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Home My WebLink AboutPermit Building 1974-2-25 c- )/Jl ~."~ -.~.-!- . II .~' "'4.'......,.; . : :1\ ',/' ." ... .' PROPERTY OWNER 1m 1. nc~ert, ~J, CONTRACTOR f' 50l:3 PROPERTY LOCATION -INCLUDE POST OFFICE v_......, ,. .......-...,. " .-.... ' . LANE COUN.UILDING PERMIT OR MOBILE 8UILDING E:J MH 0 MAlllNG ADDRESS Hce USE PERMIT PERMIT NO. , / ';II!?' i.-:,'i 17~')'4 .,. C7Q Vest C~ntcnniDI MAIliNG ADDRESS Snrlnnylnlrl. Orna~n PHONE 7!'~_Q()1:"'\ PHONE 1175 Ocndoa PROPERTY LEGAL DESCRIPTION - METES. BOUNDS 31'.d l!dd It Ion to t1occlow Green Estlltos TWP RANGE SECTION 10 02 06,'. :3 Dlr::!lk 2 lot:lB TAX LOT NO. $92-13 EXISTING STRUCTURES ON PROPERTY CODE CENSUS TRACT APPL. NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No. of Bedrooms ncbort tJ. 1lI11 r,'rtnf\ LEGAL ACCESS TO PROPERTY OnnrJAJ) ~"r"'("lt- PROPERTY SIZE - FT. WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 New System 0 TYPE CONSTRUCTION SQ. FT. # BDRMS VALUATION Ik-olllna t::rrn"n In1' !?l I' (~\ 12.3C4 Garc~o attcched uncoiled 575 G:l 3 1.72<; Covered Plltlo 1610 2 3:!? 51nstoll Sc~cr~ DlsDosnl Svst~) SEWAGE DISPOSAL 14.t:.'l1 PLUMBING INSTALLED BY PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK ill OTHERD Il;q.OO D ~O.OO ~1.00 FEES OWNER D OTHER, NAME Jock Jackson WATER SUPPLY PUBLIC ;0 o OTHER MIN. SEPTIC TANK CAPACITY WITH DIST. BOX, GAl. ~O .1:10.00 COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED UN, FT I GO TRENCH WIDTH FT. 2 OR SQ, FT.3CO TOTAL noof clcolns to street. TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIl. EASEMENT 5tJ I&J RA BLOG, SETBACKS., FT. FROM CTR, OF ROAD RIGHT OFI1,WAY, "oot Pub II c Ut 1II,uSE,ClASSIF.ICATlON, I to-,-, .. t......ot ...u:H....I.!lIo:.ulll.. FRONT 45 SlOE INT.5 SIDE ;EXT. REAR 7 Foot Pub 1 i c Ut II It los EasET.1cnt. AUTHORIZED SIGNATURE - DATE {sl J,E. Doss by C. Harbouoh 1- 1 BLDG. PERMIT - WHITE OFFICE COpy - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD John Shook DATE 2-25-74 s11 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 FORM:::: CSS-13 r' '. -- ".... -. -"'/'~' \ / __ -...,.,-r ,_ _" _""'. '~ c ; _ :J. .'.:..~-~ d"" ~ , ., !.' :. L~NE CO~N.UILDING PE~IT- OR MOBILE Hce USE PERMIT BUILDING EJ MH 0 PERMIT NO, MAILING ADDRESS ;' (~. \. ' >. /1, .::J:.r ' PROPERTY OWNER ,.... ~ ~ 1\ '""- ~ ....,.-,.,., r"l' ,/ " -.' 0 1,. _ __'" '-. ...~O PHONE ["y,:) t.~'~.'t, C.--::-; "::;)0 "1 ~~-::~"~~(:1""~D""'", :' ....,~.~" CONTRACTOR ('. '1 " -- I' MAILING ADDRESS PHONE PROPERTY LOCATION - INCLUDE POST OffICE ~ D G ::-~~~~~~ ~~ PROPERTY LEGAL DESCRIPTION - METES, BOUNDS ~::j [:"~:'~~.c~~:1 c:> [~~:-:~::J c:;:(::::) cGee ::':0 TWP RANGE SECTION ~Q Ci (:'i . I. 3 APPl. n~C"-:::':;~ ~~~~ ~"j TAX LOT NO. ,jf92/~ EXISTING STRUCTURES ON PROPERTY CODE CENSUS TRACT ~ ~~:::::7n [J. NAME & MAILING ADDRESS em..... '),J J \ ~ r' -v-~ ~\"' - \\.:.