HomeMy WebLinkAboutPermit Building 1973-7-17
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LANE COUNTAILDING' PE;MIT OR MOBILE
BUilDING ;[]l MH 0
MAILING ADDRESS
1370 \1EST CEt~TEmJl AL , 5PR I tJar I no, O~ECOrJ
MAILING ADDRESS
HOaSE PERMIT
PERMIT NO,
,
" .
,'/.!ibt:' -"13
1,00- 7:]
PHONE
746-9916
PHONE
PROPERTY owt\t"R
1-11 LL, f'lOO&RT
CONTRACTOR
PROPERTY LOCATION - INClUDe POST OFFICE
1165 DOrJDEA
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
1ST ADDITIDN TP ~&ADOW GREEN ESTATES BLOCK 2 LOT 12
TWP RANGE SECTION
06, /,3
TAX LOT NO,
CODE
CENSUS TRACT
18
02
.Jt 1/,">0-0
EXISTING STRUCTURES ON
'.\'5-1'52 AI
PROPERTY
APPL.
NAME
&
MAILING
ADDRESS 5rR I NOrt ELD, OREGOrJ
FOR MOBilE HOME PERMITS ONLY
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
RODERT N. HILL
NOtJE
LEGAL ACCESS TO PROPERTY
DOtlOEA
PROPERTY SIZE - FT.
879 ~E~T CENTENNIAL
WIDTH
DEPTH
AREA
Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT. # BDRMS
New System 0
VALUATION
D;;ELL WG
F~AME
11070 12 1::\, 284
505 C 3 1, '518
lL1,(;O~
GARACE-ATTACHED AND UMCEILED
ltJSTALLEI;lS.D.S.
SEWAGE DISPOSAL
PUBLIC D
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAilER
SEPTIC TANK rn OTHERD
. ",eLm
:;IU){)
~~,",n
FEES
PLUMBING INSTAllED BY
OWNER D OTHER, NAME
WATER SUPPLY
PUBLIC D'll, D OTHER
MIN, SEPTIC TANK CAPACITY
WITH DIST. BOX: GAl. 1000
. II? <;n
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED
TOTAL
L1N. FT
200
TRENCH WIDTH FT.
2
OR SQ. FT.
hon
DIVERT Roo;:, DRAINS TO STAEE:T. riLL SWALI:: A(:lEA TO TH'" LF'V~l o~ THr '"1flnTIr':,I(\ ()~"nH"_
SOAV 10 FT. ~ROM THE HOUS[ AND PROPERTY LIN~ WITH All PAAT~ n~ T~~ nQ^I~'~lrl M_ ~nl n TnrMrllrn
TO A 24 ItJCH MAXI~UM OEPTH.
TYPE OF STRUCTURE
OCCUPANCY
ZONE
PUBLIC UTll. EASEMENT
" rJ
BLDG. SETBACKS.. FT.
FRONT 11'1
I "11.1,,..
FROM CTR. OF ROAD RIGHT OF WAY
QA,
USE CLASSIFICATION
SlOE INT, 7 Sl SIDE EXT, r:;
AUTHORIZED SIGNATURE - DATE
/S/ J.E. 009S BY CHARLES HAnBAUOH
REAR
7
DATE
~_w_ ~RAV. ~A~ITAnl^N
7117 h~
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BLDG. PERMIT - WH ITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
Construction to comply with uniform building code and county regulations
covering plumbing and sewage disposal. All buildings require a certificate
of occupancy before being occupied.
(See Statement on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG, AT SITE)
".
LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE. OREGON 97401
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FORM == C55- \3
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~' BILLED/-i(-"73No. ["~- ,. ".,... .'.- "
fHA FORM NO'v-'Ji.J_loj{j/73 No,u,loEPART{.ENT OF HOUSING AND URBAN DE'Y{LOPMENT ,..,. ,', .. "'F~'m App'ov.'
Ro.... lona ., , FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R0296
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPL Y AND SEWAGE DISPOSAL SYSTEM
PART I -TO BE COMPLET.ED-8Y-fHA-_,' -,,, '. "-,"';:C",,;; _"..
Ilnsurlng QHlce ~-: l'I'PHA Coae Nn.
Federal Housinq Administration ,,"0' ----4Jl-'l:21695 203
Mortgsgee _ Nome, Addres. ond ZIp Code ~ Mortltagor or Sponsor:
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Portland Federal Savings <Z \, ~.' / \, ,1lnl-,prt N. ..111 1.1 "
P. O. Box 1066 vc, ~\\ \~. .....'\ Property Addre..:
Eugene, Oregon 97.,4Q1, \\: , ,\C)!' 1165 Dondea, Springfield, Oregon 97477
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\ ,~~~"., . .. su~~,,:",,5'ion:
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....Jy',. First Addition' to Meadow: :Green'"'"""" 12
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n N '"I' t "I'I"'t' . ~;. .... -' Can-1\tttC"'"Orother^Ten be-mtrde 'lillo-additional
-= _L..j{X",ew ns a a Ion bedrooms? (II YOS. how many?)
G.xNo-- .~ :;<!:n;, "'1- :ilter ~,l\enli o~' {~ill.vp.';; ~ No :n.:..-:;
..:1:,
Lot No.
L
1
"'OTAL NUMt:J,Ii'Q
~ OM" IleAIF"
BASEl,iEN',."
-..1-'-
\v.\"
O"Yes
\'lATER SUPPL Y BY,
~ Public System
SEWAGE DISPOSAL BY,
o Public System
SYSTEM DESIGNED FOR
D Community System >:-::;, De~ndi~~j.J~lcn,:It'r:J;:~_'. ~r I _ I;)isoosal
o Community System " """0 i~d';~id~~T I"":' '1 ""'l Ll ,es [xl No.
PART II. - TO 8E COMPLETE[),8,Y.:IH:AL TH DEPARTMENT
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BLDG. PERMIT 1300-7~
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HEAl, TH DE PARTMENT INS PECTOR'S SKETCH
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It is the opinion of the 0 State 0 County Loca~ Depar~,~itt of-He~lth that thls"individual water-supply system
o is 0 is not satisfactory as a domestic water supp!y for t~e..S;l!l?jes:t P!ppe~~~..:.H"
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It is the opinion of the
with proper maintenance:
IZilI Can be expected to functio~ satisfactorily. and
is not likeiy to create_an insanitary condition
DATE SIG~~~ O. I(t~ ~
9-4-73 ~~CHARD A. KiRBY, R,S:--- ()
o State
~ County
o
Local Department of Health that this individual sewage-disposal system
--"+:: :C.
_ld.f:annot.be_expected to function satisfactorily
TITLE
SUOERVIS1NG SANITARIAN
NOTE: The health authority should complete the appropriate opnion statement above and affix dote, signature and title In tho
spaces provided.
Use of the above grid for Health"Department Inspector's sketch as well as use of the bock of this for~ is at the opinion of tho
hoo Ith authority.
PART III. -FOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the
_ Individual water-supply system be considered 0 Acceptable 0 Not Acceptable
Sewage disposal be considered 0 Acceptable 0 Not Acceptable.
DATE
SIGNATURE
o C/IIEF ARC/IITECT
o DEPUTY FOR CHIEFARC/IITECT
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HEAL TH AUTHORITY AP PROV AL FHA FORM NO, 2S73
,>"'-- _ INDIVIDUAL)'fA Hi< SUP!,L)' AND .SEW~GE ,DI~P"OSA,L. ~~.~~~.~,~\,~~,:,:-:.~:v_~~O/'Z~,:. '""~:,.",,
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REPORT OF
IN4ti:Ci'lON-INj)iVIj)iJA!.'S~W AGE-lp05AL
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SYSTEM
PRIMARY TREATMENT l'OnSiSlS (If [j'. Septic tank. 0 Cesspool.
Sop.k Tank:
',"
Distance (rom' wdl,
Total liquid (apacil)'.
Inside length
C.upool:
Disuncc from: Well.
feet. Material
1000
CONCRETE
Number of compartments
(teL Inside width,
"alluns. C..patity inlet compartment
feet. Liqui~ depth
I?allons.
fect.
feel; found.Hino,
_feet; nearest lot
feel. Liquid' capacity.
o Seepa,.::c pirs. Other
line at 0 (rom, 0 side, 0 rear,
i:allons. lininR m,ucrial
f<<t,
Inside diameter, (('('t. Depth
$ICONDA.AY TRIAYMiNT cunsisls of XJ Tile disposal ridd.
TUe'Olllpollalll.ld:
Di!lranc( (rom: \'('dl
Total len,lo{th of rile lines._~7
Trench width, ?4
LcnKlh of.each I;ne, 100-Q')
Type of nher material: 00 Gra~el.
Depth of filter matcrial beneath til"
feC"'t; foumLHion. 10 fC'Ct; nt.'arcs[ lot line at 0 (rom. rn sidC"'. ~ rear.--10
feeL Number o( lines, ? Distance betwC"'en linC"'s, 10
_inches. Tot.al effe(tive absorption arca in bollom of uenches, 400
feeL Depth, (Op (!( tile (0 finish grad"
o Broken srone. Oth..,
r:.
(<<t.
f<<t.
square fen.
inches.
inches.
Depth of f1her material over tJle._?
inches.
Mepage Plta:
Numher of pits__.
Dist.1nce from: Well,
. OutsidC"' diameter feer.
(eet; building (oundation,
Deplh,
Inspection made by: 0 State. f!J County. 0 Local Heahh
feet. lining material
feet; nearest lot line at 0 front, 0 side, 0 rear,
Authority.
Inspected b)
f<<t,
/s/
G.W. GRAY
SANITARIAN
Date of inspenillll
AUGLJ<;T ":l1
19-13
(TITlE)
REPORT OF INSPECTION-INDIVIDUAL WATER-SUPPLY SYSTEM
Distan(e to nearest puhlic water main, feet. Size of main inchr-s.
Indivi,lual wdls 0 art. 0 are not (ustmnary in neighh9rhood.
Give most re(t~nr rt.'(o'rd of failure of wells in immediate vicinity to furnish adequate supply of water
Properties in neiJothhorhood 0 are 0 are nor being developed with both individual water-supply and sewa;:e-disposal. sys~ms.
lot siu: feet wide._ (eet deep. DwellinR set' back from front property lin" feet.
Individual W;Her supply from: 0 Drilled well. 0 Driven well. 0 DUf:: well. 0 Bored well.
Dlstonce of wen 'rom:
Ruildin;: foundation,
(aSI iron st'wer,
(eet; tile sewer,
feet; cesspool,
(eet; nearest lot line at 0 front. 0 side, 0 reil"
feet; septic tanl- feet; disposal
feet; other sources 0; possible pollution,
field,
(<<t.
f<<t:
f<<t;
seepage pit,
wen construction:
Diameter. inches. Total depth
Approximate depth [0 pumping level of water in well,
Sealed watertight co t.lepth of (eel.
F.xterio; spa(e around casing sealed with: 0 Cement grout. 0 Puddled clay. 0 Ordinary backfill.
Well cover: 0 Con((~e. '0 Wood. 0 Metal. Openings in well cover warertiXhr: 0 Yes. 0 No.
Pvmp: 0 Shallow well. 0 Deep well. Length of drop pipe, feet. Pump capacity,
Located in: 0 B.uement. 0 Pumproom off basement. 0 Pumphouse ahovC"' ground. 0 Pump pit.
Pumproom properly drained: 0 Yes. 0 No. Pump mounting watertight: 0 Yes. 0 No.
Type of storage: D-PressurC'. 0 Gravity. Capacity, gallons.
Has oocterioloRical examination of water been made? 0 Yes. 0 No. If answer 'js "yes," give dat,.
Quality of water 0 is q is not satisfactory for human consumption.
Installation 0 does 0 does not comply with approved exhibits, if any.
Inspection made by: 0 St.:uC'. 0 County. 0 local Health Authority.
Inspected by
feet.
Type of casing,
feet. Approximate yield,
. Depth of casing,
~allons per minute.
(<<t.
.~allons per minute.
19_
;,
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Date of inspection
, 19_
(TITLE)
GP 0 900.6112
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( ~~djng Permit
~~~~' "i h - "" -- . , ,. '. .
EV~LU~ T lori '<\~. '~~~'="~trtlR~R~;S ~ o.
~ ~~ APPLICANT: ~ "
App I i cat ion No. / lit) D ~ ?..J N/\ME J-I :t.-I
ADDRESS '
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,
~..,..:....~~ .;-.: . ~ :., . ..
. ~U!LD IliG SITE
TAX un
( )
( )
Site Inspection
Pre-Permit Investigation
PHONE
DATE
7-1"-.
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LANE COUNTY PLANNING DEPARTMENT
J.
Zoning Ordinance Compl iance
(Zone~4- )
Subdivision Ordinance Compl ianc~
NOT
app 1 icab) e
() ()
( )
( )
J )
( )
NO
YES
NAME
DATE
3.
4.
Required Access
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( )
(+-
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Lk/-
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2.
Building Site (Area, Width,
Front~ge. Setback)'
Other (see comments)
5.
~ ~ z; "'..~
COMMENTS :'
- -
BUilDING INSPECTION SECT ION NOT NO YES NAME DATE
appl icable riJ
6. Plans Submitted ( ) ( )
7. Soil Stabil ity (foot i ngs) 0/) ( ) ( )
8. Flood Plain tX), ( ) ( ), ~ _. A
9. Other (see Comments) ('i> ( ) ( ) C~.'II~ 1'~/~~ '7);
~ ,
COMMENTS:
SAN ITAT I ON SECTION NOT NO, YES NAME DATE
app! i cab I.e rP)
10. Sewage Disposal ( ) ( ) /
11. Usable Area ( ) ( ) ( ) A1
( ) ( ) ( ) . .AA-.l,0,
12. Water Supp I y /]~
(see Comments) ( ) ( ) ( ) ~ 1-'\ \~
13. Other
COMMENTS:
TO APPlI CANT:
Your Building Permit / Site Ins~~tion:
t4 Ca~ be approved. K ~ "I If".
() Cannot be approved at this time as indicated on item HO, ~bove.
Questions and further information on items I through 5 contact the Lane-
COUrny PlANN ING DEPARTMENT. Quest ions and. further informat ion on j tems 6
through 13 contact the Lane County Buildinq and Sanitation Division.
() Wi) I be held in this office until you can resolve the problems indicated,
() Is being returned.
() Your building permit appl ication fee is being returned under separate cu"cr,
Ii\W: COUNTY PU\lH: lUG llEPi\RTMENT
I'~(l Sixth J\\t:nlh~ rit<;t," Euqenf",
01""<]0n
')74UI
LANE COUNTY BUILDING I; SAtJITI\TION DIVISIOIl
135 Sixth .\venue East. Eugene. 0l"C9.on 974
l'IiON!:: 31/2-1311 EXl".411
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LANE COUNTY 4tILDING' PE~MIT OR MOBILE
BUILDING :rn MH 0
MAlllNG ADDRESS
"
\,,0 ,::,,01 Ca~mW;lIAL . ~DillC.C7ICLOj G:U;CU:l
MAILING ADDRESS
HO~SE PERMIT
PERMIT NO.
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PROPERTY OWNER
;1 ILL. ~J,,~Q'i'
CONTRACTOR
PHONE
.7"f' ~':)('(.
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PHONE
PROPERTY LOCATION - INCLUDE POST OFFICE
116'5 t1:l::D:lA
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
101 ADDIYlCfl VD t:-::A~:J ~:::;c::: E07A1CO D.e::n 2 Loy m
TWP RANGE SECTION TAX LOT NO.
CODE
CENSUS TRACT
11)
C2
cIS
'qqu 1 ~i~ (l'
EXISTING STRUCTURES ON PROPERTY
r:O;:1I
-LEGAL ACCESS TO PROPERTY
Oc;n::A
PROPERTY SIZE - FT.
APPl.
NAME
&
MAILING
ADDRESS !]l-':1 ICDl CI.D, C:1!lOc:J
FOR MOBILE HOME PERMITS ONLY
~O::J:;nT N. tll!.!.
G79 \JeOT CEN1EtlClIAL
WIDTH
DEPTH
AREA
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
fr.;e!.L tc:O
Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT. # BDRMS
vnl:.~!
1107 C 12 ~?,
New System 0
VALUATION
,.-"J.
Co... "'-~
0A~AC3~ATTAC~ZD A~~ U~CEIL~O
;jQtio3 I, 'jj(i
UlJ,( .tL~
o tJo'M~il.crc3. \!:I.S.
SEWAGE DISPOSAL
,
OTHERD
C;"0.M
j:o.mJ
,:!'L"D
FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER: NAME
WATER SUPPLY
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK []l
PUBLIC om
o OTHER
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX, GAL. lDro
, Ill) _"fl
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FielD REQUIRED
TOTAL
UN. FT 2{ll)
TRENCH WIDTH FT.
2
OR SQ. FT.
!;:~
DIViWV ~'~'I" D::lAIt:O YD OY~IIll:7. VH..1. l:i~1ALII ME:A YO YUll: L~VC!. Cl' vm: (:111011(:(1 a:'c..-c:I'\.
~at..v 10 ~v. v'~~C;,~ Y'ie t~~UDa f:lt::o ()~opeovv L H!Z tHYH ALL "~r2?1J ov Yt2R D~Cl It.:F t rrLO. t:~1.0 \;.-~~:~~(:l:r:r:
VO A 24 It:Cli ~rHc.:::~l n:1PVtt.
TYPE OF STRUCTURE
eH'l I At!;) J
BLDG. SETBACKS _ FT. FROM CTR. OF ROAD RIGHT OF WAY
FRONT I)')
",
OCCUPANCY
ZONE
r:A
USE CLASSIFICATION
PUBLIC UTlL. EASEMENT
SIDE INT. 7 11 SIDE EXT.
AUTHORIZED SIGNATURE - DATE
/0/ J.E. lJooo OV CUAtlLll:O HA~lQAUC:ll
'j
REAR
7
DATE
G.~. CnAV. SA~11^~IAU
7/17h~ co
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
\ Construction to comply with uniform building code and county regulations
covering plumbing and sewage disposal. All buildings require a certificate
of occupancy before being occupied.
(See Statement on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY, BLDG. & SAN. DIY., COURT HOUSE, EUGENE, OREGON 97401
FORM:=r~~_q
.
"
SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED ;---y DISAPPROVED ~ DATE
REMARKS
GAS PIPING GROUNDWORK
ApPROVED ~ DISAPPROVED ~ DATE
REMARKS
ROUGH PLUMBING
ApPROVED l5i;J DISAPPROVED C1 DATE 9- ')-/:1
REMARKS
ROUGH GAS PIPING
ApPROVED C1 01 SAPPROVEO C1 DATE
REMARKS
!.;
FINAL PLUMBING
ApPROVED
C1 DISAPPROVED C1 DATE
fI~.~.. ~ O~CttI'J'II'[J
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REMARKS
--.LJLD
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c.Y// /1/0 (/H~
FINAL GAS PIPING
ApPROVED C1 DISAPPROVED ;---y DATE
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE / / NOT READY TO ISSUE ;---y DATE
REMARKS
.
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INSPECTOR
INSPECTOR
INSPECTOR~/./
INSPECTOR
INSPECTOR
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INSPECTOR
INSPECTOR
InstJller.s Name A I Property Address
^ (Jy!'\(\ lttr.:> E:t::.7J 116'1 DONDEA '
No.Livingunits IBedroomslBaths I Basement I Water S~p~ly
I -3 I Yes 0 No X Public ROther-List
Sept1c TanK:
Ft. from well - SteelLJ
InS1de Dl.IllenS1ons: .'t.
Length Width
Applicant
Name
,.
ROBERT HILL
. INDIVIDUAL" SEWA~E D~SPOSAL S~ RECORD
Installer: Complete top'par~ form to
signature and return both copies to Lane
County Building Sanitation Department.
.
.
Pj:"~MIT Nn_
1 'WO- 7.
GRAY
Concrete
~
Gal. Capacity. I 0 Cl C>
Tile Disposal Field:
Distribution Box: Yes Jl!l No 0
Other Distribut1on- Type
NO. Compartments
Diameter
Depth
M '1' Feet from
al. l.ng ~ \.Ic-<:T r,:"hl"'';~'~'' \' Well - Foundation J 0
Address Lot Line
~~o I hlf"t" I t"'-."" f'\Ot""'''M Front - Side! 0 Rear I ()
Length of Lines - Ft. ] Trench ITotal SqjFt.betweenlFiller /, IF~ller deothlFiller depth"
l.l0C\2.CJ::D. 4. 5. 6. Width 2-- ft. 400llines In Type / /12.l~i~:e :2- in_ ~N~w G,. in.
Sketch (See instructions): ".
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L AU G 30 1973 ' /
I
101
I
lANE COUfm HEALTH UNIT
Date ~ -2 S - CJ .Q. Si<:nat:iure ::::.. _
For Sanitarian Use Only:
~pproved: System Installation Conforms to Current S andards
o Disapproved: Does Not Conform to Current Standards
Remarks:
.})-t / -'-C'
Date: 8"-31.7..]
Lane County Building & Sanitation Dept.
~IL) ~ /. ~_l\-13
,~. f'
anitarian's ~~ture
.
~
OWNER
LANE COUNTY 4tLDING PERMIT OR MOBILE
8UILDING MH
MAILING ADDRESS
HOM.SE PERMIT
PERMIT NO.
.
PHONE
CONTRACTOR
MAILING ADDRESS
PHONE
PROPERTY LOCATION - INCLUDE POST OFFICE
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
TIN
AN.
;,
"
NO
o
:f N~ 15
^'
APPl.
NAME
&
EXISTING STRUCTURES ON PROPERTY
LEGAL ACCESS TO PROPERTY
MAIliNG
ADDRESS
PROPERTY SIZE - FT.
WIDTH
DEPTH
AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms
TRill: URlc; TO l: E E IL ~lS F :RMI
Connect to Existing Sewa~e System New System r l
TV lNST TIO'" ~a F ftbA"Ms 'vA,LuA'IlJ~
SEWAGE DISPOSAL
PUBLIC
BUilDING
WASTE DISPOSAL
PlUMBING
PLAN REVIEW
PARK TRAilER
!
FEES
PLUMBING INSTAllED BY
OWNER 1 OTHER: NAME
WATER SU~PLY
SEPTIC TANK
OTHER!
PUBLIC
OTHER
TOTAL
s
MIN SEPTIC TANK CAPACITY
WITH 0151 BOX: GAl.
COUNTY hUILDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED
UN. FT
TRENCH WIDTH FT.
OR SQ, FT
TYPE OF STRUCTURE
OCCUPANCY
ZONE
PUBLIC UTlL EASEMENT
BLDG. SETBACKS FT FROM CTR OF ROAD RIGHT OF WAY
USE CLASSIFICATION
FRONT
SIDE INT. SIDE EXT.
AUTHORIZED SIGNATURE - DATE
REAR
DATE
BLDG. PERMIT - WHITE
OFFICE COpy - WHITE
COUNTy TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
Construction to comply wi,h uniform building code and county regulations
covering plumbing and sewage disposal All buildings require a certificate
of occupancy before being occupied
(See State men' on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
lANE COUNTY, BLDG. &. SAN. DIY COURT HOUSE EUGENE OREGON 97401
)R'-' C ~~ 13
r
,~
.
.
.
SITE INSPECTION
ApPROVED Cl DISAPPROVED Cl DATE .
INSPECTOR
REMARKS
FOUNDATION INSPECTION
/'
r....jL;z .7J
INSPECTOR'. ft
ApPROVEO / ~ / D'SAPPROVEO~! DATE
REMARKS
"
FRAMING INSPECTION
ApPROVEO ! I/! DISAPPROVEO! ! DAT~ fl')2' 73
INSPECTOR
Ii-
REMARKS
LATH OR SHEETROCK INSPECTION
ApPROVEO 1---/ DISAPPROVEO 1---/ DATE
INSPECTOR
REMARKS
FINAL INSPECTION , /J
/ ~
ApPROVEO ~/ DISAPPROVED ~ DATE /7- F -71 INSPECTOR
REMARKS~ A'f~q~ 1.j~--"~ ~..u..f--1t.D bOU.k~ J/J -IIJ-?JtI
..N\A) /YtA /~' H ~ '13
CERTIFICATE OF OCCUPANCY
READY TO ISSUE ~ NOT READY TO ISSUE ;---y DATE
INSPECTOR
REMARKS
C~^,;i
13Pt;. 1'3. 'PJ~7tdP ~/~O O~A
3.r-;'S';i -4
LANE COUNTY BaNG PERMIT OR MOBILE HOME I APPLICATION
PERMIT 'TYPE - BUILDING M MOBilE HOME Dose REG, # PERMIT # /3/JrJ. - "J.3
TY pWNE~ /J I _ L- MAILING ADDRE~. J, . 4., ~~. 9": , .', /I. 41- _ J!. PHONE
)L- J ,I(' ~~ 7), ~7' 0 W / -d7 CIU1 LlMA/lL/.b.f// a'
ONTRACTOR I MAILING ADDRESS .' PHONE
7~" - 99J6
Jf--z J::/,z
?"hi ~ . J PI 4' -J- /METES & BOUNDS 0 YES
//UA4Af....f~) ~/"M -' /4.-L--- \ ATTACHED 0 NO
TAX LOT # CODE CENSU$ TRACT
3S-tC;24
DESCRIBE EXISTING STRUCTURES ON PROPERTY IFf ANY
<--n A.ar/~
LEGA'"h.~~~D NAME OR #
PROPERTY SIZE-WIDTH DEPTH
PROPERTY lOCATION - INCLUDE POST OFFice
/LB'5" .J)ht d./ a ..J
PROPERTY LEGAL DESCRIPTION / _ ~_ , J J
LOT - BLOCK - SUBDIV. / .LJ-r" ;:; ~A .
7.1 ~E Zc.
APPLICANT
NAME
r?
~~~
AND
MAILING
ADDRESS
FOR MOBILE HOME PERMIT ONLY
Number of Bedrooms
STR'!,S,URES TO BE BUllI. THIS PERMIT
-Phl/~/~J
~'l-~ (2.2-,V"'2~ _)
, ~h L.J .,#/..V.
- SEWAGE DISPOSAL
AREA
Connect to Existing Sewage
TYPE CONSTRUCTION
~ ~h d./??'f1
t&;:{-7~
System 0 or New System Req. 0
SQ. FT. )i, BEDROOMS VALUATIO~ ~/
/ / IJ'/ re PL_ ./..~2rf9-
fi{-.. t9 .3
OWNER 0 OTHER 0 NAME
PLANS FURNISHED FACILITY PERMIT
~
YES 0 N~ YES 0 NOD /
.SI~NATURE OF '~L~ANT J A IJ DATE
<- y~ jJ-'"'- ~.j Jj, /./tV /Z b7'll
ARECEIVEO llY h DATE
(za.4 '#-~- 'A3
'-"eRMIT # /
/.3M-~
COUNTY BUilDING & SANITATION SPECIFICATIONS /
MIN. SEPTIC TANK CAPACITY DRAIN FIELD REQUIRED /
WITH DIST, OOX, GAL jd}O 0 L1N, FT..J. 00 TRENCH WIDTH FT. l OR SQUARE/E'ET '-/00
fi)~ ~ ~;c: /Jf/JtJOt., LiLf x'h~~~.J z: ,;tk ~ hd;J
. - , U ~
-1-~ j~~, r~' ~-' /~ f- L,~ rkLf I~Jdtp
.J~ {!!<1tu cJi. ~..{ -!tv 4M1LA~ ~~~*/L;)ql/~,
-TVPE OF STRUCTURE '&;./ u OC'CUPAJ~::(' v -e:t:..E TvREARYARD PUBLIC UTlL EASEMENT
BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF ::H.AY USE CLASSIFICATION
4 -I ~T, ~EfT I I
FRONT ':;> SIDE-':- '7 SIDE-alr.- z:; REAR 7 !L
~TARIAN Dot. PL1NNI~G ~,/,,:o/: BLDG, I~S . _ I ~~~_ / J
, JJJ~ '7-16-)"I.kAIA<;,ir-. '",,-'-" ~ r.-J.
U ' . ( -
Directions to Find Property:
PUBLIC 0
SEPTIC TANK bl
$_ .~: AlA)
.~'jIb
FEES
OTHER 0
WATER SUPPLY
PUBLIC 'bl OTHER
PLUMBING FEE~ J v,I-AJ
~ FIXTURES ~ l' IJ _ &-<J
BLDG.
WASTE D15.
PLUMBING
PLAN REVIEW
PARK TRlR.
CASH ,0 ~
CHECK Q"'"CONNECTION FEE
PUBLIC WATER
CONNECTION FEE
~G:o
I.,sJ
TOTAL
// ..2,0-0
COPY 1 - OFFICE
COPY 2 - JOURNAL
COPY 3 - AUDIT
Form # C55-IZ
" 5/;?
/4j5'e.::z
....
PLUMBING INSTALLED BY
Doto
'/:::/ ,,- 11