HomeMy WebLinkAboutPermit Building 1976-6-21
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CONSTRUCTION [Xl MOBILE HOME [l PLAN REVIEW [] CHANGE OF OCCUPANCY [ ]
LA~COUNTY PERMIT FOR:
.
PERMIT NO.
121i7-7"i
DOwner
,Jim .CilVllnallGh
NAME
~7'1 SHvp\" r'~::>lldn~l!: r}r;vp
ADDRESS crry
Flln!>n" Or,'nnn
-ZIP CODE
PHONE
o Contractor
S'I!np
NAME
70(,;(\
ADDRESS CITY
;'-1' ~~ <
~c:ection~Tax Lot~_ Code
Pe6t 11 B lock ~ Acreage
ZIP CODE
PHONE
0,5, Reg, '"
Twp 17 Range
5 b2d".d.l:\dd to Gardenway
u IVISlon
Census Tract
Width
Access to Property (Road Name)'
lh\\
Diamond Street
None
Depth
Existing Structures on Property:
Directions to Property. Address:
Centennial to Andarson to Diamond
1311 Diamond Street
STRUCTURE (# BEDROOMSI
\'Anni-e- oF""" n..,n.ll ~ft,..
-.. -. . ...~
~~-~~~ ~-- ~o~~~-
-.....- ._r --'-;J-
J:'lIgDn&:\ nt"fOgnn 07dn1
so. FT.
147; ra ?-lSm
~Rn III ~ 'In
3 Eled:
VALUATION
:)3~,15!j.O(l
p. J.074.[)1l
~i~5 .22Cl. 00
SEWAGE DISPOSAL:
PUBLIC I I SEPTIC TANK [
OTHER [ ]
PLUMBING INSTALLED BY:
OWNER [] OTHER I] NAMF
WATER SUPPL Y: PROPOSED [ J
EXISTING []
[ ] PUBLIC
[ ] COMMUNITY. NAME.
[ I PRIVATE WELL
[ J OTHER. SPECIFY.
BUILDING 14; nn
PLUMBIN(.; 'I? nn
3% SURCHARGF <; '11
MOBILE HOMF
WASTE DISPOSAl 7" nn
PLAN REVIEW
'TOTAL 257.31
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY:
GALS._ 900 MIN. DRAINFIELD }RO LIN. FT. MAX. TRENCH DEPTH 30' INCHES
lilS"tallln W~ approvea area or tne test no1es in back yard Ke:3p C:ra1nl1ncs l\l fact '(l"Or,l
;..0 1l0llS, ,:n<J property Ilnes
TYPE OF CONSTRUCTION "~I
GROUP
H..1
FIREZONE
STAY 100' FROM ALL WELLS
USE CLASSIF.
SETBACKS. FT. FROM CTR. OF rlW:
FRONT 8.<; SIDE EXT.
FT, FROM PROP, LINE:
SIDE INT. 5 REAR 5
ZON"
11(;1"
AUTHORIZED SIGNATURES:
/s/. ,j r- r.ln~t" hu IJ~....h.':IllI"'''''
. -- --~..
,. ,..~.....J_~_.I"'...._"'_.~
- -. -.I' .......... v..... ......,.
ISSUANCE DATE:
6/21176
d1rll
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT:
Call 687.4065 to schedule all required construction inspections. Call 687-4061 to sChedule all required
septic system Inspections. All construction shall comply wilh the Stale Buidling Cooe, D.E.a. standards
for subsurface sewage disposal and the State Plumbing Code. All buildings require a certlllcale 01
occupancy before being occupied.
(See Details on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
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,
CSS.13
LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX. 135 EAST 6th, EUGENE, OREGON 97401 \
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LANE COUNTY PERMIT FOR:
.
PERMIT NO.
12tJ7 -70
, .
