 bottom of trenches, 600
: -(eet." D~pth: top (,hlle (olinish grade-
Broken SlOne, Other 3/4 Rd. '
8
Distance from: Well.
Total length of tile' lines,~O
Trench width. 2
'Len~th of each line. - 50...50-50
Type of filter material: 0 Gravel. 0
Depth of Iilter, material be.neath tilt'
Depth of filter material over til"
4
inthes.
Seepage Pits:
Number of pits__. , Outside diameter, feel. Depth. feel. Lining material
Distance'from: Well._ feet; building (oundation, feet; nearest lot line at 0 front, 0 side, 0 rear
Inspoctlan made by: 0 State. XO County: 0 Local Health Authority
Inspected b)
J.1i.Shook
Registered Sanitarian
Date of inspettion
April 8
'74 .
19'_.
(TITLE)
,REPORT'OF INSPECTION-INDIVIDUAL WATER-SUPPLY SYSTEM
Distar.re to nearest puhlic. water main. (eet, Size of main. inches.
Individual wells 0 are 0 are notrustornary In neighh9rhood,
Give most retent Cl'Cord o( failure o( wells in immediate vicinity to furnish adequate supply of water
Properties
T-",..-;:,~--,Lot size:
;':" Individual
in neighhorhood '0 are 0 are not heing deveioped with both individual water"s~pply and sewage-disposal systems,
(eet" wiJe,=~ feet deep. Dwelling set "back 'from front property line, feet.
water supply from: 0 Dnllcd well. 0 Driven well. 0 Dug well. 0 Bored well.
Distance of well from:
Ruilding foundation,
tast iron 'sewer
(eet;' tile sewer,
-feet; cesspool.
feet; nearest lot line at 0 (r~nt, 0 side, 0 rear
feet; septic tank, feet; disposal field,
feet; other sources oi possible pollution, feet.
seepage pit,_
Well construction:
,Date of inspection
19---,-
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,!allons.
feet.
10
feet.
feet.
~quare feet.
;nches. -
inches.
feet.
_. _' ..__~"._~4_~_______.
. t'. . ~:<'
feet,
feet;
19_
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dUILDING
" MHO
MAILING ADDRESS
.I,"}v,ilt,-, t, ;. '1 <N i:' (,
t:1i:e_&""~v r~;:~';':v" ,,'~. l;'J
MAllING~MbDRESS
. < ,.~..... .', .~..,. "....' .' ,
PERMIT OR MOBILE HOIViE USE PERMIT
PERMIT NO.
i
:,~",
I
.,'
,
.. ~
, '.
to'W ..
LANE COUN...
BUILDING @J1
(,:"\~... <...;nl';
~/{..ya.lft\i '
PROPERTY OWNER
, ~;JO~0V'::W"
CONTRACTOR
e;('I}C1JO'Q;f'J1!et t~
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.:;'_,;~~~~,,~~I J>:.'{~ I,l ~n.J J) ~j ti
\?.tf\t~ :::rJf:d,
PHONE
,1to,tj6WJ1U
PHONE .
", "/
ID-G~: ..''''.,ti.,.......,f.
PROPERTY LOCATION -INCLUDE' JiOSY"c5FFICE
m7~~t~ eC;J~t;;C~~?V,S1;.:5tJfran0gU0~d
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
~c:'\le(w3~n.:it .tjU ktYJ ~~t ~@ D1GO~s'~
RANGE SECTION
"\
t..,'"
.... 'f..... '.~
TWP
b~ :U:3~n(;~e~.
TAX LOT NO,
CENSUS TRACT
~@<I>f:fj ~!3@
EXI~TlNG STRUCTURES ON PROPERTY
N:ofit'..il .
LEGAL ACCESS TO PROPERTY
'~,::~'i-aoV'~~Jr~~ $ ~ .
PROPERTY SIZE - FT.
WIDTH 19.. ;~() DEPTH ~Q)~ -
AREA
;CODE
ThV
APPL.
NAME
&
MAILING
ADDRESS
,FOR MOBILE:.HOME PERMITS ONLY
No. of Bedrooms
~]
2t
'~oo oo\tGg'~;%Dtl:(i".. @:Ill
))
Gorcuo Q t~eQO~c1~ ci€~(~~
'"",~
~.f:!~ G il
New System 0
VALUATION
~6o HJ~,
, J~~~~....
STRUCTURES TO BE BUILT THIS PERMIT
Connect to Existing Sewage' System 0
TYP.E CONSTRUCTION SQ. FT, # BDRMS
e~XrV u ~ VlfJ '
;' \.
