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HomeMy WebLinkAboutPermit Building 1980-8-27 . {~. - .~ . ~ co U N .~..." B VI LDING t!ERMIT_ - 'I, , _' < :1, ;A N E " " ., POST THIS PERMIT ON MAIN BUILDING AT SITE CONSTRUCTION PERMIT #LC 1928-80 JOB ADDRESS: ~,,'(,~ltI~ ~a.r...j.- 2764 Canterbury, Springfield, Oregon TRS, TL: 17-3-24.4.1, 302~q SUBDIVISION: Cantebury Village, first addition, lot la, block 2 CONST~UC~ION APPROVED ~Y THIS PERMIT: Addition to family room and add shower to eXlstlng bathroom; 288 square feet. Relocate and update existing sewage disposal system . CONDITIONS OF APPROVAL: 50S Installation Specifications: 1000 aallon tank existi~g; 150 feet tot~l ?f drainfields; maximum depth of trench~s; as establlshed. Ke~p dralnfleld at least 10 feet from all foundations and property lines and 100yfeet from water sources. Keep septic tank at least 5 feet from building foundations, 10 feet from all property lines, 50 feet from all water sources, and 10 feet from edge of right-of-vJay. Block old line and install new line to equal a total of 150 feet as shown on the attached plot plan stamped approved and dated August 21, 1980. Replacement area to be reserved between lines and in the front yard. ~1inimul11 structural setbqcks: from center line of roadt front, 45 feet; side interior property lines, 5 feet; rear property line, 7 feet. PERMITTEE: {harles and Shirley Janz DATE ISSUED: August 27, 1980 BY: Roger t'1cGuckin/Kathy Wiederhold/Candi Hart DIRECTIONS TO SITE: Off Yolanda, out 27th, left onto Canterbury. Dead end street. \~P 28305-5E-2 * * * * * * * * * * * * * * * * * * * * * .-------.. kme COJ~: .......... SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION' CAN RESULT IN REVOCATION OF THIS PERMIT, CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OTHER REMEDIES ALLOWED BY LAW. WHEN READY FOR INSPECTION (see attached) call 687-4065. Have the following information ready: Permit number, job address, type of inspection, when it will be ready, your name and phone number, and,any special directions to site. OTHER QUESTIONS? Call 687-4394. EN'/lHCHJrvlLN 1 IlL MftN,'I,(iFMEN'! DEPARTMENT l:?~j EAS T HI!-i AVENUf EUGENE. OREGON 97401 \ TRS, TL I J -0 ~ - Z- Lf ) ~ :Plat Plan Subdivision( mtrht1 (Mia Lot ID Blo _ 7~ ,;:.~ APPROVED DIlTE 2/ ~ gt:) ~ BY ~ ' /~ .r--- '\ ./ Vicinity Map C74-150 . , ~ 629 . Job Location (Address) 2 7'/:' '/- C,4NTER~ u R Y Permit'IIPJ7J?"2/i?f) - For ,;;1111".7: Permit II Permit II' , For (; - Permit' II Permi t II For" v Permit If {<filet i __ p~ I a!l\ ~ ~coJ1.- h~ jMla>1JAlWI.rwd1 Q/Le. ~ t -, . ____ .., . ~i' I~.