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CONSTRUCTION [XJ MOBILE HOME [J PLAN REVIEW [J CHANGE OF OCCUPANCY [ J
,0 Owner
Jim Cnvanaullh
NAME
373 Silver Mea~ Dri~e
ADDRESS CITY
EUOQ1I3 OmlltJl'l
ZIP CODE
PHONE
I,
,
i
r
,
i
I
o Contractor Samn
NAME 3 ADDRESS
O.S..Reg. # 7069 _"i1.-/fdf /
.Tw~ 17 Range 3Sectio~~~ Tax Lot //#
. 2nd A1:Id to &\rdemtllY Park 11 5
Subdivision Lot Block
. . 11;\ \ Dtali3)nd Streat
Ac~ess to Property (Road Name)'
CITY
ZIP CODE
PHONE
Code
Census Tract
Acreago
Width
Depth
Existing Structures on Property:
None
'STRUCTURE (# BEDROOMS)
Poroft f..... Ot.",l1 fnn
Pflnnf~ 9..... r,..",ntm
Contenn1al to Anderson
I~II Ulooona ~tree~
Eunone Oroaon 97401
. SQ. FT.
1475 Cil 21.00
680 0 5.30
to D1fJlI".l>nd
pirections to Property. Address:
:--..
3 BocJ:
VALUI.\TlON. 00
l)"'::.loa.
J.ON.nO
.'
:63a,li!!>.lllJ
SEWAGE DISPOSAL:
.,PUBLlC [J SEPTIC TANK [
OTHER [ J
PLUMBING INSTALLED BY:
OWNER [] OTHER [] NAM"
WATER SUPPLY: PROPOSED [ ]
EXISTING [I
[ ] PUBLIC
[ ] COMMUNITY. NAME:
[ J PRIVATE WELL
[ ] OTHER. SPECIFY.
-
BUILDING
PLUMBING
3% SURCHARG"
MOBtLE HOMF
WASTE DISPOSAl
PLAN REVIEW
145.00
32.00
5.31
.\
/
1'5.00
TOTAL
257.31
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEPTICTANK'CAPACITY:'" ,. ., . ., -ion
GALS, ,_.ellUl). MIN.DRAINF.IELD . .JllO. L1N.F.;]:. i bMAX.TRENCHDEPHL - .. ~INCHES
451......101.' I" "Ill,;: u..v'uweu tl.'Uo. u, ....\:,I '-'11)11- uti tiS n tn:K )'lJro ~Op (j"'tllll1llt~~ It) l"C:()t, ~rc!j}
~IUl IIV.;.IwU UIIJ C"I,,",,(lKJI-4-.'" ~ ;.h;l)
TYPE OF CONSTRUCTION srI
GROUP IBJ
FIREZONF
STAY 100' FROM ALL WELLS
USE CLASSIF.
SETBACKS. FT. FROM CTR. OF r/W:
FRONT 45 SIDE EXT.
FT. FROM P~OP. LINE:
SIDE INT. REAR 5
ZON"
MY
AUTHORIZED SIGNATURES:
/s/ J ri: Dosr. bv I!IIrblllloll
A A..~v/ftr.nf~n~An
Ci ISSUA.,~CE DATE:
1"(,1' v
d10
C55.13
Call 687-4065 to schedule all required construction inspections. Call 687~4061 to schedule all requirod
IMPORTANT: septic system inspections. All construction shall comply with the Slale Buldllng Code, D.E.a. standards
for subsurface sewage disposal and the State Plumbing Code All bUildings reqUire a cerUllcale 01
occupancy before being occupied \
(See Deialls on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY, DEPT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 61h, EUGENE, OREGON 97401
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
. SANITATION - GOlDENROD
.
SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED / / DISAPPROVED ~ DATE
REMARKS
GAS PIPING GROUNDWORK
ApPROVED rt DI SAPPROVED ~ DATE
REMARKS
ROUGH PLUMB I NG
ApPROVED ~ DISAPPROVED L:::7
.
..
, .
'.
INSPECTOR
INSPECTOR
DATE l}-;),Q-74. INSPE~~~
REMARKS
ROUGH GAS PIPING
ApPROVED L:::7 DI SAPPROVED L:::7 DATE
REMARK S
FINAL PLUMBING
ApPROVED ~ DISAPPROVED L:::7 DATE1::.,,2 ?~")r':
REMARKS
FINAL GAS PIPING
ApPROVED L:::7 DISAPPROVED L:::7 DATE
REMARK 5
CERTIFICATE OF OCCUPANCY
READY TO ISSUE L:::7~ NOT READY TO ISSUE ~ DATE
REMARKS
INSPECTOR
I NSPECT~~ ~"/"_
INSPECTOR
INSPECTOR
"l"
Blt\!.DINj SIT.E EVALUATION eGif) (1)1
p\1 'BUILDING PERMIT APPLICATION NO. \~'...::Jc...
