HomeMy WebLinkAboutPermit Building 1973-8-16
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lANE COUNl")
BUILDING [i]
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JllDING~' PERMlt-<OR, MOBilE" HO'fv._ USE. PERMIT,
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'MH 0" ' .'. PERMI'T NO.
'MAILING ADDRESS'> , ",!j~ ','
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'I!c:D~-73'
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J'$OO"':73
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~R~~ERTY OWNER
ttG:l5S I dt.' Garv
CONTR.:-CTOR
" HB~t(:n"C1I1'. ttGmes'
P'ROPERTY LOCATION - INCLUDE POST OFFICE
;'-l_
PHONE
.' .,.
" '
MAILING ADDRESS
2589 Nerth;,,35ti, Plece
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Spl""i'n9f't'.e~dt: OrGgon' ,:,""":1,1 "
PHONE
," -1~7...997:l ~
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27j7.~h,;r:l inllltClm
,PROPERTY LEGAl. DESCR,IPTION - METES, BOUNDS'
U:St Add ;,~, Cef1terbur~ V ill Cllfile 'l6t, 3
TWP- " "'flANGE SECTION'
"
Block 2
:1:
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~
1:7
3
24 ' L{ J
TAX LOT NO,'
~J6;;;{~
,CODE "
.1,
.~
'11
EXISTING STRUCTURES ON PROPERTY ,
Nenel ' " , '
~tJ
LEGAL AECESS TO PROPERTY
. b~t.
Bur;1 i n9t(j)I'H~"~.
:' PROPERTY SIZE - FT,
CENSUS, TRACT
',I
20-300
, APPl.
NAME
&
MAILING
....-'!,
)-.
, "
ADDRESS
, WIDTH
DEPTH
AREA
FOR MOBilE, HOME PERMITS ONLY
No, of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
Dl>1G 111,11/1)} t.1m im
G<Jlra~~'unc.
Connect to' Existing
TYPE CONSTRUCTION
Frame,
Sewage System' D
, SQ, FT, # BDRMS,
l494 @r 1-2' (~)
,Ob, '(al ' j
New System' [j
VALUATION
l7.928
j . ~.IO
19;446
I
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'instlll a'~AS-;'D ~s.
i 0 P'l umb i nill f i.~tures
" SE~A9E,. [) ISP,?SAL
PUBLIC.. 0 SEPTIC TANK lID
BUILDING <t.
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
OTHERD
,74.00
20.00
33.50
FEES
PLUMBING INSTALLED BY
OWNER' 0 OTHE~: .NAME
WATER SUPPLY'
'"
't1l:fiilys ~1 UrJD i ng
PUBLIC ~
o OTHER
TOTAL
$
.,\-27.50
COUNTY BUilDING & SANITATION SPECIFICATIONS
DRAIN ,FIELD REQUIRED
UN. FT, 225 TRENCH WIDTH '=.T. ~. 9~ ~Q, FT.
Tight..Hnli?"~requl reCl WIUlIn ~an Tee" ,OT UW\d1 VHI!:).
450'
MIN', SEPTIC TANK CAPACITY
WITH DIST, BOX: GAl. 900
Roof, drc'ns :to' street .T.
. ~,
:-' ,~ :.
;.
TYPE OF STRUCTURE
5 N,
BlDG,' SETBACKS __ FT, FROM. CTR, OF ROAD RIGHT OF WAY,
OCCUPANCY
'1' &. J
ZONE
Rl:
PUBLIC UTll. EASEMENT
"
USE CLASSIFICATION
7' P.U.E.
FRONT
~5
SIDE'INT, S', SIDE EXT. .....
AUTHORIZED SIGNATURE - DATE
REAR
DATE
Is/,;'J,.'E~., BGs,s. by .Marbau~h' ,
, J~hn' C.r~l'I,ckshaVlko fr~S.
