HomeMy WebLinkAboutPermit Building 1973-1-8
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LANE COUNn
4BUILWNG [YJ
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IILDING PERMIT OR MOBILE
MH 0 nsr. 2rG. II :{4~-1
MAILING ADDRESS
PROPERTY OWNER
{' , , Ii, : q .' 1=- H ILL I ?
CONTRACTOR
HO~-.f\ir-iJSE-P,ERMIT
, .. ., I
PERMIT ~IO.
......, ~~~~
4=1'<
MAILING ADDRESS
. 0_C;81) 1\' ')1::' P S 0
L. -/ UORTH ""lTH LACF'.-.PRINGFIr-ln. .RI"GOII"
71~7-qC:'71
'E:;TO\i,-'! CONsTRucr:OI\J
, PRo.PE~ ~~d.ON - INCLUDE POST OFFICE
-:-? C.":{TEf~~L1RY :;TREET-SPFD.
P'ROPERTY LEGAL DESCRIPTION - METES, BOUNDS
~b
~_V'I -IV
TAX LOT NO.
-# ~t?o?O
,~y '-f:O,
TWP
(A~Tfn~URY QILLAGE BLOCK 2
RANGE SECTION
7
24 ,if I
, O~
APPL.-
-NAME
&
MAILING
ADDRESS
FOR MOBILE HOME PERMITS ONLY
No. of, Bedrooms
GREINER. PHilliP
tic WESTOVER CONSTRUCTION
2'18Q NORTH ':{r) TH PLACE
, - -
SPRINGFIELD) OREGON
STRUCTURES TO BE BUILT THIS PERMIT
nW,F L L I ~!G.
(;tfi.:GF'- .'\TTI...Olrl)- UNo'li I-"n
I:.:,T',II C; n.~;.-
SEWAGE DISPOSAL
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK [lj]'
OTHERD
62.00
20.00
:;0.1)0
FEES
~
(9)
L7 ..
;7".:r-- II' '
CODE
CENSUS TRACT
WIDTH
7q
DEPTH 104
AREA
Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT. # BDRMS
r:
',~
PHONE
PHONE
New System 0
VALUATION
1212 ~ 1? (~l 14.s4l
PUBLIC KI
o OTHER
/\LA~~!'. :t' ~&/rJ ~ /4//
C---~7 v , /~:J-
~J": I!',~
filUMBING INSTAllED BY
OWNER 0 ,OTHER: NAME
WATER SUPPLY
TOTAL
$
1-12.1)0
COUNTY BUilDING & SANITATION SPECIFICATIONS
DRAIN FiElD REQUIRED
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAL
900
150
lIN. FT
'X00F ORA' N,;,GE D I VtRTCD TO THE._,.STREf.T.
'\\.
TYPE OF STRUCTURE OCCUPANCY
J \ I f.,NO J
BLDG, SETBACKS n FT. FROM CTR. OF ROAD RIGHT OF WAY
. FRONT 40 SIDE INT. ~( I) SIDE EXT. 10 REAR?
AUTHORIZED SIGNATURE - DATE
/s/ J.E. 3o~s EY CHARLES HARBAUGH'
TRENCH WIDTH FT.
3
OR SQ. FT.
1 _ l1l~;~
1", ()('! r.:
J.
\,I.~Ll yl S
450
DATE
1..b;.i'~ :.:.,
BLDG, PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBINc:; - CANARY
BUilDING - GREEN
SANITATION - GOLDENROD
Construction to comply with uniform buildin,g code and county regulations'
covering plumbing and sewage disposal. All buildings require a certificate
of occupancy before being occupied.
(See Statement on Reverse Side)
/~''i(fJ;, ,1,_
L/- (/V .1/1'/77,
ZONE
1~-1
. USE CLASSIFICATION
PUBLIC UTlL EASEMENT
JOHN CRUICKSHANK~ R.S.
(POST THiS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, o'REGON 97401
FORM # C5,5-13
--,-..,.. ~--
Building Permit Appl ication No.
L/- 73
I~~ ~/v~;;C~,2~
W\.\j , T.j.;'.3 ,5 c2 l/ tAl LOT' t?
