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HomeMy WebLinkAboutPermit Building 1973-11-26 f '-A- "jfJfJl/1j7n)fJ;i;~~~( ~~ V'~__'-'-~:~~ ' - . Ai?ff~f/)t '~11~\}~~... -_ ' ' {!::"" I)':fii}" l'J1..i''''~' ' , t' '" ~-rf"'~. ..~/~--__IoO~ "".., ,,"..,,' 'f -' ,r '"ift[..~..1r6, , ~' LAN~COUNT\ jlLDlf:'.IG PE~MIJ.. QR.'M'bBILE HO^ .JSE PERMIT. l .,':' ;"'. 7;,~1t/t 3Jt(3?7 BUILt;lING5l]!{ ;f)" Mf"'O .,. ~., PERMIT NO. PROPERTy'dWNER " . 'MAllINlY ADrll<ESS t,'CS.tOVOll' eOrlS'l:flJctioR ' '?5fl~ ~L 3Stl1(?tl;ic;,}l""$p:rin~fieldJ;el'"(!g~m' <'. ;. , ,'v I~' ........,... , :'~""''"'\'.r "',- ......,....... ., .~. r. . :' .... ,,/'.~ "'-' " '~ ,,' ," , , . hi '.." ~..... ,,', CONTRACTOR ; MAILING ADDRESS i';i!'1~o7'1 PHONE 71)7"'0Df~' \ \ , PHONE . PROPERTY LOCATION -:- INCLUDE 'P0ST OFFICE 2.74G Bud ington Ave, PROPERTY LEGAL DESCRIPTION ~ METES, BOUNDS tllnf;arbtu'v V illa('Je F u r'5t,. ,A~d i+i fllf.'l.., l~~ TWP RANGE SECTION .' ,:j, J.,:,..i;....d~~,. ; "'J:_';.:,n,t.~ :'. 1:7 " 03 14 , '-/. I H1- I1tn~rk 1 TAX LO,T NO, ~ 36~J CODE , CENSUS TRACT A~PL. NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No. 'of Bedrooms ?/1l_nf!\ 1 F:fl. ' EXISTING STRUCTURES ON PROPERTY- He$t~vor CmDst'rJuct.itim C\1n...."" LEGAL- ACCESS TO PROPERTY "/ilu.. n 1,,\,,:+........ "^,.,," PROPERTY SIZE~"': FT.- .WIDTH :, ~t... 'DEPTH n 1 ';l AREA ", ST/3UCTURES TO BE BUILT THIS PERMIT Co/')nect to Existing Sewage System 0 TYPE CONSTRUCTION SQ, FT, # BDRMS ' New System 0 VALUATION . fb~JGl Hi nlij Go r.arJCI"'~1n~ Ilod...a ttDched; u.,i7IO (" n ') - M(~ (', ~ \ - ... If,,,', 11:'-<1-(>1:\ 'Jflst'ol'ltt~i0n: G.f S.D~S. ',t {;f'6' ~~i: l~i1~;' , . , o'fU ~~ '.' FEES, , ' . ' PLUMBING INSTALLED BY . OWNER\n' OTHER: NAME WATER SUPPLY i SEWAGE DISPOSAL . , S~'~il'C TANK j.:01 ( .:t: " 'dt8~ROJ;,. " , I e;;, ,rtfl .?(.} on ?b., C;(f\'\ ,', PUBLIC 0 . :BUILDING ': WASTE. DISPOSAL '; 'PLUMB.ING' ".' PLAN REVIEW :1 PARK TRAILER .,/ ' ! J t PUBLIC, 0 o OTHER :/.. . " ",: I f " I" . , , . ""1" . l: '. ( TOTAL' ~. , l:ltt6 I:t;(.~ ....,. . COUNTY BUILDING & SAr-;lIT ATlON SPECIFICATIONS DRAIN FIELD REQUIRED . ~ .' ,. ;. ~. '. '\ MIN. SEPTIC TA~K CAPACITY, 'WITH DliT. B'~~: GAL:' ..,;. . ~(tO' 'i L1N. FT 226; TRENCH WIDTH FT. . ")' OR, SQ, FT. lVrn' ." .J l~cof ,qro'ia$. '~~0 t:.l'.:o, st V'i@Q~ ~ , . , '. ' , " i .. ,TYPE OF STRUCTURE OCCUPANCY ZONE,' '. I' i. , PUBLIC UTIL EASEMENT . :,,", ;1'" .;. 'I j; . .. 'J . .~: [J :1- t1111d .'1 'BLDG, SETBACKS,n' FT. 'FROM CTR, OF ROAD RIGHT OF WI;-Y, 11";.1 i USE qASSIFICATION,. , , FRONT 45, SIDE (NT, '.; SIDE EXT. AUTHORIZED SIGNATURE ~ DATE -ls/J.'E. 100S5 bv Chc17Jr161S MC1lrbl)unh REAR 7' DATE .~Clhr.l .r.ru i,,,,.&.ICtlll-,,[;\I, nc;: ll~?r._ 7-:.! ..r!e BLDG. PERMIT - WHITE , OF'FICE 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 certi.ficate of occupancy before. being ,occupied. (See Statement on Reverse Side) 'I , i (P9ST THIS PERMIT ON MAIN,"BLDG. AT.SITE) LANE COUNTY, BLDG., & SAN. DIV., COURT HOUSE, EU.GENE" ?REGON ,97401 RM:#C55-13 '"f ~U'LUIN~ ~llt tVALUAT10N ,'f t / W\". /7 R -&13s c::zY TAX LOT . ' G,I-,- I 'n\ ",,'\, ~f;NSUSr T, RACI,' , ' J '\ ~ \ {!/941rr"~~~/5rA-,LJLJ )' } 0 ~( APPL I ~ ..a: . L-I't9 6-/ No. ;::J;;:)\..p~-73 NN1E l.u&67Vd~ C?{).Ns:.r ADDRESS K ~u i I d,i ng Perm i t App I icat ion 'I () Site Inspection () Pre-Permit Investigation P HO N E DATE //-c:::?O-73 L/INE COUNTY PLANN I NG DEPARTMENT -, I. Zoning Ordinance Compliance (ZoneEI) Subdivision Ordinance CompJ iance NOT app I icab I e () () ( ) ( ) ( ) ( ) NO YES NAME o lITE ') .J . Required Access ( ) ( ) (). ( ) (y ( ---r (~ (y ( ) Y/, /f f"2~ 2. 