3~16"7l
t.,,' BLDG, PERMIT-WHITE
re, ,OFFICE,COPY-'-WHITE
';-"i-(OUNTY TAX ...,.,pINK
:: ::,:. ,PLUMBING _'CANARY
:":~':~liullDING;":' GREEN.. "
, 'S~~ITATION -~OlDENROD
Construction to 'comply with'~uniform building code ~~d', county r,egulations
covering' plumbing and sewage disposal. All buildings re,quire a certifiwte
of occupancy before being ,?ccupied.
(See Statement on Reverse Side)
,I. '~'h
, , '
,(POST THIS PERMIT ON'- MAIN BLDG. AT SITE)
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[:, ,,'i<:~, ,,' ,. ' , "., . LANE,C,()UN!Y ~ BLDc:;:, ~ SAN',PIY:, <:O~RT,~P~S~, EUGENE, O.~EGON, 97~Ol
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T /7 R 03 S ,;;l. r/ TAX LOT
CEN" .TRACT ' '.
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APPLlC1~: ~_.- -----t;=;?, L--3
NME~~~ J
ADDRESS ~_ ~...u:l~~ ~
PHONE
DATE f?-/ !3 -'^~
1'1 '
BUILDING SITE EVALUATION
. .
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)>4 Bu i I d j ng Perm i t App I i cat ion No.a&A:J ~ rru
() Site Inspection
() Pre-Permit Investigation
LANE COUNTY PLANNING DEPARTMENT
NOT NO YES
appl icable
NAM,E
0Ji... -
DiHE
J. Zoning Ordinance compl~e L- ( ) ( ) (
(Zone ---)
2. Subdivision Ordinance Compl~ance ( ) ( ) ~
3. Required Access ( ) ( ) , )
4. Building Site (Area, Width, ( ) ( ) 1)
Frontage, Setback)
5. Ot her (see comments) ( ) ( ) \)
COMMENTS:
~ r)....'-"Y:S
BUILDING INSPECTION SECTION
6. Plans Submitted
NOT NO
app 1 icab I e
() ()
5rV ()
~ ;;
!
YES
NAME
DATE
7. Soil Stabil ity (footings)
,y{(
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( ')
( )
(f, '1'~tfPL PJ~/"~?J;
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8. Flood Plain
9. Other (see Comments)
COMMENTS:
SANITATION SECTION NOT NO YES NAME DATE
app I icab I e ,
10. Sewage D i spos a 1 ( ) ( ) ~ d;&17Y
11. Usable Area ( ) ( ) D4
~ t
12. Water Supply ( ) ( )
13. o t he r (see Comments) ( , ( ) ( )
COMMENTS:
TO APPLICANT:
( )
( )
( )
Building Permit / Site Inspection:~
Can be app roved. /'...-/6 -'1 ~
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 application fee is being returned under separate cuver.
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LANE COUNTY PU\NN ING DEPARTMENT
135' SI)Cth Avenue E"~t. Eugelle, Oregon 97401
FtlONE: 342.,1311 EX I. 231
lANE COUNTY BUILDING & SANITATION DIVISION
135' Sixth ~veTlue East, EU~lenc. Dlegon 97/~Ol
l'UOWl: .. 3l,2-1 J II [Xl. 10 I
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JllOING PERMIT OR MOBilE
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MAILING AD!:?RESS
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1-10"'._ CfSE P'ERMIT
PERMIT NO..
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lANE COUNT)
BUILDING [i!
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PROPERTY OWNER
~on6 U oU' n &n~,
CONTRACTOR
t106}0;(J;Id0U1~!l}:SOS -.,,;~. ;\~""".,
PROPERTY LOCATION - INCLUDE POST OFFICE
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" PHONE
MAILING ADDRESS,
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BLorr-lnS;1~GQJM~ @ll'Qgen.'
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li15J1 '8tlf'UD~!f!goo
PROPERTY LEGAL D.~SCRJP.T!ON - iv\E,.ES, BOUNDS
"'itsG;'~Gd.,t~~ort~~rfi \HHQ~~ ~t. ~ah!lclt a.,
TWP-' R-'\t>lGE SECTION TAX,LOT NO,
CODE
CENSUS TRACT
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APPL.