U\)\. CEN~..._ TRACT;' ,
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APPLICANT: ../ ' J-
NAME'f.L/! f/~ ~~Aft)~
ADDRE'S5/?~
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( )
( )
Site Inspection
Pre-Permit Investigation
PHONE
DATE
/- ,) - ;7,';;
3.
4.
Required Access
NOT
app 1 icab 1 e
( ) ()
(..-1 ()
() ()
() ()
() ()
NO
YES
NAME
DATE
11, 11~
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LANE COUNTY PLANNING DEPARTMENT
~uilding Site (Area. Width.
, .' Frontage. Setback)
Other (see comments)'
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Zoning Ordinance Comp) i~nce
. . (Zone :\2-/. )
Subdivis ion Ordinance Comp.1 iance
2.
,p
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VI,
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5.
COMMENTS:
BUILDING INSPECTION SECTION NOT NO YES
app I i cab I e \
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6.. Plans Subm i tted ( ) ( ) (.\1\ ,
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7. So i I Stability (foot ing~). (X) ( ) ( )
,
i 0) ( ) ( )
8. Flood Plain
9. o the r (see Comments) ~ ( ) ( )
COMMENTS:
NAME
DATE
e~~~ 1-'!~?3
~
r
SANITATION SECTION
10. Sewage Disposal . I
NOT
app 1 icab I e
() (- )
() ()
() ()
( , ()
NO YES
NAME
DATE
II . Us ab I e Area
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12. Water Supply
13. Other (see Comments)
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COMMENTS: I
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TO APPLICANT:
Your
Building Permit / Site InnPe tion:
. Can be approved. J( c,.. / pi
Cannot be approved at thi time as indicated on item NO. above.
Quest ions and further informat ion on items I through 5 contact the Lane-
COUNTY PLANN ING DEPARTMENT. Quest ions and further informat ion on itenis6
through 13 contact the Lane County Buildinq and Sanitation Division.
Will be held in this:'office until you can resolve the problems ind1"cated.
Is beirig returned.\..
Your building permit application fee is being returned under separate cover.
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( )
( )
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,. -. - -...
'--.'- - ........ ,
LANE COUNTY PLANNING DEPARTMENT
135 Sixth Aven~e East. Eugene. O~egon 97401
PHONE: 342-1311 EXT. 23,1
LANE COUNTY BUILDING & SANITATION DIVISION
135 Si~th Avenue East. Eugene. Oregon 97401
PHONE: 342-1311 EXT.411
M55-28
PROPERTY OWNER
Gp '. d'll ~ , ,r9W!1.. to . p .
CONTRACTOR
W~3TOV2P C'~$7~UCVION
PROPERTY LOCA'TION - INCLUDE POST OFFICE
2764 CANrC~QU~V ~7~EtT~5~r~.
PROPERTY LEGAL DESCRIPTION"": METES, BOUNDS
LT t-.1"JO. 1;:'t,I'JTU-n"tmV ij,\UhGf BLOCff, 2 Lev 1.0
TWP RANGE SECTION
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LA~E COUNT
BUIL/i)ING KJ
17
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APPl.
NAME.
&
MAILING,
G~tIRERy PHILLIP .
. ~.~;/O"1:.,'E~'fO\1Er~ CONST~IJCT \ON
2589'NOfilTM 351M Pt"ACl:
SP~ I fl(if Il. Ul. OIitEGO\'.J
ADDRESS
FOR MOBILE HOME PERMITS -ONLY
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
O'oJilL I N€!l
, '.
G..-.""cr;- i:,TTk.Cm:c;- U~-iCdLrD
1~,~T'!>lL S.O.S.
SEWAGE DISPOSAL
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
v
SEPTIC TANK CI
.9THERD
OC.UU
2:0.00
30 .50
~.
(9) '.
JILOING PERMIT OR MOBILE HO.
MH Q ~C ti~{1l. If ]!~41
MAILING ADDRESS
USE PERMIT
PEP.MIT NO.
MAILING ADDRESS
2569 ~~flm 35Yt~ PlACG:.. SPw H.l(;ir-. 1,11.:1::'" O~-r.GO~u
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TAX LOT NO.