4. Building Site (Area, Width, Fr6ntage~ ~etback) Other (see comments), 5. COMMENTS: BUILDING INSPECTION SECTION NOT NO YES app I icab I e ~ 6. Plans Subm i tted ( ) ( ) 7. So i J Stab i I ity (footings) yf ( ) ( ) 8. Flood Plain 'K> ( ) ( ) 9. o t he r (see Comments) ~ ( ) ( ) COMMENTS: NAME DATE e# 71~~JII~-e.fp-):; ,p, , f' SANITATION SECTION NOT NO YES NAMfi: DATE apD I icab I e 10. Sewage Disposal ( ) ( ) 0 II. Usable Area (-) ( ) ~ ~~) i.LJ)73 (./ 12. Water Supply. ( ) ( ) J>4 13. o t he r (see 'Comments) ( , C) ( j COMMENTS: TO APPLICANT: ~~, ( ) ( ) ( ) Building Permit/ Site Inspection: Can be appr~ved.' //-.:f~- ~t('1.A) Cannot be app roved at t his t: i me as i nd i cated on item NO. above. Quest ions and further informal ion 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. Will be held in this office until you can resolve the problems indicated. Is being returned. Your buildinq pernlit application fee is being r~turned under separate (.u"er. I ,J= Your ~ l./'Nf: COUNTY PLi\NN I NG OEP/\RTMENT 13'.)Si;<.rl, Avenue Ec'lst. tugelle. Or~9nn 97401 \ ' I"IWNt:' - 341.. I J I I EX I. 231' ......, lANE' COUNTY BUILDING & SANITATION D/VISION 135' Sixth i'l"'~IUC East, E\I~leIH.', OIC'Cjon 97401, PIlO~L: JL'2-1311 ~XT. t.O I -, ---------------..- ---M5S=2S---"-'--'-- p . ,~ &~,..: ~~:~ J. PAT HORTON ',;. D'ISTR'IC: ,A.TTORNEY .' ~.~ ~~;; .~,l. . ".1" . FRED 'A:, HARTSTROIvI " ' , EXECUTIVE' ADM. :COUNSEL.'" ,- . r '......:. '.. .' , , "ASSISTA~lT , DISTRICT ATTORNEYS JACK A. BILLINGS RAYMOND.J. BRADLEY " DONALD D. DIMENT. JR, KENNETH N. FELDMAN DANIEL W. GOFF JAMES C. JAGGER JEFFREY M.KILMER DARRYL L.' LARSON GARY R, LUISI THOMAS J. MEEHAN, JR, MAURICE K. MERTEN R. SANDE TOMLINsON SHELLEY'P. SMITH, LUCY B. SCHAFER' .~ r' . ~: . . -. -. . -. 'DOUGLAS L. 'MEL.EVIN' EXECUTIVE'TRIA'L',CO,UNSEL' , , ~ ~"''':~' . LANE. C9UNTY DISTRICT ATTORNEY, 45.o~LAN~, COUNTY COURTHOUSE . '.EO:UGENE, OREG.ON 97401 ~", "','!,fr;ELEf'HONE (50S) S42.1Sp LARRY, D.' THOMSON, .f CPUNTy'COUN~EL ..,~.'.~ ,,/:S;/, ,;. i.... . ,l' -!'. I. .:,.':.",.~i_ " "' ..... ,r!"< c ,;'0:: + ,) " . :: .I:' SPECIAL INVESTIGATORS . PAUL D. ALTON November 20, 197G~ IE: (fi)' TB 1 nc JAMES L. SHARP !k/,~'.10.'!b ',:W If fffiHO~AR,D L, WIL.L1AMS MEMORANDUM" NOV 20 1973 ,VJ > .,' c, '.J,: " . TO: ":~ :':"2.-~:~:-;... :t .: _.~~" /~ ("\,.~'} <'-. _.;?:~.-.." :-'JOHN?~Em:V,' .J~u{l~i:ing. Pepait'rA~nt ,,'~Lane .:Col,Int:'y~nne:X '/.[1, '!"/_::". f''' ".L:UNfy Ht~LiH DEPT '. ',' . ," /. " ~,~ . ......, " ' . PROM,:' ',RAYMOND]. BRADLEY,' D~puty' and;Assista,nt', County. Counsel' : . " '!.,.. .... _l~ .", ." - : " . ," . ' '. _' , c. 'l ~, RE:' . . " . '. . ' . . . . "': . ISSUANCE OFjUILDING PERMITS RESPECTING~ CAN1'ERBURY VILLAGE, . .';" ~i.RS'I',..fD])ITJ:ON. ' ' ',;c'_" .. Building .'permits'. may be p'tocesse'd'and' issued if th.eycomp.iy with, the; :Lane:C~lmty''C,09e. , 'Th~pendlng; litlgatiein .which temporarily ,~1:tereci' the: ~ssuande, Of"bt.tiiding"permiTs,on ,the above 1?ubdivi'si'on h~s been ' res(jlVeq.. in faV6~ pf: ~~~ county ~ .~ -'-" ~ ,~esped,fuJly" submitted, ~ ~' . J.,P~ON, Dis,rict ~ttorney BY"~a~~puty Assistant County: Counsel arid ~~ . : 2J7/ RJB:bj. ",',. .:i . .~.~ . " >}. ;, . , :' . ~ . ~ "-;,.' . "..:-- , .1'. ., ; ..".... " '. : ;,: ' . , ' '~ ! " , .' .~. .;, "" ':': .~ " . ',,~' ,. ~,;: :-.,.. '-. ' "l'-" '.' '...~ I <: , . ..... ~. , >, ~ ~ .\ : . ", . " .' .":. ';.';: .... ' c . .-> . :<;>;->:::':'::':~'-:/' I!?;:r.~v,:":~~~~~r:.:',-;;:; l ".';'-<': ,. ," il: <..~. t.,,,,/~, ~~:,Jf.?.!- /.. " 1: ';.'.'-=w' 'l\_i-'l::-'''~ '. .c .......... ) "-,.. ......... .-~. --. T' ,- \.~-., .-<' ", h' -< .' _, ,I- '. LANE COUNT\ BUILDING r1Jr JILDING PERMIT OR, MOBILE HOl\ '.-''f'.''', ' MH 0 ~.'..;~.~. uSE PERMIT PERMIT NO. PROPERTY OWNER r,_JO~(c)\f':)? 