NAME
&
MAILING
ADDRESS
FOR MOBILE HGME PERMITS ONLY,
, ,No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
EXISTING ST,RUCTURES ON PROPERTY
00000 " .
,LEGAL ACCESS TO PROPERTY
@tj~ll~fj~,@n A~oo
PROPERTY SIZE - FT,
I." ,.
WIDTH
DEPTH'
AREA,
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Gmraso l\.ti\)i5..;
qnntoU S..uo $,.
~@PhcmM~~ V'h~~~1foS
C6rinectto' Existing
TYPE CONSTRUCTION
rr~~
Sewage Sy'stem D
SQ: FT, # BDRMS
t~rl ~ 16t' (Sb
)::J3 <kl 't;:I , .;,1,
".',
New Syste'm.
VALUATION
n7J1;~~i3 '
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UQc;.,Qvw
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FEES
,PLUMBING INSTALLED BY
OWNER D OTHER: NAME
WATER SUPPLY
t10UY,$ ~h;:~~nq@:,
~,.
SEWAGE DISPOSAL
, .;.
',' ,
i,PUBLic cr',.,..",
;''<.
B~0lDING ~
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRA)LER
SEPTIC 1ANK EJ
$
OTHERD
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'- 2m:,. tiC
~:S,,5@
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......
It..-1-
P,UBlIC LJ
D OTHER
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TOT AL'
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COUNTY BUILDING & SANITATION SPECIFICATIONS
, '
MIN, SEPTIC TANK CAPACITY
DRAIN FiElD REQUIRED
225, ,2,
,!I,I:'l, FT .. , T~!:Hc'i ~!!?T!l ti-L_^ _11 A~~QR.J ~9:^FT.
'lI.-O~If'V~\~VU-fJlVJ ""'U~f4'V.ld~ ~'~IHlf'n 'i/$,"'Oi.O"l.t:\i:..;~'l",J ~f,j'. ~~V. ,"'.YY.VCJ
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WITH DIST, BOX: GAl. S@.tp
'~~OO'a' (lW~Qcrua. ~I>ifQ~O:'OlJlI>. '
':.: '~\. :
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TYPE OF STRUCTURE
\, ~ t~
OCCUPANCY
fr,t.). J
ZONE'
~ B '
PUBLIC UTIL. EASEMEi'!T
BLDG, SETBACKS __ FT, FROM CTR, OF ROAD RIGHT OF wAy
FRONT 4!li SIDE INT, S' SIDE EX'r, , ""0
AUTHORIZED SIGNATURE - DATE
,1'01 J.~.. (j@lJ{1 by .~CW'bct.rvSiJ
REAR
USE CLASSIFICATION
1.8 V "U. E4'.
Jcll~.&m.t:~Q,h~ltl!l,'tl.~..
. .' \''-
,~~1~~7~ ' DATE;-'i~l~Y:~;,
BLDG, PERMIT- WHITE,
OFFICE COpy - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
,i '. ' .,
,Construction to ~omply with uniform building code and county reg'q,!QFons'
covering plumbing and sewage disposal., All buildings require' a certifi'Cafe
of occupancy before being occupied. ,,~:1',' ..,'."
(See Statement on ,Reverse Side)
FORM..: c.55 --13 :
;if',
,(POST', II"II,SPERMIT ON MAIN: BLDG. AT SITE)'
- .:.)~~.~:.{.~. .' .' ". .
LANE COU~T~t:.~LDG>& SAN, DIV" COURT HOUSE, EUGENE, OREGON 97401
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SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED '/
/ DISAPPROVED /
REMARKS
GAS P I PI NG GROUNDWORK
ApPROVED /
I DISAPPROVED /
REMARKS
ROUGH PLUMBING
ApPROVED ~IP( / DISAPPROVED /
REMARKS
ROUGH GAS PIPING
-
ApPROVED JK I 01 SAPPROVED /
REMARKS ~'r+ ~ "=:! I
FINAL PLUMBING
ApPROVED . /
/ DISAPPROVED /
REMARKS
FINAL GAS PIPING
ApPROVED /
/ DISAPPROVED /
REMARKS
CERTIFICATE OF OCCUPANCY
I DATE
/ DATE
/ DAT(l~/'I.;;J
fI. .,.
