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HomeMy WebLinkAboutPermit Building 1974-2-8 /"t:;.:;.dl)&d#.~;!;)--1.L&f:.ri;\Wic~'~iz-..e~ C?l?;'~" jl~,.' '~"",~:l:~~" ~,o!_..'" cO..~ .." 9 ::<._ >" . .. ...r .-t{'_',"r_~~~':,.~.: c:::;f ';'_ "~" ;"~~ (-."/~'~, ;., '1 ..~,' F:~l (., f:~ . ' " . "::.'~ I, __ '\' : 'ei'\: , lANE COUNT~ jIL~N~<gERMIT OR MOBilE. HOl'. JSE PERMIT ~iJllDING~" MH D',' .; ".' ,: PERMIT NO. 93...714 PROPE'RTY OWNER MAILING. ADDRESS . ." t:'O$tOV0!" '~V1struc~ fan. tCt!:90GlV .4~34 Moufl Spr.Jfl~fooVdt Oreg@n CONTRACTOR MAILING ADDRESS. . f .~a"Jo " J-' . " ~. PROPERTY .LOCATlON - INCLUD'E POST"OFFICE . . . .') ..... - . . .:~ ;,'~. ~.f~r~~~ ~~~ 2102 CCi1tQU'burv Si, -,SprhJ\ilHe(M PROPERTY LEGAL DESCRIPTION - METES, BOUNDS tDntarbtH~\1 .Vii 1G,90 lst"rSdtHt Dan RANGE :SECTION 1,1 i7 03 ,.!. 2l}.<f./ . ~ -l., lot g...Ph.,>e1, -2 T~X LOT NO. CODE . CENSUS TRACT i:P.::~' ',: 7 3t>z.R' 20Q~n 'ISO EXISTING STRUCTURES ON PROPERTY~.,'::r , I, Nane e' LEGAL ACCESS TO PROPERTY . Cant@rbilllr,y' St.; 'PROPERTY SIZE - FT. WIDTH 7,!)~ 36 DEPTH 1 O~ I AREA TWP APPl. NAME. & MAILING ADDRESS /,\, ) . t~Gs.t0vaH~': C'l!)nsi:r~ Ct)~, . , \ f)' t '\.' " \.: "- " . FOR MOBILE HOME, PERMITS ONLY No. . of . Bedroom~\ . \ ~ 'STRUCTURES TO BE BUILT THIS PERMIT ~t.1~ 11\1 Vlt.! ' ", r~~' . /"\ \\. ".. Ii I t10rQOO ., <9ti>~c~d .,c\i{uncolled " : J !. :\ Conn'ect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. # BDRMS F r'im'e 15@2 @: 12 . I 506 @. :3 , f. " .~ /Ltf ./.: \ .' p'HONE 7~1",S!)jJ PHONE '. New System .D VALUATION 19.62l:. l~~ifl 19..5!j2 '... . OTHERD 74.00 ~o.~oo ~~:f:lO ,PLUMBING INSTALLED BY OWNERD OTHER: NAME tfoHvl.-g P'lumbnCll WATER SUPPLY 'PUBLIC 0 '0 0rHER . . SEWAGE DISPOSAL . ,PUBLIC 0 SEPTIC TANK [!t] BUILDiNG' ~. WASTE DISPOSAL PLUMBING PLAN REVIEW . PARK. TRAILER' FEES \. TOTAL t'; 11&". (bO . COUNTY BUILDING & SANITATION DRAIN FiElD REQUIRED lIN. FT 150 OR SQ. FT. SPECIFICATIONS MIN. SEPTIC TANK CAPACITY WITH DIS;-. BOX: GAl. 9dllO' 4 \ . 1 t. 'l ".. I ~,. " . ".r- '. ~~~ TRENCH WIDTH FT. . '\Re-dllndmnt. $ys-tcrim" re~ui i"~cl;;as i'err,.p lot.p libn.., . ...; ..j.~ t TYPE'OF STRUCTURE OCCUPANCY _ " PUBlI<: UTll. EASE,MENl:. OZONE . . 5~~ '. ' l &:J . BLDG. 'SETBACKS n FT. FROMCTR, OF ROAD RIGHT OF WAY . US.E CLASSIFICATION FRONT 40 REAR , 7 SIDE INT. 5' SIDE EXT. AUtHORIZED SIGNATURE - DATE .. . './sl,J..t:'El0ss :bv. IC~' H8rb6u~h , J~~Ii. \Sttt)Q>f{ 3ee DATE 2...8..