0.')f.J'J'&G'C1GY: UG:7a CONTRACTOR MAILING ADDRESS \ ')C;I'1;",; 1'1 '.',':~<?;', Ui"rn n:'6>~"'n,(Ntr"!!,,~ ,"~~)..0d .\.... ct '-c../c.:'d.i -\l- If u\..,.......-......~ ....."1./' U .ii...; ,"-' lb..... Q CtU'C:t:,3:7J ,:~~~~:r.i""I;~) PHONE (/~.)~ C)~j:)V U MAILING ADDRESS PHONE PROPERTY LOCATION - INCLUDE POST OFFICE 0'1JL,r; i"':' 0 l? 11 n ,~ "J' ",?<n' ,,"i;';Y;~ ,,'i:-'~;'t.;" . GI/ '-'\.,.1 ~....j ~ U"II~~ b.....:..,tJ .. .t;U. . PROPERTY LEGAL DESCRIPTION - METES. BOUNDS 9Jfil;Ur~~Ur\'1 mUYC:-:::J [?UfO{~ tti1dD~V(l;Ci'''' P.nt'! i)G :::D(>>."~r' 0 TWP RANGE SECTION TAX LOT NO" 't-.... ,..,r 'l"~":'..-;r~. CODE CENSUS TRACT i;r @;) :?nt> S, ",:. "r:.J 11 ;'('j EXISTING STRUCTURES ON PRO-PERTY' , f.PPl. NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS QNL Y No. of Bedrooms t':;OCO'tiOff' ~Qri~'C?t.1CD: B~ r'l~~-, LEGAL ACCESS TO PROPERTY f',V;:-' 1~ ~r-~"'_';r)('\'~1. ,,\T"~ PROPERTY SIZE'''':: FT. WIDTH '7J('\ DEPTH ;) TI '.'1 AREA "'. STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ, FT, # BDRMS New System 0 VALUATION C:.-;o ~ n a[~n n~,~'Ti (., HI ({,,"; ~H'''r', GDr-c:::;;:\;?~~~c:::U k~,:rQtG:c~~~:O i~eeoDlc8UCQ oq 500.3. fJl.r",:'~ r-~ lJ Ii!;. r '\ c~0._~~_~ SEWAGE DISPOSAL PUBLIC 0 SEPTIC TANK 2sBJ BUILDING ~ WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER OTHERD (';51..PiGl ~ In -51&.. C@ FEES PLUMBING INSTALLED BY / OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC 0 o OTHER TOTAL t 28(51. r::n COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED "\ MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL ~f,J L1N. FT ,120) TRENCH WIDTH FT. Q OR SQ. FT. E\-:;(:~; ~~=::0 'if cJ ({' 0 U VtlO \>'10 ~ k:3 9 t:-rccrlJ: ~ TYPE OF STRUCTURE Ie! ~ FROM CTR. OF ROAD RIGHT OF WAY SIDE INT. S SIDE EXT. AUTHORIZED SIGNATURE - DATE [;san b); CGX'}fUCQ h":.Jfi'bGtlfld~ OCCUPANCY CR..:J tD REAR ZONE j)"",D USE~.LASSIFICA TION ~f' PUBLIC, UTIL. EASEMENT ;;J CJ BLDG, SETBACKS __ FT, FRONT t~JS 71 DATE tOQ il~:O \ ,.enQm v;ti'i'nfrlet1{\t);""r~~ r,6\~ fi n",)p(\,o'i7:~ "..' Construction to comp'I~,&ith uniform buildi~g code and- count; - regurJ!hons covering plumbing and\..sewage disposal. All buildings require a certificate of occupancy before being occupied. . BLDG, PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY .BUILDING - GREEN SANITATION - GOLDENROD (See Statement on' Reverse Sid'Ei), ..;, '~-~..t (P,OST . ~~IS PERMIT ON ~,AIN BLDG. AT SITE) LANE COUNTY, BLDG. & SAN. DIV" COURT~HOUSE, EUGENE, OREGON 97401' . ('\,,, FORM#C55-13 \ \ :~~... ~ SLAB FLOOR PLUMBING GROUNDWORK ~ . :,,{ ApP.ROVED / / DISAPPROVED / / DATE -./...-' REMARK'S - ._ GAS PIPING GROUNDWORK ApPROVED / ,. r REMARKS .!{ ~: ", 11..... ... ~4t. .::-10 / DI,SAPPROVED 1:__/ DATE ROUGH pLUMBING' ApPROVED / X / ,. DISAPPROVED / REMARKS ROUGH GAS PIP I NG~,: ApPROVED / /. ,"D I SAP PROVED / REMARKS " .-. FINAL PLUMBING ApPROVED ~ DISAPPROVED / REMARKS - FINAL GAS~PIP~NG .:!o ..... ApPROVED /\ / DISAPPROVED / '! ..' , \ \ REMARKS " r .\ , " . ..I' ." ~'. 1/;; \. l. CERTIFILATE OF OCCUPANC~, :-, -' j '-' INSPECTOR I!'JSPECTOR / I . 1~ f. DATE/-,29-1'l INSPECTOR ~N Vi, / DATE / DATEJ - j-'-}~/ / DATE READY"T'(j ISSUE ,I: / 'NOT -READY TO ISSUE / REMARKS' / DA TE , .' '. , -", "" .~ INSPECTOR INSPECTOR INSPECTOR \,,----.,_i"'-...... '. ........:-'.... . , .J'.>" "j " . u "''/..f'l~:..... .....' f .) :.... ....-1_ . " i~.... . t "'~~.".O:""" ~;',i!,,,.., "">0 ..: .,~.I~_I:_;-j"''''''.~~..i."",......:-,._. ;~.--:. '" -} ",-.,,-..' :; '~-'r,!" ,,'.,'~:;r, .-, -_', _..._ '. 't,.-'; ;"'....,_r". _-:',",",/ ". LANE COUNy'l~,~JILDING' PERMI1:.,~OR MOBILE BUILDING [5]'( , MH 0:> :.,~;. :::> 'i MAILING ADDRESS ~~I <}'::Ict ~'.