, I ~ I ,'<~ I I "
;, I'l I,
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INSPECTOR
INSPECTOR
I"""O'~~
(I
/ 0",//-d.7:J l"."m~~
II -/ J,;' c>' 'j, 4~
- , - ~#--
/ DATE
/ DATE
READY TO ISSUE / '/ 'NOT READY TO ISSUE /
/ DA TE
REMARKS
INSPECTOR.
INSPECTOR
INSPECTOR
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FHA' FO, RM NO. 2573...\ ' ~ /U.S. D ARTMENT OF HOUSING AND URBAN DEVELOPMENT
Rev. ~0/70, \,' ,....0. ~1.10 . FEDERAL HOUSING ADMINISTRATION
1>-1c 0 'J. HEAL TH AUTHORITY APPROVAL
~~\.\.~Q /, /.(7113--~o' INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
Op..~ II~ PART I-TO BE COMPLETED BY FHA
1Y>~rlng d;nie
'.
.ft e-/
Form Approved
Budget Bureou No. 63-R0296
Mortgagee - Name, Address and Zip Code
'FIRST NATIONAL BANK OF OREGON
Springfield9Branch
665 Main Street
Springfield, Oregon 97477
I
-Mortgagor or Sponsor: ~.\
Gary M. Kessl'er
F'D)ca~~' ~ ~ W ~ p
,~
OOT 24 19i3
Properly Address:
L
2737. Burlingtl~rf{t'6l1~JTY HEALTH DEPT.
SpT'n~fipln OTP~nn Q7u77
Subdivision: .. --
Lot 3, Block 2, Canterbury Village
Firs t Addi Hon
Lot No.
~
3
TPTA t-_1Hllj'lRRR
I IVING UNITS RRQB.Q.QMS RATHS
BASEMENT
IXXl New Installation
Can Attic or other Area be made into addition81-
bedrooms? (If yes, how many?)
1
3
2
D Yes IX>> No
o Yes [UNo
SYSTEM DESIGNED FOR
WATER SUPPLY BY:
~ Public System
SEWAGE DISPOSAL BY:
o Public System
D Community System
D Individual
No. of
Bedrooms
Garbage Disposal
D Community System ~ Individual 3
PART II. - TO BE COMPLETED BY HEALTH DEPARTMENT
o Yes ~ No.
HEALTH DE PARTMENT INS PECTOR'S SKETCH
BLDG. PERMIT 1600~ 13
_1_______ I I ,I fL ';- -- -'- I ___
;;; ~ ~ ~ i ~ = ~ ~ ~~ ~ ~ ~ ~: ~ = ~~ ~ ~~ ~ ~ ~ ~ ~ ~ I'~ ~ ~ ~ ~ ~ ~: = -:: ~ J ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ - - ;;;;;
~ ~ ~~ = I 1 ~.: ~ ~,: ~ ~~.: ~::=: ~ ~: ~ - ~ ~ ~ ~ ~ t= ~ ~,= ~; ~ = = ~ ~ ~: ~ ~ ~ ~,~ ~ ~~ -; ~ ~ - - ---
I
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------~--- ,- ,--- ---- ------- --- ,--------
====-- 1-=== -f= :==== =-=c: -=====1 F===:::==
"It is !.he,_opiniop,QUp~ ,,0 State r- County Local Department of Health that this individual ~a!er,:,supply system
~' -=--,......-_.
G is D IS not satIstactory as a domestIc water slIplliyrnr:rhe, suoJect property.
