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HomeMy WebLinkAboutPermit Building 1973-9-12 ~:\--! ;"."--;-r. ~ t-,:,;,'::o1M _ GVl1rJ:t;r.i/;;: e.:./tt}:;L~. . v(./~'~ ~'~">~'Y v . 1 #! ~ . ',,~. . .. ',<:9 .., . i' lANE' COYJ BUILDING =. ," BUILDING.o'" MH D PROPERTY OWNER MAILING ADDRESS t'JosteVGi" tons~ ~ 255:) I'Jor 11:t'l .]j)tCl c' PE:~\IT( '6R."d~ior;;~?PERMIT .~(. '" PERMIT NO. .. 177:;...73 \) lCl~8 ~Dd i1l8f a.ol cg, OroGon PHONE "Itrl"'9~1-1 PHONE CONTRACTOR MAILING ADDRESS . ", PROPERTY LOCATION - INCLUDE. P<:>ST. OF,FICE 27~~ Dud.i l'igten PROPERTY LEGAL DESCRIPTION - METES, BOUNDS . .F j rs t ads. CDI'I~Oi"C>C:.Ir-y~.nUt:l(0Q I ./i': ~";:'i~!' 0] SECTION. 2~JLf,/ lot- 13 bi@ck i /:tX LOT NO. ;30 / g EXISTING STRUCTURES ON PROPERTY CJcno CODE CENSUS TRACT TWP RANGE 11 2a- HiO APPL. NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT ... LEGAL ACCESS TO PROPERTY .l)ttrlingtofl AWe. PROPERTY SIZE - FT. WIDTH DEPTH AREA c;,;JO i 1 i ilg Connect to Existing Sewage System D New System D TYPE CONSTRUCTION SQ. FT. # BDRMS VALUATION ~rC:;JO 12~U 0 ~2 (3) tt},OSl2 @Draoo aH. CJi::JC. 528 03 -L~ ?9lJ iO,LJ/O iflStill1 S.D.S. ~ ~OL~~Jna ~I~t~ros SEWAGE DISPOSAL PUBLIC 0 SEPTIC TANK D't BUILDING .t WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER OTHERD 65.00 2@.OO' 3@.!S@ FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PU BlIC [1]: o OTHER MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL. ?IQt pUem riot fCtmdo~ i ori U II n~.!i5@ COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED ~~@ L1N. FT. ~f.iO TRENCH WIDTH FT.. ] OR SQ. FT. _ P>53 occuro'i:o. . '\JO n .1tiVO t~ 110U4il nV'$~ - trcnCl"i '(fie I:lBHv.lUfil HI veOl!: Tre.n order ~Ci) get ill Ci"/Ol!Qh drC'JJ~fjt2M. ({erA drnifrls ta street. TOTAL t TYPE OF STRUCTURE 5 w OCCUPANCY o & J . BLDG.. SETBACKS u FT. FROM CTR. OF ROAD RIGHT OF WAY FRONT 4s SIDE INT. 5 SIDE -EXT. AUTHORIZED SIGNATURE - DATE foGI J.~. D~ss DY ~C'JrbaMD~ 40 REAR ZONE r. I USE CLASSIFICATION 7' P,:rJ.{Z. PUBLIC UTIL. EASEMENT Gaorao Woryrord, n.s. DATE 9-12-7~ BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Construction to comply with uniform building code and county regulations covering plumbing and sewage disposal. All buildings require. a certificate. of occupancy before being occupied. (See Statement on Reverse Side) ,.:~ (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 97401 FORM;ttC55-13. .,~ T / 7 R Q3 S ..;; sf' TAX Lo'T cET . TRACT . , /S7 AIJO C/i..vrU:X/,e(! [I~L- APPL I CANT: 8c,j( / /-b-f' /3 N/\ME 0Es T&UEle C&MJSr: ADDRESS .:<.... . ,.~;. s~ }"" .' - ". . <<.:;. o,i/It BUilDING SiTE EVALUATION <- Building Pe'rmit Appl ication No. /77G73 pq ( ) ( ) Site Inspection Pre-Permit Investigation PHONE. DATE V-~- 73 -.