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LANE COUNTY 'UILDING PERMIT OR MOBILE
BUilDING 0 MH 0
MAILING ADDRESS
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"USE PERMIT.
_~ERMIT NO.. ::~;"'I;:'
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PHONE
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MAILING ADDRESS, .
2359 M(!lrtb 35ii:h:~n ., ~;lfd.
PHONE
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PROPERTY LOCATION - INCLUDE POST OFFICE
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PROPERTY. LEGAL DESCRIPTION - METES, BOUNDS
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TWP RANGE SECTION TAX LOT NO.
24/-1. I ,. ti :3 O;?l 3 ~i)-[D
EXISTING STRUCTURES ON PROPERTY
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LEGAL ACCESS TO PROPERTY
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PROPERTY SIZE - FT.
CODE
CENSUS TRACT
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APPL.
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NAME
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25G~ PJcrt:, 35dl 'PJ .
MAILING
ADDRESS Si,>drilgfield, 'Jr.' 97477
FOR MOBilE HOME PERMITS ONLY
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
UtJEl ~ ~ f 110 ...; rw j Ii
WIDTH
DEPTH
AREA
Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT. # BDRMS
New System 0
VALUATION
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3
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Gar2g~ a ~et. - u~c.
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VtlstaH S'3;;JGl!jif? ~rrspC5QU sys\:f.;e; 7 plulUblng fhtt-lJJriE5 <P 3;(j')O '.;la,; l:t;f::(;1r roi1r.~c~hm ... ~ <~::
SEWAGE DISPOSAL PLUMBING INSTAllED BY
$
OTHERD
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:W.~O
2lt1.50
FEES
OWNER D OTHER: NAME
WATER SUPPLY
:~::) I ~ y
PUBLIC D
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK D
PUBLIC D
D OTHER
TOTAL
$
106.50
COUNTY BUilDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED
L1N. FT , 50
TRENCH WIDTH FT.
3
OR SQ. FT.
l;011
WITH DIST. BOX: GAL.
MIN. SEPTIC TANK CAPACITY
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T';()fD(~b::J~ S!f:~MU{1 be 2lt.lO m"m.!u;Jum d6iJ>th, reef @i"G:iNG nh~u~d be to ~h~S'i:rc.6t.
TYPE OF STRUCTURE
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OCCUPANCY
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ZONE
PUBLIC UTIL. EASEMENT
BLDG. SETBACKS n FT. FROM CTR. OF ROAD RIGHT OF WAY
FRONT f}~; SIDE INT. ~ SIDE EXT.
AUTHORIZED SIGNATURE - DATE
/;j C~SS bV u~~rb6XJfjh
USE CLASSIFICATION
REAR "I
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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 certifica'te
. 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#C55-13
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APPLI CANT: ~A""
NAME LY~~
ADDRESS ~
BUILDING ,SITE EVALUATION
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~ Building Permit Application No.
() Site Inspection
() Pre-Permit Investigation
PHONE
DATE
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. LANE COUNTY PLANNING DEPARTMENT
3.
4.
Required Access
NOT
app I icab I e
Zoning Ordinance Compl iance () ()
" (Zone~~L)
Subdivision Ordinance Compl iance () ()
() ()
( ) ()
() ()
NO
YES NAME
DAlE
\..--
Building Site (Area, Width,
Frontage, Setback)
Other (see comments)
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I-J~-73>
1.
2.
5.
COMMENTS:
BUILDING INSPECTION SECTION NOT NO YES NAME DATE
app I i cab I e ~.
6. Plans Subm i tted ( ) ( )
){5
7. So i I Stability (foot i ngs) ( ) ( )
8. Flood Plain 11 ( ) ( ) ..,A I
tr {17ft ~ iI4f I-~" 4,
9. o the r (see Comments) ( ) ( ) ./, '. ~. ,,~,. t
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COMMENTS: I
1. ~SANITATION SECTION
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10.