____---.,- , ,;( I I 'PR01"QSEt:> IrNE:.vJ 1-1 !JE.~ ~ '- ~:--~- - ~ \. ---'0''--' OLDLL/N~~), .. -~ ( \'-\\ \1- YROJ>OSEb bS~.~\:TLOk)_____ -- ""}- C) - "3 t:>~t> f<.ocM HOlJsE. 30' ~IO!-::' (;.2' ~^ - 19' C~ ~Jred- o N For For For , At _' \V.SV~lrJv N~' ~1~~ ~~l~ ~ ~# (Sr If\f5 J.. JJ.d 1 '- \,./') ) , \; atPl fJVV - ())lv !]V \ .. I 0 & j&J( Uf'VlP/ 5 1'VJ'f^'. \ V\. eJ. s(jJJ;\ ~. ~)~~ ~ I V j f'OJ)j\ ll1'w,g ~ n I Qdl "t ,,, ~-,fY- t~ <\~ ~}.J -~~ if ..J \ ~_~ l~ A '- vtfJ1 '\JVfl1J' ~ ~Vl ~) ,a;Jef;{v t ~ OlAfwvd/ ~}tv\P Vl^~ - - - 'KE-PLACEJVlENT LtN~5 I A? :.) :' :,4 . A , t ' H ,~(:' '~~'~PARTr'IENT OF ENVIRONHENTAL r1ANAGEi~ENT I PSB, 125 EAST 8TH AVENUE EUGENE, OREGON 97401 . Vlr- /~'>"'i /' ,I" .- / ........... , ..., ,- '),,~,~ /' ~ -7' ./ ,P ~"(A- : .. " /f; /. Job Address A'Wf:/ / /,'" ~""",,-t."z/ .(/-'1:,.1',- A'=, # Ci ty ~A':;~G...,. "C-I:- To~nship, RangE'~Section:;'Tax Lot 1"'7""/)""':;:':';;;~,:'tJt YoRl. I' ?'::~~ 7 , " 1/ '-.'4 / -, b',' - ,-', ,/'/., .. i ';:",p ,..',,":"c l. . '" - (f, <? " /' SubdlV1Slon t /:~,f,.~/../it. ..L--/.c.!_ :r">. //', jl""/-{.....,".,,r/ltot., <If') Block ~~ , . /' ) >'''''''- L. . ~. .~ [--"- ~,' " \ ' ' "', f' ,",.,," . /;d"jJ ~. ,.A,~' t'/"r -;?';t Application for~-7;'c;~~,'\., ~2~..;..->:..., ~\ 1~~7~~~._.iCA~ 2: ~LA'/""t;.1"";::6i!C; 0->2~'" """..~k:"> Structures now on the property !f'Yt:9.../'L.t~u ,J r' l. Proposed use of property: iC/'~Resioential /-/ Commercial Affidavit: I, 'VG:qO l: (Y1r:U)~ \~ ...;~) ~(please print)' If this application is for~n agricultural building it will be used for purposes allowed by the State Building Gode and Lane County Code Chapter 10 (zor;ki'ii'g) and for no other purpose. I have the 'following legal interest in the property: owner of record; \./ contract purchaser; lessee; holder of an exclusive option to purchase; duly author1z~d to ,act for the owner, who is knowledgeable of this application. ,-- n Signature/AddresS;-,r(~.rn'fI" ',,{', {YJr It .c" (Iii Lr f(~j';tl(,lI LD ..~j),j)lb(ZiP) {~;7l7,) .~'-" J th,~hone )tl i ( ;11 ~ or D'ate If S .. When permit is ready noti fy:Jr/ Appl icant /\//O~~er C/ Contractor Qz.: C/ ma il () phone Owner L ho v /;'::'- <:\ ,-~ L . ~,I(:. (, '''7r ,1/' (zip) Phone 7'-1{~ -7 7.lr Contractor '\(:'...~ '7 :J-' -..J......... ' (zip) Phone ,1St=-.; I ~~ l rl t.( 'VI.c V- I Appl ication ,ff ~ .'. . t:, 1. .'..~~. ~ Li I /,) ,'..;:; ( '. . .# Assigned Numb~rs I ,L ~\ C/ Indus tri a 1 L/ Publ ic , hereby certify that this information is true and accurate. Contractor'~ OSR# Plumbing by l I If Commercial: Residential: # of stories # of bedrooms ,"P"') SI test holes ready DO NOT WRITE BELOW THIS LINE # of employees # of SDS: un its .