It is the opinion of the D State '. 09 County
with proper maintenance:
fXXl Can be expeCted to function satisfactorily, and
is not likely to create an insanitary condition
DATE SIGV~ ro., D ~1\,: JL
10-24;'73 ~'\ICHARD~RBYJ R:5: I
D 'Local Department of Health that this individual sewage-disposal system
o Cannot b~ e'xpected to function satisfactorily
TITLE
SUPERVISING SANITARIAN
NOTE;, The health authority should complete the appropriate opnion statement above and a~fi,x date, l!ignature and title in the
s po ces provide~. , :.. .. "
U.se of the above grid for Health Department Inspector's sketch as well as use of the back ofthi's form is at the opinion of the
health 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
i~dividual water-supply system be considered 0 Acceptable [J_ Not Acceptable
Sewage disposal be cons'idered D Acceptable D Not Acceptable.
-. .'~.. ~~ .~~
DATE
'SIGNATURE
D CHIEF ARCHITECT
D DEPUTY FOR CHIEF ARCH/TECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA FORM NO. 2573
Rev. 10/70
REPORT OF INSPECTION-INDIVIDUAL 'SEWAGE-DISPOSAL SYStEM
'~,
PRIMARY TREATMENT consists of iJ Septic tank, 0 Cesspool.
Septk Tank:
Distance from well,
Total liquid capacity
Inside ,length,-1*
C...pool:
Distance from: Well.
feel. Material
1000
feel. Inside width 4i
CONCRETE
Number of compartments
"allons, Capacity inlet compart4~nt
feet, Liljuid depth, ~
gallons,
feet,
feet; foundation,
_ feet; nearest lot line at 0 front, 0 side, 0 rear.
feel. Liquid' capacity, gallons, Lining material
o Seepage pits, Other
feet,
Inside diameter, fecI. Depth,
SECONDARY TREATMENT consists ofXJ Tile disposal field,
TIIe'Dlapoaal fl.ld:
Distance from: Well, feet; foundation, 10 fee~; nearest lot line at 0 from, ~ side,'K1 rear,_10 feet,
Total length of tile',I~<.-:-_,-:} 1)0 _ fee,t,-,Number ,oUines, - ' ? . Distance ,between fines, ,to 'feer,
-'-Trench wiJth, .:9 ,inches, : Tot~l effective absorption area, in bottom of trenches, , P::;O sljuare feet, ,
length of each line,'" 71::i-7r:; feet, Depth, top of tile to finish grad~' ":,, 'nches,
Type of tilter material: 1KI Gravel. 0 Broken stone,' Othf' "
Depth of filter material beneath tile" 6
inches,
Depth of filter material over tile,
2
inches,
Seepoge Pita:
Number of pits__, ,Outside diameter feet,
Distance from: Well, feet; building foundation
Depth feet. lining material
feet; nearest lot line at 0 front, 0 side, 0, rear
feet.
Date of inspection
OCTOBER 14
0, Local Health Authority
Inspected b:
Inapectlon made by: 0 State,' 1XI County,
19.11
/s/ JOHN CRUICKSHANK, R.S.
SAN IT ARI AN
(TITLE)
REPORT OF INSPECTION-INDIVIDUAL WATER-SUPPLY SYSTEM
Distaole to nearest puhlic water main. _, ~eel. Size of main, inches,
Individual wells 0 ~re 0 are not customaty in neighbprhood,
Give most recent r('Cord of failure 'of wells in immediate vicinity to furnish adequate supply of water
Properties in neighhorhood 0 are 0 are not being developed with both individual water, supply and sewage,disposal systems,
lot size: feet wide feet deep, Dwelling set back from front property lin.. feet,
Individual' water supply from: 0 Drilled well. 0 Driven well. 0 Dug well, 0 Bored well.
D1atanc. of well from:
Buildinj.( foundation
feet; nearest lot line at 0 front, 0 side, 0 rear'
feet; tile sewer feet; septic tank feet; disposal field
feet; cesspool feet; other sources or possible pollution, feet,
feet,
feet;
cast Iron sewer
seepage pit,
Well conatructlon:
Diameter, inches, Total depth, feet,
, Approximate depth to pumping level of water in well,
Sealed watertight to depth of feet,
Exterior space around casing sealed with: 0 Cement groUI. 0 Puddled clay, ,0 Ordinary backfill,
Well cover: 0 Concrete, 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,
located in: 0 Basement, 0 Pumproom off basement, 0 Pumphouse ahove ground, 0 Pump pit,
Pumproom properly drained: 0 Yes, 0 No, Pump ,moun~ing',:,atertight: l:J Yes, EJ No.
