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