-;'1, I L/ Existing, BP # Cj;4 /~/ Proposed, 51 # , , ,..-")' I~ I "q Fee Code Description Sq. Ft. or # of Sites Unit Cost Valuation Fee / 7- i .~' I :..":. y '( .) t", (..,(\) Y ) $ $ $ ;"""\~':>,,~':tz r1\ tJ. J 'f' -':'.J,;.:.~:"'; $ ,-,/. ,,,-, /0....... ~' f.~.",. li<^"" ~ :"-='1'_.1 \- \ ~ -~; Total Valuation: $ $ p--.A"V' " Plumbing fixtures at $ ..""\.......,.~. each $ i f Sewer/water conn. at $ '",/ each $ 5ubtota 1 $ 4% State surcharge $ Plans check fee {2C1.tO(Cl"tL ....'c $ Gha,J;lg.e...o,f"lkcupiHIG;Y l.).-tX~ ctt.,t d. ,D, d,;",$ , ,~"1':' ,[1.....,1 ,...::1, ')' '.:,~ rlril1 ~ -+ lr'\) \ ('1> {' ...,} (..-. \.t ~" -Il.": ~ \.'. _..~.~ " ...\. , j i '\(J i ' 'I -(1 ,', t l '''.' I., " .' '10""\("": f""n' lM'i(-~ l ..t.. _!." .v (' .II. ::t <( '! ,,{1...... 1 I '_. ..1' C/ Cash C/ 'Check l Received by Water Supply f';'n I Y\: i:0:r ~ I (' I '):j} tti'"n Proposed,( '\t'\~r{C:--' Existing" ,7 .- -~ , Year Installed TOTAL $ PERMIT PROCESSING Minimum setbacks: / ~j(,.",... ZonE;,.",,:,..,<5''l r. IS' '/' f 1., front .;;'J' ~. ~ Pa rt. # Parcel # ,\f 1, side into Parcel Size \(}A;rt:. "'Ie) ,j.~, ( '., t' :~/ ~. ~ ... ........,.. rear ~~~~~ -7' n tJ , . i . ';., , ~.'.: ,J' Comments To be typed on permit I By ,. ~ It f :il-J 't , I ~ / I Da te ,~ 1-1(-.-, ~ , ~ () - ' l\.- . f' Directions to site ('n j . i ./ i~t{f{t C,~h tf'i ,- Plans to: "' (,,...,~ ~.~ . ...... \.(~f (J, r y-! n "... -~ (\' d ~?'7fL "",., \ -. :;:~:~ :,..-'(1I;..J \~ t,-,,) l(-~"j \, \"-;-r, .', ).. . . \. -j} /l I. ..' l r. ,___ \....{ . ,.... '- ,7 ) \" . CP&I.' set(s) ,Date Hold Slip WPC set(s) R'equired to PCC L..JlL r("'\j '~j :": l ((1 1\ i n17':"" f.,( !.l f' '; C/ SIFO Da te COlllpleted Da te to pcc - .....- Ii //CP& I .".' /.- /..D/WPC C/ Planning /....-/ Public Works C/ Elevation C/ Address /~/ Facility Permit /..../ Environmental Health -/.... /y/ n/ a FOR INFORr,\ATION about progress of your appl ication call: Permit Control Center 687-HELP (687~4357) H L APPLICATION # LOCATION NAME ADDRESS '.,' , ZIP CODE The Lane County Water Pollution Control Division cannot proceed with processing your application because: 1. Incomplete application (items deficient). I Address and/or directions to application site. l Proposed number of bedrooms in dwelling. 'IApprovab1e plot plan (see attachment). L--l Notification of date test holes will be ready. Verification of existing system required (memorandum explaining this procedure attached). 