() SITE INSPECTION
PLANNING DIVISION
Not
Applicable
PI>. l)
( )
( )
( )
( )
1. Zoning Ordinance Compliance: Zone
2. Subdivision Ordinance Compliance
3. Required Access
4. Building Site (Area, Width, Frontage)
5. Other (see comments)
COMMENTS:
T I j R~ 34-z..4TAX LOT
SUBDIVISION:
LOT: II BLOCK: 5
APPLICANT
DATE
No Yes
()~
( ) ok1
() ~
( ) <.>f-
( ) ( )
CKI~ t..-~-1c...
6. Setbacks ftom ell of road:
Front ~'
~J'~1:.:..~
Setbacks from
Side
Rear
Interior lines:
5'
.s'
PLANNING DIVISION ACTION PENDING: YESl ) NDl ) APPLICATIONN
BUILDING INSPECTION DIVISION
Not
Applicable
~I~
( )
( )
7. Plans Submitted
8. Soi I Stabi I ity (footings)
9. Flood Plain
10. Other (see comments)
COMMENTS:
WATER POLUTION CONTROL
Not
Applicable
l )
( )
11. Meets Department of Environmental
Quality Standards.
12. Other (see comments)
COMMENTS:
No W
() ~!
( ) ( )
( ) ( )
( ) ( )
No Yes
() "@"
( ) ( )
CK'D BY~-/tI'1(p
DATE
CK'D BY:.,AlU ~_ tyr('7l
(J DATE
TO APPLICANT:
~o~r Building I Site Inspection:
I ~ Can be approved.
:/>C& ( ) Cannot be approved at this time as Indicated on item NO. above.
\~y Questions and further information on items 1 through 6 contact the LANE-
\i. COUNTY PLANNING DIVISION. Questions and further information on items 7
through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION,
( ) Will be held in this office until you can resolve the problems Indicated.
( ) Is being returned.
( ) Your building permit application fee is being .~~turn~d under separate cover.
DEPARTMENT OF ~NVtRONMENTAL MAMliEMEN.
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANNING DIVISION PHONE: 687-4186
C55-28
"I~..,..." . .
Btr~~:I'~G~ S I~L EVALUATION . { ,
. A~f~~~:DiNG PERMIT APPLICATION NO. \dA~I-I(...
v. \.\
,
( >-. SITE INSPECTION
.,
T Ii R~ 34.z..4TAX LOT
SUBDIVISION:
LOT: II BLOCK: 5
APPLI CANT
DATE
PLANNING DIVISION Not
Applicable No Yes
1. Zon I ng Ord i nance Cemp Ii ance: Zone g A. l) () (:..-)~ 6.
2. Subdivision Ordinance Complllar,'c~( ;) () ( ) (<)
3. Required Access ~;~ ( )//1/( ) (><l
4. Building Site (Area, Width....Frontage) (j,)t! () (.>):.
5. Other (see comments) () () vI') / I
COMMENTS:
. I II
J~' '
,
CK I D-BVJ .b, '(.., -~. 7 ""
Setbacks from c/l of road:
Front 4s '
'S.i'de.Exte"j or
Setbacks f rom Inter.! or- Un as :
0'1.. jl9,e " I d :"Ji! t.-~
Rear .!::'
f
J "'\
I
BUILDING INSPECTION DIVISION
PLANNING DIVISION ACTION PENDING: YESl ) NOl ) APPLICATION#
7. Plans Submitted
8. Soil Stability (footings)
9. Flood Plain
10. Other (see comments)
\ \
, i
Not
Appl icable
l )
( )
( )
<.>
I
COMMENTS:
WATER POLUTION CONTROL
.
Not
ADDl icable
l )
( )
II. Meets Department of Environmental
Quality Standards.
12. Other (see comments)
COMMENTS:
"'
.,
No Yes
()"W
( ) ( )
( ) ( ) .
( ) ( )
CK'D
I~/t/ I I" ....
.".