--.--....--.. ....~_. --... . ,.,.. ,_..~.--".- LANE COUNTY PLANNING DEPARTMENT NOT NO YES NAME DATE app I i cab 1 e (J IJ 9'~7-73 1 Zoning Ord i nance Comp I i~C! ( ) ( ) ( I , . . (Zone - ) c~ \2. Subd i vis ion Ord i nance Comp'i i ance ( ) ( ) ( ~ Requi red ( ) ( ) ( ) . 3. . Access . \ 4. Bu i I ding Site (Area, Width,' ( ) . ( ) ( ) Frontage, Setback) } 5. Other (see comments)' ( ) ( ) )\ COMMENTS: BUILDING INSPECTION SECTION NOT NO YES NAME DATE app I i cab I e (,fS 6. Plans Submitted ( ) ( ) 7. .' So i 1 Stab i I i ty (footings) ;X) ( ) ( ) 8. Flood Plain r ( ) ( ) rjJ;;~~ 9. Other (see Comments) )) ( ) ( ) Cj~ / z~?3 ......-... ...._~.. e A ..".-,....---.. ".,.," (f COMMENTS: ..."..... ----.. -~--,....~ ....~-, ... ,.,..,., 10. Sewage Disposal ..... NOT NO YES appl icable ,(/ () () r-- ()()() () () () ( , () () SANITATION SECTION 11. Usable Area 12. Water Supply '13. Other (see Comments) _...-~~... .. ..., COMMENTS: TO APPLICANT: " ( ) ( .) ( ) ~:;l:~n:p;:~::~.'I 59;/2/73ct;;J. Cannot be approved at this time as indicated on item NO. 'above. Questions and further information on items 1 through 5 contact the Lane- ~OUNTY PLANNING DEPARTME~. Questions and further information on items 6 through 13 conta,ct the Lane County Buildinq and Sanitation Djvision. Will be h~ld in this offJce until you can resolve the problems indicated. Is being returned. Your building permit appl ication fee is being returned under separate cover. ". jj j Your .0' LANE COUNTY PLANNING DEPARTMENT 135 Sixth AvenQe East, Eugene, Oregon 97401 PHONE: 342-1311 EXT.231 LANE COUNTY BUILDING & SANITATiON DiVISiON J35 Sixth Avenue East, Eugene, Oregon 97401 PHONE: . 342-1311 EXT. 41l . C55-28 V,-:"",c"'(?~r~~~~{~..'~~!'" ,C'~"r": ~. . i~ t'''"'~~J' "_ L"-,, ~l "':"v~~~i~\r~,;r,:_':'-f;: ~.'" - .'''i[f~\.;' ',.~ -i.>.~11 ,...--;..",~~-..~ ''1'''':' t.. :'" \.' ii' ~..... . ~~. ,Date' ~~~r 24.. If!)7.3 Permit No. ;. 1115"'13 11:1.85 CURB CUT . . PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY WHEREASr the attached application has been fully considered by the Board of County Com- missioners of Lane CountYr and it is the opinion and judgment of the Board that the said application ;,; . should be grantedr and that a permit should be issuedr nowr thereforer it is hereby. ORDEREDr that a permit be and is hereby issued to ~"'.st..~ ~'tn_iOtl or constructing the following facility: for placingr building })rivaw,ilW" a~Qh with ~U;-b cu:t.. 2iga'a'liti:'1~tlAv.~ upon the right-of-way of County Road No. 1549 r M!le Post 0..07 Lafl; Sidf,l in strict conformity to the exhibits attached heretor and subject to all termsr conditionsr agreementsr sfipulations and provisions contained in the appl ication and permitr the Rules and Regulations Gov- erning Facilities to be Permitted upon County Road Rights-of-Way, as set forth by the Lane Man- ual 50.190(2) any amendments thereto.~ and ~ny other applicable regulationsr law or ordinance. Special Provisions: 1. Driveway will be constructed in accordanc~ with the attached driveway approach specifica- tions (Drawing M98-50). 2. Permittee will be responsible for the immediate removal of all mudr dirt and debris from the roadway and right of way caused by his operationr leaving the roadway and area in a neatr acceptable condition. This permit is revocable at any timer and will be strictly adhered to and no work oth~r than that specifically mentioned above is hereby authorized. This permit shall be void unless the work herein contemplated shall have been completed be- fore Se~t'2:4,. r19'4.. Expires r 19 Inspected and Approved Approved by Board of County Commissioners -By,. Date'"'' By . 'Director of Public Works WHITE - OFFICE FILE. GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUILDING & 'SANITATION DEPT. YELLOW - REAL ESTATE G98-79 1" ~.. ,0'" _0 ('<;-; ;,:~,) ... ~ [;late. Building Permit # '~o.....,. , APPLICATION FOR FACILITY PERMIT I, (Applicant's Name) hereby make application under Rules and Regulations Governing Facilities to be Permitted Upon County Rights-of-Way, to construct the following facility: ' ,'-'''' .- } . Upon the right-of-way of County Road No. , at mile post on the I No. I So. I E. I W. I side of the road, or (mark with X) as shown on the exhibits which are attached hereto, in strict conformity to the statements of the exact nature and amount of work to be done, and to the description of the facilities contained 'in said exhibits. The applicant will be the principle owner of the facility as constructed, or other- wise primarily liable and responsible to. members of the public for its proper maintenance, repair, operation and use. The applicant accepts all terms, conditions, agreements, stipulations and pro- visions, in Rules and 'Regulations Governing Facilities to be Pe~~lnitted Upon County Road Rig'hts- of-Way, as set forth by the Lane Manual 50.190(2), any amendments thereto, and any other ap- plicable regulation, law or ordinance. To Permits Processing Noted Date Noted Director A"~' ~."':; .~4"".J~~ ,~~~~';~::.'.~ ,~: . , l ,..:,,',,: ~:.:~;i..~/ ~"{,i~...,.t,i:~: ~~ ~:.::.. ....~" . Principal Engineer Subdivision Engineer Signature Permit Engineer ~i :J".:..: / , .~ . . ~ . .....,.". 1':',' , J-i Ii;."""" ~ Address Weighmaster Zone No. WHITE - OFFICE FILE GREEN - RESIDENT ENGINEER PINK - PERMITTEE . C98-78 BLUE - ROAD sUPV. ORANGE - BLDG. & SAN IT. YELLOW - REAL ESTATE 0,0., .- " . .~''\~~>~< .-1" ~/c f .~ Phone No..;'M?",:?',:Ji" 1j , ; . w&GfO/XYff,rr CbIUS1-i-:z/c'77/0 1-1., LANE COl BUILDING [J Y BUILDING PERMIT OR J'/\OBllE MH CJ iVlAILlNG ADDRESS )ME USE PERMIT PERMIT NO. 1 n .i-/3 PHONE PROPERTY OWNER .; '. :~t~. '.! .:r' 'j :n:.:.~" . . , , i -. i . J r. " I CONTRACTOR MAILING ADDRESS PHONE PROPERTY LOCATION - INClUE;E, POST OFFICE 1 if9~ lJa\ V- i /117 f f 0;1 PROPERTY LEGAL DESCRIPTION - METES, BOUNDS ~ i r 5 \. ;:" ,J. 11<.':-I"..;r)' . t ) ~.~ .;: 1': :) 1. - ' TWP RANGE SECTION TAX LOT NO. CODE 2n~ 1 :::~ EXISTING STRUCTURES ON PROPERTY CENSUS TRACT j" I ','.J APPL. NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT LEGAL ACCESS TO PROPERTY J'.r-fin'.:tc.'il J\ve. PROPERTY SIZE - FT. WIDTH DEPTH AREA '~ , . I 1 t Connect to Existing Sewage System D New System 0 TYPE CONSTRUCTION SQ. FT. # BDRMS VALUATION fl'i",: l;ii'i -;2 (3) )1;,-..: 2 ,: .....,....:"), .,''',. ~ i '0' I t,;: " c t t:. ~. ~ :~; !I' JPLU~/!f3ING. ""_. . AP,'=>RO\'F"f)' ;~1?~ :j~ Date~ ----. PltiJ.i:BING INSTALLED BY t..~,.. I ~, :'. ....;. 3 J r;; : l~, __~..1-:: . I \.J, ",I :,,' Insti"il :';.J.). ~; /rlI':lJfll" t'f::tlli~;~ SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER FEES OWNER 0 OTHER: NAME WATER SUPPLY ftBLlC 0 0 .oTHER ~1 ~jA 7--jy-lJ SEPTIC TANK D' t OTHERD l TOTAL ~ MI~l. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL. COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED L1N. FT TRENCH WIDTH FT. .~ OR SQ. FT. ):5'1 ~':l._"t:. :)1.:":'1 fL..It ~:.>.:...;ttl.~ 11 .:-.J..... 'L_~ ::'."f" "):-.~';; "t:r.;:",l':rr I.:n~~ illl;~J;:l:ri,; I:! Tl.;';l: TrCI\1 fpunr:;t:t'":.tl 1:1 f.,:~"".:~~r tfJ (j'~t i:1 t i"i:':r:"fh {~r2infj21d. t~c~of rir~ins to street.. FRONT SIDE INT. SIDE EXT. AUTHORIZED SIGNATURE - DATE I: .~, REAR ZONE I. I USE CLASSIFICATION ',' I !;. !. I:: . PUBliC UTIL. EASEMENT TYPE OF STRUCTURE OCCUPANCY t .. ! 1 i, .. BLDG. SETBACKS __ FT. FROM CTR. OF ROAD RIGHT OF WAY Isl ~.: I.' I:. :J"~~5 bV ;.I;.:ro,:':,I: > CG(;i"'e t-leryford, r:. <: !', I) >J .., DATE 5-11.-73 SLOG. PERMIT - WHITE OFFICE Cory - WHITE COUNTY TAX - PINK PLU.'.-IBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD 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. (C::ee Statement on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 97401 FCRM ::: C55-13 .. .....lIfI. . ~md 'DIVIDUAL SEWAGE DISPOSAL SY~TF ~ECORD _!staller: Complete top part 0:" ,rm to signature and ~et~rn both copies to Lane County Building Sanitation Department. '. P.RMIT NQ. 1775=73 Heryford ~tallerl~ N~er~ No.LivingUnits Bedfooms Baths I <3 / Sept1c Tank: Ft. from well Steel 0 InS1C1e DimenS10ns: t't. Length 1:0 width ~ J Applicant/ Name Westover Construction Property Address 2798 Burlington Basement \.. Water ~ply Yes 0 No~ Public ~ Other-List concrete.~ No. Compartments / Gal. capacity.! t)00 . Tile Disposal Field:~ Diameter Depth "'7< J- Distribution Box:Yes No 0 Other Distribution- Ty e ,..--...-------. .1-.~ FeWfro~ ;J // 1 W ~U))JfFoundatj{-::Jn I () L t Line I _F <hnt /0 Side / () I Rear / c1 Tot;tJ sq.Ft.between Fil~ V Filler depth Fi"...ler . depth /r"l\ /.A above ")/ be..ow J ft. tI (J lines/, v Typ tile P' in. ti ~e b iJJ... ~ Mailing 2S8g North 35th Pl~ce_ Address. .. ~eqon L~h~o~~nes - Ft. Trench l/.J 2#3. 4. 5. 6. Widthd Sk1tch (See instructions): { , \ \.\ ~W . \ . , '\ 1\ I' .~\. . \ ^~ f,o k, ...' J-tE; --0--1 t'.l-{~-- lJ _-- I 7J - -+- .- ;\ I [I J- For Sanitarian Use Only: ~APproved: System Installation o Disapproved: Does Not Conform Remarks: Conforms to Current Standards to Current Standards . . Il ~ /- Signature(~ C^-ltJ/fltr<-1 Date, iff?> ~&;nJr9u:'aiJ'.~~ ) . ~~n's Signature & Sanitati n Dept. , Date lo.~ U - 1'1.7 J- ..l,.... Lane County Building r...... _it :::}?f1j~~~~-"-: ':i..... I '." T1~::j~,...-~7!^." ~~r~~ "~~1. '(<';,. ,..Pl' .jl" :/ PROPERTY OWNER "..t.OV.'" ~t.. LANE COU. '. ... BUILDING []~. .-.."':- '~~"n_ ::"'....~. .'~ ~..... ,"p_.-"'", ---,. ",,,-.,; .._~~: .;....~'\-,......~'> -,- .'-;.' . .-.~..~-v.,_.---....-._,"_.t,'~__'!_"""~;,..,~~ ~_'70<".'i\;'''- ~./";.~~ .: "'" ..;!.,\\.;,\........ . :." .. ;.\ ..----. . , .;.~~~~~;~~.l',li'''.i7.,~.;.;.., . BU'I~.DJNG PERMIT OR 'MqBlt~~,~h~Iv\E USEP.ERMIT .r ,,-:;'-M. . H .0 . !.. . "'.~' ,.:\,.;.'.,.:. PER MIT NO - -':"-,f # . MAILING AQDRESS . . _..' . "t'~:L .' 2SS9Ror~b )5th. ",-' . $t:tth't~ie'cJ~' Oregon . MAILING. ADDRESS l11S-1J' PHONE 141-9971 . CONTRACTOR PHONE . ~,,),~"';f, .~": : 'L,~ ,II; ~ PROPERTY LOCATION ...,-'INCLUDE .i~;9S.J;.i~0.FFI~E :' 1798 .~... hlgt,On . '.' PROPERTY LEGAL DESCRIPTION"": METES, BOUNDS . " rat adel. .c.Rterbttry Vn!tge ~(jIt 11 b'odcl TWP 17 .APPL ,,!AME & MAILING ADDRESS RANGE SECTION TAX LOT NO. . '."CODE \,. :"'$0 CENSUS TRACT " 24 . '\'-.... .~., . \ ;~~:~...~ EXISTING STRUCTURES ON PROPERTY "NoM': 1,., . . .: ........\c... t.~: ..~, '\ - . \: r~., 1... - I ';. '\. ',,-. ~l ~~ \. t '; LEGAL ACCESS TO PROPERTY a"".11 ",too. Ave. PROPERTY SIZE -FT. . WIDTH' DEPTH \ . , ,*-. :\ , . AREA ! . FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO .BE BUILT THIS PERMIT .."., . ....'.., Connect to.Existing TYPE CONSTRUCTION '''Me' . " . ,~ '- ~\.-~ " ~ , . . :\'S28,~ ,,' Sewage System 0 New System D 'SQ. FT. # BDRMS V~LUATION l;24' ~.t'l (J.) 'lt~892 _.!.:~~ .0..../0 Owe H 1"9 Y I"'. Gares.- ~t~.' ............ - htst." 'S.O.$.. ~- _.... ..... ,--,.. ~ rl~'ng rJ~~Ur~5 ~t,. ,. ". . " " :~~,i \r '~t~ \. \~ \ . ,., '~ j \ . . . h.~).~. h 'S t',,~ \ . '.\' ... ...... . . ',,, \ '\-..: \y,..~';.)( ".... SEWAGE DISPOS~L :,r. PUBLIC 0 . SEPTIC TANK BUILDING . WASTE DISPOSAL PLUMBING PLAN REVIEW PARK T1~AILER d' . $" . OTHERD 6.5. OQ 2G.OO 30. SO . FEES' PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC .c!J". .' 0 OTHER :' I" --''! '" . -r . ..... . 115.SO COUNTY B.UILDING & SANITATION SPECIFICATIONS' DRAIN FIELD REQUIRED !JOG . '50 3 -SO WITH DIST.lIPX: GAL"- ... JI.N..FT . . . ~ TR!~CH 4WIl;lTH FT... . . Q.R sq.: Fr.... 6' 'h .. ru,... p.en'w:l\;f;. ~Ut"Q1ii'h "IJ' l~ '~u nUl"" 'f,f."- 1inllmiin.~nV.lII"umWIIII lJV P...~ ,.~ f~"M 1.~~It"rti.. \~ti~; l~: '~'~,~~~~!'nfltd<!. .~~ drat". to:::~':~~~t~. ..\{\~.,,~ . I. \ . y, .\ )" \.\ .~~\ "~' (i0. ~::;;:.i\;':;'''''l .'" '''.' .~ \\, ";" -''Y- ~.~\ .....~.:,...\(...._- .~,.... . . ~'10..'. I t -.I(..X\\} 'i-" ~ -' '..,.'S- :,1.l.. ~L' ",'. '. ':'. .'. \ ~ -tl "'" '"":~.\. , . \ '..' "'J - $ , TOTAL MIN. SEPTIC TANK CAPACiTY .~' .:. '>: 'f ~'. '.~. .,1 l. . . \\',- S;':.:-to' ZONE a t \o.S~.:' ,- . J TYPE OF STRUCTURE' . SM I.. OCCUPANCY." . " J ..:... ", PUBLIC UTlL./EASE.MENT .f 40 REAR USE CLASSIFICATION 1~ P.~tJ;iE. .. . I ~. ~()';~W.ryfotd; .1\.$., .. i DATE. , . '''''~.13 BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX ~ PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD ! j ,~/' Construction' to comply with uniform building .,'code and county.. regulatior1s covering plumbing andsevyage'aisposal. All :'buildings require .9. certificate of occupancy before .b~ing.occupied, . , (See Statement on Reyetse Side) .,'r",-' / ./ (POST THIS .PERMIT ON', MAIN ~LDG... .AT SITE) LANE C~UNTY, BLDG. & SAN. DIV., couin HOUSE, EUGENE; OREGON .:97401 .~; \ . ; '~, \, FORM #C55-13 SITE INSPECTION ApPROVED / / DISAPPROVED / /. DATE REMARKS FOUNDATION INSPECTION ApPROVED / J/'f DISAPPROVED / ~ . / DATE H9..73 REMARKS ~ 'r FRAMING INSPECTION ./ ApPROVED /' / 01 SAPPROVED / / 0;/ tJ-/# -;; 7:1 REM"" ~.~ 1"/f/'''~ / .; I LATH OR SHEETROCK INSPECTION ApPROVED / / 'DISAPPROVED / / DATE REMARKS INSPECTOR INSPECTOR INSPECTOR INSPECTOR ~ If! "'PEE'OR ~ FINAL INSPECT/ . ) ApPROV'ED LK-/ 01 SAPPROVED / . / DATE /,9. ..~~ 7 j REMARKS~U/o-2a~77 ~~1:JIJ.:J..'r-7' it:. ( j CERTIFICATE OF OCCUPANCY READY TO ISSUE / ! NOT READY TO ISSUE ! ) DATE REMARKS n~ /77J-7J lY~/;~q8 ID~ INSPECTOR eR Z). .3 0'(/ .. L":. . ~,. ". ~ . . LANE COUNTY 'ILDING PERMIT 0 R MOBILE HO^ PERMIT TYPE - BUILDING 1& MOBILE HOME OOSC REG. # PROPERTY OWNER MAILING ADDRESS ~.