CENSUS TRACT
COD~
..
,1:,' 2&- iCO
. EXISTING' STRUCTURES ON PROPERTY
l\lo~~!-.'
LEGAL ACCESS TO PROPERTY
CAN1~RmU~V STRQET
PROPERTY SIZE - FT.
WIDTH 79 DEPTH 1CI~~
AREA
Connect to Existing
TYPE CONSTRUCTION
Sewage System 0
SQ. FT_ # BDRMS
1<:12 *: ~c: LJ
'-i
/'
-~.~.......~
I'
~
.~
FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER: NAME
WATER SUPPLY
PUBLIC ''0 0 OTHER
111:.'0
COUNTY BUILDING & SANITATION
DRAIN FiElD REQUIRED
'150
-TOTAL
t
MIN, SEPTIC TANK CAPACITY
900
WITH DIST. BOX: GAl.
ROiOP".....fliW.'(5f CliV'-.HTE:O 70 Tm Sl'R[ET.
TYPE OF STRUCTURE
5 'N;
BLDG. SETBACKS u FT. FROM CTR, OF ROAD RIGHT OF WAY
J '
.to SIDE INT. ~ 5 SIDE EXT. 1 r)
AUTHORIZED SIGNATURE - DATE
/r.l J .t. 30$\;) 8Y 'WfAt'tLltEl HAk6MJGH-
FRONT
BLDG. PERMIT - WHITE
.OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN '
SANITATION - GOLDENROD
SPECIFICATIONS
lIN. FT
:3
OR SQ, FT.
TRENCH WIDTH FT.
OCCUPANCY
,pH) J
PUBLIC UTll. EASEMENT
ZONE
f~-l
USE CLASSIFICATION
REAR 7
JOHN CRUICK9HA~KJ ~.S.
,-
'It
..
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PHONE
PHONE
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J..{ , ~~'.r'/ r )
New System 0
VALUATION
. .
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,',
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....
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450
DATE
I-~i", :/ -:~ '.) ':1
Construction to comply with uniform building code and county. regulations
covering plumbing and sewage disposal. All buildings require a certificate
of occupancy before being occupied.
(See Statement on' Reverse Side)
(POST THIS PERMIT ON ,MAIN BLDG. AT SITE)
FORM it C55-13
LANE COUNTY, BLDG, & SAN. DIV" COURT HOUSE, EUGENE, OREGON 97401
"
SLAB FLO~R
PLUMBING GROUNDWORK
ApPROVED I
I DISAPPROVED I
REMARKS
GAS PIPING GROUNDWORK
ApPROVED I
I DISAPPROVED I
REMARKS
ROUGH PLUMBING
ApPROVED
"
Ix I
DISAPPROVED
REMARKS
ROUGH GAS PIPING
ApPROVED /
/ DISAPPROVED /
REMARKS
FINAL PLUMBING
ApPROVED
;r/
DISAPPROVED I
REMARKS
FINAL GAS PIPING
ApPROVED I
I DISAPPROVED /
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE I
/ DATE
/ DATE
I I
~
DATE2..... /7/-73
'7
/
/ DATE
/
DATE(I'-/?... 7:1
1
/ DATE
/ NOT READY TO ISSUE I
REMARKS
/ DA TE
INSPECTOR
INSPECTOR
I,
I NSPECTOR ~/ --t5)-- .
V
INSPECTOR
'"'P"'O~~
INSPECTOR
INSPECTOR
..../......
. LAN'I: cOL
"""'''':'. ""-"BUILDING [IJ
PROPERTY OWNER
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.f BUILDING PERMIT OR MOBILE '.
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MH 0 '.. iJf"., n-;, f' /:' :1
MAILING ADDRESS :.
. MEUSE PERMIT
,0, p'ERMH NO;
CONTRACTOR MAILING, ADDRESS
~~,7'~1.',,' " C~~il~._ "J'j-;lj,tl1(j'l }''-~'W. ;"t'lh:"VW1 ~~t'l';-": ,1.;'.1~ "..f''-,': ~.P'r' '.~'~..':- .,~;. .."'.;."'\',.i",,_~'1' ."