~)~;') :;~} .:? U ;:-t. :iQ~t,/, J'~t ~ Pl. :",) HOI\,,-,,JSE PERMIT PERMIT Np: ...' ( ", ~ " PROPERTY OWNER :..~,:;f:'<;G>';'::;fj' C~:::')J2udG:::: nC:~ PHONE o '::~~~C;~~~:.) ),'}/-<' ,"?' CONTRACTOR MAILING A'DDRESS :' \ , I , , PHONE PROPERTY LOCATION - INCLUDE ,POST OFFICE ::t;;~,;r:- (.\."""""'0' 'I,...., 1"').--.' - i''.',~.-'~,~:" f).~':)'~\ (..-;; 0/''-...1 l.,_'.; {..~~;..Jt:,.,),J "I""'(,"'n~.~I'J.~.1~}! ". " ",\. PROPERTY LEGAL DESCRIPTION - METES. BOUNDS Ce" ~,~:~"~.~ ;-~7:)~.':' G~".;i 8:1 \) 1) D 5 c; ,-:! G? J i"8 (( RANGE \ 0;; (, '.:J~ J ~'~ n(l::.~~ SECTION O.r:,r-~ no r;;t'~c":~ 1\ TAX LOT NO, .CODE CENSUS TRACT TWP pl) <;V\ r: ') 1,'\") EXISTING STRUCTURES ON PROPERTY"- , APPl. NAME & MAILING ADDRESS . FOR MOBILE HOME PERMITS ONLY No'. of Bedrooms l~:(:}{ .'i CO\.;C;? I".l::';-.." r:.t...,~'fH.() P',,.,,, ~:cJ_!/2..}:.:~,....-,h.lj-t....L11 "," --.J~ 'C\-o\~\.\ r .,.~ ,....,r) f LEGAL' ACCESS TO PROPERTY , I ;'")~dfPn G\.~~~}'_~lr---_'n {.1;~'~"1 PROPERTY SIZE':'::' f1'. C . ~ WIDTH -:11') DEPTH r D '; AREA STRUCTUf,lES TO BE BUILT THIS PERMIT C':::J f f:;:] Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ, FT, # BDRMS New System 0 VALUATION ~.~-.;:,.] (.) p~;') ;~~t~'" 'Ii! t ;:r ie',' Ii '~"::O ~,"V"" n 'Cv" ,1,..:,';'') r;'. 'l~IL,,-,.-'1 ......' .v.....- (...~-r' \.nI-J...............; ~ .J\,"''''-I'--.Jt,.>v<'-~'''''''''""""",~ . t,.(':'.; ...." ~I 1.(' r ':., ~ COG\:uU nC5C~G:J ~>{ f.3'#I.Jbr}~, ". r '.. \~ \Jl _ , ..... \ ,\ ';'v 'i \\ \ -' " \ ," \. :".:", ,: r PLUMBING INSTALLED BY '40WNERD "OTH'ER: NAME . WATER SUPPLY ,".> PUBLIC D 'D OTHER SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILE'R ..', . SEPTIC ',. ANK rj~lJ -." ...:.' $ OTHERD~ ('{i n (<(:i 5':lJ,') ;,;)}i" n Wj FEES ~ . , , .l'l Y f'~ ~ . - ~ H. r TOTAL '-i-- ~ liC~)" I]:::) MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL. COUNTY BUILDING & SANIT A nON SPECIFICATIONS DRAIN FIELD REQUIRED -t:J lIN. FT rJQ{'1 (,<...'.J TRENCH WIDTH FT: 8 OR SQ, FT. L.~ 'f. ''': :':~)V 0r.::1'\ ~..,(,)".;. f,,",'l'....j "f;'PC -'Ie, u (, "..,;r,~v .l"-"" Ll " >. . TYPE OF STRUCTURE OCCUPANCY [) ::, 0 U~~~ ".!) BLDG, SETBACKS u FT, FROM CTR, OF ROAD RIGHT OF WAY ZONE PUBLIC UTIL. EASEMENT If_~~ g USE CLASSIFICATION " I'? FRONT lu<:) SIDE INT. :; SIDE EXT, AUTHORIZED SIGNATURE - DATE REAR /7 DATE fhl' n pc I";" (Iq'* !:'z:;.:j<::J ["il CD~~~')V(?':1 ~.J ~~0C:~;-{: ~~ sln CL"~j UC-f':l:;:'::~c ; .("1 t " Ji""> \l n.,-, I ',.r BLDG, PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - POLDENRQD , " Construction to cO'!lply with uniform building code and county regulations; covering plumbing 'and sewa'ge disposal. All buildings require a certificate of occupan~y b~fo're being occupied. \..; }. -,~ ~ ~ '" , ';' . S ...' ". .- ., . . '. .' '. .., ' ' .. .....\. ,-. '-.... -:: '- ;''i(POST' THIS""PER'MIT "ON" MAIN\BfDG.. A,r"SITE) \ " \~ ~\:..."" ~\ FI'.- (See Statement on Reverse Side) " ( LANE COUNTY" BLDG. & SAN, DIV., COURT HOUSE, EUGENE, OREGON 97401 FORM#CSS-13 r// \ '\ \. {, '~ SITE INSPECTION ApPROVED / / DISAPPROVED / / DATE INSPECTOR REMARK'S FOUNDATION INSPECTION ApPROVED / J// DISAPPROVED / / DATE/j"/~'"13 INSPECTOR REMARKS .:'-"~?...:..L.(:; .. " r:2 FRAMING 'INSPECTION J -)....3..; ill a ApPROVED ~.v~ 01 SAPPROVED / / __._~-~~fi1~' I NSPECTOF~t~/L.. REMARKS ;/l11/ffit> '0<. \f/41-t!/~ -/~J i./j7 if ;-~I'~ /... '!J()... it!, , . I { I LATH OR SHEETROCK INSPECTION ApPROVED / . (, DISAPPROVED / / DATE INSPECTOR REMARKS F I.NAL INSPECT ION ,/ ApPROVED ~/ DISAPPROVED / REMARKS 4~N~ :2 - 7' 'Ji./ (j / DATE :7-- t- 1/.( INSPECTOR CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE / / DATE REMARKS </ 2l'''// ..,rf---i V' ~"" fJ'1 I V /l ) .t// ~ . ' .~(,(~eLb?'~ ' 1f~~J(7~~}IJ~ " ',,- / a/~I INSPECTOR IRe> ~ 30D ~ · .