-7 t;. s~l of .f. BLDG. PERMIT - WHITE : 'OFFICE COPY -:- WHITE COUNTY TAX - PINK PLUMBING - CANARY . BUilDING -'-.GREEN' SANITATION _ GOLDENROD . ( Construction. to. comply v,/ith unif.orm. building code and county regulations covering plumbing arid sewage disposal. AII'buildings require a certificate of occupancy. before being occupied. '(Se1 Statement on Reverse ,Side) ~; , .J," ;r. . ~. ~ . -, ~~ ':~i'; ," . ~ ~;;:- ~ ~ .,,*'! ~jj.~., . . '., \,' ,,'-'FORM 'jf: C 55 - 13 ~:":. '... ~ ~y. ." (POST THIS PERMIT ON MAIN, BLDG. AT SITE) .,' .lANE COUNTY,BLDG;' &SAN..DIV", CbURT: HOUSE; EUGENE', OREGON 9740r- ,.,....J....'.!.......;. ..~...lo.. ~.'.~~.....~..._. :....i :.-.,...;<~:~'..:.',:. ',.....:. ,-".:.: ~..- .,. .:'. ,., ~,;,. }' '. .: {:t: '~.. 1. ' "- , . ~ .,11 \..- ;. -~.~. " .",\ /: r BUILDING.SiTE EVALUATION ) ?,J:0./-I, Building Permit Application No. 93-7Y A1 , Tfl.~ -:;> S 2 f/ TAX LOT CENSU~ .A~T . farrterb,'rv Utll, Irtatld. L-'1 8-2 APPLI CANT: / N/\ME. ADDRESS () Site Inspect ion () Pre-Permit Investigation PHONE DATE 1-l-Y-7Y , I. Zoning Ordinance Compl iance (Zone...fi - ,L) Subdivision Ordinanc~ Compl iance NOT app I icab I e () ( ) ( ) ( ) ( ) ( ) NO YES NAME. DATE LANE COUNTY PLANNING DEPARTMENT 3. 4. Required Access ( ) ( ) ( ) ( ) <-~ (~ (~ (~ ~~~'.'J'.~ ( ) 1.. - ;;v1\""-7t/ 2. Building Site (Area, Width, Frontage, Setback) Other (see comments) 5. COMM ENTS : BUILOfNG INSPECTION SECTION NOT NO YES NAME DATE apD I i cab I e ~ 6. Plans Subm i tted ( ) ( ) 7. Soil Stability (footings) )~ ( ) ( ) 8. Flood Plain ~ ( ) ( ) )-, ) {)1t. A ~ 9. Ot he r (see Comments) 9Q ( ) () e 't~~ " 2d~ -7Y - r COMMENTS: I 10. Sewage Disposal NOT aDD I icab I e () () ( ) () () ( ) ( , () NO YES \~ \\ (t(\~~ (.(' ("" (f DATE SANITATION SECTION ~ -7 -71 II. Usable Area 12.. Water Supp I y 13. Other (see Comments) ( ) COMMENTS: TO APPLI CANT: . of Your Building Permit / Site Inspection: f) --7 \7 (~ Can be app roved. ' ~ () 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 Building and Sanitation Division. () Will be held in this office until you can resolve the problems indicated. () Is being returned. () Your building permit appl ication fee is being returned under separate cover. LANE COUNTY PLANNING DEPARTMENT 135 Sixth Aven~e East, Eugene, Oregon 97401 PHONE: 342-1311 EXT. 231 LANE COUNTY BUILDING & SANITATION DIVISION 135 Sixth Avenue East, Eugene, Oregon 97401 PHONE: 342-1311 EXT. 411 C55-28 ~'j , , SITE INSPECTION ApPROVED / / DISAPPROVED / / DATE ,I NSPECTOR REMARKS FOUNDATION INSPECTION /' ApPROVED / 1Y / ,,0 I SAPPROVED / / DATE;J.- )(,-11.( I NSPEC;OP REMARKS FRAMING INSPECTION ApPROVED /~' 01 SAPPROVED / / DATE~' REM""~iJ~ r 3 ~1/"f.""Eno' (! LATH OR SHEETR~5PECTION ApPROVED / ~/ DISAPPROVED / DATE 3-/ L/~1L(INSPECTOR ~ / REMARKS FINAL INSPECTION , / ApPROVED /L../f DIS / OHE t, 2.f · 71/ I ""no, & 'f . -J"'Jf'/} 1/ REMA~KS/Jt{) /)(.;yf ~ Q'-/6::' /fJ{' f . p CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE / / DATE INSPECTOR REMARKS . . ./J /f) ,~J~ If./-D- - -' T 13-11/ 1PK~~ ;2-7 ?;;.' -' 11...1 .t\ ~ ~I ~I . 