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HomeMy WebLinkAboutPermit Building 1976-4-27 NOTE: '. .... PERMIT if NO PERMIT W. BE ISSUED UNTIL THIS APPLICA~:'HAS BEEN APPROVED 7 bb -J ~ APPLICATION FOR: CONSTRUCTION rp ;t p j{ j) n /'I IJ (I'J.. ::(.t411 kt I P Name Address MOBILE HOME CJ PLAN REVIEW CJ CHANGE OF OCCUPANCY C=:J r"Zl CONTRACTOR LH-/(J?V l..;h:i1.MBN f Nam~ O.S. REG. II 9'3 5l.. ;; !'?' tj ~ !lINe'? Address ff '1J'i!-.ve1 't'7'1~/ ~ity Zip }:::'vgeM 97L/OL" Ci~ Zip Phone CJ OWNER f3 /;"N 4-fiS--f.',6h~- Phone Block - ;!- Z-Census .I- ~'2- Tract /,0' Wid tt>LU.Depth 'i .2S. t o'J / Twp, J7 Range .." ., Section /+ Tax Lot I "3~.? 0 Subdivision Lot rty Acreage h~'RRI' J?/)- 3 3. ~ t9v/"g/,Jq ACCESS TO PROPERTY (Road Name) De.-rrj) /}(/r!l Existing Structures on Property: J.I" V7 e. , Property Location - Address!Directions:--P "',Ji ~ (4Ln- LJe,.lr I2LV1 fi--# /'c.<:' AI Y lj ./ld:t.fj-",1' .~1-{l/rn-I'f.:"~;/LA<./(:,d L,U- h4...._/.,-t-lA'..eA ~.4,.L~ o-U, ~:..fY~ ~~ T; ,;7 f.t3,; ~-:ror{;~; Use On~ibtXXXxxXxXxxxx~xxxxxXxxXxxx ~xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx ~ m fP' C}:2 )() (., Sq, J 572. (ii) u:r3'n ~o37 60 \ / SEWAGE DISPOSAL: Site Inspection # '" Existing S ,.....- L..t.Lf or New System Required CJ WATER SUPPLY: Well Spring ______ Other Publi CJ Conunu ity CJ Name of Community or Public System , PLUMBING: Installed by Owne PLUMBING FilS i iV Other CJ Name FEES: Bldg, Plumbing 29;.- .. 3 % Surcharge ~ste Disp. 1 Plan Review Mobile Home .s ~ ,~ TOTAL \. ~ ~ Min. Septic Tank Capacity .ft.'1 Sewage Connection Water Connection PLANS FURNISHED FACILITY PERMIT cJ'I, 1 ~I o CASH ~ ~ Signature of Applican Fee Received By: - J::::::=1 YES _~ NO ' /~L~-?"';.;z;~~; i..:,:~' ::;!.~<-- - (J V D~te:; Cf-?03-j:, Drainfield Required - Lineal Feet Maximum Depth Type of Construction ~l / 0/1/ G~"""1 , . Fire Zone Use Classification BIdg Setbacks - from Center of Road ~ht of Way: Front E 0 Side Int. .!5 Side~ Rear ~ Zone ~ r;;N~: '),( ~~(. DATE: 'YV\ ~'::1E: 4~-7I:: Cs;':" LANE COUNTY DEPA~ i ENVIRONMEN