D."r7frnr:>
V'u ....~"-l...)c;J
~38Q7 0 n~
,'I
1'1 ");l I?'~.'~:i
IJ"'Q~"
~'l :
SEWAGE DISPOSAL'
..
PUBLIC 0 SEPTIC TANK ~
OTHERD
(ig.. (T,j
~C..@,.3'
~~,,(ill'
FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER: NAME t;.!)Q a y~ [;; P h?;;I~ h40
WATER SUPPLY
, BU,!LDING $
WASTE DISPOSAL
PLUMBING,
PLAt'l REVIEW
PARK TRAILER.
PUBLIC 0
o OTHER
TOTAL
tU ~~'.0t)
MIN. SEPTIC TANK, CAPACITY
WITH DI5T. BOX: ~AL.,~@l
COUNTY ,BUILDING & SANITATION
DRAIN FIELD REQUIRED
L1N. FT "'S;fJ . \
SPECIFICA liONS
TRENCH WIDTH FT.
a
OR SQ. FT.
~6~
n(Jd~~:::1c~~OVBf:d'b ~'C(~JG7~ -!~' DO~ &ilUoe~U~o
TYPE OF STRUCTURE
OCCUPANCY
fi ~ J
ZONE
PUBLIC UTlL. EASEMENT
~rJ
BLDG. SETBACKS.. FT.
FRONT to
, ~.
FROM CTR, 'OF ROAD RIGHT OF WAY
SIDE INT. 1\ SIDE EXT.
AUTHORIZED SIGNATURE - DATE
In! J.1!.." f'",?OO b~ (t'. , Cbi;>bCi;1't)h
USE CLASSIFICATION
<:;,
. REAR
"J
.,
^""J'\<--.; :C~/~~1
~:r;,t.~1l v~~~,"-
, . DA TE';.~,;~lf:';)~', :
~~~U1~}: ";.MJ~r>:-:i'.
:J ."....A....~ ".
-]1.', '., '
BLDG. PERMIT - WHITE
OFFICE COpy - WHITE
COUNTY TAX - PINK
PLUMBING -CANARY
BUILDING - GREEN
SANI.TATlON - GOLDENROD
Construction ,to comply with uniform. building code. and county r~gulat.ior:is.:
covering plumbing and sewage disposal. All buildings require a. certif,ispte ;
of oc<:upancy before being occupied. ":'~~.::' .....:l\o~~~/
(See Statement on _ Revers~Side) , .
(POST, THIS PERMIT ON MAIN BLDG. A TSITE) ,
, ... r .
LANE COUNTY, BLDG. 8. SAN. DIV., COURT HOUSE, EUGENE, OREGON 97401
'.,
[ORM # CSS'.13.
,': ,
. . .~l ......
. t :.-.. 'i~.J ,~:' ~
SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED Ir~/ DISAPPROVED j
REM'ARKS
GAS _PIPING GROUNDWORK
ApPROVED /
/ DATEL- /1-/9
REMARKS
/ DISAPPROVED 1___/ DATE
ROUGH PLUMBING
ApPROVED J,X' / DISAPPROVED /
"
REMARKS
ROUGH GAS PIPING
ApPROVED /
/ DI~APPROVED /
REMARKS
FINAL PLUMBING
ApPROVED / V / DISAPPROVED /
REMARKS
FINAL GAS PIPING
/ DAT~ --/2- /f
/ DATE
/ DATE,ff':-IZ -7 't
/ DISAPPROVED / . / DATE
ApPROVED /
REMARKS
CERTIFICATE OF OCCUPANCY
,READY TO ISSUE /
/ NOT READY TO ISSUE /
/ DA TE
REMARKS
"
i
'"'P'C;O~~
- ,
I NS'PECTOR
,INSPECT~ .~
, ',!/~
INSPECTOR
INSPECTO~___jP.v '
,(/
INSPECTOR
INSPECTOR
~. . 1. ~
h
"~ ,
LANE COUNTY r
OING PERMIT 0 R MOBILE HOME
APPLICATION ,d
PERMIT:#= q4 - 7;:r
'/L1./Jd 7~7-9r7/
77'{ c.. PHONE
."..',
PERMIT TYPE - BUILDING U
MOBILE HOME Dose REG. #
MAILING ADDRESS
~J?""Zt) (PLY,", 4/:/31/ C;;nah
MAILING ADDRESS
PROPERTY OWNER
/~Jt:;%11~
CONTRACTOR
~~ " 417
~TY LOCATION -: INCLUDE POST OFFICE j,J- ~O\...