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PR~PERTY LOCATION -:- INCLUDE'~O,Sr;6.F!jq!,', .,: ,'\i. ":;" .~ : ',\:-\" " ':; ,
<~,,; t.7:"'I;J\...1!'J ':;T;.::r{l~~'j'Wt{~ "t,..,....'\t. .::;-~,. ~~\.~~~'l;;~.,.l\.". .,
PRbfERTY LEGAL DESCRIPTION - METES, BOUNDS' ~ / 1 '" ' '. .
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TWP
SECTION
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RANGE.
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;:>}~::: I r:N~ \ ..l. S}, \:.iAF:f:\~t.f
APPl.
NAME
&
MAILING
ADDRESS
FOR MOBILE HOME PERMITS ONLY
No, of Bedrooms
~TRUCTURES TO BE BUILT THIS PERMIT
:;'~i:: t ~." H(~
" 1', i,:~:" :',ir' c:uq)",
U~K f'\~
"'. . ""';-,., ~
.._.~..........::
.:;T;,A. :;,3.'1"
SEWAGE DISPOSAL
PUBLIC 0
BUilDING;
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
~
SEPTIC TANK 0'
,,OTH.Em
lL~j~ "). ~Jtti .
~
\~; ~+; 4 ~.HJ
{J},.
~~.'::.;. ~ :)~,}
TOTAL
$
",: Q- ~4.-~".J
JTAX;L0T NO.
,> -,:'-'(..
CODE
CENSUS TRACT
I ';'~1!-~'~ .
, .\
\
<""\ .,..... \
1'> \.. iI.....
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C,,:'Q 'i-: \ ~t, ~\.
l'" \ . "V' . "
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- EXISTING STRUCTURES:ON 'PROPERTY
J.~(~t:;,
'- ' LEGAL ACCESS TO PROPERTY
ChM~i~J~~' ~rn!~,
"
"',\,'
PROPERTY SIZE - FT.
~ ~ q, '"', . :"\. ~" ., ... \_' ~ . . }~,': ~'. "-
~ -l.. \ - ~JDTH\ ~^-,\.t).\QEP.:rfl,:'-\...;~,,\.~-~AR!,A
~... ~.:J-...)~..,;::~. '<oi,,'~ ',l"i .
Connect to Existing
. TYPE CONSTRUCTION
, .
\,
Sewage System 0
SQ: FT. # BbRMS
l~.k
t;' 'j'.
~~~;:l\ $::,'- \,;- ',' .. '" .~ . '-
:5~-:t\ -'\ t '-"\'~., :J,,~ \'s~'.~~~~~~~~:' ~\\ ".'~ _."
. . ,~~""-'~~'-l:\-'\:.5:\.:)'''-.-'>'',;~~~~;' j'&
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(\
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"
FEES
PLUMBING INSTALLED BY
OWNER 0 'OTHER: NAME
'WATER SUPPLY
,.' ,
PUBLIC "0
o OTHER
'....."
MIN. SEPTIC TANK CAPACITY,_;>--....
)jt..t~'l,
WITH DIST. BqX: GAL ' " . "
"N '-
I ."(,:~~,~!~ ~..\t; i~ ~';~(,j.t; .:~;:' J V ';"flr"r,~ "':l~
COUNTY B.UILDING & SANITATION SPECIFICATIONS
DRAIN FiElD ,REQUIRED
. <:iiY'
lIN. FT
.~
WENCH WIDTH FT.
OR SQ. FT.
.......
. ~~I,C-.\'\'
".7^ilTV.t: \' " ~- "c, '" ......
\ " ''-\
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r:- \' ".', ' .. " \ '\\. ,', \\ ,,\\;-1\\'\~, '~" .'
C A - .~.-,,~*--~, .' j<i<J'~ \,..>'\..t,', &, -1_%,N"~",li-l 'f'::~:~ >\\. ~,<'\ .
" 'j;:l '\ \" '1:' \- ~ " ~'i;>~'-CI'-'
11,1 i
TYPE OF STRUCTURE
I.