Sewage Disposal
NOT
app I icab I e
() ()
( ) ()
() ()
( , ()
NO YES
. NAME
DATE
I I. Usab Ie Area
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( )
( I)
( )
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12. Water Supply
13. Ot.her (see Comments)
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COMMENTS:
TO APPLICANT:
Your BU,ilding Permit / Site Inspectio~,
('~ Can be app roved. / -c:<.;;l.- 7J ~J,6!:Jj/
() Cannot be approved at this time as indicated on item NO. above.
Quest ions and further informat ion on items I through 5 contact the Lane-
COUNTY PLANN ING DEPARTMEN~. Quest ions and further informat ion 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 indicated.
() Is ,being returned.
() Your building permit application fee is being returned under s~parate cover.
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
M55-28
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P'ERM IT
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 tl1e 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
!Ly~ge!rr~ ... Me~ t(1)V~~ H~fi'~$
and constructing of the following facility:
rniYJet1~.v QtJP~~cll r.rHfj cwlf'b eu~.,.tmn~af'tnl1~v \rt H.ae~"'Lot 4 ~l~)(~k ~
liN39 l!hll?11Fl~l~1l .
upon the right-of-way of County RoadNo. ~~4~ , 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.
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for the placing, building
Special Provisions:
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Bifi ~y ~ Vi! . l)~ eo~~~ ~fi'~~# ~'.ab' wee~~~~' vl tit th!!J;' "B;tWlC:hr3rl" '~1V'~ V(y;uy I~~;~'V'~[~Q:':?
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~~'M~al~ wHl ba V'el}OOfta~b1e ?i\#tl'thc 1fnti~:ltd1~t.i# N(~1;Jn~ 01 an t~9 fJ~rt !..m~
ijf~lHri$ f~ thtW ~'lC)d'N4;iY a~:cl ?~~M~ (if \J7ay. Cf1j~~cl tcly t1~S oPa;lf'll€1@f!p 14;l&m~~;: 1::%
l";Gi:;l6t1my and Qtre~ 'hl C) triG€l~" ('Jclf.@f;tia~le cortd~ ~1~~
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 Jal~Mk!tIY 2~ , 1914. Expires , 19
Inspected and Approved
Approved by Board of Comrriissioners
By
Date
By
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Director of Public Works'
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Wt:llTE . OFFICE FILE PINK. PERMITTEE. ORANGE, BUILDING & SANITATION DEPT.
GREEN. RESIDENT ENGINEER BLUE - ROAD SUPERVISOR YELLOW. SURVEYOR'
C98- S2
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APPLICATIDN FOR FACILI..., PERMIT
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Upon the right-~f-way of County. Road No. /:74,1, at the foll~wing 'f~~;i~~f'~< :' ~- ,;; '. .'
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as shown on the exhibits which are attached hereto, in strict conformity to thest~te-
. 'mEmts of the exact nature an~ 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
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public for' its' proper maintenan~e, repair, operation arid use. Y~ur applicant accepts.all
terms; conditions, agreements, stipulations and provisions', in. Rules and Regulations
. Governing FaciHties to be Permitted Upon .County Road ~ights-of-Way, dated March,31,
. .. . . .' 1
1960, ~nd ariyamendments thereto, and any other. ap'plicable regulation, law or ordinance.
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Signature
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Address /
WHITE ..OFFICE FILE .
GREEN. RESIDENT ENGINEER
PINK. PERMITTEE
. BLUE. ROAD SUPERVISOR
ORANGE. BUILDING.AND SANITATION DEPT.
YELLOW. SURVEYOR
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BUilDING 0
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U1lDING ,PERMit/OR MdBILE H~:' -', lJSiE . PERMIT..
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EXJSTI~G STRUCTURES. ON PRql'ERTY
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LEGAL ACCESS TO PRbpERT'Y'-~_
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PROPERTY SIZE',- FT.
FOR MOBilE HOME PERMITS ONLY
No. of Bedrooms ".~~
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S~wage Sy~t~m D'
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~.ALUATION
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DRAIN FIELD_REQUIRED
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WENCH WIDTH FT.
OR SQ. FT.
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BLDG. SETBACKS n FT. FROM CTR. OF" ROAD RIGHT OF WAY.
