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PERMIT #
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LANE/COUNTY PERMIT
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Acreage or Lot Sizo
Contractor's O,S, #
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Partitioning #
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STRUCTURES NOW ON THE PROPERTY
( ) Contractor. (
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APPLICANT'S NAME AND ADDR""" :'j
OWNER'S NAME AND ADORES"
CONTRACTOR'S NAME AND ADDRESS
Mail permit to (/..-)'Applicant ( ) Owner
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THIS PERMIT IS FOR .'
'ATER SUPPLY, " j,
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SEWAGE DISPOSAl
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PLUMBING BY
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THIS PROPERTY IS WITHIN ONE MI LE OF THE CITY OF
I hereby certify that the above statements are true, and accurate, and that I have the following legal interest in the property: _owner of record;
contract purchaser; _ potential buyer; _ realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of:
record, and that 'j"id owner is aware and approv,of this action, I hereby agree to comply with all applica,?le Codes relating to this permit.
Fee Paid $. L) l ,,:] (: (/~ If '5:22!E . Signature .)/.adC-C if: .LkCI' OW to /;:1.1/77
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( ) NEW ADDRESS ( ) FACILlTy'PERMIT TO TRANSPORTATION DEPT ( ) SPECIAL PMT. AREA. MIN, ELEVATION:
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
BUILDING
C A/ Type of Construction .j -,-r7:;oup
, ,,-.'~ I'se Classification
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Fire Zone
SANITATION
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By: ~.., c.. - .""'. Date: -..~:". .~..., By: 1: l ,-r-;!-.-" /~...,.", ""--='..t':"r.l~Date: I; - ;;
PLANNING REOUIREMENTSSATISFIED. Bv:,,"p ;c, 1'--: Date: {.r~;l/- 77 Date Issued: 7-5-77
ZONE: ,{~: .4 SETBACKS: FRONT L": 1/ SIDE FACING STREET (FROM <:/U INT. SIDE YARD 7/ REAR ~/:Y(FROM P/L)
LANE COUNTY DEPARTMENT OFENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401 PHONE: 687,4394
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POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. PERMIT - WHITE; BUILDING -.G~EEN; PLUMBING - CANARY; SANtTATION- GOLDENROD; OFFICE COPY - WHITE
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INFORMATION SHEET
(}() Building Permit ) Site Feasibility Study for Septic Tank Number of sites
Acreage or Lot SIZo /? . -ast holes wd I be ready
Partitioning # ( ) Completed '~,s,on /J1~bA'1~/~ .h/f)~~
( ) Pending } 0
APPliCANTS NAME AND ADDRESS '^/,," 1/1 lZ. P W, J I It..fo 7 AI 6 d<;~""J' ~ elt!
OWN ER'S NAME AND ADD R ESS, If different fro'l4, apPlicant';Je,...... 1-/,/1 :2 Y7D ("I. QT-eov PI' -S;.ro.y:6..e/d'
CONTRACTOR'S NAME AND ADDRESf:
Mail permit or results of site feasibility study to IX) Applicant I ) Owner ( I Contractor
, ) Prefer to pick up Call (owner, etc ) when ready
Lot
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Block_ /3
Phone 74-'6 -?36 7
Phone 74'(, - !i"J?'~ ~
Phone
Contractors O. S. #
STRUCTURES NOW ON THE PROPERTY
tin use
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PROPOSED USE (this permit) 70
WATER SUPPLY RON. "nO<)
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(existing or proposed well, etc If publiC, name of systeml
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SEWAGE DISPOSAl
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(existing or proposed septic tank, etc) S I ~
PLUMBING BY
Address
) PROPERTY IS WITHIN ONE MILE OF CITY (
* * * ** ** **** **-ll--ll- * * ** **** * **** ** * * *** **"* ***** 0 FF ICE USE ON L Y BE LOW TH IS LIN E * * * ** ** ** * ** * ** * * ** **.. * * * *... ** * * * * *... -IE-"* * *
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( ) New ~s~ecessary ( ) Facility Perml) Necessary
ZONE~ rr SETBACKS Front -0.5 Side FaCing Street
(FROM CENTERLINE OF ROAD)
) Special Permit Area M,nimum Elevation
Interior Side Yard 7 (Rear '8 () I
(FROM PROPERTY L1NESl
To Planning/Building Inspector/Sanitarian/Surveyor
ThiS applicant appears to have a problem with
Your assistance Will be appreciated
By
. Permit Processing Section
Responso
C5512
By
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Pemllt Processing Section
125 East 8th Avenue
687-4394
DIVISion
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JOB LOCATION
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/ j , 'PERMIT #
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Acreage or Lot SI70
Contractor's 0 S #
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Partition I ng #
APPLICANT'S NAME AND~DDRF""
OWNER'S NAME AND ADD'RESC:
CONTRACTOR'S NAME AND ADDRESC:
Mail permit to (,t..).Applicant ( ) Owner ( ) Contractor
STRUCTURESNOWONTHEPROPERTY 5-FD,
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THIS PERMIT IS FOR ::J/.;rIJ'J~'9."j(?, (J~: J c~~1LI (}J7 ~
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iT..u..-lI ~ SEWAGE DISPOSAL
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LANE COUNTY PERMIT ,J.Acf!
