HomeMy WebLinkAboutPermit Building 1982-2-2
PLANNING & COMMUNITY DEVELOPMF"T
AC .1VITY If'~iFORMATI01~
SHEET
bne county
"
COMPLETE THIS SECTION
INCOMPLETE FORMS WILL BE REJECTED~
CITY
STATE
ZIP CODF
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'-----"
~4 CPtJnT~11 ,L
MAILING ADDRESS
~~d.
'fITU'
L!.o1\J?:?S
PROPERTY OWNER
(i)
.
,
.
PERSON MAKING ill {JVEST
MAILING ADDRESS
BUSINESS 'lELEPlIQNL NUMBER
HOME TELEPHONE NUMBER
i87-Q7dOLj
BUSINESS TJ:LEPl-IONE NUMBeR
HOME TELEPHONE NUMBER
Q) TAX MAP/PROPERTY DESCRIPTION NUMBER (from
lr 03
Townslup
tax maps ~n Department of Assessment & Taxat10n
?j3, 3,0rax Lot(s) ~
Sect10n
o Out of TL ~
or from tax statement)
Hap & Parcel Number
Range
./
By Partltlon ~
Tax Map & Parcel Number of Ad]Olnlng Property In Same Ownershlp
Tax Lot(s)
Townshlp Range
o None
Sectlon
o Unknown
Q) SUBDIVISION (J.f appllcable)
COMPLETE THIS SECTION FOR LAND USE,
CONSTRUCTION APPLICATIONS, OR PROPOSALS
de5mbe wformat>on needed) (l21ty\ fi 1.(1 AI\ (Irl Q:OC~ rJ(A;;~ ,
(,l YAh D ,hm 1 ex J) lPitv-G ~Y 0 (J
,
/
@ REQUEST (brJ.efly
nJ.')(d nis"
Q) TOTAL CONTIGUOUS PROPERTY PJ SAME OWNERSHIP
acres
**FOR STAFF USE ONLY**
NUMBER I G
:::: IrzEf{uJ1V ~
Jo : tll
-,;;... .-
SEE *NOTE BELOW
Q) PROPERTY ADDRESS
Q) PRESENT USE OF PROPERTY
CHECKED BY
Modular home
RV ~n use as res1dence_____
Storage_
ATTACHED EXHIBITS
o Plot Plans (2)
D Constr Plans (2)
@ NUMBER OF STRUCTURES ON PROPERTY
Standard home
Moblle home
Garage_
Other (speclfy)
Shop_
Barn
Ds>te Plan
[JCopy of Tax Map
Dother
@ ACCESS TO PROPERTY Pubhc Road Name
SCREENING VERIrICATION
P~lvate Road Name
By
Road Easement
Wldth
# of
Users
Date
@ OTHER EASEHENTS OVER PROPERTY
T~me In
Out
(j) t1ATER DISTRICT
@ FIRE DISTRICT
o Accept 0 Reject
Routed to
@ PENDING PE~1ITS ON PROPERTY
9/81 REV
(OVER)
*NOTE ATTACH A COPY 0-
TAX MAP SHOW EXI~~I~G
STRUCTURES AND TAA LOTS
IN lOUR O\{NERSHIP OB-
TAIN TA~ ~~p IN S~lf
BEL? ARE~ OF A & 1
COMPLETE THIS SECTION FOR LAND USE OR CONSTRUCTION APPLICATIONS.
~ PROPOSED US1 or PROP~RTl IN DETAIL
{!) BUILDING RJ:QUr:STS
Contractor's #
(for mobllc home setup also)
Dlrectlons to Slte
Check the type of permlt requestcu
D Dwelllog
DNew
D Md>bon
o Addl tlonal,
o Replacement
o Alteratlon,
o Moblle Home - Model
D Standard Constructlon,
Year
D Modular Home
DRV
o Plan Check Only
o Conunerclal
Use
Floor Area
o Agrlcultural
Use
D Others
Use
Floor Area
o Cha'1ge of Use - How?
Q) NUHBrR Ol~ BLQROOHS
NUMBfR or STORIes
Q) SANITATION REQUESTS
[] Sltc evaluatlon for SDS feaSlbJllty
[] New system lostalJatlon
D Repalr/replacement
o Alteratlonjrelocatlon
o Hook 'to eXlstlng
ADDITIONAL INFORMATION
**FOR STAFF USE ONLY**
..
70NC/LAND uc;r
By _~
Dote z- '7_
Tlme In )~t
D Accept
D Reject
D Planolog ^p~llcatlon
[]C~uctlon Permlt
~formatlon Only
QA
l\pp
Zonlng
Comp Plan DeslgnaLlon
SANITATION
By
Date
Tlme In
Out
D Accept
D Reject
D Constr Perfil tIssue
o Slte Lv"luatlon Issue
PLRMIT ISSUr::O (SAl'-1E DAY ONLY)
Permlt ff
ny
Date
Tlme In
Out
,
MEM,RANDUM
lane county
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SUBJECT (" IT'n.f.JJ1;,Jl,., ,__ -7;,. f;.
~~ DATE 62.~;t- ~
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