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Home My WebLink AboutPermit Building 1974-3-27 r L 0"73 tv .~ bl fL LANE COUNT-_ILDING PERMIT OR MOBILE HO_SE PERMIT 37i'-74 / BUllDINGXIXJ ~ MH 0 . PERMIT NO, '?:7 4 - 71.. MAILING ADD.RESS --~ PHO-~Ei-- ~, ." '. ..)..AI'"'..... PROPERJY.OWNER ,,' l.,n"''''1.ct''' CONTRACTOR alnnrlnn ChArlng, Jr, 11~8 Dondea Street MAILING ADDRESS Sarlnafleld. OreClon 747-4920 PHONE ~j""!,n PROPERTY LOCATION - INCLUDE POST OFFICE 'll~'R J}n~rl<:,'" l!.trp"'r So:>.dnofiAld, O"coon PR6PERTY LEGAL DESCRIPTION - METES. BOUNDS lor 1'- Rlnrk 1 flrgt Additln~~padnw Green Estates Subdivision TWP RANGE SECTION TAX LOT NO. CODE ----' " CENSUS TRACT lR " 06 . / . .3 12100 ICJ-02 EXISTING STRUCTURE,S ON PROPERTY House LEGAL ACCESS TO PROPERTY Dondea Street PROPERTY SIZE - FT. APPl. NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No, of Bedrooms r,lpnrtnn r.. Innn1.!/n,.th. Jr. WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewoge System 0 TYPE CONSTRUCTION SQ. FT. # BORMS New System 0 VALUATION B~A;.;^" ~F a~~lly Rnnm . Hdd I t Ion of Ut i I i ty room and bathroom J:rAmp 4lln tW 1 2 120 (1i1 9 4.000 I,oeo 5,8Ctl SEWAGE DISPOSAL PLUMBING INSTALLED BY PUBLIC D BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER v SEPTIC TANK ['] OTHERD . U.OO FEES OWNER D OTHER, NAME WATER SUPPLY PUBLIC m D OTHER !?nn MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAl. s 44.00 COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FiElD REQUIRED TOTAL lIN. FT TRENCH WIDTH FT. OR SQ. FT. Not aDD11cab1e TYPE OF STRUCTURE OCCUPANCY lONE PUBLIC UTll. EASEMENT ~-~ BLDG. SETBACKS __ FT. FROM CTR. OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT N IA SIDE INT. Ii_ SIDE EXT. - AUTHORIZED SIGNATURE - DATE REAR 7 Is I ,I. E, Bnss bv C. HarbQuah Bob Lowry DATE 3-27-74 slf BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK , PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule 011 required inspections. All construc- tion sholl comply with Uniform Building Code, D.E.Q, standards IMPORTANT: for subsurfoce sewoge disposol ond county regulotions covering plumbing. All buildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) ... FORM :t C55-13 - . (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 13S EAST 6th, EUGENE, OREGON 97401 BUILDING SITE" EVALUATION ~"~ji"rd;ng Permit )' Site Inspect ion J:~_ / C. I-!- . (I , App I i cat ion No.J;7l/- 7'1 () Pre-Permit Investigation T I5[""R ~S t;./,3TAX LOT CENSikS RAcT - . ...L 1st . ""e~ GTee~ u,. APPL T: . NAME -.La"auJ^rfl... ADDRESS r:r- PHONE DATE ~-~"O-'7Y DinE l/\NE COUNTY PLANN I NG DEPARTMENT NOT app I icab Ie () () ( ) ( ) ( ) ( ) I". Zoning Ordinance Compl iance (Zone d??1 ) Subdivision Ordinance Compiiance ( ) ( ) ( ) ( ) 2. , ,. Required Access 4. Building Site (Area, Width, Frontage, Setback) Other (see comments) 5. NO YES NAM E (/ ( ...y" ( ..y' (y ~ ;?$-~ ( ) . -. .:3 -,..2/- ., v' , COMMENTS: -= BUILDING INSPECTION SECTION NOT NO YES NAME DATE app I i cab I e h 6. Plans Subm i tted ( ) ( ) 7. Soi I Stabi I ity (foot i ngs) * ( ) ( ) 8, Flood Plain ( ) ( ) 9. Other (see Comment s) }f1_ ( ) ( ) O:Jf~ ""J 'J' - ?L,/ ~ COMMENTS: y YES re.r TE - SANITATION SECTION 10. Sewage Disposal 11. Usable Area 12. Water Supply 13. Other (see Comments) NOT NO aDD I ~ cab I e (~ () ( ( ) ( ) q () I COMMENTS: \N \\ TO APPLICANT: ( ) ( ) ( ) ( ) ~ Building Permit I Site Inspect ion: Can be approved. Cannot be approved at this time as indicated on iten. NO. above. Questions and further information on items I through 5 contact the Lane- COUNTY PLANN ING DEPARTMENT. Ques t ions and further in format ion on items 6 through 13 contact the Lane County Buildinq i,,,d Sanitation Division. Wi II ue held in this office unt i I you can resolve the problems indicated. I. ueing returned. Your buildin~ permit applic.Jt.iun fee is ueing ret'urned under separate eu/er. Your 3/26~f ~ ( ) ( ) ( ) ( ) LMI' COUN"! Y I'LiINN ING DEI'/\RTMENT ! :PJ ~;.x fI, Avenue E~, I. EU\jene. Clr~9,)n 9740 I /'/">Nt: 31'1..1311 Ex!,211 1\ LANE COUNTY IlU I LO I NG [. SI\N IT/IT ION D I V I S ION 13') Sixth ~vC1,ue EdSl, EII'len.,. Oi'C'<Jnn 97401 1'lll1NL: 31;2-1311 fliT. Ifll "'M5s=2"if-'- .-,-- r " ,. ... ........ - I '(" 1 f\_ " LANE COUNTvelLDING PERMIT OR MOBILE BUllDINGtA:iJ MH 0 MAILING ADDRESS i , "-'\ HO.SE PERMIT PERMIT NP, :;7~-7'j , .J 'i PHONE PROPERTY OWNER .n.'1..-..~~.,th r,:',...."'A.,':'\ rt-.""'I.........n CONTRACTOR M I. II~n nnQ~~n ~~~~~~ MAILING ADDRESS G~p'o~OI~ln nr~~n ~r\?-.lf'll)r' PHONE q,~ . PROPERTY lOCATION -INCLUDE POST OFFICE n n ()f\ f'~1"'~I""" r,.~p-'~..,....& ~,.t"~ IpnO Intl1 (\oo()r'1'Ion PROPERTY LEGAL DESCRIPTION - METES. BOUNDS .... f..:,,",Co 1~ Olt"\......:\. "1..01> !\i"A8~1^.,.. f.\"""A-:--1 n.f"~ l1'!_c-nt""n QtI~rllu.l('\lnn TWP RANGE SECTION TAX LOT NO. CODE CENSUS TRACT nn I~ 0<1. 171M ~I l/C'l_,I)?, 'EXI.STING STRUCTURES ON PROPERTY APPL. NAME & MAILING ADDRESS FOR MOBI~.\ HOME 'RER,~ITS ONLY No, of B~arooms "'"'--..: ,l '\ ,t. \ . ~ , '": \\ " " "- ~,-\.\ ~ ~,. t:f...,...u'V'\ LEGAL ACCESS-- TO PROPERTY . ,,-' " ' ~"~.......n ~C>&"'I'"'-"')to ,\ ~ PROPERTY SIZE - FT. nl,...~""'lI'" n 'r,r,.~_"'''r-" , . ~ .' , ,~" ,I. , ,,\ . ~ ~ ,. - WIDTH DEPTH AREA 1\ ~ ~~'~~Connec!\ t~...~Existing>, S:.~age .Sys;e.m" 0 . New System 0 TYPE CONSTRUCTION SQ. FT. # BCRMS VALUATION , ' STRUCTURES TO BE BUILT THIS PERMIT "!:''';{).In...... ".,4 fTr-.....llu n.~ ~,.jit Ie;! of '\l~'H I~V~ crod o;:thr=:\,o.'~, ';'C ".~ I.~n n I? '-J hIp^) '\ +~(J 9 1,r:::J_, " .j , " ., ~OC~~:: WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER \~ '\~ J'. " ''''....~,,> \:-:"" ~W\~"",\ "'50~"~~'\ "~\~~ ~~.\ ~l": "_."t>-_ '"'- ~, "i '" \ \ PLU~8.ING INSTALLED BY OTHERD '\' OWNER D' ',OTHER, NAME lI::!.no FEES '\ \1\"(\ .W,ATERSUPPlY :.. PUBLIC m \ ..0 OTHER ,~ ,,~ ."fln ';\\:.~\-"~ \' ~\ ~ ~\,-\, SEWAGE DISPOSAL PUBLIC 0 BUilDING " SEPTIC TANK ['J MIN. SEPTIC TANK CAPACITY WITH 0151. BOX: GAL. . l.t\, on COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED TOTAL UN. FT TRENCH WIDTH FT. OR SQ, FT, C1t ,::01 ic:tlle' , . ~'-: TYPE OF STRUCTURE ~ So:J \ BLDG. SETBACKS __ FT. FROM eTR. OF ROAD RIGHT OF WAY \9C,CUPANCY"~ ,..... ZONE PUBLIC UTIL, EASEMENT USE CLASSIFICATION FRONT,JI" SIDE INT.',; SIDE EXT, a AUTHORIZED SIGNATURE - DATE /0/ J.il. CeOl! bv G. 1~i'bCll'1h REAR 'j Ocb b~rll DATE 3-27-70 0 I '{ BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK,' ~;.:; >... PLUMBING - CANARY BUilDING - GREEN SANITATION - GOLDENROD , '0- \ .....\ ' \. , . "iMPORTANT: . . ~.. <;011'687-4065 to schedule all required inspections, All construc- tion shall ,comply with U~iform Bui)ding Code, D,E.Q, standards for :s~bs~rface sewage dispgsal an~'.'county regulations covering plumbing, All buildings require a certificate of occupancy before being occupied. . (See' Details on .J~:everse \Si4e) '.' \ .... ... .J ,~l..~":. , . , . ',,' " .' ,"..' FORM:: C55-1) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT I COURTHOUSE ANNEX. 135 EAST 6th. EUGENE, OREGON 97.01 . . , (, .~~... ." .~..; \". SITE INSPECTION ApPROVED ~ DISAPPROVED ~ DATE INSPECTOR REMARKS FOUNDATION INSPECTION ApPROVED ~ DISAPPROVED 1--/ 1/-; ~ -7L!INSPECTOfi)/ DATE . REMARK S FRAMING INSPECTION ApPROVED / \.-"'/--01 SAPPROVED ~ DATE 1/'- 3tl-7<; I NSPECTOR~ ~ / REMARKS LATH OR SHEETROCK INSPECTION -- ApPROVEO ~/ 01 SAPPROVEO I , DATE/j'-I'J'7t/' INSPECTO"~ ~/ I REMARKS FINAL INSP~C~~/ ApPROVED DISAPPROVED ~ DATE Ij, f, 71/ INSP[CTO~ REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE ~ DATE INSPECTOR .3 71/- 11( - ~ ~ "" ;/ ,/'Ij .<l f tJ . '('. ~tJ/ q /f'1U.:A1 ~ ,I'l 1) ~ , 1/ 8., /)".",j/a. REMARK S '. ;-"', :tlT i..'Y tL LANE COUNTAtJlLDING PERMIT OR MOBILE HOaSE PERMIT BUllDINGLD MH 0 PERMIT NO, MAILING ADDRESS ". '0" ...~-\-;.I '\).'f, ,-, :p~f "It'' j ~OPERTY OWNER ) I ..;. ,. tj PHONE ~~t/JoC, ---;;:;1 PHONE Dr. ,-----"'~.~.~L (Hrr:~';,':1 f~l~l('n_ /". l~~;-J r:::~~~i: S-~~rc~c CONTRACTOR MAILING ADDRESS r')rir.ivloICl. C,C::::lrJ 0;"~'''''''' PROPERTY LOCATION - INCLUDE POST OFFICE il"" i' ".'Ai: n'~{",,~ !."'wl,....,Qlnlc1. UI'Gttl"::l PROPERTY LEGAL DESCRIPTION - METES. BOUNDS p",>. If, i)ln'C', tlirnp .-,C!(H;,!n:', ["0rc:r., r,rr.~:) fi!lt;!;OCl GulldIVIOIC:l TWP RANGE SECTION TAX LOT NO. CODE \ \ CENSUS TRACT '''1 I' C:'l Iml.W 19-02 EXISTING STRUCTURES ON PROPERTY tC'!!J:i LEGAL ACCESS TO PROPERTY !k:".r.CO IL ~CG e PROPERTY SIZE - FT. APPL. NAME & MAILlNG ADDRESS FOR M081lE HOME PERMITS ONLY No. of Bedrooms rHn,-'"n r.. 1.0:'lf""'nl'.c,. JI'. WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT, :;t BDRM5 New System 0 VALUATION ./1"11('>1",") (1; fJ:"l'hJ' ;"-....."'"' fir..:) 1:f::-l " 12 (.~ .'] :):~JUCi8;l ()("u~n icy ~ l.r.::l bJthr= lro () D .. I ~- '~ .... , __:;;'..Z: -z-_'" I: 'J" SEWAGE DISPOSAL . OTHERD ();1.Cfi FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER " SEPTIC TANK 0 PUBLIC G D OTH ER I~.n MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL. s. t:~.C() COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED TOTAL L1N. FT TRENCH WIDTH FT. OR SQ. FT. [)~ C'~'l; i C,; 10 TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIL. EASEMENT $le~l BLDG. SETBACKS _. FT. FROM CTR. OF ROAD RIGHT OF WAY FRONT nr.'1 SIDE INT. 5 SIDE EXT. Q AUTHORIZED SIGNATURE - DATE Inl J.C. C:J:J~ ~" c. t:J~bct.!'l~' USE CLASSIFICATION REAR f c("~ !,r.~?)1 DATE o ~'i '1' " vOt'; 01') ~).,/ BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule all required inspections, All construe. tion shall comply with Uniform Building Code, D,E.Q. standards IMPORTANT: for subsurface sewage disposal and county regulations covering plumbing. All buildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) FORM::: C55-13 (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY. DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 SLAB FLOOR PLUMBING GROUNDWORK . . "../' .c. ,. -' . ApPROVED / / OISAPPRQVEO .0 DATE INSPECTOR REMARKS GAS PIPING GROUNDWORK ApPROVEO / / DISAPPROVEO .0 DATE INSPECTOR REMARKS ROUGH PLUMB I N9 INSPECTOR 44 ApPROVEO /Xl D'SAPPROVEO C1 DATE5- to -J'-/ /'J ' V REMARKS t1-r try U-.'M, t>11 ~r:;:1x> ~/d... Df 5"''''~'''''V"'''l -1/'r,> v'/ur- DJIJ ,.e;",.,~eyL I Jd./ PI.!"'- (-<.J::7-1-<!!or.g:IJ?.... '7p!:~/n ,Zd{/ D};Z./y, 'rH~:J~-7'/?"'{r CO'o4../-;1 fd.J2.,+ ~~.... !J'ud".... hAV'-;'" ) . ~ ~::1"J.. " to- (f.~J.. 0 /)11 J...,...1 .;-.\ ~.o.... e,,'" ,-r-.2. "f' A. ~ . I ROUGH GAS PIPING ApPROVED C1 OISAPPR,OXED C1 DATE INSPECTOR REMARKS FINAL PLUMBING , -' . /~ .?? DmP-J'.cr-;l) INSPECTO~iiIt 0 (/ ApPROVED ~ DISAPPROVED C1 REMARKS FINAL GAS PIPING ApPROVED. C1 DISAPPROVED C1 DATE INSPECTOR REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE C1 NOT READY TO ISSUE C1 DATE INSPECTOR ,. REMARKS LANE COUNTY"OREGON. . DEPT, OF ENVIRONMENTAL MANAGEMENT . .. ..,.J t.r-- JOB ADDRESS / / :.;> X' II '/ '; ,I' /."T"1..,., A",--- I TO: NOTE: .,,/ It 17 /1"( I -; {-~ :' I'/.A ~ ../ ~ d J/ ,'i -1;//..,_tI'n.: e~_ // C74-184 Phone 687-4065 INSPECTOR'S MEMO /1 ] ,j \"./ ..( V--'"l....,.. .-t- J?'7 \.):-. 1/ --+-' i.-f.-r..- .1.., _ _ ,~; t . "1'/J ,H;>) . ~ /AA /J j) p /" f~ """' I ,/.~-r / , INSPECTOR CONSTRUCTION PERMITS & INSPECTION DIV, DATE ,~" -' ',/ . I~ ' .o.ti ,.:~ J . <.J I I If!:, .- , / : (/ __--.._,... ~, /\ I I ,. ,/ I I j:/' , \..-/ I (J : /c;//!o'11 11-- .....~.. .'" " .L&'iEn--LQillUY__-1NS_EEtII 0 N __BECillill TRS#_~-~-Q~-\:i\ \~:~\)~_-==:.= DATE ISSUED:L\}~~\?-':2.. ::~~8~:~~-- - -~----- --- S8~~QtI~M~N9s p("l~ --..-------- ----- CLt FRONT CL. SIDE INTERIOR REAR WORK AUTHORIZED_BY PE~T - - - .. ~~S}\J I ,Cl~___.._""""__________""'_'n__________ DI-J~S,T~~~,c:.&,,~~ -\K) ,~\~\ ~~V) \;\~VW (O.~~i"f)'i. _ \ ~ 5Y>\~Qf"I~~ (\{:)~ ~~ ~p~ ~~ ~{) -<:::0'" SITE ADDRESS i - -, "" FOO\\~~/ ~t'~i&r~~Y~nfOME" PLACEME"K'(Cj""-TNSPECTION-" Approved Date jCorrection__,_,_Date ______Inspector PERMIT# S"BJc.- 5'-.':1. PHON~NUMBER PHONE NUMBER 7rPLUM~~;~fIWli~ts -PLUMBING GROUNDWORK [NspCi~TION---- Approved Date_____/Correction Date Inspector_ UNDERSLAB PLBG, 0 /UNDERFLR PLBii, 0 I NSPECTI ON Approved Date /Correction Date ____Inspector SLAB INSPECTION App ro ved Da te jCorrection Date_________Inspector ROUGH PLUMBING (TOP OUT) INSPECT raN Approved Date /Correction Date Inspector FRAMING INSPECTION Approved Date /Correction Date Inspector ROUGH MECHANICAL . Approved O~ Date~%3,'il3/correction INSULATION / VAPOR BARRIER INSPECTION Approved Date /Correc ti on Date Inspecto~ Date . Inspector LATH / GYPSUM BOARD INSPECTION Approved Date_:-,___jCorrection Date Inspector FINAL MECHANICALJ--j\olOOI5""STOVE[l""---:- .-------- '"' .fl ^pproved~_Date_~3~1/correction___.__Date_ ___.Inspector ~~ FINAL PLUMBING INSPECr"lorr--- ------ .---- Approved___Date ____/Correction _Date________Inspector "FINAL INSPECTION BUIIoTNCntJ7M-O,IIlTlibi.fCO-7A-GPCACEMENTj]- AfJproved Da te.._ _.___.. ,__..__j':orrecti on___ _,_,Date__u.___.._.._.._ Inspector CERTIFICi\TE OF-ocCUpANCY 0----'- - IEMVdRMT-CERTlrrCATE OF OCCUPANCY [) Approved___,_Date_..,_____,.. _.., Ins\, '_.__ __ _ _""______.Approved________Date Insp. .___+.....__. _.._.._ ___ .._._.u.__._.._.. _ ______.._ ._.._ _._. _._ ___._ ___.__ .._ .__ _.._ ~._ ...__ -- . 1\ " . LANE COUNTY .DING PERMIT OR MOBILE HOM.E APPLICATION '. ( j ,- PERMIT TYPE - BUilDING E! MOBILE HOME Dose REG.# PERMIT:#: 37l./- 7'-1 ~ROP RTY OWNER ,I. MAILING ADDRESS (4 PHONE PJndf)n C'f/o..r/es / tJ,~uJo,..+h :-tv. Il~fr ,J)t'JndP/1.5t.Q-.,I";~t-,e!d '1(7-~ C R (TOR J I U MAILING ADDRESS - V('1 _ n / PHONE n Cn.a..ne5 Lonou?oc1bJ1,L,j/d? Umd&Si L"XJr/(!J.:tWd 7Y'7-~ PR, J R~ ~CATIOD~C~Od;: OFFICSt V Sp r; ?J.c. e /d OVrJlJ Y1 9~ S/ 7 7 PROPERTY LEGAL DESCRIPTION I AI ( fl.1 II I J' >t t ('f "'" ~. / f1..'"ESAASMETES & BOUNDS 0 YES lOT - BLOCK - SUBDIV. (...!(:y_ lP ').l rt'J<. ~I I'" ///&d.lU)Uf/?nn ATTACHED 0 NO T\~ jGE Sf;; I ')X, ~(f C/"9 -O~ CENSUS TRACT AP:'~~:NT G..1.ebd.ofl C Lon wov-+-\--. Sr DESCRIBE~~~~UCTURES ON PROPERTY IF ANY 1("'\ JrL LEGAL ACc'ESS TO PROPERTY -IjPAD NAME OR # AND 111,~ ,\ j(Jnrlllll Yr ,f)tJl7det< S+-- :::';;S: S,or', t)~ Ci j~ OYf9)IJh PROPERTY SI'EvtH ;3H3 FOR MOBILE HOME PERlfIT ONLY J Number of Bedrooms STRUCTURES TO BE .AUI~T IT~IS ~ERMIT Hr.lr:11 hOll U+--l L' ~ AREA jJ() ~ Sc.~ V .~ o +' ra m 'j 9 Ra A-h Connect to Existing Sewage TYPE CONSTRUCTION I?tlflm "FYrum-e System 0 SQ. FT. S""':JO or New System Req, D yd(n@~I-2:UALtbbo l.;{o@."1 \0'60' 5?>l()' SEWAGE DISPOSAL PUBLIC 0 BLDG. $ WASTE olS. PLUMBING PLAN REVIEW PARK TRlR. SEPTIC TANK ~ <?- FEES OTHER 0 WATER SUPPLY PUBLIC ~ Pl~~BING FEES ~ FIXTURES PLUMBING INSTALLED BY OWNER ~ OTHER 0 NAME PLANS FURNISHED FACILITY PEHMIT TOTAL PUBLIC WATER CONNECTION FEE OTHER YES 0 NO 0 \1C3NATURE Of APPLICANT @-':<.\ L.--:X ~4- r FEE RECEIV~ BY :x l<; PERMIT # YES 0 NO 0 l?- CASH 0 SEWER CHECK (l CONNECTION FEE DATE ~-"........A-~, ' -- ~ DAlE ?mH~~L 3-jQ,iV \.l,lj. - /" ,/ MIN. SEPTIC TANK CAPACITY WITH DISl. BOX: GAL. COUNTY BUilDING & SANITATION DRAIN FiElD REQUIRED UN. FT. TRENCH WIDTH FT. SPECIFICATIONS # J .OR SQUARE FEET V \\~ TYPE OF STRUCTURE .s-t/ OCCUPANCY / ZONE REAR Y ARC PUBLIC UTIl. EASEMENT BLDG. SETBACKS - FT. FROM erR. OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT 4' A SANITARIAN (&-L SIDE INT. ~ SIDE EXT. - pale PL~.k 'MIJ-J /1 J ~.J-..v -.?f/ > I / Date REAR? . BLDG. INS~ (I 4& Datu '3. ;U~ .?j/ Directions to Find Properly: COpy 1 - OFFICE COpy 2 - JOURNAL COPY 3 - AUDIT Form # C55-1Z