Type of storage: 0 Pressure, 0 Gravity, Capacityg'allons:' -
Has bacteriological examination of water been made? 0 Yes. 0 No, If answer 'is "yes," give date
Quality of water 0 is 0 is not satisfaaory for human consumption,
Installation 0 does 0 does not comply with approved exhibits, if any,
Inspection made by: 0 State, 0 County. 0 Local Health Authority,
Inspected by
Type of casiny
feet, Approxiri13te yield,
Depth of casing,
gallons per minute.
feet,
gallons per minute,
,19_
Date of inspection
19_
(TITLE)
GPO 900.682
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PROPERTY ~ER
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'cONTRACTOR
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~ROPERTY'LO,,(.ATlO~ -,IN,CLU,P, E POST _?~FICE
I. .' "P O;\lr;(;;@l7'J,
, PROPERTY LE<?AL DE'SCRIPTION -METES, BOUNDS'
, !. .: J..'~..I CbfllUOJrfill1,~1J"6 \1finUq;3 t..gg ~OtGC8. a
TWP,' RANGE SECTION TAX LOT NO"
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HOh...- USE P"E~'Mlr
PERMIT NO.
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lANE, COUNT.
BUILDING rn
,U1lDIN,S:; PERMIT OR MOBILE
MH 6.:' ' "'.'} ;,;:
MAILING ADDRESS
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CENSUS TRAS_K;;
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NAME
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'MAllING
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ADDRESS
I
F9R~~~c~JME
No. of, Bedrooms
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EXISTING STRUCTURES ON PROPERTY
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: LEGAL ACCESS TO PROPERTY ~ "
, !1k:.:rU UCVD~elY [':tiJ9o'
PROPERTY SIZE - FT.
...
WIDTH
,DEPTH
AREA .',
PERMITS ONLY
'SEWe.GE DISPOSAL,
~~:PUBlIC D ;
~~ '
SEPTIC 'TANK' 'E]
Sewage System D New System D '
SQ, FT, :# BDRMS VALUATION...
U~~),_ Q, ~2 <<D>> U? C'$:f!O
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, '. ':::.. ~,.~\'\ '\,. . P.LUMBi~G"'INSTArLED BY' " ~,'...' "", ,
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OT.t!,EREI.~' '-), ' ...J~ ;'3' )OWNER D OTHER, N:AME'" Hif i?n\:.~>;~Unfj
il.L')..L~;; FEES WATER SUPPLY
~~",'1jt') PUBLIC' 5
Connect to, Existing
TYPE C,ONS:rRUCTI9N
C"trC3. ,
STRUC;:Tl,)RES TO BE BUlL,] THIS"PERMIT
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" BUILDING"
., WASTE DI~POSAL
PLUMBING
PLAN REVIEW
P.ARK TRAILER
$
D OTHER
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.'
TOTAL
$
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MIN, SEPTIC TANK CAPACITY
WITH ,[),r~T.:.,BO!<,;..G.~.L;,_
~~\~~lr.; l,./U WV \iJ.!..~ ~\';.:J
, COUNTY BUILDING 8: SANITATION SPECIFICATIONS
DRAIN 'FIELD REQU,IRED
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'-ZONE \I PUBLIC UTI!.. EASEMENT
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TYPE OF STRUCTURE
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OCCUPANCY
H [;. 49
BLDG, SETBACKS ~_ FT, FROM CTR, OF ROAD RIGHT OF WAY,
~~ 0 ~o
FRONT SIDE INT, ,SIDE EXT,
AUTHORIZED SIGNATURE - DATE
toJ J)..(io GenG .~~f~c:Ji)&'GO:Jeh'v ' . .
,REAR
~(I F}l:fu;,ltoSSIFICATION
<l),lZD~fu1 C~~'OcltD~C;;i~;to W'l~.