81 _: --..................-;., " A r \..., ..FhA. FG-i?M NO. 2573 u.s. [ RTMENT OF HOUSING AND URBAN DEVELOP/' 1.R'l.~t:10?7 - '),j 7' Ii. "J(7 F.EDERAt HOUSING ADMINISTRATION :BILLED -0: -, --mO. ,,:L-I)(.J_ ?~=5 HEALTH AUTHORITY APPROVAL bATEt, -6 -7J1 I ..., -"'7/INDIVIDUAL WATER SUPPL YAND SEWAGE DISPOSAL SYSTEM PAIn <r ",_ ~ /h .J:) . PART I -TO BE COMPLETED BY FHA J?- ~ -:J...d First National Bank of Oreg~n, Real Estate LOan Division i 11, Mortga&ee - r;ume. Address and Zip Code (',' \!::;: Co --, Mortgagor or Sponsor: I 'I? ;--... . fYII I . First National Bank of 0regod, ~v. ~'-;(1-11 "Fust National Bank of Oregon, Real Estate Ln. D Real Estate Loan DiVis~'lon I'~'/-""":' folle$7~,ddress: P.O. Box 1786 4 MillY] ~ ~ . 278 Canterbury, Springfield, Oregon 97477 Eugene, Oregon 97 0 1: 79 "',-.... I ,71 S'ubdiviSIOn: ......,.....DN! 1--.... ............/'EM.,., ",-C'ANTERBURY VILLAGE FIRST ADDITION BASEMENT ........,., PI ?~j New Installation D Yes ~No ( ,~. . ",~',. '-.' . ~,..,.,..".,. . .' ." . .... . .... I ' . r' '. ~ ~ . . 9$-7~ ( Form Approved Budget Bureau No. 63-R0296 insuring Office FHA Case No. L Lot No. d/..f, :2. 9 "T'~~W!RF:R r rVTNG UNT'!'''' Rl<OR()().MS..J BATHS Can Attic or other Area be made into 'additional bedrooms? (If yes, how many?) 1 .L .... ::J 1 3i4 DYes @ No SYSTEM DESIGNED FOR WATER SUPPLY BY: ~ Public System SEWAGE DISPOSAL BY: o Public System o Community System. o Individual No. of Bedrooms Garbage Disposal o Communi ty System ~ Individual 3 DYes ~ No. PART II. - TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DE PARTMENT INS PECTOR'S SKETCH .,'. t:'::'={ ::,$1:::: :::: =*= = == = =1- _1=1= = = = == _ _1=f'~I= = = = = =:;1= _~ ._11'= = = = = = 1=,= = = = = i' 1_______ ____ ____ L_________L_LU__ I -------- - - - t = = = = = - - 1- = = = = = = = I: = = = = =: =1= = = =1+= r-t= =-F = = : ::::::~~~~ ===:~~ ~~~ ==: ~~~~~~r~ ~ -: :_,=J,=,=::~ ~= : 1- =1= = = = = = =F = = = = - 1= = = =[= = - - *-= = = = = = = = -*- = = = fit = = =[ ______ __ _________ _______ __ _____L -- -L I ----- - L I --+--- ---- ------ ~==1 ---:~~~:===,=f=:~~~~~~~ ~~,~ ~~':,~~~-:~'=: ~::, ::=~ - + --===:- - -- c:::::: l=-Lfi _1---1 -;=::,-- ::= 4~t:: =r - - -::::: tt'=i=: ... =:: =~ ~ ~ ~ ~:::: - - - c:: ~: =:,:: :c::: :'~'t'_ ! I ----I c__ -- r--1---- --- -~ J---:___:: ------ ,-=:r- .fr,=,===-1 1- -B=====l :==-== = =:= :=bt =+:= ='= =:= = = = =:tt=tt = = 1= = = ='=:=:= +l-- - --I: = = =F = = =1= '=----::=L=11 n::::::= - ==---t=~~_=~J brl1=f ---,- L-.rl- ======__-1.c==IL.l_LJ ---- o ft.:ta ,-f-Jll - ij -=[ I I [-- --1-- -1- , i ' - - -- _\ -3-\ L_ -- --- L -- --- - -- i- - - ~-- J -- , I - -'- - - ------ 1-- -' - - .