~ r-.J?t.c; ~~,;;7..~ d-/C),(J~~~"-~'
PROPERTY LEGAL DESCRIPTION /./ _/. ".. _ _ "l"V ,_ /?~ __ '7': /. _ . _/ ' / ;: I~ . METES & BOUNDS 0 YES
LOT - BLOCK - SUBDIV. ~c~,-..- (~U I///fae/ ATTACHED 0 NO
TWP RANGE SEe. TAX LOT # CODE/ - tf'CENSUS TRACT
17 03 c:2Y - ---- ~ -c/J/~O
APPLICANT /12- / "" L--._ I. DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY
. NAME ',./..........,- ......'-(;,..../C ~ ~L-
~ LEGAL ACCESS TO PROPERTY - ROAD NAME OR :# I
~Ul/U4 ~.
PROPERTY SIZE-WIDTH DE?,
7 9. .~ ~
. /
AND
MAILING
AREA
ADDRESS
joy
FOR MOBILE HOME PERMIT ONLY
Number of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
'-:1a1-AY ".; JL.. ~L1'4n..P J
~~-~fiJ-~dl.
Connect to Existing
TYPE CONSTRUCTION
Sewage System 0 or New System Req. 0
/3-; 7e/l oJo;~~A~U/~Oyr
~~o@s / /.'-fL/o
lia () f
... .
SEWAGE DISPOSAL
PUBLIC 0
SEPTIC TANK }6
>I: 6?, tOG
~ ":j 0.. t:!J CL:.
0/,OI?J
FEES
PLUMBING INSTALLED BY I ' , " ..'
OWNER 0 OTHER LiNAMEkJtil..P.uO 1!t..J~/Jf.5J
PLANS FURNISHED F.lllllTY PERMIT /
YES .J<K - NO 0 YES Dr NO 0
srt':'AT~_FF A APPPP)lL.9':N~ At? J /~ DATE~
/f ~~ ~~ '> /k 7,-/
FEE Rr-CEIVED BY ;:DATl
1,~~4 vAl
COUNTY BUILDING & SANITATION SPECIFICATIONS /'
DRAIN FIELD REQUIRED ;1
UN. n. I &-0 ",NO" WOO," n 2. o' '0"" "" . 0
S'~ s i"",-- 'f'Q.'fo!.". J (;LS V ,,+ p )a,.M,.
OTHER 0
WATER SUPPLY
BLDG.
WASTE DIS.
PLUMBING
PLAN REVIEW
PARK TRLR.
TOTAL
PUBLIC 0 OTHER
PLUMBING FEES@V.3
~IXTURES r:..2 7, '0 0
- CASH 0 ~ER ,'.01, ~ O.
CHECK ifCONNECTION FEE "
/;;A 9; (') LJ_ ' ~~B~~E~tci~R FEE ~ .. f) 0
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAL qo 0
(~ -ecl'4N\.0fPJ.'~+
TYPE OF STRUCTURE J::' J, OCCUPANCY)
,'\If V . ,ICY
'WG. ""^''' - n. '"OM no. m ODAD "G"' OF WAY?
. F~ONT ,,'t..,!? SIDE INT. . S. - "" "'. ,,^' ?
\n~ ~.h/:'/'/~ /_;;~~;DGIN"
~ns to Find Property:
ZONE
REAR YARD
PUBLIC UTIL. EASEMENT
USE CLASSIFICATION
_ L?;
1t$~U;l~{;'~J!t
P · I f
Date
COpy 1 - OFFICE
COpy 2 - JOURNAL
COpy 3 - AUDIT
r
Form#C55'12
OJ;:',';'"
. '.~'... .... . "'0'" .; ... ,,,,.,,,..
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. ,.;/;
". .".. "-' ..'
';.'~J ~.I.,~:: . "_"',.' ,'f'..-;:
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POST THIS PERMiT ON MAIN BU'H:'DING .';Ln' SITE ..
'.
JOB ADDRESS:
~16t) n~~ijfcOO Spfd
, 1 "~:'iPze)..o.~<il fl3020
CONSTRUC,TI'ON PERMIT #
1t.0e1$~1~"'" 19
~,i
~.
TRS, TL:
Subdivision:
~Q;<z';~m'Y \fat'lep t.o~"1!.lo il$l:h 1 .
., :.~
. ..
, " This p~rmit for ~he refer~nced p~op~rty. is hereby ~~~CtO Setba;ks,and ~ther cq~ditions of approval must ~e strictly 0bserved~ Violation can
',i,.' . i , resu,lt In revocation of this permit, citation under proVIsions of Lane County s I nfractlon Ordinance, and/or other remedIes al,lowed by'law.