11' i\(' .',",1
'W:?v _;.cJIc':;
DATE
BLDG, PERMIT - WHITE
OFFICE COpy _ WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION":" GOLDENROD
Con'~truction to co'mply with uniform' building code and county regul;ti~ns
covering plumbing and ,sewage disposal. ,All buildings, require a certificate
of occupancy befo~_e .peing R\ccupied, '/ ' .
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:(See St9tement on Reverse Side)
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(POST THis PERMIT ON MAIN B~PQ;" AT" Sn:E) ,
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LANE COUNTY, BLDG,. & SAN, DIV" COURT HOUSE, EUGENE, OREGON 97401
FORM :tt'rt;t;~ 11.,
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, 4
SITE INSPECTION
ApPROVED / / ,DISAPPROVED I / DATE:
INSPECTOR
REMARKS
FOUNDATION INSPECTION
/'
ApPROVED / V / DISAPPROVED /
/ DATE q:,,/:z '" 17 INSPECTORM
REMARKS
FRAMING INSPEC~ /7
ApPROVED I Y I DISAPPROVED / / DATE.;...tJ.../P'7':J INSPECTOR!:C...
REMARKS~~9"'1;)' ",,&
f
LATH OR SHEETROCK INSPECTION
ApPROVED /
/ DISAPPROVED /
I DATE
INSPECTOR
REMARKS
/ ,
/'
FINAL INSPECTI~ ~
ApPROVED / j/ / 01 SAPPROVED / I DATE / 1- ~ 73 INSPECTOR
~JfKS ~~A,~~~_d./J/IJ-~J~~1~,~Uhlv~ Q;;o~f ~
::I J(U ;e;;:;;:, ;"TI~ I 1-
CERTIFICATE OF OCCUPANCY
READY TO ISSUE / / NOT READY TO ISSUE / / DATE
INSPECTOR
REMARKS
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Ins[;Jler I s Name ~ /
No.LivingUnits Bedrooms Baths
I \3 I
Septic Tank:
Ft. from well Steel 0
Ins~C1e D:unens~ons: .t.t.
Length ;{...r-' Width V;J'- Diameter
\pplicant Gary Kessler
Name c/oWestover Homes
2589 North 35th Place
~pringfield~ OreaRn
INDIVIDUAL SEWAGE DISPOSALSYSTF.M}RECC~
Installer: Complecetop part form to
signature and return both copicQ to Lane
County Building Sanitation Department.
..
''-
pro:eerty Address
2737 Burlington
Basement ~ Water S~ply
Yes 0 NO~' Public ~ Other-List
PI"RMIT NQ_
1600-73
J.e.
Concrete
~'
No. Compartments
---
Depth
"I~ -J-
I Gal. Capacity, 10 0(7
Tile Disposal Field:~
Distribution Box:Yes ~ No 0
Other Distribution- Type
L, \,,':"'/
',J ..~;;c,.,
Feet 1. om
Well/b
Lot Line
Front Side I (J Rear 10
FilJ!e\-.p. V F.iller depth Filler depth
lJ.d above be low J
TY~fV;u.. , ' !.il~ V in. tile C!J .:iJ4
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LIt ,-- c C 1 19 1973 ' ..
ItJ
Mailing
Address
Length of Lines - Ft.
1.7.[2.713. 4. : 5. 6.
Sketch, (See'instructions):
AI
Trench Total, sq,Ft.between
Width dft.;jtlJ lines 10 I
'10
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LAi'1E (iOU\~n HEAL1H UMI1
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Date
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For sanitarian Use Only:
'~Approved: System Installation
b-Disapproved: Does Not Conform
Remarks:
.olIIIIl
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lANE COUNTY P
liNG PERMIT 0 R MOBilE HOME
APFLlCA TION
PERMIT TYPE -' BUILDING ~ MOBilE HOME Dose REG. #
PROp, ErsJ7RT OWNER ,11./ '.. MAILING ADDRESS
K ..P~~, , '1:7~ /
{ONT~A~TOR /J-- /, ~ rJ-' MAILING ADDRESS. ' ' .," -' ~ qC
(JJ~;9.'ev ^~ c:J,c:r 99' ,~.b:, S-
PROPERTY LOCATION - INCLUDE POST :FFICE 02 '7 .3 7. ~ ' f ~
~ ~ .W"p~" '_, ,It
PROPERTY LEGAL DESCRIPTION.3 ~
LOT - BLOCK - SUBDIV, .,,--
TW) '7 R]E Sc.e/' TAX LOT # <:,ODE
./
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PERMIT #
/6 CJt?-:z?