2. f 3. , 4. r,J ~Je ,1t~ o 1 ~\ vv ~0 \)J \rzOft .' + . '~~JN..uJ(1 (\Yj,0'~v ()Y ^J) 4 \',' ~ LiSlJ J t.y01 j}^-' 1- ((}J t . i~~. ~r:l till SIGNATURE I \yCJOY \ OFFICE' HOURS Two test holes (21X4'X5' deep) required for expansion or repair of existing sewage disposal system in the area of the proposed drainfie1ds. Other: ,',"~ DATE PHONE If the necessary corrections are not made within application will be denied. days, the 6ne county BUILDING & SANITATION / ENVIRONMENTAL MANAGEMENT DEPARTMENT 125 East 8th Avenue / Public Service Building / Eugene, Oregon 97401 / (503)687-4061 --- ,fr, . '-' \ ,: " , I ' " .\ . '; ~ , , , ,,' ,]B'J 1]1 . . " J :J 26 .'.1'" -. . 11, u '~, . . "', "\' . . ' '. " , ' ~ . " -~.." ~ 2~ 26 . .' ~6 , " ',' '1 J'~ , uJ j ,) I Ltll",l!::: COU1.".!TY 'DEPT:ENV hGT F:ECEIP"'f'." oil: "'i':?2f:::~)i:) 'J.)rYIT ()7i.:S, f::'j P Ft L. I C:~f~:) j",~ T .j (:":j N Z.l C; 1..1 f:":'; F~ L. E ~'~;.'. f::11~~ 1) ::.; 1..1 I f~ L. E: \~ ~ (, ,J.) D F;.~ 4.:3"f ,L:.'-=1 i{ S..~ () f"~ t: f'''~ E L. 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':,' ,ES1'~ CC)MI:ll_E:"'I(:lN' DA'T'.I~: 0'725EJ0 , TO T f:Y!..: FEE ')('1" 1''', B:. (/.4 :.'" :\~, ~, 64 "01.', Q ~ ... z 6 ~ ;; ", 0 3 ~ 0 ~ 62 " \ ;1 , . ,'\.' T~l1r~" T4 (I; li-t)'?J- Z-Lf)Ll) Plat Plan Subdbrision ((/;Y/lfrblt1J./l Lot /0 Blobt P~PPROVED Qi TE 2/ /h gt] ". f ~/J -".-' r.\' 1l . Vicinity Map tJJj () 7~ Job Location (Address) 27 t, 1- L.A-^JTERB iJ R Y, Permit 1J-Ei7>PXD For, )111,17 Permit (i Permit fi For 1/ Permit (i Permit (i For v Permit fi J A-/L" ~l ' I I 'IF' IJ"j r:tU '1 /: 10 }-" P \ 0. v,, V1,olfO ~(J ,) o~r;j ~. t,o.l1/Jp"'(~,/-J., /1, r; I";,'I)I/'.....-:(U,; Jll'l)!. ,,;> >,// ".1/; Jt . n l.V '-"'- ,,,u J - ' .u_ c t " ' - ~- ~ {- ".:>05ED-':"-: JrlJBvJ /..wES I ...- t . ....... ~ ,i Olb'L/N(S'J,' ~ (f29 , \ I \~ V I. I I I I i -- I ""t- I ~I I ~/O~ /" '( { '/1 ~ or;> I'l\ ... -a ' ?Rc~os.c.b A DP>\T1 ol-.l "3 C"E 'b K 0 a,\''\ Hol..! S.c. {;,2' ,\\ ... "', ,:}:' '~\ i' , ^' (, \ \:' I U," I ------ _._--~,--------_._----~-~--_. 79' , '!' I, , / ! ._~J ! I '-i-' , . , I E-104 I ; I 30' For For For ~ " ,,' i- 1\ f";' I l./l /_1 ~ . j I ) " '0 ,. I ~,\ j\')' ,U " ,~u:.; ; ']' \jTt/ I , b '.'0 } { ) 0 \\1 \ ,') 'j , (" .. c, ' \' ( 1'1 ), ". I r t"" . - (' '. ~, .. ..L ~. .Ir "'- t, C \...\.. .....- J-- ,l'j vJ ; J i) \' /_" \; '_) ,},;-. "v'' V:,.J-' , '/(' I L,\ J I IV 1,(1 I, ,"., \\'-" .'