- - - 1--- -- ===--1- 1--- -- ~1 ~':> ~ npjn;nn nf tb.:. o rrmnt;.... ::...e::J D::..:L:~1IC-0{-M"'d..l-;;ft tPat th;", individual ",.,t~",ul'l'i'y ""y""~en= ,.D -- O :.'~ -.,' 1:.. ".....1. ~C1l~o::Jfc:l'-lv1J as El dgM"l~c::t;r water suoply fn;...J"Jtc ~u.L;c.~l p.Lope-Ft.:. It is the opinion of the D State Q County 0 with proper maintenance: 4et Can be expected to function satisfactorily, and is not likely to create. an insanitary condition DATE ISIGNAT~R' A..A #17 fT)1 . .c.:;I,~K,_~ , I-' 4/24/74 I RT KTRB"( iL~ _ ,M.'_H _ ~1'{'p..."iqiT\g-S.AnH.......-r An NOTE: The health authority should complete the appropriate opnion statement above and affix date, signature and title in the spaces provided. Use of the above grid for Health Department inspector's sketch as well as use of the back of this form is ot the opinion of the hea Ith authority. Local Department of Health that this individual sewage-disposal system o Cannot be e~pected to function satisfactorily 'TITLE PART III. FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the Individual water-supply system be considered D Acceptable [J Not Acceptable Sewage disposal be considered 0 Acceptable 0 Not Acceptable. DATE SIGNA TURE o CHI EF ARCHiTECT o DEPUTY FOR CHI EF ARCHITECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA FORM NO. 2573 Rev. 10/70 -'-....,.. .~, .... REPORT OF INSPECTION-INDIVIDUAL'SEWAGEoDISPOSAL SYSTEM PRIMARY TREATMENT consists of (jCSeptic tank. 0 Cesspool. hptk Tank: -,.~'._-_.. Distance from well. Total liquid cilpacity Inside length Co-.pool: Distance from: Well. feet; foundiltion, _feet; nearest lot line at 0 (ront, 0 side, 0 rear, Inside diameter. feet. Depth. feet. Liquid' capacity, gallons. Lining material SECONDARY TREATMENT consists of cJTile disposal field. 0 Seepage pits. Other feet. Material 1000 Concrete i-- I '~allons. upacity inlet compartment feet. Li~uid depth, Number o( companments gallons. feet. Inside width feet. '7\t feet. Tile Dlapoaal fl.ld: Distance from: Well feet; foundation, 10 feet; nearest lot line at 0 (ronf, ~ side, e9 rear, Total length of tile lines feet. Number of lines, 3 Distance between lines Trench width, 2 inches. Total effective absorption area in bonom of trenches 600 un~lh of each line 50-50- 60 feet. Depth, to3 of tile to finish grad.. Type of tilter material: 0 Gravel. 0 Broken stone. Other /4 Rd. Depth of filter material beneath til,. . 8 inches. Depth o( filter material over til,. 