-/~~./. 'o2s/1 ~'.:357'L CONTRACTOR ~ MAILING .ADDRESS JSE APPLICATION PERMIT # /775--73 /)" '. A';' PH.O~')NE" _/ . . ~~; --O/~. . /;' 1l'f'j0NE ~~7-> 9171 PROPERTY LOCATION - INCLUDE POST OFFICE c:279? &M~~ PROPERTY LEGAL DE~.CRIPTION t. 1. .11 / LOT - BLOCK - SUBDIV. / ~.~_ . TWP RANGE. SE;/ /7 tJ..3 ~.y- L! "! ':: ~_ t...' ., I'~~ TAX LOT:# (J r/ V- i I~ I <9. '" ~ / ;;)' L:? ";;J..I' . _. /. ~ETES & BOUNDS 0 YES ~ ~ /-.-J r7.J~1 ATTACHED 0 NO CODE ,.. CENSUS TRA@) - c;l.t5 -I$D DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY Y14~ LEGA.1I'CCESS JO PRO~..EERR~Ttt - - R RGOAD YA;ME' OR # ~ tuA-e.-.. PROPERTY SIZE-WID# DEPTH AREA APPLICANT NAME AND MAILING ~~~~ ADDRESS FOR MOBILE HOME PERMIT ONLY Number of Bedrooms STRUCTURES .TO BE BUILT THIS PERMIT. ~~MAA./~~~ . 4AUJ~ tdI-l~ ~ (7 Connect to Existing rTYPE C.ONSTRUCTlON . ,'. ,. , -z....<:.-,; . . Sewage System 0 or New System Req. 0 SQ. FT. # PiEDROOMS)VALUATION /,;;:JL/ / J/J ~ i.2, (3 I Lf..X~tj:2 I - - s-::I-? -4 @ J /5 ff '-I /&..If-J b / TOTAL //5.60 CASH 0 S~ CHECK ryONNECTlON FEE PUBLIC WATER CONNECTION FEE -2 PLUM~ING "INSrAL~ED BY -) ./ .J'NI / OWNER o OTHER 0 NAM~ PLANS FURNISHED FACILlTY~ERMIT YES Ii(. . N6 0 . YES 0 NO 0 ~~~~ !jr:JJ73 ~ECEIVED BY . DATE i 9/1//23 RMIT # SEWAGE DISPOSAL PUBLIC 0 BLDG. WASTE DIS. PLUMBING PLAN REVIEW PARK TRLR. ~. SE~TIC TANK "rsI IE? .5 , tJ-..iJ . . ~.O. JI--i) 3 (!J>"StJ FEES OTHER 0 . WATER SUPPLY . PUBLIC ~ OTHER PLU~'~G FEES e.J1 -'. .~ 7 FIXTURES -2 /, ~ ~ _ISo - - -------- COUNTY BUILDING & SANITATION SPECIFICATIONS /775-7J MIN. SEPTIC TANK CAPACITY q DRAIN FIELD REQUIRED WITH DIST. BOX: GAL. ( I? 0...... L1N. FT., 11:t/ TRENCH WlDTH FT. .' 3 OR SQ4ARE FEET . ~ IS. .,~ ? / {/ T P !C?n. !/J V I .~--+--CC t:< 00/<e.., ~,l ( he // e ~ ~+-- I _ ~, J / J ~ f"' -r->. _ _ r- _. I 1'_ ~ i ......... I /.-, 1 J'......,.... I''/ /./"........-7. / L) 7--/. / IT / '-" l---n t- ~ (-:r'~. r L. ~ ( f'-----P I '-- r - ~ " . t. . ... if>. < - - . . c.- ' . TY'/;) VVl . i/ uu '" rV~ /;/0 VI I /~ D ~J~;/ ~o ,7 e (-j.t-; . e t/l. 0 l"z 0 t C/ J/1c:; (V) -?'rel d;~ /( 0 c) + d i/14' (t-z.J .~ 5 T;". € c::. 71 TYPE OF STRucn1'RE r/1 / .J O.CCUPAN~' . ZONE' REAR YARD PUBLlC7TIL. EA. MENT V fV : Ir,;T 12-/ ' . BLDG. SETBACKS - FT. FR. OM CTR. OF ROAD, RIGHT OF WAY. "USE CLASSIFICATION FR9NT f ,C:;=- SIDE INT. ~-' SIDE EXT. i/ I) REAR 7 Pu ~ _ I 11TARIAN . j /. . ~at~.~IN>>. Il Date BLDG. IN~P'.rll . /fL .t:l/(;yo Da!e ./ ~~--</.~z~ -"\.A / . 'JJ};,IA/jUb-a-~7"'}3 ,~ ~~tJ/.~~ ~~ ~f I ~ C' f) 3 / '. V - /. . # -- .. . Directions to Find Pr perty:' COPY 1 - OFFICE COpy 2 - JOURNAL COpy 3 - AUDIT I Farm # C55-12