~' i' -{)J ,\.f'-" ,-'\J 1/;:/ .,.' f'( '(i),,\ v r ,{, u' ; I :')~\"'" ' Iv \ fl f. .... (I'."J \:., "J i),,' I ; /1 / YJ\ )11 "'/ ~l, 'f) rL, '." it".. " {'.;.......... ~':\ ~ .../' r^", \ :' , " f 0 S, ~ ,I" ~ 'I .. I \ I ' ... . . ~ I I ! I 5-- - ,;; i 1..,1- J, "f ',' I j, !ILL ,,"" \. I } I . l' ~j. \ 't, ',:' .,', :.; ./., , :...;- ",I I , "1.- .: I _ r , U ~.: \,. " -, - i I ,/, \: )- " ~,r. -' j . r ,,' -~ -'" .' . -:<il \^,i) \ \rc.;.. \. l I \ ,I .' ' -' " ~'j- I L'.\,' '. I D I V!U)) , , ;in ~, .~." ,)/'J, ,\,.1' (I.';, .. , , j '\ , I , ,), I' I. , \~ - KE-PLACC(Y/ENT LiNeS 1;/.~ ,. POST THIS PEmUT ON f~AIN BUILDING AT SITE CONSTRUCTION PERMIT #lC 1928-80 JOB ADDRESS: 2764 Canterbury, Springfield, Oregon TRS. TL: 17-3-24.4.1. 3029 SUBDIVISION: Cantebury Village, first addition, lot 10, block 2 CONSTRUCTION APPROVED BY THIS PERHIT: Addition to family room and add shower to existing bathroom; 288 square feet. Relocate and update existing sewage disposal system CONDITIONS OF APPROVAL: SOS Installation Specificat,ions: 1000 gallon tank existing; 150 feet total of drainfields; maximum depth of trenches; as established. Keep drainfield at least 10 feet from all foundations and property lines and 100 feet from water sources. Keep septic tank at least 5 feet from building foundations, 10 feet from all property lines, 50 feet from all water sources, and 10 feet from edge of right-af-way. Block old line and install new line to equal a total of 150 feet as shown on the attached plot plan stamped approved and dated August 21~ 1980. Replacement area to be reserved between lines and in the front yard. Minimum structural setbacks: from center line of road, front, 45 feet; side interior property lines~ 5 feet; rear property line, 7 feet. PERMITTEE: Charles and Shirley Janz DATE ISSUED: August 27, 1980 BY: Roger ~1cGucldn/Kathy ~Jiederhold/Candi Hart DIRECTIONS TO SITE: Off Yolanda, out 27th, left onto Canterbury. Dead end street. vJP 28305-5(-2 ....,.., '. (. ,"", "........ rt. VICINITY, MA~;lt{f~ : .', . ,! 0 r C/t~v~ ~ " N ~I -A, C\J YOLkPDA 'f""" "M.UST BE IN BLACK INK " , form c55-11 Permit No, 1!J 2><- ~ D Twnshp..1..t ,Range -f1 ~ Section ~{41-'" ..lax Lot '30 2~ Standard Syste~lternative .fu'stem'" (~peclfy Type) t<P.)OLALt:- M~) r 1. jJ.Je:; FoR. AD b, Job Location (St~ddress) ? 7/P zr C AAJ':rE:ie S ~ ~V Subdivision/Partition #CANTJ;;RRDI!-Y [lit_Lit- 1~ AO~ Parcel Lot ) D Block 2..;> DETAIL SYSTEM PLOT "~NAS CON~~lao. tJ~v.J L./lve - O~ I-bctl> ~ D ... ,~ J:/<16-riNG l...Jue II)' r#' ~ ~ "' ~ , l~ -- . '..r- ~p~~ ~t='tL!> -'- *()DrTlO~ . " __/-::-It) .-- " /.25 A/, fr.-.r.,' \\ ,... .,0 ~. ,r C ,'-' ",,,", 4' k~ B 0 ,~"~ ,~~ . " ,t '..j) . .{-" -~ l>> ....'f .,.~- ~~ 6 0.'0 ~ :v . 