~1jd7"_' :;L_">51j.~73.. , ' F~A FO~~ NO~*~1zd.N"~::Z;::.OEPARTMENT OF HOIlSlH" AND URBAN DEVELOPMENT F'.m A"...., "'~1~t?~~J. t:C . FEDERAL HOUSING ADMINISTRATION CANE ccf.udtt Bureau No. 63-R0296 ,\\..\..~ ~ Q,......11\'\o. . HEAL TH AUTHORITY APPROVAL O/R" NV. HEAL;' O~1; ~ INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYST -. . 11 D1V~ rl"''\- - PART I - T,O BE COMPLETED ,BY FHA. J~, I' ---..J___I Insuring Office FHA cVN;;':- I ,Pt B 2 I ~ ) ?- J. -:It/ . , a~ ,r '" 7 7974 J-_/ Mortgagor or Sponsor: ~ BODENHAMER, JUdy/r.,DI/F ',.......... TEMP ............PFRM i Mortgagee - Name. Addr..ss and Zip Code r- First National Bank of Oregon Rea 1 Estate Loan 0 i vi,s ion P.O. Box 1786 Eugene, O'regan I Property Address: 2746 Burlington Springfield, Oregon 97477 L ~ Canterbury Village First Addition Lot No. 10 Elock 1 Subdivision: I T TVTNn 1JNTT~ '1'Q~r, l'HUdIlRR RRQRQQl,fR RAlJIR BASEMENT ~ New Installation I I Can Attic or other Area be made into additional" bedrooms? (I!. yes, how many?) DYes USJ No SYSTEM DESIGNED FOR 3 DYes [iJ No WATER SUPPLY BY: Q Public System. ' SEWAGE DISPOSAL BY: D Public System tJ Community ~ystem o Individual No. of Bedrooms Garbage Disposal D Community Syste~ W Iridividual 3 , PART, 11.,- TO BE COMPLETED BY HEAL TH DEPARTMENT DYes GJ No. HEALTH DE PARTMENT I'NSPECTOR'S SKETCH , ' , , , . "1_'_'_' , I ' , , ----- ---- -1=-- " I' 1- II' c= I ' , 1_'_'_' , , 1_'_' , , ~J ' I. . . I , - --- 1-- - --- ----- - -- I - ----- 1 -- -- ---- I --- - I ...,. - - - ----- ----- --'-- - - ----- -- ----- --- I -1- - - - -1-1-- =---f: =+-- ----- ----- -- -- ----- - f-- ----- ----- - -- -- - ----- ----- -- - ---- ------ J_ ---- -- --- :::ff 1 I - I TI--~--- '- --- - - -1- - I ----- I 1 1 I I.IT-j-r I. .- -1- - - ----- ----- '. I - I I I ----- ====C =_1__1_ _ _ _ _I_I:...... _1_ _1_ --- ..:.1_ _'_U_'_ - f-I- , ----- ----- ----- ----- ----- - ---- ----- -- - ----- ----- ----- ----- ------ - ---- ----- -- - ----- ----- ----- ----- ----- -- - -1- - - - ---------- ---------- -- 1 - -- ----- ----- ----- --- -- ---- ---- ----- ----- ---- 1 -1- -- f------- -- -- :;F:= ==:=I:t=: 1 I {-- -- -- -.,-- ----- -- - -- ----- +_1 ,: -- ----- ---- ----- ---f-.:L I ---- I I -- --- --- I-- -1-- -- --- --- '-- -- ~t -1-1- - I I -- -- I I I - I 1- -- - I " I I. 1 'I I -- --,1_,-,,.- --.::.U-,- _ _I_ I I I I - I I I --'- --- -- --- -.,-- -- ---- 1 1 I I '--=- --- --- ,.:.- - ----- --------- - ------ ---- -- - I - - ------ ---- ~- , , .' ----1- - -I-~ =-1- 1 1 I I I I 1 1 1 1 1 I I I 1 I 1 ,..I~ upinlu;,0:-tn,:. D ~tate -- 0 Gettftty- Local DCf18rtlReat of Health that thi~ individual water-supply system D:s D is not slil.tisfactorv as a. Qomp<:U::: \7.::1::: ::',::;;;;~:; :er tA8 EIiSjooi ';:':':'.I:'.:.:t.1' '. I ._,.. . , It is the opitii'on 'of 'th'eD State . l' " with proper maintenarlce': ' [X] Can be ~~~ected to function s~tisfactorily, and .,' '.. ,t' is not likely to create an insanitary condition DATE,. ' ,_: '., SIGNAT~REe)1 tJ n G, I~ .', .?/27Llb. ," .~, . ' . ,~::'-'~<.~_::-~":-""-:'. ," _, ichardA. Kirby R.S . ij.H. ~ 'Co~nty . 0 Local Department of Health that this individual sewage-disposal system D Cannot be expected to function satisfactorily TITLE , Supervis ing Sanit'arian , , NOTE: The health authority should complete the appropriate opnian stotement above and affix date, signature and title in the spaces provided. ' ' , _..' , . " , , Use of the a~ore grid for Health Department In;;pector's'sketch'as w~l(a's -~;;~ ~f th;-ba~k-of this for;;'-is at the opinion of the' health'authority. ' PART HI. FOR USJ OF FHA OFFICE TO THE CHI'EF U'NDERWRIT'ER:, I have ,reviewed the foregoillg and the pertinent FHA Compliance Inspection Report, and recommend that the , Indiyidual water~s'upply system be considered D Acceptable [] Not Acceptable Sew~gedisposal be considered D Acceptable D Not Acceptable. DATE , ' SIGNATURE, ~ .,;....., "."