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BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
Construction to comply with uniform building code ~nd county r'egulcitions,
covering 'plumbing and sewage disposal. All buildings require ~i certificate
of occupanc'y .before being occupied.
(See Statement on Rever.se Side)
(POST THIS PERMIT O~. MAIN BLDG,. AT SITE)
LANE COUNTY, BLDG. & SAN. DIY., COURT HOUSE, EUGENE, OREGON 97401
FORM:;:; C55 -13
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SITE I NSPECTI ON
ApPROYED / / DISAPPROYED / :/ DATE
REMARKS ~@J~;J.- -?-"?~
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ApPROYED / vI DISAPPROYED I
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REMARKS
,FRArfI+.JG INSPECTION
ApPROYED / t~../r 01 SAPPROYED / / DATE -5'-Z:-?-J,:J
REMARKS
LATH OR SHEETROCK INSPECTION
ApPROYED /
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REMARKS
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WIDTH DEPTH
AREA
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FOR MOBilE HOME PERMITS ONLY":
No. of Bedrooms
.STRUCT.URES TO BE BUILT THIS PERMIT
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Connect to Existi(1gSewage System 0
TYPE CONSTRUCTION SQ. FT. # BDRMS
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~ ;.~ !)~)'y'~
~ r.
~~j'.J~:Iuu Ib'i~JUll~\br., l1:j,j It e, Q \'.:.:.:.~
hn~'nnu GC~~':;:~Df'H~~zi.:1f'~11~~0~ 1 f;l!n~t"lbl~~fbitl!;B"e[l @ ).$.J'iJ @{).; Unffo.r (fnruH~q;:\:J~l "" L5(:
SEWAGE DISPOSAL.
PUBLIC 0 SEPTIC TANK 0
BUILDING :1:,
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
, ;.....pT,I;l,E,RO
l.J/4. \.F(;:7
FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER: NAME
WATER SUPPLY
';')
PUBLIC ~b 0 OTHER
'l:itJJ t if
(J,~" \'Ji,f
.-- -:......-
G:;~. cJ'U
,I);':: ,'.'
:- ... ~ :.1
TOTAL
$
--,0
~ "'(~.'1., l)l\':
MIN. SEPTIC TANK CAPACIT~ n-Df',
,thYl\I:
WITH DIST. BOX: GAL.
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED
. ~I?;g
L1N. FT ~ TRENCH WIDTH FT.
:3
OR SQ. FT.
R''i(~/t?\
..~'~.
::.l~CU\~(",n!;~ -;:('Ir,';'ch\~;'f.f~tr.: t~l:I3 ~f':;vQS'~Y i1ioo c.~t'l ~'~ISO whDu aU ~8L"q;9 @'? ~!':;:) cll"81~~fUd:lt.
'hC:'".ri7'!'l!:3~ Sl-.-:.~g kt '~le '?/h/c F)c.J,~ffi&ln' (j:k4.,tGn~ f'Qf;}f4fJQ"Q 58l~ 5tUDM'I@ bo ~()li.;h:J GtrrcoC.
TYPE OF STRUCTURE
:~~~~: j
OCCUPANCY
a f;;. J
tONE
PUBLIC UTlL. EASEMENT'
BLDG, SETBACKS n FT. FROM CTR. OF, ROAD RIGHT 'OF WAY
r~~ ~ .
FRONT -.~J SIDE INT. ..,;) . SIDE' EXT.
J~ 0' i" ,'" a'i' llJt~ ,~,~.,; A~THORI:?:ED, SIGNATURE -:DATE
".If! ,,':);J,,) .), Ii\:D~,k,~r.;it
REAR '1
USE CLASSIFICATION
ri.l}. Gf~,,~'~lo ,-let 0 .'~..
DATE' "
~~-fJ'j "';:"~j','
BLDG. PERMIT - ~HfTE
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. .AII buildings require a certificl;lte
of occupancy before being occupied.
(See Statement on Reverse Side)
'.~.~
(POST THIS PERMIT ON MAIN BLDG.: AT ~ITE)
LANE COUNTY, BLDG. &, SAN. DIV., COURT HOUSE, EUGENE, OREqON 97401
, .
FORM#C55-13
"'"
.
SLAB FL00R . '
PLUMBING GROUNDWORK
ApPROVED / / DISAPPROVED / / DATE
REMARKS
GAS PIPING GROUNDWORK
ApPROVED / / DISAPPROVED /
/ DATE
REMARKS
ROUGH PLUMBING
ApPROVED / / DISAPPROVED / / DATEJ~2J...?">
REM~RKS /{~;:...~ '5' ~~ ".....~.ICJ:lrJ
.ji! <f I'<tee-"f ~'" iI# "3 - 2/ - / 3
ROUGH GAS PIPING
ApPROVED / / DISAPPROVED / I DATE
REMARKS
FINAL PLUMBING
ApPROVED /.t</ DISAPPROVED I
/ DATrU- /?- 'J.J
'7
( ,
REMARKS
FINAL GAS PIPING
ApPROVED / / DISAPPROVED / / DATE
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE / / NOT READY TO ISSUE / / DATE
REMARKS
INSPECTOR
INSPECTOR
I""CTO'~.
AI?) ,- ~~/ --R>~.
I NSPEC'TOR
INSPECTOR~~~~
( ~ It
INSPECTOR
INSPECTOR
Co
.... '.... ...
~
~~. mN'"
~'l:ajfer' s NaJ.T\ef
No.LivingUnits Bedrooms Baths
I d /
Septic Tank:
Ft. from well Steel 0 Concrete "1Xl
Ins~Cle D:unens~ons: ,t"t:..
Length 1 J-- Width ~ J - DiaJ.T\eter -
~pplicant .' Lyngard
NaJ.T\e We5tov~~ ~~~
INDIVIDUAL SEWAGE DISPOSAL SYS~~M RECORD
Installer: Complete top part form to
signature and return both cop~eS to Lane
County Building Sanitation Department.
" ' '
4'''-
III ;.',,~ .. ..
Pf'l~M I T No.
72-73
GG
property Address
2749 Burlington Av.
Basement Water ~ply
Yes 0 No ~ public 11/ Other-List
Depth
th/-,
I Gal. Capaci ty. I tJ () d
Tile Dispos~l ,~eld:
Distribut~n Box:Yes ~ No 0
Other Distribution- Type
No. Compartments
Address
Springfield, Or.
Length of Lines -Ft.'
1.1ffi.l!IJ3. 4. 5. 6.
Sketchj(See instructions):
uJk&
Trench
Width ~
Feet f~m _ J1
wellNu IU1'._LH~>undation / d
Lot Line
Front Side /~ Rear /(1
Total, sq.Ft.between Fill~'" . ' ~ F.iller depth Filler,,' deptfi
,L/~ . "'7 - , J above below /
.ft.I" b . hnes, A J . Type btJ...u _' tile Z- in.. tLl.e {,I? in...
I .
,(
Mailing
2589 No. 35th Pl.
,
J
I
1 ,
D:;i-, '.Jl f{t'..tt.-
p;:: 0 I~w;,i~
,~~~ 1 I
4:-
r
I
I
IJNfl HliBH ,uMno~ 3MVI
I
.1
I'
I
i_
- -
70
For Sanitarian Use Only:
Jf:- Approved: System Installation
D Disapproved: Does Not Conform
Remarks:
_I IT' lliil 8 0 CltlVIJ ~.
11 21 iA\' jl '::!I Jir::11 U
"0' _, ..::Ii IJ\ LI ~ (jJj ~ n
~ )j AtN
f/ ,11
Conforms to Current Standards Date: :5/ 't173
to Current Standards
~o
Date ~ - ,..J -- -- /9,7 .:J-
Signature
Lane County Building &
C~J1vC1w-AJ~;
~ .~ Sanitarian's
Sanitation Dept.
0.. )
/j~
Signature
C55 -"
\
LANE COUNTY P' . OING PERMIT OR MOBILE HOME p-e APPLICATION
. ' ' PERMIT TYPE - BUilDING):) MOBilE HOME 0 PERMIT # 7;( - 73
~~ROPE ,=ER d~ MAILING ADDRESS / PHONE
~ CO 'ACTOR - ~ " / /- MAILING ADDRESS '. ~ PHONE
r~/~~-#~ p,~E-9., 7:?~.// 3,~~~_-,~7V-7-977/
. eOPE7RTY ~LO::;;O. N ;?NCLUDE~?_ T O~F~ /-:J_ ) . / / / /~-------
eX 77/~~~~~ " ~ 'I 4/~~...L
P PERTY LEGAL DESCRIPTION ;7 / '4 #' ~ .# ' , 7/ JIr./ ' METES & BOUNDS 0 YES
LOT - BLOCK - SUBDIV. / ~ ~ ~ /~ ATTACHED 0 NO
TWP RANGE SEe. TAX LOT # CO~ C'ENSUS TRACT
/? 3 ~-c/" :2--0-E.D /00
APPLICANT ~ / _. _ / . DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY
NAME ~ - /.4~ ~
AND L~L:Y-ROADNAME OR #
MAILING PROPERTY SIZE-WIDTH' ~
ADDRESS
AREA
FOR MOBilE HOME PERMIT ONLY
Number of Bedrooms
STR~RES TO B~ B~T THIS PERMIT , , - .
:&:2 ~~
,/
TYPE CONWTION
- y{~~
Connect to. Existing Sewage .System 0 or New System Req. 0
SQ. FT. @.AL!EDROOMS VALUATION
/~/~ (3 / /~S~~'
?7~-.f
(/ ~~~
'-7?jCJ !f;C;'l
t~d~
\Ew AGE DISPOSAL , /.
PUBLIC 0 SEfTlC TANK iJ\
BLDG. $----W'$/CJ cf . FEES
, ~/)t'Jl)cJ
~ ~, ,C;-CJ
PLUMBING INSTALLED BY ~ ' ~ d
OWNER 0 OTHER~AME Mf..--t. ~
PLANS FURNISHED FACILITY p' ~~' C/ .
Yi;$ V NO ,DYES f2t(' NO 0
. \/SI~,NE E OF OF}:J P~I ~ DATE,'
...:?/cnJ ^ ~~~ "-"/-/7-/__
'. ' 'I 'FEE RECEIV~Y DATE
.P,40 ffd-wc- '\, /-/7- 7.
.' " PERMrf # P "
j ~ S?J "7 -2 ~ 7 ~ ::;>
COUNTY BUilDING- & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY DRAIN FIELD REQUIRED '/
WITH DIST. BOX: GAL. / () 00 UN. FT. /5"'0 TRENCH WIDTH FT. 3.... ~ SQUARE FEET ~ S-O
7fl1i.~~ ;Ii;U ../J- ~ ~ ,/JL~/7~~- /d /urj) .L~_ "-7.(~) ~'
t' f/ '. --fAVT.Nrvy;. /1/ - - .
~ elf ~ ~j7M~_ k~-. ~/L/n- 2~<<~ ve:~,
~~4~,4~~~ /.
"" OF '"ueJURE 0' ;./. .. oeeu"i'::r if' 0/ .
10 b.,,q)
OTHER 0
WATERXUPP .
PUBLIC
PLUMBI G F~ES
7 FIXTURES
CASH ~ ~
CHECK ~NNECTION FEE
PUBLIC WATER
CONNECTION FEE
OTHER
WASTE DIS.
PLUMBING
PLAN REVIEW'
PARK TRLR.
TOTAL
REAR' YARD
PUBLIC UTIL. EASEMENT
BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY
FRONT 4 S SIDE INT..s SIDE ~"Jn':-
SANITARIAN~ Date !L~~~G
4...tJ.-d ~~ l- ~2-7./1/!1V? 1-/8-7.. I~
- . 0 'I Y
Directions to Find Property:
USE CLASSIFICATION
I
REAR 7, _ ~
Date BLDG. I NSrJ, M2 __ A "A~~,~J 'I , 1'1 Date
ffv.;;r~~L IG" ~ '?;y
(j /
COPY 1 - OFFICE
COpy 2 - JOURNAL
COpy 3 - AUDIT
Form # C55-12
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