BY l~/ . I J /1' W. f U
DATE
/
No Yes
() "RY
( ) ( )
CK'D
By:At.u~. to- r(-7L
(I DATE
TO APPLICANT:
Your Building,-'I Site Inspection: .,.
i -0") Can be '~pproved. .. _ (JJ ../l
'-'ie fjJ( ) Cannot be approved at this time as indicated on ite~;.NO.I,;' above.
, '0,'p Quest Ions and further i nformat I on on Items 1 through 61 contact the LANE-
\:;-.' ::-;\ COUNTY PLANNING DIVISION. Questions ana'f.ur.the~ .Information on items 7
... . ,.' ,
through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION.
( ) Will be held in this office until you can resolve the problems indicated.
( ) Is being returned. '
( ) Your buildi.ng 1?ermlt ap'pllcatlon fee is being retu~rl.~d under seDan.te cover.
vEPARTMENT OF tNVIRONMENTAL MANAGEMcNI
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANNING DIVISION PHONE: 687-4186
C55-28
~
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.
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.. . Dotp I
June 21
1976.
Permit No
.
1247=76
CURB CUT
PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
WHEREAS, the attached application has been fully considered by the Board of County Com-
missioners 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.
ORDE.RED, that a permit be and
373 Silver Meadows Drive
is hereby issued to
Jim Cavanaugh
Eugene ORegon 97401
for placing, building
or constructing the following facility:
2nd Add Gardenway Park Lot 11 BLock 5
1311 Diamond Street Eugene Oregon
upon the right-of-way of County Road No. Mile Post
in strict conformity to the exhibits attached hereto, and subject to all terms, conditions, agreements,
stipulations and provisions contained in the appl ication and permit, 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 any other applicable regulations, law or ordinance.
Specia I Provisions:
1. Driveway will be constructed in accordance with the attached driveway approach specifica-
tions (Drawing M98-50).
2. Permittee will be responsible for the immediate removal of all mud, dirt and debris from the
roadway and right of way caused by his operation, leaving the roadway and area in a neat,
acceptable condition.
3. Sidewalks will be constructed in accordance with the attached sidewalk
specifications'and drawing M98-49. The Standard Curb Type shall be
constructed unless otherwise specified.
This permit is revocable at any time, and will be strictly adhered to and no work other than
that specifically mentioned above is hereby authorized.
This permit shall be void unless the work herein contemplated shall have been completed be-
fore
June
21
19IL.
Expires
19_.
WHITE - OFFICE FILE
YELLOW - REAL ESTATE
PINK - PERMlnEE
ORANGE - BUilDING & SANITATION DEPT.
Approved by Board of County Commissioners
By . } . _, .
(ff! L./vA,L(~V ~-C-lxI! JJ:b-t/
Director of Public w~
C74-129
Inspected and Approved
Dat"
By
~
. PROPOS EO SEWAGE DISPOSAL SYST'RECORD . '
Complete top part of form to signature and submit both copies with appl icatlo(l:'" " '.
PERM IT NO J 247-76
GG
~, ..
INSTALLER:
. .
INSTALLER'S NAME
1? A- ~ D I} U. \.s 1S'"AU<' tl-oE
No. Living Units Bedrooms Baths
l ~ 2-
Septic Tank:
Ft. from well Steel 0
Inside Dj,mensions: Ft.
Len'1th IrS Width ~ Diameter
OWNER
NAME
PROPERTY ADDRESS
Di amond Street
Baseme~
Yes INQ}
Water SlJP.P I Y
Public ~ Other-List
Jim Cavanaugh
Concrete ~ No. Compartments l Gal. Capacity
Tile Disposal Fiel~
Depth'8 Distribution Box::-~sl No
Other Distribution-Type
\000
HAILING
ADDRESS
373 Si 1 ver Meadows Dri ve
Feet from
WEll
Lot Li ne ,
Front fao Side /0 Rear 12
I Ft. Betwee'l IFi ller, IFi Iler Depth IFi 1 'e~ Below
Lines fO Tvpe Ih-Above Tile '2..ln.lTIle \a In.
-I
Foundation ,~
Eugene Oreqon
Length of Li nes-Ft. t Trench I Total Sq.
. WI Ho 3fo4. 5. 6. Width'2.. Ft..'~~O
:'Iot Plan (see instructions):
'01 MYIO"o.
s-r.
