HomeMy WebLinkAboutPermit Building 1973-3-7
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~.. LANE COUNT'
BUILDING KJ
JlLDING PER~t~hc{Bi(l~~61
MH D.'
MAILING ADDRESS
2,aq .NURYH i~VH PLACE SPRINGrIELD. ~€GON
MAILING ADDRESS,
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~SE PERMIT ,~ ;~, ....
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PERMIT NO. i2q~ 7i
PHONE
747-9tJ71
PHONE
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PROPERTY OWNER
WESTOVER. CONSTRUCTION
CONTRACTOR
SPEI:: HOI.I:::'" d, '
PROPERTY LOCATION - INCLUDE POST' OF(ICE
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2797 BURLINGTON
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS.
LOT 7 "BLKo 2
TWP
1ST CENTERBURY VILLAGE
RANGE SECTION{'
0, 24,4lJ
~ LOT NO.
.$t?c71,6 20-EI)-150
EXISTING STRUCTURES ON PROPERTY
CODE
CENSUS TRACT
17
APPL
NAME
&
MAILING'
WESTOVER CONSTRUCTION
2189 NORTH 11TH PLACE
NONE
LEGAL ACCESS'TO PROPERTY
BURLINGTON STREET.
PROPERTY SIZE - FT.
ADDRESS SPR I NGF' I ELD. OREGON
FOR MOBILE HOME' PERMITS ONLY
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
WIDTH
DEPTH
AREA
Connect to Existing Sewage System D
TYPE CONSTRUCTION SQ. FT. # BDRMS
New System D
VALUATION
Dt1E-LL I NG -l\1A I III
rRAME
1200 @ 12(1)
'14n~OO
GARAGE ~ UNilE I LED .~ ATTACHED
501 @ i
1 ~ 511)
-r5,9f5~
INSTA'Ll SUBSURFACE SElt/AGE DISPOSAL SYSl'EMo
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SEWAGE DISPOSAL.
PUBLIC 0 SEPTIC TANK fill
BUILDING t
WASTE DISPOSAL
PLUMBING
. PLAN REVIEW
PARK TRAILER
OTHERD
62.00
, 20.00
24.~
FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER: NAME
WATER SUPPLY
PUBLIC )tJ
o OTHER
TOTAL
~,
106. l:j{)
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX, GAL
900
L1N. FT 150'
TRENCH WIDTH FT.
3
OR SQ. FT.
450
ROOF DR fllNS T.O STREET.
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TYPE OF STRUCTURE
OCCUPANCY
ZONE
PUBLIC UTIL EASEMENT
~!\l I & J
BLDG. SETBACKS n FT. FROM CTR. OF ROAD RIGHT OF WAY
USE CLASSIFICATION
FRONT 45
SIDE INT. 5 SIDE EXT.
AUTHORIZED SIGNATURE - DATE
REAR 7wmn~
Is/ Jo 80ss BY CHARLIE HARBAUGH
JOHN CRUICKSHANK R~S.
4h(l~~
1:Jlli1l1I...U;j
BLDG. PERMIT - WHITE
, OFFICE COpy - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
Construction to' comply with uniform building code and cou'nty regulations
covering plumbing and sewage disposal. All buildings require a certificate
of occupancy before being occupied.
(See Statement on Reverse Side)
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LANE COUNTY, BLDG. & SAN. DIV., COURT HOU!iE, EUGENE, OREGON '97401
FORM if: C55-13
BUILDING SiTE EVALUATION
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. APPLICANT: .' 7
Appl ication No. 32.3'--73 NAME W~lO VF-r2.. G-Ndll<,
ADDRESS,
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.x' Bu i I ding Pe rm it
() Site Inspection
() Pre-Permit Investigation
PHONE
DATE .3--1- id
LANE COUNTY PLANNING DEPARTMENT
I.
Zoning Ordinance Compl iance
(Zone R:' )
Subdivision Ordinance Comp -iance
NOT
. app I icab I e
() ()
( )
( )
( )
( )
NO
YES
NAME
DATE
3.
Required Access
( )
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2,
4, Building Site (Area; Width,
Frontage, Setback)
5. . Other (see comments)
( )
COMMENTS:
BUILDING INSPECTION SECTION NOT NO YES NAME DATE
app I i cab I e J/r
6. P 1 ans Subni i tted ( ) ( )
7. Soi I Stabi I i ty (foot i ngs) Jr1 ( ) ( )
8. Flood Plain ~ ( ) ( ) e~~/L' 3~~,j73
9. o the r (see Comments) .j) ( ) ( )
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COMM ENTS : rf"
SANITATION SECTION NOT NO YES NAME DATE
app I icab I e J>4
10. Sewage Disposal ( ) ( )
jl. Usable Area ( ) ( ) <A ~~. ~if73
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12. Water Supply ( ) ( ) <Xl
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J 3. Other (see Comments) ( , ( ) ( )
COMMENTS:
TO APPLICANT:
You.r r y B. rrJing Permit / Sit, e Inspect i~
( V Can be app roved. .3 -? --- ? 3(f!gf, . .