... ~;... o CHIEF ARCHITECT o DEPUTY FOR CHIEF ARCHITECT HEALTH AuTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA FORM NO. 2573 Rev. 10/70 'REPORT OF INSPECTION-INDIVIDUAL SEWAGE-DISPOSAL SYSTUA PRIMARY TREATMENT consists of ~ Septic tank. 0 Cesspool. Septk Tank: Distance from well, Total liquid capaciry Inside length, 7.5 Ceup_l: Dis(;!nce from: Well. feet. Material 1000 Concrete Number of compartments ~allons, Capacity inlet compartment 4.5 feet. liquid depth, 4. 5 feet. 1 gallons. ft:et. ,Inside width feet; foundation, feet; nearest lot line at 0 front, 0 side, 0 rear, feet. liquid' capacity, gallons.' lining material o Seepage pits. Other, feet. , Inside diameter, feet. Depth SECONDARY TREATMENT consists of ag Tile disposal field, ...~-- """.-' Tile' ~Isposal Field: ' . ":'Distancefr<;rh:" Wdl '..., ':':":';' -- ,__r feet; founllatiOr'1~ ~,,~ 1 D .........,1~~t ;'near.:!st 'lot:lih:e-at~trfii>n; ,e:s;at.,g;~S;:;:~--8:8.>~ :' f;~~ Total lenKth of tile lines,_ 225 feet. Number of lines 4 " Distance between lines~-:y:,.,::::J,(ih;'2~~;;!iteet. Trench width 2 ,inches, Total effective absorption area in bottom of trenches, 500 <quare feet. Len~th of each line 35-60-40-40 fee~. Depth, co'p :,f tile to finish grade 'nches. Type of niter material: 0 Gravel. 0 Broken scone. Other I. :#2 Round Depth of filter material beneath tile,. 6 inches, Depth of filter rnaterial over tile, 2 inches. . 50epage Pits: --.. ~-~. Number of pits_~, . Outside diameter feet. Depth, feet. lining material Disl3nce from: Well feet; building foundation ,feet; nearest lot line at 0 front, 0 side, 0 rear, Inspodlon made ~y: 0 State, 0 County, '0 Local Health Authoriry, feet. Date of inspection . 2/11/74 Inspected b:' John Cruickshank Regl;tered Sanitarian (TITLE) 19_ REPORT OF INSPECTION-INDIVIDUA~ WATER-SUPPLY SYSTEM DistarKe to nearest puhlic water main, _, feet, Size of main, inches. Individual wells O.are 0 are: not customary in neighh9rhood, Give most recent fl'Cord of failure of wells in immediate vicinity to furnish adequate supply of wate.' 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 hack from front, property lin.. feet. Individl!al ,,:ate.r'supply from: 0 Drilled well. 0 Driven, well. 0 Dug well. 0 Bored well. D1sta'nce of well from: Buildin~ foundation cast iron sewer feet; tile sewer, feet; cesspool feet; 'nearest lot line at 0 front, 0 side, 0 rear leet; septic tank feet; disposal field, feet; other sources oi possible pollution, feet. -feet, feet; seepage pit, Well construction:, Diameter, inches. Total depth, feet. Type of casinr ,Depth of casing, feet. Approximate depth to pumping level of water in well, feet. Approximate yield, gallons per minute. Sealed watertight to depth of feet. Exterior space around casing sealed with: 0 Cement grout. 0 Puddled day. 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, gallons per minute. LlCated in: 0 Basement. 0 Pumproom off basement. 0 Pumphouse ahove ground. 0 Pump pit. Pumproom properly drained: 0 Yes. 0' No. Pump mounting watertight: 0 Yes. 0 No. Type of storage: 0 Pressure. 0 Graviry. Capacity gallons. Has bacteriological examination of water been made? 0 Yes. 0 No. If answer 'is "yes," give datI' 19_ Qualiry 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 !.<x'al Health Authority., Inspected by Date of inspection 19_, (TITLE) _, GPO .900,682 :., \" ~ :~. , ". I I , . TNDIVIDUAL SEWAG~ ";DI~POSAL S~STF'MRECO~.. ~,,'.' : ". . ~' .nst"atl~x.: : COflllilete . top part,,< 'Ornl' to " signature and "ret,\uj:'p boUt" cop:t,e!:> to: Lane ~ m '. , : .'