" 1HZ.,\lE'
I
f
f
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HI CEIVED
iJY~
'JUL 0 2 1976
LANE COUNTY
ENVIRONMENTAL MGMT.
"'0 ScALE
Date '7/ fD / "7 b
,
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)-
;
\ ~'
-+-
,30. pvc. 4/1
,
"
f\
.~o0SE
For Sanitarian Use Only: Date: 7-Y-?,t:'
In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certificate is issued
as evidence of satisfactory completion of a subsurface sewage disposal system at the above
location.
ct(lApproved: System Installation conforms to current standards
c::J Disapproved: Does not conform to current standards
Remarks:
] 107" ~
- -4'.. - - '-l-- ~'"
-:k1Y t:l'" ...
- . lo'..Hl -;...
.......... ., r--. (}. ,]
S i~qnature~ Y Jt' f'V!'t..l\l~ 1/ ~
CERTIFICATE OF SATISFACTORY COMPLETION
( ":
"
C55-11
'------ 4 ~--
- sanltarian,sri re
LANE COUNTY
STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALIT
r
.
LANE COUNTY PERMIT FOR:
.
PERMIT NO
CONSTRUCTION I ] MOBILE HOME [ J PLAN REVIEW I] CHANGE OF OCCUPANCY [ ]
Owner
NAME
ADDRESS
CITY
ZIP CODE
PHONE
Contractor
NAME
AODRESS
CITY
ZIP CODE
PHONE:.
0.5. Reg. :::
Twn
Range
Sect ion
Tax Lot
Code
Census Tract
Subdivision
Lot
Block
Acreagp
Width
Access to Property (Road Name):
Depth
Existing Structures on Property:
Directions to Property Address:
STRUCTURE I" BEDROOMS)
SQ. FT
VALUATION
SEWAGE DISPOSAl.
PUBLIC I I SEPTIC TANK I
BUILDING
PLUMBINr.
3% SURCHARGF
MOBILE HOMF
WASTE DISPOSAL
PLAN REVIEW
OTHER I ]
PLUMBING INSTALLED BY.
OWNER I I OTHER I I NAME
WATER SUPPLY PROPOSED I I
EX ISTING [I
[ I PUBLIC
I J COMMUNITY NAME
[ ] PRIVATE WELL
[ I OTHER SPECIFY
TOTAL
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY.
GALS. MIN DRAINFIELD L1N. FT MAX. TRENCH DEPTH INCHES
TYPE OF CONSTRUCTION
GROUP
FIREZONF
STAY 100' FROM ALL WELLS
USE CLASSIF
SETBACKS FT. FROM CTR OF rlW
FRONT SIDE EXT
FT FROM PROP LINE
SIDE INT REAR
ZONF
AUTHORIZED SIGNATURES
ISSUANCE DATE
s
SLOG PERMIT WHITE
OFFICE copy - WHITE
COUNTY TAX PINK
PLUMBING - CANARY
BUILDING GREEN
SANITATION GOLDENROD
IMPORTANT:
Call 687-4065 Ie ~ :hedulo all r"qUlrlid mslrucll Insp -lions Call 687-4061 10 :hadulf' 0111 reqw,tKl
5epllC system Insp -lion~ All :onslructlon shall (lmply with thfl Staff' BUldllng Cadf', 0 E 0 5lanaard~
lor subsurlac;f' sewage dlSpl .ill ijf'ld lhl Stall P1umblllg GOOf All bujldino~ /eQulre II certIficate of
OCcupanl:Y bf>fore b4!mg 0 ~Upl id
IS . 0 >lal n R"ver' Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY OEPT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX. 135 EAST 6th. EUGENE OREGON 97401
~
.
.
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'.
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.
SITE I NSPECTI ON
ApPROVEO Cl D'SAPPROVEO Cl DATE
INSPECTOR
REMARKS
FOUNDATION INSPECTION
APPROVEO.LX1 DISAPPROVEO,~/YATE ,;, INSPECTOR
REMARKS ~/(7~ ~~L~~Z;;;ir:2;?~ft&
~~-~EwA-r/ K .U.'lrr: /=".."...~. -;Ii? /~8/:::> '"
FRAMING IN~~C~
ApPROVED DISAPPROVED
Cl Om 1- 30 -1~
&/'
~
INSPECTO~ &/
,
,
REMARKS
~.