4 10,,' 5 feet. feet. ~quare feet. ~nches. inches. Seepago Pltlll Number of pits__. . Outside diameter feet. Depth feet. Lining material Distance from: Well, feet; building foundation, feet; nearest lot line at 0 front,~ 0 side, 0 rear. Inapectlon made by: 0 State. 0 County. 0 Loc.al Health Authority. S'h" /k' J .H. 00 Inspected b) Registered Sanitarian (nTLE) feet. Date of inspenion April 8 19 74 REPORT OF INSPECTION-INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water milin, feet. Size of main inches. Individual wells 0 arc 0 are not customaty in neighb9rhood. Give most recent r('Cord of failure o( wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood 0 are 0 are not being developed with both individual water. supply and sewage.disposal sys~rns. L)t size: feet wide. feet deep. Dwelling set back from front property lin.. (eet. Individual water supply irom: 0 Drilled well 0 Driven well. 0 Dug well. 0 Bored well. 01..0_0 of woll from: feet; tile sewer feet; cesspool, feet; nearest lot line at 0 front, 0 side, 0 rear feet; septic tanl<- (eet; disposal field, feet; other sources or possible pollution feet. feet, Building (oundation. cast iron sewer seepage pit, Well c_tructlon: Diameter, inches. Total depth feet. Type of casin~ Depth o( casing, (eet. Approximate depth to pumping level o( water in well (eet. Approximate yield, gallons per minute. Sealed watertight to depth' of feet. Exterior space around casing sealed with: 0 Cement grout. 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 pipt' feet. Pump capacity gallons per minute. L>eated in: 0 Basement. 0 Pumproom off basement. 0 Pumphouse above ground. 0 Pump pit. Pumproom properly drained: 0 Yes. 0 No. Pump mounting watertight: 0 Yes. 0 No. Type of storage: 0 Pressure. 0 Gravity. Capacity gallons. Has bacteriological examination of water been made? 0 Yes. 0 No. If answer 'is "yes," give date 19_ Quality o( water 0 is 0 is not satisfactory for human consumption, Installation 0 does 0 does not comply with approved exhibits, i( any. Inspection made by: 0 State. 0 County. 0 Local Health Authority. Inspected by ~eet; Date of inspection 19_ (TITLE) GP C 900.682 .. ," ~:"'...... ~.. ........ ,,' ('. ') &", .-.... ._~ .-.... -. ,....~_.-.- ',') ;. ' a. SLAB FLOOR PLUMBING GROUNDWORK ApPROVED I I DISAPPROVED / REMARKS GAS PIPING GROUNDWORK ApPROVED I / DATE I DISAPPROVED L___I DATE REMARKS ROUGH PLUMBING ApPROVED /~/ 'DISAPPROVED / REMARKS ROUGH 'GAS PIPING ApPROVED I 1_ DISAPPROVED / REMARKS FINAL PLUMBING ApPROVED /.it' I DISAPPROVED / , REMARKS " FINAL GAS PIPING ApPROVED / / DISAPPROVED I REMARKS CERTIFICATE OF OCCUPANCY READY TO ,I SSUE I I DATE '} -//-;;'1 , I DATE . , '. INSPECTOR INSPECTOR INsm;o~ I NSPEqOR . i' I DATES""'~V)t..j'INSPECTO~P.. '. - VtTC . . . I DATE / NOT READY'TO ISSUE / REMARKS / DATE ._i INSPECTOR INSPECTOR . '~.?