4:~ Q ,- ~, ' ~ c, e" '\~ .-' , o'~. 'J ~.,:o-~ %iz 'ii~~.f<:f~~~~.~ ..; fit> ,"~~ . \; ~ , ~ ~ II~ L - - ~t05 ..Y -~ N' ' .. " .~ ~ '0 "Be {)120,OJJ\ , ~('Ubc , , ~p..i ' O\\j6 ''Of- "7~1 Installer' Telephone Ise No, DatI'! . USE/BLACK INK ONLY FORINSTALLEFi'S USE: Trench Depth "5 .' Gravel Depth Below Tile Tank Capacity":-- - Mar)ufacturer <O!:iJ(/~it Measured Distance from Well to Tank From Dr fielrl COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INST TION: I (installer's name) . certify that a (Mfg) and Mercury Float Switch (Mfg, and No:) . JI (Title as shown on DEQ license) Total Length of Lines /50' .. Bonding Company (Model No,)' Pump have been installed with this sewage installation, (Signature of Licensee) If ~:ed By Owner- ~ature ofl~ ~ / Applicant's Name & Address CHMeLE3"S '~~~. "Z 7h4 LA1\JT~~UeY 6v-: 6PFL-~ (J R;tf &r>A) q 7477 DatI'! 10-7-fD Signature- _ DatA .~ FQR.SANITARIAN'.S USE m(.~Y Y::. '_ ._ .)~' sys.tem APpro. ved . .0 System Disappr vl3_<!. '. 0 =.s Correc!p~.) . CO~~~: ~J~~ ~~~~ ~~Jt~~Fv1~ff)- r'~~. _ . # ~~ , . 'DS te Co r cted DatA X _ System Capacity Y.8l gal./ day Signatur; . Date 1.;1'(~~ ' INSTAllATION RE,CORD & CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this certificate is evidence'as per ORS 454,665 'of satisfactory completion of a subsurface sewage disposal, system at the above location, Return this form to: Water Pollution Control Div" Dept, of Enivronmental Management, located in the basement of the Public Service Building, 125 E, 8th Avenue, Eugene 97401, TRS, TL (I~ . , .... I J -() ?J - ?}--( ) "-U ,Plot Plan SUbdivisian~rb/IJlM I };,/ja Lot /0 " Blaa. 7~ P-.PPROVED qr Tl' r- 2/ /17.//11 Xt) -- ~"', d -) r.\, u'!il/( / J...- , -_.~.. !,', .... Vicinity Map :) (J29 Job Location (Address) 2 7 ~ if . Permit fI Pi ~5PXD For >0;11]7: Permit fI For {/ Permit fI For v !<flJai CA-MTt.R'?-,0 R Y, 1\ Permit fI Permit II Permit fI I I { I;.v () /, .L P () 0. V1pJfO ((. CLU OW-J -- rlU! IV" '-' Jl'r1J!.O> U/.t v';rJ2I/d~ Uu (j/JJ./Ao;'-u t 12:' _ ~ 3_ --_-- - --71 j I t='ROl>O:)ED~ : fNBvJ LI kJES I ~ =- .,...... ------,-=--~ 'i t ' I OlD,LlN(:::') ~IO'-" ~::-- ..... , \1..\\ , 'I -0 I ?RC't>OSEb A D~\T\OW -- "'t- C) -- ""3 be:. 'Q KG D 1"'\ Houss ' 301 I -/O~ (;,2/ ,,\ . '\i';:"'~ rrl<;, : Q~~ . J I --_\._----~- 19' /' ( 1/ .;:..., '"../ J I ' I . i, .: . - / I I , Ii' '.."-ri .' ~. ' ~___..J .' '. r ~"'f' For For , For !. f . .. 'l (vJJ'vd" \ , I \I/',C:J-,I'\ /1)'..1 I __ ~ t \J ., . (_ \) . ." I \\\::)\(:; \ \ .J"....., " I') ,"V, ",'J I oJSLO I ';1' (. r'.': l"':~ . II. ..r , . f] ') \eV-x 1. . .vI ~ I ( I' I) ;\ ';"L 'I ' ' \~I ',,~'l 1,1 \ , v I, I' }v I 1j,f...;U', \ i'O f (,;\ ,J . 