() Cannot be approved at this time as indicated on item NO. above.
Quest ions and further informat 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 Divisio~.
() Will be held in this office until you can resolve the problems indicated.
() Is being returned.
() Your buildi~g perm~t appl ication fee is being returned under separate cuver.
LI\NE COUNTY" PLI\NN I ~G QfP/\RTMfNT
lOll, Sixth l\venUt~ East, ELJ~Jelle, Ore9un
97401
LANE COUNTY BUILDING & SANITATION DIVISION
135 Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342-/31 J .. EXT. 411
PHONt.: " }llt-:13 '.,1
JXT. 231
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PERM IT
IN THE BOARD OF CQUNTY COMMISSIONERS OF LANE COUNTY
WHEREAS, the attached appliCation has been fully considered by the Board of
County Commissioners of Lane County, 'and it is the opinion and judgment of, the Board
that the said application should be granted, and that a permit ,should be issued, now,
therefore, it is hereby
ORDERED, that a permit be and is hereby issued to
WC3t:~o.e ('wst!'tl:!:!ti()fl C(l\::J:;l.aBY
and constructing of the following facility:
for the placing, building
Lls-;li'iN,!i\:my a\?r~l:'ooeh l.0it~ ~'lf~~;) oot-u:;'j:\ccw11ll.'lt"\j \I'!11age-nlcck ~ il. .l>t /j
.1.. 71'S) I b\U? .lli,\1t&itOfi ' Ll.. h.' . n .. U if iUr~tH.. l5i'1O
upon the right-of-way of County Road No. 1$/~9 , in strict conformity to the exhibits
attached thereto, and subject to all terms, conditi.ons, agreements, stipulations and pro-
visions contained in the application and permit, the Rules and Regulations Governing'
Facilities to be Permitted upon County Road Rights-of-Way, dated 'March 31, 1960' and
any amendm~nts thereto, and any other applicable regulation, law or ordinance.
Special Provisions:
CJtiW;JO~p 'h'r.t;. 11 't>e cml$ tlft-lCt:CiJci in aiC(i:07,i1&~u:; 1;1r:l!I t:~\;;>~t e.~~j'iC,(1' f~ds.J(:t ;;~;\?
ZJ~lP~":I.(lif.I o~Q(\~f1Gat1ontl (H)\1':Ot:fint ~;9~-Sij)..
Pel:r;::.i~li.:C~ mlll be r<?o~:9I!rlLDle fOl!; tbD 1(:;:Dw.iato i:iQCll}wHl @1] ~\!1 c,!d ~ dig"
€llil,d 4ob:if;'io ffo.1l;\ the roa.dlt.flAf Ilif(~ 'det1t of \.ir,l,V' CI,1MWilll;J. hl1 ht.'3 'oi!r'g'2~1f3i!~
1{~t1\i':fl"lJl[~ ~{J; l'oor;1!i1'ay <lad C\'rOQ i;i U (2.B.:.l€:jl 1;;~eCt~t:,JbJ.{il c;ru~ti€i:;'i';)o
This permit is revocable at any time, a.nd will be strictly adhered to and no work
other than that specifically mentioned above is'hereby authorized.
This permit shetll ,be void unless the work herein contemplated shall have been
completed before
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,19 . Expires
, 19
Inspected and Approved
Approved by Board of Commissioners
By ,
Date
.,
.; .
By
Director of Public Works
'" WHI'TE . OFFICE FILE PINK. PERMITTEE ORANGE. BUILDING & SANITATION DEPT:
GREEN. RESIDEN,T ENGINEER BLUE. ROAD S'UPERVISOR YELLOW - SURVEYOR
.os- 52
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APPLICATIDN FO'R F:""ACILII'" PERMIT
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IN T'HE BOARD'OF_COUNTY COMMIS!nONERSOF"LANE COUNTY
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Your appl ieant,' '. h" . "'-::'" \:j. ,,(ii, .
,herebY makes 'appncat.ion under Rules and ,Regulations.Governing Fa'cilities to be
, mitted Upon' Co~nty Road R,ights~of-Way, to constructt~eJollowing facility:
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Per-
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Upon ,~he right-of-way' of COl.lnty Road No.
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,at the following location:', .. -:, '.