BLDG. SETB~,<;KS c- FT, FROM CTR. 0F ROAD RIGHT OF WAY
H\ '!~ :) lfi
FRONT SIDE INT. SIDE EXT.
. AUTHORIZED SIGNATURE - DATE
J,', t :<y,:: ".'! '),f\e:':t (; fj ;;, fl:;tl\Vi',
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLU'MBING - CANARY
BUILDING - GREEN
SANITATION - GOlDENROD
.t' ~
.. f-i )f~
OCCUPANCY
. !1tJf~)
ZONE
hi";' 'f
PUBLIC UTll. EASEMENT
'~1
REAR !.iI
USE CLASSIFICATION
.. "l('}rf'" C"f.! ::r.';.',~'
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0"
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PHONE
, PHONE
. I
New System [
VALUATION
-'
DATE
, '
(.
j
Construction to comply with uniform building code and county r.egulatior
covering plumbing and se'wage disposal. All buildings require a i certifical
of occupancy before being occupied.
:;~ff. ,}/ ;:.' .
. f, I. , '. ~
(See Statement on Reverse Side)
l~\'\''.~
(POST THIS PERMIT ON MAIN: BLDG. AT SITE)
FORM # C55' 13.
LANE COUNTY, BLDG. & SAN. DIVe, ,COURT HOU~E, EUGENE, .OREGON 974~1
}
.
SITE I NSPECT I ON
ApPROVED
/ / D "","OHO I / DOTE I ""')J
~~~~ .I'-.J 3/-'7J <<c:
/
REMARKS
FOUNDATION INSPECTION
~
ApPROVED / ~ / DISAPPROVED /
/ [jA TE
/-. '3/--73 INSPE~
REMARKS
FRAMING INSPECTION _ ~
/' . ~
ApPROVED /1/ / DISAPPROV~O /, / HE /-3/- 7;] '''''CTO~
REMARKS ("Jh,A/U-J~ 4~-,;J..-q'7'7k/
/ ~ ~
LATH OR SHEETROCK INSPECTION
. ApPROVED /
/ DISAPPROVED /
/ DATE
INSPECTOR
REMARKS
~-
FINAL INSPECTION . ~
ApPROVED' / l/~I SAPPROVED / / DATE rS -fr ' 7 J INSPECTOR U
REMARKS~~a-t;;UJ..'J.}'7JJ ~V?- 3~).. J -?'J <..
~ ... 4'-/$'-71 It'' lJ
CERTIFICATE OF OCCUPANCY
READY TO ISSUE / / NOT READY TO ISSUE / / DATE
INSPECTOR
REMARKS
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D~jlte Jllf'a.sar.v "'. -' 1913. /
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'//j/' PE R.MIT
\ " (; , ;,
I~1" THE BO~RD/OF COUNTY COMMISSIONERS OF LANE COUNTY,. ,. ,
I '/
) . WHEREAS';; 'the attached application has been fully considered by the Bo~rd' of . '
GQunty,Commissioners of Lane 'County, and it is the opinion and judgment of the Board,,^;~.'
t.l)fat ,the said application should be granted, and that a permit should ,be issued, now.."'
}7herefore, it is hereby . " :0:" I;
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~ PM" Ip 0....'".,. c/o ~/~.$tcve'" Ccnstructlott Cof!l)sny
,
v\ and' constructing of the following facility:
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j Or'vewtlY ltppro.ch with C:iJrb eu't...()c1nferbuf'y Vlllege4Heek2 t.Gt to
~ 2764 Can~rbu.ry t'S't",ot
~upon the right.,of-way of County Road No. fl!edieaTed, in strict conformity to the exhibits,
>attached thereto, and subject to all terms, conditions, agreements, stipulations and 'pro:' ' :.
,~visions contained in the application and permit, the Rules and Regulations Governing' . :c,'
f' Facilities to be Permitted upon County Road Rights-of-Way, dated March 31', 19.60 and,,!; ",
l any amendments thereto, and any other applicable regulation, law or ordinance.' . '. "
i Special Provisions:
; Ortvoweywlll be constructed In accordance' with the .ttec".d drhov~v ,iq~Pf;;'i j'};~f, "
l sp.olf'lca,t'I~$ (Drti~lng M9~30). '!, . . ~ .~l ,f'"
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ORD.ERED, that a permit be and is hereby issued to
. .
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for the placing" pUiidlng'
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Permlttea wll' ~ f"$spenB'bt~ f()r the l!:lIMId'a-t. removol of ~n t'ii,l:dao d~rt ;;)1\"5 .;" ,"",,'
debr'-. ft"'Offl1 th~ roadw~y ~nd rl ~ht of way eou$edby h hi OpGrath~n ii '. ~Wrl'@ ';'l~\.~ : ,: 'j, ~ ; , ~::
roadwtlv and '~",i- I n' lIS neet, elol$pteb>l& <<>ndJ tJon. , '" . ,;' ,
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This permit i's revocable at any time, and will be strictly adhered t6 and no wOrk
other than that speqifically mentioned above is hereby authorized. . .
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This perIl}it shall be
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completed before." '.',. ,
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Inspected and/Approved
t- ,
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void unless the work herein contemplated shall have 'been ',' ".' .-':
74
, 19
Expires
,19
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Approved by Board of Commissioners
By
Date
By
~'r"
.' '\~ ('~~~ ,~~
,I,
..\1"1
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Director. oJ Public Works
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WHITE. OFFICE FILE 'P.INK . PERMITTEE. ORANGE, BUILDING & SANITATION DEPT,
GREEN, RESIDENT ENGINE,ER, Ei,LUE,; ROAD ~UP~.RV'I?OR YELLOW,o,SURVEYOR,..
-'1\ j , i' , .. .'_ ___
" C~8- 52,,,, .,
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C54.104-0::Z '17-104-IJ
C55 -1~-09
C56-10<l-IO
MEMORANDUM
.. .., III
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D ATE ______~:_l_~:_!_L________
Department
Phillip Greiner
Westover Construction
At applicants request Building Permit # 4-73 which was issued on Lot 10 Block 2 - 1st
addition to Canterbury Vi~lage is being transferred to Lot 11 Block 2 of the same
sub-division and addition.
New Address is: 2746 Canterbury Street.
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APPLICATION FDRFACILITY PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
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Your appl icant, ;. " 0,', ,-
hereby makes application 'under Ruies and Regulations Governing Facilities to be Per-
mitted Upon County Road Rights-of-Way, to construct the following facility:
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Upon the right-of-way of County Road No. fL, < J.li .', tt;~'t the following location:
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as shown on the exhibit~ which are attached hereto, in strict conformity to the state-
ments of the exact nature and 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
facil ity as constructed, or otherwise primari Iy I iableand responsible to members of the
publ ic for its proper maintenance, repair, operation and use. Your appl icant' accepts a II
'terms, conditions, agreements, stipulations and provisions, in 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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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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one o. .;' '"' / -. " /,'
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r:Jalier ~ s Nam~ /'
No.LivingUnits Bedrooms Baths
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Septic 'Tank:
Ft. from well Steel 0 Concrete
Inside D~ensions: Ft.
Length ;tJ --Width iJ ---- Diameter
f\pplicant '
Name
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INDIVIDUAL SEWAGE DISPOSAL SYE RECORD
Installer: Complete top part V~ form to ..
signature and return both copies to Lane
County Building Sanitation Department.
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'I-f...~.:ty Address
~CANTERBURY STREET
Basement Water Supply
, Yes 0 No 0( . Public Ii Other-List
PE.RM...I T No. 4-73
CRUICKSHANK
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Tile Disposal Field:
Depth t/,.J ---' i Distribution Box:Yes ~
Other Distribution- Type
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Feet : '~m . /)
Wellll~~oundation
Lot tLine ~
,Fron t
'Total sq.Ft.betwee~.FillrrJ~ \-
. ft .~J"'o . lines ~ J TyPf/~
No. Compartments
Gal. Capacity. I a 0 (!7
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No 0
Mailing
Address
Pfi/LlIP GREINER
LIO WESTOVER CONSTRUCTION
21)8q NORTH ':{~TH PLACE
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SPRINGFIELD, OREGON
Length of Lines - Ft. Trench
0-2.~--r: 4. 5. 6. Width ~
Sket~ (See instructions),
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Date Z.- 2/ -lif 7 3
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For Sanitarian Use Only:
~Approved: System Installation
o Disapproved: Does Not Conform
Remarks:
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Side 10 Rear / 0
F~ller depth Filler depth
above below 1
tile '2,./'" in" tile k it:,},.
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Signature , )~.YL- /141- K-4
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Conforms to Current Standards Date: ~ '13
to Current standards vr
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Lane County Building & Sanitation
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~~ Sanitarian's-Signature
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LANE' COUNTY BUILDING' PERMIT OR MOBILE HOME USE APPLICATION
PERMIT TYPE - BUILDING l MOBILE HOME Dose REG. # j ~ /' PERMIT # .41- 73
~ ~ MAILiNG' ADDRESS PHONE
CONT~AC.r~ . /J..... ) IlING ADDRESS _/..p--. ()~..#/J PHONE
~)~L/ ~ ~J<r-Y/lJ~ 30~,~~1 ;7f/7-./?7/
PROPERTY LOCATlON-,,'NCLUDE P~OFFICE... n..4 ~~/7 -" ", .~~ '
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PRbi.~.(~ifAL DES~RIPTION /~ ~"P~ _ T. ; v '/ J' - ~ //4 .:l .p ~ (; METES & BOUNDS 0 YES
LOT - BLOCK - SUBDIV. /~. (~ 1//0 ~ I ~/ ATIACHED ~NO
Ti 7 '3GE jE%c TAX Lor# ,ct5DE CENSUS~ll_'3C)o.-
APPLICANT DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY
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AND
MAILING
ADDRESS
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; NAME
PUBLIC 0
BLDG.
WASTE DIS.
PLUMBING
PLAN REVIEW
PARK TRLR.
SEPTIC TANK M.
ot ~ ,J. ,0 d '
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-3-0 ,s-l)
FEES
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/Y-{/r/ , ' Con ct to Existing Sewage System 0 or New System Req. 0
. 71-/ ~.~~\TRUCTION, /J;;~/~# ~Er~O)S 7~A;-;tj
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. . PLUMBING INSTALttD BY - . / l~' > -
OTHER 0 OWNER 0 OTHER~NAME. tv! '
WATER SUPPLY PLANS FURNISHED FACIL Y PERMIT
PUBLIC &. OTHER YES e( NO 0 YE~ NO 0
PLUMBING FEES', SIGNAT~OF AJI]ICANT c:--.. L- DATE
rFIXTuRES ~ ~ 0 [j x.. -;;p'~ 'z?:.)~~/-..J -;;3
FEE IiECEIVED BY - DATE
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PERMIT # .~.-/ 7
,-/- 3
LEGAL ACCESS TO PROPERTY - ROAD NAME OR #
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PROPERTY SIZE-WIDTH ./ DEPTH
7 Y /~/t/
AREA
'FOR MOBILE 'HOME PERMIT ONLY
N.umber of Bedrooms
STRU TURES TO BE BUILT THIS PERMIT
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S2-~ S?~2j
SEWAGE DISPOSAL
TOTAL
/ /;2, S-O
CASH 0 ~ER .
CHECK ~ONNECTION FEE
.PUBtIC WATER
CONNECTION FEE
d.06
/ -3'.'-73
/,SD
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COUNTY' BUILDING & SANITATION SPECIFICATIONS /
DRAIN FIELD REQUIRED r
q(') 0 UN. H. /6<:l TRENCH WIDTH H. 3 ORSQUARE Fm 60
~ stJ~t9~fr.
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MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAL
TYPE OF STRUCTURE
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OCCUPANCY
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ZONE
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REAR YARD
PUBLIC UTIL EASEMENT
BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY
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FRONT L-f-() SIDE INT, S SIDE EXT.
SANITARIAN PLANNING
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USE CLASSIFICATION
10'
REAR 1-7
Date BLDG. INSP.
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to Find Property:
COpy 1 - OFFICE
COpy 2 - JOURNAL
COPY 3 - AUDIT
Form # C55-12