1\/' Iv'''- ," tVJlCGj~U ~cl,S'!: " r\( VI>> .,( I) 1 , tv,.., Ij ; 1/\Jv - . l"i , ",~/t"i ,I I \ ! ' '.#" 1"'\ n . P' \{l}!',...' , 'a !-}./\, )\1C.../ Chi)l 11\'--;," 'J ' ,(r).'v)" I (O'.;.-~ \ \1\( v t '\ I I , i' ... '1 LI"" J . . t), . ~_ \ I (LL- t' .', ~ ,,' \ Iy" 11- ij - , . /.\\;_' ~ \ /, ltj .}..J ( ...,1" /' '\ . J \ :. ~ ~ ~ '...-41 tv I /., , . , fj / J.J I ,J r; i r }~ \ ,~I ,,\ V t " ,:" ./\'V ,-' . \ J, (/ '-' J '1 ' __(' t \--- .l-{'l . r,0 V\ {'" \" \ ~"'\~ I . ' - 09\ 'J' ^ J.,). . " , j, ,y, !}' t ,'., j;JA!vJ ) ^ ' ' :'. (io. ~ j/ " /l}t;,'!" " ., J ,( / ,J J' I 'i' . I '~ It J 11- ~ \ I I \.. - 'KE-PLACCMENT LiNeS l 7.- 0 ':;::;, -. ,"" J A I".:tt ~ u'~ :;:;>C1 . J~) ~. 'I . ._1 u / . . ,-- ....OEPARHiENT OF EN,VIRONI1ENTAL r1ANAGE:~ENT . 'I " f2..- TV\' ' PSB, 125 EAST 8TH AVENUE '\/ JvU EUGENE, OREGON 97401 \:" Application # r /' /'Y -~ ,-- / I () - V12/~')-0 0 Job Address ~/ ~ V( &;/,?-:t;t:..~(>..:J/. City ~L/cI? As~igned Nu~be;s Township, Rangriection,,;'lax LQt 17-ff?j;:~:,'1!{Y,,. /. ' / ,~~ ~ i 5ubdivi?ion t l:4.V(i!....p-/U,.~,'_ -!/~~./L//~pqJl) -- Block ~ ,J /",,/) " "..... L.. ";~,l<.'!..lr.I". i,<:>Jf ',- ',.. \" ',' ' "';_ f ~ ./ ",~j{l.,-:-;, iI' //'f L/ ~? AppllcatlOn for~~<.";(', ~ __> \ L'-.!-'-+' \.1 ~,~ Z.__---.L//6':'p;:.';'!iJ3:~1~.-".~f~C/-z--? _ Structures now on the property . ~.C;~ ...J ' 1 Proposed use of p'roperty: /Cj---Resid~ntial r/ Commercial C/ Industrial L/ Public Affidavit: I, Tl2,qa LJ- Y)1nUJ-Q ~ ,'hereby certify that this information is true and accurate. ...J...} I (please print)' If this appl ication is foran agr)/:l:Jltural building it wi 11 be used for purposes allowed by the State Building Code and Lane County 'Code Chapter 10 (zofJ,ing) and for no other purpose. I have the following legal interest in the property: owner of rec,ofd; \/contract purchaser; lessee; holder of an exclusive option to purchase; duly authorized to act for ~he owner, who is knowledgeable of this application. ~ /1 Signature/AddressCrOFt141Al ~J.i!/1 LI?/ L.c\ /c~n"',p b L,{). .Jo-r/b (zip) Q7q)) ....><-' A fIr ' ,. .--.... " 1/ I .. U lie M:;phona, , 74 7- <- (':J I ~ ~ or Oa te When pe~it is ready notify: VC/ AP~ C/ Contractor Qi.: C/ mail A.77Phone Owner "-.ha......lp"-. Q <::;/"1",/01, \(",vi/ (zip) p~/7'1~-77..?(l Contractor .<)e -7 ~. . -:..J v - " ...., (zio) Phone Contractor's OSR# Plumbing by ~)P I,{..: / r)U)/IIO .\,.-- 1-' J ) , If Commercial: # of stories ..."