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" as shown on' tl)e ~xhibits' ~h':ich)are atta~hed.h~reto, in strict confdtrl1i'ti:,to'''the "'s~~t~ .,"
ments ot the~exact'nature and amount of work to ~e d~ne,and to the' description of 'th~
, .' . " . ".', '.. .', -.
:facilities contained in sa'idexh'ibits. Your applicant wiU,be: the benefiGial owner 'of the..
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.:facility, as constructed, or otherwise primarily liabl~ and responsible to members of ~he
, pubHc', for its' proper maiQtenance, repair, operation and use. Your a JlP Ii,can.t a~cepts tall,
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terms, conditions. agreements., stipulations and provisions. in Rules .and Regulations
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GO\l'er.ning Facilitie~ to b~ Permitted Upon Coun'ty Road Rights-of-Way, 'dated Ma'rch' ,31,
. . . I .'
.. '.1960;'and any amendments thereto, and any other appli~a~leregulatio'n; !aw orordinan~e.
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Signature'
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Address
WHITE - OffICE fILE
GREEN ~ 'RESIDENT ENGINEER
, ,PI,NK' - PERMITT~E
BLUE -ROAD.SUPERVISOR
ORANGE- BUILl)ING A !liD SANITATION DEPT.
. " YELLOW -SURVEYOR
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FHA FGRM NO. 2573
Rev. 10170
'-
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
FEDERAL HOUSING ADMINISTRAT~:ON
HEAL TH AUTHORITY APPROV AL"'~
.... I,N)b!Vl~L WATER SUPPLY AND SEWAGE DISPOSALSYST~
H". ff.,~,~ PART I -TO BE COMPLETED BY FHA I r \
( '.v,.",~"~,, ., I'
.:.t ~ '''~'' ,t~<~',;:....~. FHA Case1No.
1'10. __ .
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'.:7 - 3-.) Y 3i(3~7r
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Form Approved
Budget Bureou No. 63-R0296
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Insur){llfoffice ~
PAID <.
~~~~W~rm
1'1)
MAY 11973 L.::/
Mortgagee - Name, Address and Zip Code
I
First National Bank of Oregon
Real Estate Loan Division
Po o. Box 1786
Eugene I Oregon 97401
Mortgagor or Spo~sor:
I
WESTOVER CONST~~~J;~~~H DEPT.
Property Address:
2797 Burlington
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SubdiViSion:
Lot No.
L
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CANTERBURY VILLAGE FIRST ADDITION 7
II Can Attic or oth~~e ~ade into additional
K--1 New Installation bedrooms? (I! yes, how many?)
o YeshJ No
SYSTEM DESIGNED FOR
T9TAL- ~ll.~R"R
T TVTN" TT~r'l''' I RF,OR().QMS RA.'I'H!':
BASEMENT
1
3
1.
D Yes ~ No
WATER SUPPLY BY:
kXJ Public System,
SEWAGE DISPOSAL BY:
o Public S):'stem
o Communi ty System
D Individual
No. of
Bedrooms
Garbage Disposal
D Community System CJ Iridividual 3
PART 11.- TO BE COMPLETED BY HEALTH DEPARTMENT
DYes
GJ No.
HEALTH DE PARTMENT INS PECTOR'S SKETCH
B.Po 323-7$
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::=::::=::::::::=::3=El!=i= ::=============:~: ::t'= --I I_=F=:: -
~~~~,t~f:=~~~:-::==~~- ~h~~~~,f~~~d:..:'~ r,~,=~= ~r,~ __--
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!!! ~I~~~:~ ~ ~ [~~1~,~~ ~~ i:~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ - ~,-,~ ~ i ~ =~ ~:: =::rn,= =:
:::::::: = i:: =:: ~ = = ~ = ~ = = = = = = = ~:: = = = =[= = t =:::: ~ - ='='= =:::= =:= =, t = ='=: =:= ~ =,
It is the opinion of the D State D County Local Department of Health that this individual water-supply system
o is D is not satisfactory as a domestic water supply for the s~bject property.
It is the opinion of the D State [i] County
with proper maintenance:
KXJ Can be expected to function satisfactorily, and
is not likely to,create an insanitary condition
DA TE SIGN€!' RE
o
Local Department of Health that this individual sewage-disposal system
D Cannot be expected to function satisfactorily
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5-8-73 A. KIRBY, R.S. SUPERVISING SANITARIAN
NOTE: The health aut~rity 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 at the opinion of the
hec Ith a uthori t>:.
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 Acceptaqle
Sewage disposal be considered 0 Acceptable D Not Acceptable.
DATE
SIGNA TUR E
o CHIEF ARCHITECT
o DEPUTY FOR CHIEF ARCHITECT
HEALTH AuTHORITY APPROVAL
INDIVIDUAL WATER SU PPL Y AND SEWAGE DISPOSAL SYSTEM
FHA FORM NO. 2573
Rev. 10170
REPORT OF INSPECTION-INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PRIMARY TREATMENT consists of IKJ Septic tank. 0 Cesspool.