. County BUilding sani~at4>n Department. " I}l'St~liex'fis,N~~.,,::;,~{, ....' ""I'~~Op.~rt~LAd~;r~ss' ;': ..,', ' :PFRMIT No. , VI ro M g. ,,: ',:.,.'.. ,-:. "," ~':':'J5tS.)274b: Burlington Aven~e," No. Living Uni ts Bedrpoms Baths , Basement, ' Water ~UPPlY" , " : I .. -d ::', - /.' Yes ,r.J", ',,'. ,NO;VJ, ' " 'P,' uhlic ' ,'01=.h, er.-List:,' , , septJ.c ,Tank: ' '" . - 'Ft,.'fromwell S,\:eelO':: :concrete,~' ".NO>. c'omp~,rtrnents . I" GaL Capacity. 'I 0,:) 0 'Inside Dimensions: Ft. ., .: ", " ....-: 'Prle Disposal Field: . ' ' .Leng~h 7:J-f:wi<it~~"J."'2:biaJneter' ,Depth ,if, J 'Dis~ribli~ion ~ox:Yes'r;r , No.D Applicant" r'" W~stove'~ Constf:uct i on , ..othrrJhisy~bU, t", ion..; Type Name' '... J-Za .Zi_G , ,," 'Feet' froItl ' I'''>> " ' ,{ Well (Foundation. U J 'Lot Lirie J,' 0 ' 0' .. ' ::Frbnt.", Sid~'j, Rear I Total ~q.Ft.betweel F~~k~Filler. jepth~FJ.ller,deptfi (I"" " I' ,-,', ,aoove' below 'j '.. ft. dO b hnes _ (!) TyE' ..hUe V in. tile G; 'iJ4, , ,', r' . ,', '. . r, ~' ,; - -~'--(.. 4~f~ti~~_ ~ ;/ ~~~'I 73 Cruickshank Maiyng' 2589' N,,'35th prace Address Springfield, O~egon Le~th'jOf'}jnes' -, Ft. : ' Trench liJ 2'.b03'704:.%'S~":"6'.".:, '.. ,Widthb-,:. . S,k?;Ch ,('see :in:s.tructions~,:' '. . . ~JJ- I ,I I ---.~_ .;,__.__.,__.1..~__..___...,:-,,_ ., .. . , ,', ~ ,. -, ; .~j. . ~ - -.', ~ . '^. . ."&l:i- : I, , )~. 4./(9..Q . !\ (- ',:i zY)I ~~. l.(~i~'\)r " . ~bB~ Jf-- ; f. 'T~':I':'. I,' I, r:1' .)" ....~ ~/j '.,. <:': ,,<~'> (~' ", 'c"'.., '''''~I'''' " , ~; ""~' , '-.' . ,......, "':'-~:". . "f:' , ")'-; ,; 'J' ,I, ~ ..~...". :,/,: #; , .~;.~, -'- ~ : ~ . .., , ,. M ; :~. \. ~ ~/ ,1, .', ' . .,. .,' .,' " . ~ .'" , , ,.-' ," ',f" ,,' :. .' ._ J. . I ""~ b 0 '~cQ;' " rp l' .. "/ . ."?,' , ':g"""f"".',(. , "" ,;' .,' '..,' . '..... , . '. ~ . . . '. . . . , - t, --, '.i',," ," '.- ~.' :', , .'". " f) sig~at)lreA 'kJ2. -" . :,..,l./I,_' .;. (, >..r I. ,'<- "F0~ jani tad.an. 'Use, . Only: '" " . )S-..APProved:::' syst~m In~tal1atio~ , ,0, pisappr9ved,: Does' No.t Conform " R~marks :' ' .' /.' . '<I K&/t ~ti<-;,Cj'"' P"~:t~, 1-ftf;y .' . - D'~te'>Z ~ .J;~"/Y? -fL: . Confqrms, :to Cu~rent Standards.', toC~rre~t Standards .'.' , '" , ,L~e' County Building. , .(WJ,Jd~/,.;i{)~' .' ", . " :, V. rrt ,Sani ta,rian I s st~na,ture, '&'Sanitation ,Dept~. . ~.:~.. " . ' .. '... .fro '. ("'1j,1j, ..11 .-, , ' .' - . ,. ~ " .~'.' ',> "-.,. ~:~ .~. ~.:~..' :' ~ ., ,: ;",>:}' . .- ",,<-,. . .' ~..- .'-. . , ' ":'~ . ~ =." "<, '. _r' .-. . "',, .4_< , ."\' I '.' '. ;;: , " .~. f._ .. - " . ,",- . . ' :....,'.1. .'- ,~_ I ~ .- " ..': ,,~~! y" .17:,,'1 :9'74' :-. '-: . .., .::1.., ,~ ~. .':. .~- .': :..'.' '." ~ ,,~N ", -: ~. ' .' ~ .... ';, ,t' . ... '" t.. 0:-. ". ,. " ~. 'l.. _ "'- . . -'. ,-..'., . ":., . r' . .....' . '.' -.... . - G" . /,', : ~, '. ,0' , /;. .-.,' .'- ", ..~ .", .... I L' .;, '. ". ."\ ,~ . .' - .' .~ ~ ~, ~. .. ~, . ~r. ~ . , - ":: '. ./ ; , ,. . 4 . ~ ~_ 'Mrs. 'Bodenhamer", '. . " ":: ", .,.,.,<, :" " '-', .:; ,2746'8urll"gton:A~"enue" ,.':' " . ' , ". ,SprJngf.'le~d~:, O,re~ ,~ " .' ~ " ,,'. _',' ':;,'~"'L ,~''i,' <", '.. .. ,~.'.' :.' ~ -.. . ",' -,-..'.:., .',' ..,"-' ~:-, .;. ;:' ,R,E?""Ca,nt,er~ury VI1..1age.::'FIr:st-,~d.~:~~tlon.',:Lo~ ,,1.0, ':~..lod('N : ",' . ; '\': ~",' """,' ' ~"'\v" , ." . :::::~:~::::::: abOve pr~~ty~"VIS'oft h~sre~eel!ed . ~',. " ", t~~t th~: r~qu I red ~epth o~, ba~kf f~~ l~as '~07' 1 aced:'over ~_he ,sewa~e. "I':" , '. ' dl,s~o~~1 : system. ' " .' ','>\.V/"; ',.':' ". ' ,:'.... . ,- " ", , .' . .,~. . 'f' .' . ~~',", ~~.~" ... .' JT.-.tl ;- I " : ,: "(' ,. The 'S~a~e"Departnie.,t of .E~~n~al .Qua,llty .ru"es~ perta.lnlng ,to,' ,'. ',' standardi,. for, sUbsurfacel.