'..( ) Completed Subdlvl~,on /r;.t: hn..-<~ }J1'ci-/~ ,I
Lot ~ }/' Blo{k / ~
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Phono
Phono
(owner, etc) when ready
# BEDROOMC:
WATER SUPPLY
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THIS PROPERTY IS WITHIN ONE MI LE OF THE CITY OF
I hereby certify that the above statements are true and accurate, and that I have the follOWing legal Interest In the property _owner of record, ~
contract purchaser, _ potential buyer, _ realtor or agent I further certify that (If not the owner) I am authorized to act for the owner of
... --
record, and that said owner IS aware and approves of thiS action I hereby agree to comply with all applicable Codes relating to thiS permit
Fee Paid $ Lif."::; rl S,gnaturp _ "J.Ia.L..-J, I? Lt/P Date ~ /.:1.//77
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) NEW ADDRESS ( ) FACILITY PERMIT TO TRANSPORTATION DEPT ( ) SPECIAL PMT AREA MIN ELEVATION
SANITATION
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M,nimum Septic Tank Capacity (Gallons)
Dralnfleld ReqUired Lineal Feet
MaXimum Depth , '
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BUILDING
'SA./ Type of Construction 7-,7"'G.:up
IJ I 4' /7 _Use ClaSSifIcation
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Comments '
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Fire Zone
Comments
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By ~- ~'!-l,*-~_ Date b -;L) -7? By ~r. U~ 1.)-''tJ ~~Date ,(., - - X ' 7'7
PLANNING REOUIREMENTSSATISFIED By lJrl, XA.A~ ), 'Date frri/- '/71 Date Issued 7-5-77
ZONE ik-) ;:::+. SETBACKS FRONT L "')/1 SIDE FACING STREET (FROM CIL) ...!..NT SIDE YARD 7/REAR<-50/(FROM PILI
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE, EUGENE, OREGON 97401 PHONE 687-4394
POST THIS PERMIT ON MAIN BUILDING AT SITE
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C5513
SLOG PERMIT - WHITE BUILDING - GREEN PLUMBING - CANARY SANITATION - GOLDENROD OFFICE COPY - WHITE
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SITE I NSPECTI ON
ApPROVED ~
DISAPPROVED
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REMARKS
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FOUNDATION INSPECTION
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ApPROVED 1-.:::..1 D\ SAPPROVEO L-I
RE MAR K S ...::JJ .t::- ~ ~ .j",.,
DATE J{~/?-7J INSPECTOR ~
t!~.- ?- 1~-77 ~.re
FRAMING INSPECTION
ApPROVED 1-:71' DISAPPROVED 1 1 DATE .>]- /fo - ? 1 I NSPECTOR ~
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REMARKS
LATH OR SHEETRO~SPECTION
ApPROVED ~ DISAPPROVED ~
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DATE cf-')./~I'7 INSPECTOR 9~
<0/"-)"2.-"77 ~
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FINAL INSPECTION
ApPROVED ~DISAPPROVED
REMARKS
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17 DATt->- k>-7>? INSPECTOR V" ,-~~"
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A....n--J/ - ~ rA<~ /2-/2.-77
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CERTIFICATE OF OCCUPANCY
READY TO ISSUE / / NOT READY TO ISSUE 17 DATE
INSPECTOR
REMARK 5