^ Residential: # of bedrooms ) 51 test holes ready DO NOT WRITE BELOW THIS LINE # of employees # of units \ SDS: C/ Existing, BP # OiA.-.?4 I /~/ Proposed, SI # Fee Code Description Sq. Ft. or # of Sites Unit Cost Valuation Fee $ r~(1(~ I -{ irr(,\ ('));. {-1O!Yn L l I./';{ h ()7JY'(') (It)(1 n tHIn :~, Stir {r'Ph l $ ,~(': C \/ \ ~~tl /'''(~ . r"Yl+J/'.~lH M,")') I - -.. - $ I .... -( , ') ..QBf') U1 (0,) ::v ~-B"2) $ '--" --' Total Valuation: $ $ $ p:',.A\I' '\ $ Pl umbi ng fi xtures at /VIJ each Sewer/water conn. at $ ~ each $ Subtotal $ 4% State surcharge $ Pl,", check foe e~.cd:t- . $ r r J Gl:la,r+ge_GJ...OcGupa.l"c:y U:' .:,lXtL ~.1;), ~,'$ ::;.r:::'{:K;.. " - '-/ TOTAL $ C/ Cash C/ Check i Received by Water ~UPP1Y P'O Irr\};((\.,( 1'') (j 'b.tQ..s- Proposed'".I)l~):ktCF Existing\r Year Installed 1., side into Parcel Size \0.4x"!C) 4>r.:::::..,/ l~-r.:<:"" ~ \ rear. ""'"'?~ -../ {, " PU f. PERMIT PROCESSING Minimum setbacks: Z02--t:~ " r. X I 4~( 1., fron:t ' , '\ ...... , '-'" Part. # Parcel # Comments To be typed on permit By (i n rrrl , Date 7-I(~-)<{) '- -" ... ' L.5 ~~ I~J ' Installation ~:~t1i;ltions: <f.y'JI-17n .Jal. tank; Ic;n,' (]VJtP. ft. ,Of drain!ield~xjlePth of trJnches: -CtS-eSfn Jotl . To bo typo' eo por it t'1 0 Id J ~M.d (/Yla7Ua iL/UJ!I ~. ./ ~') -,-'QJiJiilq . JS'b1 'r; ~(J0~). o~d vJ,f'fkBfa-p./ ~~~ l ' , 'U~f4u. Hd.aa./fl1MA;foJ(.fj ,?O/ ~A}(J~ J./&/l/\7, 'U1iJi.Ll a~, r::u ---' ,~1..." ,Telephone lff).&J F..'-' ,.' "J""" Da~e ~ Oi?~tions to siteOi-d-~/()}(~.O{yvj(1.....-()?rt",r,_"J7.i'h,_,~,,-, l,..oJ-t-' (/(yl(") C(I~/H~t07f",',,_,"))i(Dh 1.1 i j ))('Qri Olhy\ / \~I 1'1 Dot' 'L I M?11()1~I rllt\{(jk~~ n__V _n II /_::'j 's I F;- - Plans j:{'" CP&I) '-" -set-( s)-T/) \ Oa t~ '.. .. Ho i d~ Sl i ~ Date Oa t~ to-n- WPC set(s) .Required to PCC Completed PCC ,-L 1L1 C'J.L I/;r1!pc C/ Planning C/ Publ ic Works I~/ Elevation /~/a C/ Address C/ Facil it)' Permit C/ Environmental Health WATER POLLUTION CONTROL FOR INFORt-1ATlON about PTogress of your' appl ication call: Permit Control Center 687-HElP (6~7-4357) ~ [\ I ~ , '. {, . '-' . . ~ -. INSPECTION RECORD . . Approved DiSopproved Date Inspector ,r- a ,n :P -l a :z l 1. Site Inspection 3. Framing Inspection " IlL ~ 6\ ~ 2. Foundation Inspection 4. Lath or Sheetrock Inspection 6. Slab Floor, Plumbing Groundwork 7. Gas Piping Groundwork 8. ROUgt1 Plumbing 9. Rough Gas Piping 10. Final Plumbing 11. Final Gas Piping . 'li\ 5. Final Inspection y~ I tJ- () i~fO f II-, / '\ ,~ :.. " II-~ ;j-:fo ~ , ' , , ~ Remarks: -c 'fT'1 ~ I-' ',H ready to issue; not ready; ___da te; \ inspector. " ~ ~ 1 ~ 12. Certificate of Occupancy: