HomeMy WebLinkAboutPermit Building 1978-5-3
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JOB LOCATION
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LANE COUNTY PERMIT
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Acreage or Lot 1'0 ~ -" artltlonmg # amp ete u IVISlon
Contractor'sO,S, # ,:7'/":;"(,/ ,1 /'; , y' V Lor .. "Blac~
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APPLlCANT'SNAMEANDADDREC;C:::>"', ~-"-"'-. n ,_,_.'7' j( u . /,~. /, Phano'
OWNER'S NAME AND ADDRESC:: 'A "/;~}..,J ~i1'.~"~"-~, ",.<oJ / ,{,".e" =,'/.<.<" .-:'-. ,-....-//'--'.;'1... Phonp
CONTRACTOR'S NAME AND ADDRi=c::c::,-',P//v-I/ I ;".'...,;.,-, --- -- Phono'
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Mail permit to ( ) Applicant ( ) Owner ( ) Contractor. ( ) Prefer to pick up, Call (owner, etc,) when ready,
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STRUCTURES NOW O~yHE PROPE~T~~ / . . :;.<.. 1 ' ..,," ' I .'
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THISPERMITISFOR'V~~/' " ....-v-~,Go-V---.;.-/-'..........~/,.-;'~.
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SEWAGE DISPOSAl
# BEDROOM"'/'yI'J# PLUMBING CONNECTIONS "'I.
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S,I. #
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WATER SUPPLY
THIS PROPERTY IS WITHIN ONE MILE OF THE CITY OF
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PLUMBING BY
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I hereby certify that the abave statements are true and accurate, and that I have the fallowing legal interest in the property: _awner 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.amJroves of this action, I hereby agree to comply with all ap[llicable Codes relating to. this permit. _
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Fee Paid ~ ,/ "'-- 6~~ Signaturp ,-. L, Dato
( ) NEW ADDRESS ( ) FACILITY PERMIT TO TRANSPORTATION DEPT, ( ) SPECIAL PMT, AREA, MIN, ELEVATION:
=
SANITATION
Minimum Septic Tank Capacity (Gallans)
Drainfield Required. Lineal Feet
Maximum Depth
BUILDING
Type af Construction r.roup
Ilse Classificatian '
Comments: d t7?-<.-A. .~ ...~, 2;:',.... ~
Fire Zone
Comments:
.
By: Date: ,~
PLANNING REQUIREMENTS SATISFIED, By: ,-;;T" '~~' ,'~' ''-.,...
ZONE/i/ /1 SETBACKS: FRONT SIDE FACING STREET
BY9z/~~~ hi-
Date: ,;; ~ :::; :V G . Date Issued:
(FROM C/L) INT, SIDE YARD REAR
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c-_ "l - 751
Date: -" - ,_
(FROM P/L)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE" EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT SITE
PHONE: 687-4394
C55.13
BLDG. PERMIT -WHITE; BUILDING - GREEN: PLUMBING - CANARY; SANITATION - GOLDENROD; OFFICE COPY -WHITE
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TRS,TI /.7~ <;-/y -/70 cJ
written Directions
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Job Location c,.OR".....<t .L9........ &...........L'" ~lr2\1 0;- 5&.L.,.Q" U I-E.l.<)
INFORMATION SHEET
( 'fJ Building Permit
) Site Feasibility Study for Septic Tank, Number of sites__
Acreage or Lot Size Test holes will be ready
Partitioning # ( ) Completed Subdivision Lot , Block
( ) Pending
APPLICANT'S NAME ANDADDRESS c.Qr?~ P^I"_l.L-pc... b '-1'1'3 ~ l...r-.t~ Phone'197'&7'Og-
OWNER'SNAMEANDADDRESS,ifdiffere~tfro aJ:>plicant's fY)..'J/1r NJ...J.lloLJ) '::2~1 .t.Je...tP""",'-5 ~1P~VI~4'hone'
CONTRACTOR'S NAMEAND ADDRESS rr, c.o~'\rlt ,..., ....."'_"R ~, J...D~t'y Phone 9~ ?~711.
Mail permit or results of site feasibility study to ( ) Applicant ( ) Owner ( ) Contractor,
( ) Prefer to pick up, Call (owner, etc,) when ready, Contractors O. S. #
STRUCTURES NOW ON THE PROPERTY
1>1,., us€..