Septk Tank:
Distance from well.
Total liquid capacity.
Inside length._Zl\~ 5~)
C.up_1:
Distance from: Well.
feet, Material
r"'........~t..
Number of compartments
i:--'
._"eo
feet. 'i.\
l.'allons.
too.n gallons. Capa<.:ity inlet compartment,
feet, Inside width,!i;~r;~3 feet. Liquid depth, ;,;k-~\
feet; foundation,
_ feet; nearest lot li'ne 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 IKJ Tile disposal field,
TI":Dlspasal FI.ld:
Distance from: Well, feet; foundation, 10 feet; nearest lot line at 0 fronf, ~ side, ~ rear, ,10
Total length of tile lines,Cj sri') feet, Number of lines, 2 Distance between""JiQ,~~,_---Z--i-~\
Trench width, ':t6 inches. 1;oea.1 effective absorption area in bottom of trenche~. ~"J..s',g
Length of f.:ach li~e. }.:Z~t.... A0' r) feee, , Depeh. cop of eile to finish grade '
Type of,filter m~eeriaI:. [2g Gravel. 0 Broken stone: . Oth....
- - Depth of filter material beneath til.. h inches. Depth of filter material over eil.. 2
r '" ge Pita:
feee.
feet,
square feet.
inches. -
inches.
Number of pies__. . Outside diameter, feet.
Distance from: Well,_ feet; building foundation
Depth, feet. Lining material
feet; nearest loe line at 0 front, 0 side, 0 rear
feet.
Inspection made by: 0 Staee, lXJ County,
Date of inspection_
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o Local Healeh Authority.
Inspeceed b~
,19_
John Cruickshank, R.S.
Sanihar i an
(TITLE)
REPORT OF INSPECTION-INDIVIDUAL WATER-SUPPLY SYSTEM
Distan<.:e to nearese public water main, _, feet. Size of main. inches,
Individual wells 0 are 0 are' not <.:usrornary III neighh9rhood.
Give most recent r<.:'Cord of failure of wells in immediate viciniey to furnish adequate supply of water
Properties in neighborhood 0 are 0 are not being developed with both individual water.supply and sewage-disposal syseems.
Loe size: feet wide.___ feet deep. Dwelling see back from front property line, feee.
Individual water supply from: 0 Drilled well. 0 Driven well. 0 Dug well. 0 Bored well.
Dlatanc. of well from:
Bu ilding foundation,
cast iron sewer
feee;
nearese lot line ae 0 front, 0 side, 0 rear,
feee; septic eank feet; disposal
feee; ocher sources or possible pollution,
field,
feee.
f-t,
feet;
seepage pit,
Well construction:
feet; tile sewer.
feet; cesspool
Diameter inches. Total depth,
Approximate depth co pumping level of water in well
Sealed watertight to depth of feet,
Exeerior space around casing sealed wieh: 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 pipe feet. Pump capacity,
Located in: 0 Basement. 0 Pumproom off basement. 0 Pumphouse above ground, 0 Pump pit.
Pumproom properly drained: 0 Yes. 0 No. Pump mounting waeertight: .0 Yes., 0 No.
Type of storage: 0 Pressure. 0 Gravity. Capacity, gallons.
Has bacteriological examination of water been made? 0 Yes, 0 No. I('answer'is "yes," give date
QualitY of water 0 is 0 is not satisfactory for human consumption.
Installation 0 does 0 does not comply with approved exhibits, if any.
Inspection made by: 0 State. 0 County, 0 1.<><:a1 Health Authority.
Inspected by
feet.
Type of casinr
feet. Approximate yield,
Depth of casing,
gallons per minute.
feet.
gallons per minute.
,19_
Date of inspection
19_
(TITLE)
GP 0 900.682
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PROPERTY OWNER ' 'MAILING ,ADDRESS 'i';.' " ,
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CO,NTRACTOR "MAILING ADDRESS ,.' .', ' , .
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"PROPERTY LOCATION -;- INCLUDE'POST'OFFICE ' '
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PROPERTY LEGA,L DESCRIPTIQN-METES'.~O(jt;lDS ,
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TWP'''' RANGE SECTION. TAX LOTNO, COD,E
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US'E PERMIT
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LEGAL ACCESS TO PROPERTY
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PROPERTY SIZE....:. FT.
APPL.
NAME ~~'llQl:fQ.Vf!Q (oOJ-lST~JtlCf. lorJ
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MAILING "~""..\,,. , \~. i,"""
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ADDRE'SS " g;~n t~a9. ~t..9J1;HQ;I~GQn , ~
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No.: of. Bedroom's . "S '. .
,1,' "STRUCTURES TO BE BIJILT'THIS PERMIT
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WIDTH, .
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';~t'" TYPE CONSTRUCTIoN
. V'aM,$ .
t\<~ \:. \ \
. ,
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'lln' ~'I ~''f'', " '.. ,. , \~ _ '" 't,~ ,,\ ,.'~:" "-',.,... ,\:'\. ',',
\., . .. \'f..i' \~ \. .
'.\
',"":SEWAGE DISPOSAL .
,DEPTH
~.},
"',
Sewage SYstEimD
SQ, FT. # BDRMS
laoQO tft2, (:;)
r;;:, ;:,n,: hi (> i)
J'{-4!i.' );;}
\~
" ,
~";.~".,. -".. l~-., ':"
\~ :,:.;
~.~
SE~TIC TANK,i ~
. PLUMBING INSTAqED BY
OWNER 0 OTHER: NAME
WATER SUPPLY
"",'
PUBLIC' [j
OTHERD
61:.. CO
.ti!0400
,~ 4." Ii).'
,', '
~ '. - ,-
..~
PUBLI!= .I!J
BuiLDI~G
'w ASTED ISPOSAL
.J. '". ~ ,r-
PLUMBING,:
Pl~N;,..REV~EW
PARK ;rRAIL,ER
t
FEES
lOG. ~
COUNTY 'BUILDING & SANITATION SPECIFICATIONS
: , : M,' IN."SEPTlC TANK CAPA'cfT\. ~ .DRAIN FIELD REQUIRED
': WITH DIST. BOX: GAL ~~\ ~1t~.\FT.,\ J~ TRENCH WIDTH FT. .3
_~,) \:.." .'~ - c,
. g;:Ci'f::,? Oi'J Mt'~e t~~'m:&l. ! ~\ . ~_~~ \ ..... A
" , .', - ,.. '~""'(~', .
~.,' \;, ,
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,.,' TOTAL
~
.0 OTHER
'-.pR, SQ.. FT.
. ;,-,. ", .
,. \:~. "',-, '\. ~,1~ r"::"';'i...'i. ': :r,
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-~"t~ \'~ ~~~~
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TYPE OF STRUCTURE,
OCCUPANCY
'. &,4
ZONE
P"1' '
.L~k~
BLDG. SETBACKS
FRO NTP)J'
".6..:" 4 'I
!f 01;~ '\II.,
n FT. FROM CTR. OF ROAD RIGHT OF WA.Y.
SIDE INT. ;; SIDE, EXT.
AUTHORIZED SIGNATURE - DATE
,8t't$$ ,f;V ttfA.!:'H.t$ ,Hf)nt~.t.\.oo}J
'1tz~J~}
'~,. ~U.ti\$"i\NK R.S.,
USE CLASSIFICATION
REAR
, ':'BLDG.: PERMIT - WHI:rE
'OFFICE COPY - WHITE
" ,'COUNTY TAX - PINK
,PLUMB,ING - CANARY
,. BUILDING~ GREEN
SANHATION - GOLD,ENROD
I..'
,
" ,
('; S,') U'
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~t
,,..~ '\..; .; ~"",,-t;
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j'" ,
FORM'#CSS-13
" ......-.- ,.
';'
AREA'
New System 0 '
VALUATION
. t4,t~. , '
l~~lS: _~_~
't 5.j~n ~~.
..
--,.#
'."
~
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PUBLIC UTIL. EASEMENT
;'-
-i~':S/i;5
; ,
, ,
C'onstrl!ction to comply, with.uniform, building code and county re'gulations
covering plumbing 'and")e,wagedisposal. ' All, buildings require a i,certificate
'of occ'uRan'cy bef,ore, being,o.ccupied.
r:",\~..t..::::;_\ "-'~.~'\" ~~":;':}:'~"~...\)_. ,~'.~.
, r~:~\,-',,; "";>";;'):"""!\See' Stbtement on R.everse Side)
'!w.~ . .,"'< > \),~~t1 $"~ \',:>:".; ',,~ "~':."_i'<ii'; ,'-\, ~nl,,,,t'-> V;';'"
t-K":C\')'~'\f~'.}:'~''',..~\\.J '\. '\, \ .J", ,,-.';j" ':/ ";. .,.,:~~"');,,,. '''..' ,,,' '9 ~..' .i', ';,,/
"'(POST tt:llS PERMIT 'ON. MAIN BLDG. AT SITE)'
.t, .'" ,I. '-. I
LANE COUNTY, BLDG. & SAN. D.IV., r;:OURT HOUSE, EUGENE:" o.REGON '97401
j'
,. ~.. "".....
'l " lJ _'II
SITE I NSPECTI ON
ApPROVED /
/ DISAPPROVED / / DATE
REMARKS
FOUNDATION INSPECTION
/
ApPROVED / {~I DISAPPROVED I
',?~l 7 ,),7 ,"'}
I DATE ,"J '~c;>" (./.
REMARKS
FRAMING INSPECTION
ApPROVED / i/ / DI SAPPROVED / I DATE L/. -( f'/7~1
/J .' /. / . .-:2.' ,~)
RE M (>. RK S /-'d'-t'V-~cti..-:c-A0'{#;...?:~i!4-1'..(i ,3.:.2 a -' ~'f.1 k~
/- ; i
/
,
LATH OR SHEETROCK INSPECTION
ApPROVED I
'\
REMARKS
\,
/ DISAPPROVED I
/ DATE
".. ./....--
INSPECTOR
INSPECTOR tZ!('
.. 7
INspec'o'~ .
INSPECTOR
FINAL INSPECTION
/' , "2,.....11
ApPROVED / tA DI SAPPROV.ED / / DATE ,,- I ~, INSPECTOR
Re""" rl<fiI~~ .r~fl' 73/( 4th>.f'-2t""
CERTIFICATE OF OCCUPANCY
\
\
I ;ft:Tt
,
, READY TO ISSUE / I NOT READY TO ISSUE /
REMARKS
INSPECTOR
~ ~- ~ DO
..
~
,. . _ .' .' <', . , . . . ~-,~:~......~.~..Jt.\~ ~f~j~i,fi,tj.~J,~'F:ril.:'~~~~v,~...ut'~~i~
~}~~j;,..Fr:7:~c::C:I~G-:r i~:'MO~I(t~6C::ts~ 'P;RMIT . '~,::::~l~,
,. , BUILDING rn ' ,MH, 0 ,_, PERMIT NO.. '. ~~t~~' ,','.
, PROPERTY OWNER MAILING ADDRESS PHONE ,
d::rNf.lVrl~ ,C!~t,:s.'fwtt:enQc-$ 2~~ U~fJ'i'h'3~ ~t1~j ,,~)tAet~ _~~:itSf"&-1l;:l;;~!l' .(t;-'ifrot}~J .' /1.~rffd:J!)1~' '
CONTRACTOR MAlq~G AD,DRESS " , PHONE
, .o.. {'. . + ';~;tl:-<'m." i
f~ i;Jrt-r~ ';t"trff~~f!~ .. I " _
PROPERTY LOc;ATION - INCLUDE POST ,OFFICE
~~j~~v gU1~ M-i~VOt~ .
, PROPERTY LEGAL DESCRIpTION - METES, BOUNDS , " '
"tn<:i 't' ~t.tt.,"2 is"" CltN''I'tR1)URY Vn..~iv,M~
T,WP '., . .j ~ANGE
,:
,
't.
\,....1.
SECT!ON~
'''':-~'~~~~T Ax-'~6T~~O~=\ ~ \
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'x C;o~E'"
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<;- :,.. C'ENSUS. TRACT
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e!~
t~~%~'
EXISTING STRUCTURES ON PROPERTY
, .t,.~~lt
, LEGAL ACCE~~ TO PROPERTY
~Uf('" tfilGT@,t"lt Sm~l!T...
PROPERTY SIZE - FT.
APPL.
.,NAME
&'
MAILING
: ''If!td~1'(;)\ttVl t~~O,.t'1u~'l~N'
. ~~ '~al'~' 35"4'>> 'Pe.tic~ "
ADDRESS, 8Pfl 0 t4Gte'$ ~{\'Dt, 'l1mib4~j
FOR.M.OBllE HOME. PERMITS ONLY,.
" . No. of ,Bedrooms.
.STRUCTURES TO BE.'BUIL T THIS PERMIT
WIDTH
DEPTH
AREA
Connect to Existing Sewage System 0
'TYPE' CONSTRUCTION SQ, FT, # BDRMS
, BIi~a,t. u~o * M~ Hi..
tRAM~
!f_ (} '~2 (j).
New., System D
VALUATION
i.' ~'
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-: "'-:
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,","'SEWAGE DISPOSAL
PLUMBING INSTALLED BY
'.:'
. , .
P,UBLlC .0
SEPTIC; !ANK lEi
" BUILDING
WASTE DISPOSAL.
PLUMBING
,PLAN REVIEW
,PARK 'TRAILER
t
OTHERD
62.00
, 3{).,Qn
:. '21~. ~D
FEES
"
. 'OWNER [J " OTHER: NAME
WAT,~R SUprLY .