-< !1, .., ~. ~.. P~#~EDSUBSURFACE'SEWAGE, DJSPOSAL~:~TEM :t~~:;~~~=~ :~~~;i~:'~~"lO)~ " ..' (Exhibit NCf.' 1), ,. Permit No. 93-# ~~;Z.4~"&lprlrJ~7ilu~C/~cZ4~.J.' , , No... LiYing,.. units.' Beclrooms:.. .Baths- Basemen~,.. / Water,StiPI>.l.Y. ,/. . , " . .', ',: (/. '.. " . . I:' ,~:;",., /" e:3:. ,,' " d.. Yes~" 'NO..x ", COnunun.ity .,',:~,.'Publi~.." Other-List_ ". ,Septic Tank: Ft. from well ' Inside Dimensions: Length width Steel' , Ft. . .. . X'" ,Concrete.' , No~ Compartments .Diameter Depth' 'Gal.. Capacity /tCJ ~c::? Tile DispoSal Field: ',' Distribution Box: Yes~ No.."..., ,,,,,.--'i . , Other Distribution -'Type L _ ,. "."._" L-C/~ ~),6?" . I, ' // Feet from MailinCJ '. YtJ dt/ ~//;//'?f :J~;r;' " Well ' 'Foundation /-7)' Addr'ess . J/A AA~ 2:';'/'A /J..4, /J/JV'.' ..,', . " Lot' Line. ' ./ =)' /?"" rnq~~ lHi~~(ift:-'~~r.ff.~~lJi:~fe:~en~i: Im1#:;t~ al;;Pi~ Plot Plan dSeelnstruction.s', : 1'". . ' , l_.-:-~:=i ~~i"",.,.~". L=,:.". =~I=_,...,,~~_I 'T____=___:_::.~=' L "'..'~,....-,____ ,""'" - ..__ _____ ,--------o--',..--,..-..-'..'-....,-..--.,--.,--..~-.......- Applicant Name ,~., '.. '~!~'_-_~ ----:?,J"- __ .____. __"___._ ,_~. "...., _.___~ I___~. .~ "_._____ ___ ~__.__ ____u -,--__ ~ _..,-,...-_--;- __..._ ._.__.u. _n.__~. '__~_ _~ ."';_.,_._ _____,".,: I" 'I, ,~~jld..,;.... .1 &... c~~ - ~ ~- ~-- - ~-- t,'-'L_',.j ..'1--'-- '.C--~--~~ ~~ ..----,,~~. \, ~:.~,."!,::',:'.~.-,',-'11I',,..n,..,..,',','-,,','~:,:,'..-,., __,.n... '~n ..... ,..=....,' -~-..... -~, ,.. I.... ., ~,-' '1;. .~.~.. ~,(:...~. ~.~.'.~.. I~l.'-"_/... ...~.~:c.:: :~::-:::::~ -. , : _ .... .. -ro.'" _, 'p--'--r rl _ ~.,_.~_, ~".",...,__. ......._....~ _:.~_~_,,_ ....____,_._l__......,,;. ....___ ~_..__.,-,__: ~;..o 1- '.\~~~F+-,V:!,,- ~)~~~:';::::;~~;~~~ '::;Ii: ... ~..:--, I,.~.....,.....~L.--" '....J.?,.o. ,--=:: ,3>:.. 7"/ "'--.. ".'~ ....~- '''-- --"'., -=" ~;)' ' ~f~ I~ 4L----, ... ~, ! . -,-ij <I / ..~\- -- .::::: ::.:. = =-- ':-.~ . , ..)1__ ~_.. __.._. ~___" __... ",__~.:- ,.,~" ~ .....' : ',7 ':/"'1-'-- -- \ -.;:,;;-""""'"'--:=- ---- . ,. 'I "', ____ ---....-,..,.. ---+-._,:~- ) , I -- ...... - ...,..'/ ...' ..._.. '.. . j i' '-----..-.--'---.,.7.' ,... -..~; 1.,"-"'''' , " , '''I:'' ~~ ~ . ~...... "1, -. :-1,!~I-" -- ~--: = -~, -;-- C:~~:::2nZ-: it: -:l,.~::1:49{t,:~.... :ii~~::!..,. .. f! I --.