PROPOSED USE (this permit)
b
F,", u. W"Q(j..;-' 0 Ir
JI RPilrrrmc;
WATER SUPPLY
(existing or proposed well, etc, If public, name of system)
SEWAGE DISPOSAl
(existing or proposed septic tank, etc,) S,l.;:
PLUMBING BY
Address
) PROPERTY IS WITHIN ONE MILE OF CITY (
*******************************************OFFICE USE ONLY BELOW THIS LINE ******......******.********...**.......**.............
( ) New Address Necessary ) Facility Permit Necessary
ZONF SETBACKS, Front Side Facing Street
(FROM CENTERLINE OF ROADI
) Special Permit Area,
Minimum Elevation:
.
Interior Side Yard Rear
(FROM PROPERTY LINES)
To, Planning/Building Inspector/Sanitarian/Surveyor.
This applicant appears to have a problem with
Your assistance will be appreciated.
By
Permit Processing Section
ResponSt"
C55.12
By
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Permit Processing Section
125 East 8th Avenue
687,4394
Division
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JOB LOCATION
LANE COUNTY PERMIT
Acreage or Lot Si7~
Contractor's O,S, #
Partitioning #
) Completed
Subdivision
Lot
I310c~
APPLICANT'S NAME AND ADDRE~<:
OWNER'S NAME AND ADDRES~
CONTRACTOR'S NAME AND ADDRES<:
Mail permit to ( ) Applicant ( ) Owner
) Contractor, ( ) Prefer to pick up, Call
Phon~
Phon~
Phon~
(owner, etc,) when ready,
STRUCTURES NOW ON THE PROPERTY
THIS PERMIT IS FOR
# BEDROOMS
# PLUMBING CONNECTIONS
.
WATER SUPPLY
SEWAGE DISPOSAL
S,I, #
THIS PROPERTY IS WITHIN ONE MI LE OF THE CITY OF
PLUMBING BY
I hereby certify that the above statements are true and accurate, and that I have the following legal Interest'" the oroperty' owner of record,
contract purchaser; _ potential buyer; _ realtor or agent, I further certify that (if not the owner) I am authOrized to Jct 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 S
) NEW ADDRESS
SANITATION
Signature
) FACILITY PERMIT TO TRANSPORTATION DEPT,
Ddte
) SPECIAL PMT, AREA, MIN, ELEVATION
Minimum Septic Tank Capacity (Gallons)
Drainfield Required. Lineal Feet
Maximum Depth
BUILDING
Type of Construction
I Jse Classification
Group
Fire Zone
Comments:
.
Comments:
By: Date:
PLANNING REQUIREMENTS SATISFIED, Bv:
ZONE: SETBACKS: FRONT
By: Date:
Date: Date Issued:
SIDE FACING STREET (FROM CILl INT, SIDE YARD REAR
(FROM PILI
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE" EUGENE, OREGON 97401
PHONE, 6874394
POST THIS PERMIT ON MAIN BUILDING AT SITE
C55,13
BLDG. PERMIT - WHITE; BUILDING -GREEN, PLUMBING CANARY; SANITATION GOLDENROD; OFFICI:. copy WHITE
.
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SITE I NSPECTI ON
ApPROVED L::::7 DISAPPROVED L::::7 DATE
INSPECTOR
REMARKS
FOUNDATION INSPECTION
ApPROVED;----? DISAPPROVEO L::::7 DATE
REMARKS ..d)/~., ~".:".d Lh.T /I.::
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INSPECTOR
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FRAMING INSPECTION
ApPROVED / / DI SAPPROVED / / DATE
INSPECTOR
REMARKS
LATH OR SHEETROCK INSPECTION
ApPROVEO ~ DISAPPROVED L----/ DATE
INSPECTOR
REMARKS
FINAL INSPECTION
ApPROVED ~ SAPPROVED L::::7 DATE <= f 7- 7f(1 NSPECTOR ~
REMARK 5
CERTIFICATE OF OCCUPANCY
READY TO ISSUE L::::7 NOT READY TO ISSUE I / DATE
INSPECTOR
REMARK S
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