P\.lBLlC 'r~':
o OTHER
'~,'
,t
TOTAL
~.
~O~. '10
Co.UNTY. BUILDING & SANITATION 'Sp,ECIFICATlONS
,DRAIN FIELD R'EQUIRED
11:.'fi
L1N. FT " .1"_,
. <:.... ~,-. \)"- - <. .
TRENCH 'WIDTH, FT.
,.3-
,.,9R SQ. FT.
~
~~5Q',
-'<. .
. .
. fAIN;. 'SEPTic TANK CAPACITY
- '~
c.ro:
. JI . ..':-....
')~...."'-'~' '.
, ,""''''' -.'<
$cYll1l:tT.
WITH DIST. BOX: GAL.
".' t~citl~ci}~ M~S:' it)
TYPE, OF STRUCTURE . OCCUPANCY
'i!~!, I a J
BLDG. SETBACKS _ FT. FROM CTR. OF ROAD RIGHT OF WAY
FRb!'l'T:~S ,SIDE INT. , ; SIDE EXT. REAR
AUTHORIZED SIGNATURE....,. DATE
1.S/. J"i" . ~e~ Qy ,Cnf.:~t..H~~'~A~{#A~\)H
. ZONE
PUBLIC UTlL.EASEMENT
USE CLASSIFICATION
1t~~w:.1
JOf~tj CR~.~~Ct'Jntjr..Q.~Ji '
,{i~/ .,
BLDG,' PERMIT - WH ITE,
OFFICE COpy - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
.BUILDING - GREEN
SANIJATION - GOLDENROD
Construction to ,comply" "";ith' u~iform building code andcounty~egu\al!otis .
.~ covering plumbing and. sewage disposal. ,All buildings require- a certifi~cite',
of occupancy before'being oc<:upied. .
(See. Statement on Reverse Side)
. ,............
.....~, - f-
. _ 1'. _ . . .
, '(POST ,..f-HIS, PERMIT,-.oN,[MAI~,f ,BLDg., ,A T SITE) ,
~ '. ' . . I _ '~ " ,1. " . \ .
LANE COUNTY, BLDG., & SAN: brv.;COURT HOUSE, EUGENE, OREGON 9740'"
~
K..'..
~., ;J"RM,,:it C55,-13,
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SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED I
I DISAPPROVED I
REMARKS
I DATE
INSPECTOR
GAS PIPING GROUNDWORK
-ry-~.Z-7::S - ~..;- j..~ ~~k
ApPROVED I
I DISAPPROVED /
REMARKS
ROUGH PLUMBING
ApPRO'VED / xl .01 SAPPROVED /
\.
REMARKS
ROUGH GAS PIPING
ApPROVED /
I DISAPPROVED /
REMARKS
FINAL PLUMBING
ApPROVED /~4 DISAPPROVED /
./
REMARKS
FINAL GAS PIPING
ApPROVED /
I DISAPPROVED /
. ~ . .
. REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE /
I DATE
INSPECTOR
'-iI>.
'.
,-. ot..
/
DATEC/~//?-?3 INSPE~TOR~~
t/
I DATE
INSPECTOR
I
DATE r;-.Jt.I-73" INSPECTOR~.
I DATE
INSPECTOR
I NOT READY TO ISSUE /
/ DA TE
REMARKS
INSPECTOR
.-
~
j.
.. , . ',"
.
INDIVIDUAL SEWAGE DISPOSAL SYS' RECORD
Installer: Complete top part ~ form to
signature and return both copies to Lane
County Building Sanitation Dep~rtment.
"r. _
jIII'.
I'
/
.:;J , ., I
-)C/t." /},':';-::r
rns'taller' s Name~/
r ' /1
L/ .
No.LivingUnits Bedrooms Baths
/ ,,~I
Septic Tank:
Ft. from well ,SteelO
Ins~de D~ens~ons: Ft.
Length /j<J'/ Width t,.?-J--
~pplicant /
Name Westover Const.
o.
P~RMIT No_
323-73
JC
Property Address
2797 Burlinqton
Basemen~~ Water ~~ply
Yes 0 NO~ Public OJ'. Other-List
Concrete JsJ
Diameter
I Gal. Capaci ty, I Od r!J
Tile Disposal Field:
Distribution Box: Yes ~ No 0
Other Distribution- Type
Feet Worn /f
Well/Ui" tc.'7"dundation / 0
Lot Line
Front ' Side /0 Rear /0
Tota.l sq. Ft.between Filltlfjr Y'F.ill,er depth' FU.ler depth
ftJ.I~A l' 4(......- ,above_ below/
, .,..1 I{J wes/,..) Type t.j.le:: V iD: tile:: ~ ...il:4.