~f:Wage' ~u\~~eS\~lnl!"um 'of 12. 'Inche~ ~f ~ . backfill. . Ou~: .1 nv"s~ I p-at ~ on',,) n~. I ~a~ 5 that. four,' .~o.. 6 I nchet of back- ' "111 was pl~ced:on, y,ou~rt1JsYst~.. ",~ " ,:.'., ' ~":' ' . . .,,' , : '. / . .... "";~'... ~. :.', .:'::' ....:'~. ..... I. .' ,,~.~ (~ " .'./.....,. .' ,t.,', "..' ROY'BURNS.'~I~ ,,~:,'~' ~"", ."', :" \ " "W.s,t~r..Po~ 1/~~I~,~n,C~trol"Olvlslon', , . 8Y:"~~~Sy:.~:' . : .':~rea~,Santt1rr.l~: . ".~. -~:~. ~"'.' " .~~. <0 " i , , '\', ' .: ./'. . ',;X '" 0' ".' "~" . , " , ..... JS:slf ."', ',' .~' ';"< ; ...... .>,-' '.....- ., " ., '. . ~ ,'...- .. -'. :: ,. - ~- . "'- :..,' . , "'. ... . . ." : >: 'f.' . '<' '. - .', ..\ . ,'Lt,. ._ ;i "'.. ..: . :_" ~ .,. :- ~ .- . /. - ',' -"0' ~! .' .... ", ',. ~ ...;~ " -....." :- ......... '~.' Or. ',;- . " '.~ .:f: . . . - \. ~;, i . '. ., .: , ' ':.',: r'. . '. , ~, '.' , " ..." .~... ~;':".,'. "or:.. i.. ' . ... .....- '- , :. " - : 4 ~; :~5."' <; ., ,.. ~ ' "r .. ..; ,..- :~ ' t.,-. " .I' \ " , ,r, ." . . .~. ~ '. LANE cOUNTYF ,,)ING PERMIT OR 'MOBILE~,8Q'ME . '~, APPLlcATi(>N . ...' . .' , _ PE.RMIT TYPE - 'BUILDING'fb.... MOBILE HOMED05CRE~.#:.,': ,'., PERMIT # c?c;j&<tC 7J w~lW~ ~s:f~ . 05~~9ESS,d,~:S;~f?~/;~~L:). '7V7-r;97/ CONTRACTOR.' , '," MAILING ADDRESS'/',::: 'or;:,:., , :. PHONE' FeJR',MOBILE HOME PERMIT N~mber of Bedroom~ , STRUCTURES TO BE BUIL1 THIS PERMIT A~- '/,... ~"~#7T'''';Ulc.JcF.r~/') , ". ~ ,~,.,... .~~ j -;jet' ~. " ...., PR:?7~~0~dd~,~~C---_'" . .. 'PROPERTY LEG~L DESCRIPTION,/'t7"., _LL..,"';:,,'..~. ';' .!j:)~// ./1_//../1, ", :":,-~':-.i fL2.A/l 'L '1~' 2_(' METES & BOU'NDS DYES .LOT-BLOCK,.... SUBDIV. ~V,..,..., .l/~~'r:z.dC:uirrrrlY' -/fIt/~." ATTACHED 0 NO ;7~;' 93'c5,'c/' TAX LOr# , ~PDE'. .~. :J~~RW-/S-O mUCANT (.. ~.E:E~I\~G STR_~CTURES ON PROPERTY IF ANY . NAME ~ ~ND,. a~~D~L-: MAILING' .PROPERTY, SIZE-;-;WIDTH , _ DEPTH ADD,RE,S,S "'. , :>....J " .~ /~ t '/1::;' ( ,'. ~ >.... .. /,t.e' ~ ~ ONLY ,', . :.,;.... , ~ .~.. '~;,:"'',;t'" . , ", . Connect to Exi~~ing<S~\yage System 0 or New System Req.' 0 T.YPE<:ONSTRUCTIO,N','1'i . ",,;, :,,' . . . , . SQ. FT. , .!?~OOMS VALUATION ' ,..::{c:~i:/,v({2.9 @ / ~ .311l/'IOO ,'(f'133@3 LI /44C(. " /~~C; . AREA .;,-',.S . ~{ii-u- 'S1:>. S:, SEWAGE PISPOSAl . ? (-" plIJMBI~G"INSTALlED BY . ....i.'t' J.;;.#1.r:i_~~'~:;{,~~,.;~.~:,: : ',' J:-:' PUBLlq.o" '. ' SEPTIC TANK ,~, OTHER 0 .Ow.N'E~'n':' OTHER'O NAME " / C) F'J--. WATER SUPPLY ,. .;. PlANS.)FURNISHED FACILITY PERMIT BL~G.:.,:-: $~'~ FEES ,Or'".''' :~~~,:j~':~' ..'2!1~ . .:,~::::::s.. :;;~,~^_:/.1r,!;~,'.~,~~{~~~,~:"~ :'~~ _~~T~ -., ' PlAN:~~~~,I~W , _ 7c..~: ~ -- Q(':(....I-/~ R R R" . CASH 0' ' , . . "~"'EiV 'BY. DATE' PA K:T~.. "f" SEWER " N"\ ',~ " ", . ' . /.J ~O?'<!., ,"", . 'CHECK")4. CONNECTION FEE '-J"" ~ ~ . '...;;.,.;. ,.' (/t - ~. '''- .-::> .. -'P.E~M.I,i.#i / /.... .C--/"'I ,.', ,,,,,;, "'" / -- \.::) ~ - _.;, ;":, ..1 {;J:~ . .---.- COU'NTY BUILDING & SANITATIO~(,S,P~qIFj5:ATldNS / MIN:}?EP.tIC TANK CAPACITY DRAIN FIELD REQUIRED . ~.. '-;~':;:,J':;,' ~ W,rM D"Y; BOX, GAL q CJ 0 ,. UN. n.. 2A" ,,'NC" W'~T"',ilL;..# "~",' so':"' ,m ~. . . J?'?rf'4m.ibS ill~, / .... / " ~E~ARD ,~ TOTAL , ja~.<~Q . PUBLIC WATER CONNECTION FEE ":; ',r.!., " T~.PE:'OF S~RUCTURE "\.1- AI' OCC~:;:r BL[)G:lSETBACKS - ~T. FROM c;TR, OF ROAD RIGHT OF WAY 'OON~A{f. {If} "D~ 'N>.f ~l~t'Nq,'DE EXi. '" <~r;Ia~P)JJ/::J.iJ7?;1 ~M..~ I , "ZO!'W:,: :~'." PUBLIC UTlL. EASEMENT Direc,tiors.:to Fin'd Property,: K'/ ." .' REAR 7' f .. ,::. '~, , .. ~hr;~.' BLDGm:~~-u!fJLJ I~ ~ '-~7~a'e f ". II - - " . - ( -_. w" .V -.;::.}.. ~,'~',,~"" . .,:, / .~ '; " USE' CLASSIFICATION' "" . ".".' " '.' 't. COpy :1.,., OFFICE COPy j-..:.::jOURNAL . COPY. '3:": AUPIT ' " Form 1'): 55-12 '