- -~~T-l----- jLU_L_~~.:...j~ ___~K__~_: Date~/ /}'I) ~;7) ..m. ----.;i~~~~~-~~~t':-"~~ . I J , / / '- f{ ~ / /f.... . . For ~aria'n Use Only: . ' . . '\ ' ~~~;oved: System Installation Conforms to DEQ Rules: for Subsurface Sewage Disposal o Disapproved: Does not Conform to DEQ Rules for Subsurface Sewage Disposal .. . Data<~Z(IY (t F:fr 0 (A ---L< ~itari~n'8'si~~~ure : L......_ L__.~_,_ ___. .__,__ j Remarks: ..--......: 1-<:. .. "" Interim Form #2 State of Oregon Department of Environmental Quality LANE COUNTY r n1NG PERMIT 0 R MOBILE HOME (: APPLICATION PERMIT TYPE - BUILDING 0 . MO~ILE HOME Dose REG. # PERMIT # 9'...3 - 7t/ LZE~~) ~:AI&~RESS1"o~~ ~~~N 7~;~0997/ ,~ ,MAILING ADDRESS " / / PHONE PROPERTY ,LOCATION - INCLUDE POST OFF CE t/-tl f' ~ ~ ~ A .#? ~/r,J.. .~,j~/ C0U) , , /" I' ' ' PROPERTY LEGAL DESCRIPTION ~ C/ } . "#,, , /. 4./1,"" ,L-018" METES & BOUNDS DYES LOT - BLOCK - SUBDIV. /~~ /ST...y~ 7 -~ ATTACHED 0 NO TWP, RANGE SEe. TAX LOT ff' CODE CENSUS TRACT /7 0=3 ~t/' , . 0CJ-~LJ/-5D ~' / DESCRIBE EXISTIN, G STRUCTURES ON PROPERTY IF ANY APPLICANT _' , ~ NAME LEGAL ACCESS TO PROPERTY - ROAD NAME OR # ~/~~ PROPERTY SIZE-WIDTH /'DEPTH /6/ ./ J AND MAILING AREA ADDRESS 79..30 FOR MOBILE HOME PERMIT ONLY Number of Bedrooms S~UILT THIS PERMIT ~- ad-~~ t7 Connect to Existing TYPE CONSTRUCTION \,~~ Sewage System 0 or New System Req. D SQ. FT. /:;) '! ~EDROOMS VALUATION ,/ .1.5 0;1 t..::::-I~ L3J /'~, ();:J 't r~ CJ ~ Q 3 --.-6 "~ / Z. I:CfI :5 C;:) SEWAGE DISPOSAL PUBLIC 0 BLDG. WASTE DIS. PLUMBING PLAN REVIEW PARK TRLR. SEPTIC .TANK M $ 14, ()I:J \ " -=/0 ,DC; ....l? q'" 0 f"'1) PLUMBING INSTALLED BY I Af"}J1 . OTHER 0 OWNER 0 OTHE~ NAME LttJ~-:t:/tnlf#[9; WATER SUPPLY PLANS FURNISHED \. FACIlITY/PERMIT -, 7 FEES PUBLIC 0 OTHER YE_S)2r NO 0 YES cY' . NO 0 PL.,UMBING FEES @!.3 ~NAT~F A?9CANJ..--~' d ~ , /DATE . ,/CJFIXTURES 0t)..Z;O 7U-i:{.: ~~~//2-V//</ CASH 0 SEW~ .FEE RECEIVED BY I DAtE / ' CHECK ~NECTlON FEE d ~ cJ t!J X ~ 1/:2 <./ / ,(/ PERMIT #. c/ /Iy/ OJ - / PUBLIC WATER "'1 /l 0 CONNECTION FEE d ,,(/ - q ( ':J -7 ,d COUNTY BUILDING & SANITATION SPECIFICATIONS / DRAIN FIELD REQUIRED ,llZD 0 lIN. FT. I UO TRENCH ~IDTH FT, IJ..... OR SQUARE FEET f'''-f:[ ,:, ('eo! Cl,;- peA pi" -f 'F Jq /l . TOTAL /3 $1 00 MIN, SEPTIC TANK CAPACITY WITH DIST. BOX: GAl. q DO fY Q elL\. v-J ct"V -\ ~:J s4e....... '--""'" TYPE OF STRUCTURE ....- -!fIV ZONE REAR YARD PUBLIC UTlL. EASEMENT OCCUPANCY, ,d . laY^! BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY FRONT . ~ CJ f SIDE INT. .s- t SIDE EXT:- ~~~f\ \\ a I late PLANNING ,~ 'J../7 '1;<4 ~ l USE CLASSIFICATION Date REAR '7 I BLDG., INSP. L* ,U~ f , /J - /:;/"p Dale ~t~11' (.ff!;{. $ ~ c.? '7 L' / - tf). J:"- 7 'f Directions to Find Property: COPY 1 - OFFICE COpy 2 - JOURNAL COPY 3 - AUDIT Form # C55-12