..,. . ~ .
'M'
.t-~'S.:
Fire Zone:
';';:f+'
:;z;.'
gal. mih. septic tank capacity;
Applicant/ Address: ~ W'" Ci?@~,1' ZM atl:'~42li'1 A~9 $ilHo O~n Telephone: 1t"1""$liO/'41~5~1
., ,Owner! Address: .~~ Telephone:..';' .
. C0ntractor/ Address: Telephone: \. ,
, ' ~ontractor;s OS # I '.' Total Construction Vglye:, ,1 ..
, '..~"', . C Jd b 'h' .', <, '.,,;/:," ,...,'.
J: t~::r:~::I~approv: c.Y, ~5 ~~~~~t: '. b~d~.&~ -&a'@:::.:r::m~ # :::g:u:~~ep ~~~:#~~~loVe;s:'
iv>, "PLANNING DIVISI~;o~7;g~7 . l't~t . Partiti0ning # '. " .',' '" Parc'el #, . " Parcel Size: 39~,.a lU~
\.,.j~t' ,~inimum.requireCl str~ctur~1 setbacks, fr?m:1[;~nterline cJfroag,jr?nt: :;1} ; centerline of r~ad;
\~ Side ~xterlor: 'l'l'.':1 ; Interior property lines:, 5(J;rear'~:9pertyllne: SO
'>::; ~. , .,Speclallnstructlons: ..,
M "
~
"'S
For information call' 687-4394,
'!'!t._ .-:..-.._ 'I.'@i-.'t ~ ,If .;0,.
~.t7-~ 'rI,.--.;7_~_
i:icks
~ 'ior property lines
'. :' . geaf road right-of-way
~':..':,:;, 'Bl!i1ding foundation'
~.. . <.,'Vyells, other water so.urces '
Septic Tank
10'
10'
5'
.50'
..
'Site I nspection# . I nstallatibn specification~~ .
Ii ri'ea I feet of drainf~rdrequired; maXi depth' of trencms:
~. ' ..... .', Sp~cial In~tructions~_k'.i!'~~la rmn.~~'~.F~
Dra,1.iO~field ':.' ,. <', if '." .,' ,',. ,;.;.:Jf?", , .
,I .,._,.... >'>', ,.._.:,;..../...&'
_~I-....~... - ....__.~..,- . .
i:o" ' ......~,..........- -",..;";' ,,' ",:,'
~.....;.....,...,~~,~~.o.i"""'~~" , ... A ;&: . .rf"
,lEY ) "/,,.' .~:-;. <'i,,;."""'-
100' , For information call "". between.8:00 - 9:00 a.m.,
't~,z.
;," ..~
,/,.c,;,f.
i, "
WATER POL:LUTION.
CONTR 0 L,ll) I VI SI ClN
,y:_~, ,"1;'';\ .
, ~t:'-...
/'"' ..\I~
-,;t"~{.
;-""",'
'1Ii!"o~:i-~'~
.,' ./ /
. " ,j.;.~':~~#:"t~;~
!'~~~';~ .
~;,:, ::',,~CONSTRUCTiON
!!;" " PERMITS/INSPECTION
r"'" .... . ~ -' ." '.. . .
~:'>; DIVISION
~,<
[W: . ,
~~:.;: '[jjrec~ions to Site: ~
~t,:,:::, 'DatelssiJed: .'1.,2-1~.[9' " ' 'By:,
i"f!\,::, ',. . , ' '.' DEPARTMENT ,OF ENVIRONMENTAL MANAGEMENT '
~~t'"'::: , " '. ", , "."", ..., ,.' COUR:[HOUSE(PUBLIC'SERVIC'E BUilDING "'-,'"
~,._:~;~;;;~.~,tJ) :,,:J;__A,: ,',..,,'c;: i:~;;,Li,;i'"ib~,::.;<;c;"':."",;~"-'<~;:;6~,..2,~;,~i~,;'~~i:':,~;.:::~~t,1'~~',,~,T:~XH:-!Y.~'~,~.~:...~:Y$,~:~:~;.~,~ !t~E' ~ ':~z'1qJ~'~i.':
~
Use Classification:
-.::.,.,
Type of Construction: 5-N Group:
I nstructions:~~Jm ~~~?'it'i?'i?
,~W~~~~
.:-t
"','1';'
For plans information call .' between 8:00 a.m. and 9:00 a.m., : '
. , .~1fGi. ,.,
F.or inspections (see back of this permit) call 687-4065 between.8:00a.m. and,5:00 p.m.
. bne cou~~t~
~, A~l1k"