I
I
Depth ~f J-
No. Compartments
Mailing
Address
2589 N~ 35th Pl.
Sprinqfield. Or.
Length of Lines -Ft. Trench
1.,M 2$03. 4. 5. 6. Width ,J'
Sketch (See instructions) :
N
'&J ~
J'.-
I '
f l~. ~G .Ji,&
131 't ~f/ <b 1 '
. ~ f () of) ~
\r_-f. t". Y,c 1\
nOVJU _ _ _
.~<~
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__' i---
~~ r
Date
;/, z'I.- /Cf 7 j.
Signat~re
()
I)~
/J
Q 1d/lE.7
;r D~~e' 1Ifi-7)/3
..
FO$ani tarian Use Only:
Approved: System Installation
Disapproved: Does Not Conform
Remarks:
Conforms to Current Standards
to Current Standards
Lane County Building &
~jr~~J
~ Sanitarian's
Sanitation Dept.'
II
5i:!!!e ~
LANE COUNTY .LDING PERMIT OR MOBILE HOM, SE APPLICATION
PERMIT TYPE - BUILDING ~ MOBILE HOME Dose REG. # PERMIT # 3;;;) 3 -7':;>
1?~~&0 'MAI:;~;r ~~S-CiC~ 7;;;-9~7/
CONTRACTOIf" /';/ MAILING ADD"" / -/ __ _ ~:;;:;, ~ . 'HON'
"OOR~~~N~~/ ~;~~r ,
PROPERTY LE~AL DESCRIPTION , .-/ ..L 7 . ~ / / v dl ~ / -;;U:/ L -. "ET" & BOUNDS 0 '"
LOT - BLOCK - SUBDIV. j?(!f-7 ,.;- ~ /-';:?--7 ~~ ~ ATTACHED 0 NO
TW/P 7 OR3ANGE ~c.. / TAX LOT # CODE /" CENSUS TRACT
~ 'f' ..::ICJ,-E D- /SV
~ ./ DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY
APPLICANT
NAME
~
LEGfi~~ 4::-~~
PRol'ERTY SIZE-WIDTH / DEPTH ~
AREA
AND
MAILING
ADDRESS
FOR MOBilE HOME PERMIT ONLY
Number of Bedrooms
STRUCTUj!ES TO BE ~U~HI: PERMIT ...
~;uL--/'~____ ~
, ~"../ I ~ ,/
~~~ ../---"-:7'~~f ~---r~
~A~-?/ ./~,
Connect to Existing Sewage
TYPE,~
System D or New System Req. D
SQ. FT. a5/z!!. ~R'\.OMS VALUATION
/.20(7 (3) /~ ~~()
" 't'1!!fl) ./::-
..s-o~ '3 I) S/.5
- ,
;s;q/S
BLDG.
WASTE DIS.
PLUMBING
PLAN REVIEW
PARK TRLR.
$
SEPTIC TANK ~
w~ht-
~/)u10
-~ -:/rS1J
FEES
OTHER 0
WATER SUPPLY
PUBLIC ~.
PLUMBINl FEtS
7 FIXTUjl.fi8" ,;:2 / - t::J (}
OTHER "
PLUMBING INSTALLED BY
OWNER 0 OTHER~NAME
PLANS FURNISHED
YESY' NO 0
~TURE ~F APPlI
FEE RE E BY
~~~fi4
YES ~ NO 0
SEWAGE DISPOSAL
PUBLIC 0
DATE
::s -/-Z3
DATE
3--/-7-3
CASH 0
CHECK tJ
TOTAL
J tJ b (s;t>
~e ttJ () ~.e.-
~RMIT r
PUBLIC WATER ~
CONNECTION FEE /;.~ 7J ..... J :;):3 - '7 '- '7f
COUNTY BUilDING & SANITA~N SPECIFICATIONS
DRAIN FIELD REQUIRED / .
L1N. FT. I~ TR~CH WIDTH FT. '3> OR SQUARE FEET sL~()
~
MIN. SEPTIC TANK CAPACITY
qao
KemP cJrttA n$ 'W
WITH DIST. BOX: GAL.
TYPE OF STRUCTURE --6"'/1' OCCUPA/C~-......--r
BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY
FRONT 4s SIDE INT. s- SI,)~ ~^l':'-
~'3lW!~
Directions to Find Property: c::2 7 <::7 7
ZONE
REAR YARD
PUBLIC UTIL. EASEMENT
USE CLASSIFICATION
REAR I J ' _ A
Dale BLDG( INSP. J/::V:J ./ /' ff
~S-7~ JrVY~(~Y'0
A----~L117~ 7
Dale
,73
COpy 1 - OFFICE
COpy 2 - JOURNAL
COpy 3 - AUDIT
Form # C55-12