PHONE
PHONE
70-.97~
NAME
CENSUS TRAC
-<0 - d c;? C7
DESCRI,BE EXISTING STRUCTURES ON PROPERTY IF ANY
=--:b~
LEG4 ~S TO PRO,PERTY - ROAD NAME OR #
'~~L~_~ ~.
PRQl>{RTY SIZE~WIDTH ...e-,. ~EPTH
'" MET~~
ATTACHED 0 NO
APPLICANT
AND
MAILING
ADDRESS
FOR MOBilE HOME PERMIT ONLY
Number of Bedrooms
STRUC RES TO BE BU~V THIS PERMIT ..
A e ~ g7 ,- )J~~-~.
-r~
~ "..
AREA
,Connect to Existing
T~6NSTRUCTlON
0--4~- ~-
Sewage System D or New System Req, D
SQ, FT. .J;) # BED~O~ VALUATION
'/U~cY/;- Cd') "Vfi;.G.j
, " @~ .- / ,) 9dlr
;.5lJ6 I ,_/?
1/..... '0
'- 1/2 '/I/J/
I 1./ 't}~
......
/
SEWAGE DISPOSAL
PUBLIC 0
.TOTAL
:/2 \7. ~ ~
PUBLIC WATER
, CONNECTION FEE
.3 d"'dt?
.;< ~ .cJ 0
/~,-S~,
PLUMBING INSTALLED BY A ~ -'./7 ~
OW~ER d" OTHER~AME tJ/~PG",_~
~ANS URN ISH ED l- , FACILrPER,<!;IT 7
YE /I NO 0 YES V NO 0
SI AT~F APPLICANT.. ~ '\ DATE
.7Ld.".A~~ ,,-P'...../';:>-73
I FEE RECEI~.EDEY - DATE
, , A4q/' J 9-/';>-2.5
PERMIT 1/: . / ~ -
/~ ,r')/1 -' ::<:<
6
SPECIFICATIONS
SEPTIC T~}lK f;f;
. ~"'t " 7"r~d'O
~cJ,.od
73 r ('\71
" ,OTHER 0
FEES WATER SUPPLY
PUBLIC 1('
PLUMBIr(!G FEES
../ 0 y.tXTURES
CASH 0 S~
CHECK...6A"ONN'ECTION FEE
OTHER
BLDG.
WASTE DIS,
PLUMBING
PLAN REVIEW
PARK TRLR,
COUNTY BUILDING & SANITATION
MIN" SEPTIC TANK CAPACITY
WITH DIST, BOX: GAL.
Cjoo
K6'of .draihG t6 ~et'~
'+;'eI7 {f( ',hI IiI ch'h4 .
~ '" (/
DRAIN FiElD REQUIRED
lIN. FT, 2-],6- TRENCH WlbT'HF]. 2-. ,OR SQUARE FEET
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'.
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TYPE OF STRUCTURE If"tI OCCU/~4 e~1 REAR YARD PUBLIC UTll.jEMENT
BLDG, SETBACKS - FT, FROM CTR, OF ROAD RIGHT OF WAY, 'I, USE CLASSIFICATION /
FRONT "~SIDE INT, ~ SIDE EXT, ---- REAR '7 fI'(J'r:r... \ ;
~~Jd;; r~/MMA f'~;~:nLDG IN5P~ ~.o~ V/ t. _;;
r - (' I' p- cr VY;;I ~ c;;e>[-
Directions to Find Property:
COpy 1 - OFFICE
COPY 2 - JOURNAL
COpy 3 - AUDIT
Form # C55,12
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