"
LATH OR SHEETROCK INSPECTION
ApPROVEO L4../ 01 SAPPROVEO
REMARKS ~/"\ RB E<1B~
- -
1--/ DATE ?' / .::z~b(-. INSPECTOR "7v< 4........ /
~ ~ /'I. 15 f 19 h> (. '-c..... c:::;(
'"
-..
FINAL INSPECTION
ApPROVED
~ DISAPPROVED
CJ DATE/t)-IS-1~ 'NSPECTOR
u>>n
t/
REMARK S
CERTIFICATE OF OCCUPANCY
READY TO ISSUE CJ NOT READY TO ISSUE L:::7 DATE
INSPECTOR
REMARK S
-
/f/ ////,
JV / //t..P V f/7///P
/.:I,I17-7t- {~ I 1{/4<:"'</u!~
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I]
O~OTE:
.
.
101'/7 - 7 6
.. PERMIT II
BE.PPROVED
,-
-,
NO PERMIT WILL BE ISSUED UNTIL THIS APPLICATION HAS
APPLICATION FOR:
CONSTRUCTION I >c::1
MOBILE HOME c=J
PLAN REVIEW c=J
CHANGE OF OCCUPANCY [=:J
~J--;m. C ;?PAA'/-*q/}h 37:tIVt'L- /1I~tJ:Jd~ Cw, E<<{;EN.tr ()~
Name ; Address City <lff6 y Phone
c:z:f CONTRACTOR ,.____ ~. 6y,!;vd.:J/
7 A j;;me Address / / City Zip Phone
O.S. REG. Dr/If?7 V ei?)
Twp. J 7 Range () 3 Section. ~ ~. Code Census Tract "31 -~
Subdiv1sion2AJO /itt/ a.o.i?a&r""':.k~Lot .....<:"" Property Acreaga Width2l..:'Pth~
, ~/lL;<'-
ACCESS TO PROPERTY (Road Name) ,i") j /.J /77.. $-1 ;
Existing Structures on Property: dCJd..3i?' /
Property Location - Address/Directions: t';:;4.1 T:!?AiAJ/)4" / ~)
_.#" '7"/,d-- - ./) / /C)M-d All? IL e' rl-
-X I
Below r Office Use OnlvXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
I /c/-? ~ Oll-K 0 OB~oms) ,~ ~ .va,I'S-5-: 0 0
I '<;:-- PrJ .s. 3 0 \.. -, ./ 3~ () 7 Y. 00
I .3 . <-. ...?-~ 9. t' 0
,
~NER
-'l.,)~".<!t5o'" L.rJ A?_/;;. ~""'("',
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v
SEWAGE DISPOSAL:
Site Inspection U
Existing S
ge Disposal System
Public [=:J
Community [=:J
c=J
or New System Required c=J
WATER SUPPLY:
Well Spring
Other
Name of Community or Public System
TOTAL
PLUMBING:
Installed by
er c=J
Other [=:J Name
FEES:
Bldg.
Plumbing
3 % Surcharge
Waste Disp.
Plan Review
Mobile Home
3
of Fixtures
Sewage 2-. Water
Connection Connection <---
PLANS FURNISHED FACILITY PERMIT
~ c=J NO [=:J YES 0 .Iv -
CASH
Type of Constructiop
._~/
<.!; Iv Group
~H"J:'" ,Q. Signature of APhant:
~flu Fee Received BY~ ~t
Required - Lineal Feet J f'U Maximum Depth ....m 14
. n"'J.- __ p:..&u --rW'~LL;I -:. ~a
~ 'r- hL.: L.,..,,__.;?_ _.P ~ --Z-J / - >..L.
- -,'- ......-
/~ Fire Zone Use Classification
Date: (; -fl-"7 b
P S/j. :51
",~' ~~"'" 'I'M>
.J~~r,
. A 11'/
_ J.-5:,,,U) ;Y,<<-h___ ,.
, .
BIdg Setbacks - from Center of Road Right of Way:
Front A...:; I Side Int.~' ~..:.__ _..~_~___
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