- '€ ~ 't'\ -\\, Ii: LEGAL ACCESS. TO PROPERTY r:,c:':" Gr.,,,'~r, PQOP~TY SIZE,,- FT,. i' " ~.""':"""",..J:-:1'}"'I...'~ WIDTH DEPTH ',- "',0 AREA FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. # BDRMS New System 0 VALUATION ,'::.:J 0 u eCl ., 1/,7, ~~ ::'''>1 n f,f) ~\1~ C',"\ ' ( ..." (~"':}:',:;:J C'l~:-:.c;:::j c::::::JB~cj ""~'~'1 \')-"1") \,.."..,-,JI....-. ........1. \ -..... :: . ~;J;:) c ;) ~ W'\ - \ - \,\ ~:""W\y:,,,,,~(,~,'C;"n :)~~, ~::-t, \ ~'" w~ ~,""\'\~>:\,' . \ PLUMBING INSTALLED BY OWNER 0 OTHER: NAME ~~~~:.__:. WATER SUPPLY ~ ( '~ , \.r:/,'( ) c Cc~c( ,0 D [~,::'. '"'"::). ~) OC:<::~QU G150~:!>> SEWAGE DISPOSAL :'~~,\(/,'\l") PUBLIC D BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK i:b OTHERD ~ !);~.C:J ,) ~:J6C:J ,))U.C) r" ~ ~., ,0 FEES \ '0\'\~0 , PUBLIC itb o OTHER , ~W\.\ '-l ,I~ MIN. SEPTIC TANK CAPACITY $ Of.J.CJ COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED tiN. FT E CJ TRENCH WIDTH FT. 2" ....f',) OR SQ. FT:'/~~~ TOTAL WITH DI5T. BOX: GAl. S:--..J " \,,\ \ , ..... ....-..... ......... \ " ~:'::;~ L:::JO:::> C:)'C8S:~1;. ", '+,' 0 ,0{ .~ ......~_ .' \ '\ " , , .. ~,..,~~' ~'=""'~~'"K:~- -...:.'-~~,~ ~'::.,_~~_ :;.... TYPE O,~~!R~,~T!J,R\..'-'J: '.....~~.....~,~ :__~~~,'~"'" ~~ ..(?~~UPAN!=~~' ,..~:..t;~ _ '\:'~Z~E\~... ~ '':- P~BlIC UTll."EASEMENT f" r'" . -" '''. ~'\.'~ '\. f1 h -'f '-"". '\ " .J I.. ",-" t .~'t-...''-:\ .... ,...... 't. L! Y .: ", .',,'1.... ',.t........ " .... .\_ BlDG, SETBACKSh FT, FROM'CTR. OF ROAD RIGHT OF',WAYor vS1""I>~v1s,l' (""v\': "'USE"c;lASSIFICATlON. . , ' FRONT ('J ~ \Sl~~ INT.\], \' ....."SIDE1~x)~./,' '~~"*\'~"RE~-~~~":::::~ rfSu$Gs~~1~.1~C~~~~~~~~~,:;_~o,,, AUTHORIZED SIGNATURE - DATE \\ \ C~--:J tv G. [~_'J::::~:::-;) (.~~;::',: [;~- ~.-=j r,," ~ C (,' ,I{ Co ~. /,,'/' BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUilDING - GREEN SANITATION - GOLDENROD DATE II ('" {"., c:>'---_ )I/-,i Construction......to comply~wit~ uniform building code and county regulations covering~pluml?ing and ,sewage disposal. All buildings require a certificate of ~~po-"~y~fo~~li.e~n'g,q~cupied. '\ (See Sfatement on Reverse Side) _~"""'~""~'~ -i,: "\ \ \ ';'\~~ ~'\ ~"Z ")'~\ (POST THIS PERMIT ON MAIN BLDG. AT SITE) lANE COUNTY, BlDG, & SAN, DIV" COURT HOUSE, EUGENE, OREGON 97401 FORM ::t C55-13 J ~' c--- . SITE INSPECTION APPROVED.Cl DISAPPROVED.Cl DATE REMARK 5 FOUNOATION INSPECTION . INSPECTOR ApPROVED .L.lLl- Dl 5APPROVED / / DATE REMARKS h f-& d/J~~t~.d.~ / ?.::z/. "141 INSPECTOR r2 _ "3 ~/'- ';'1 to../. , (!3 I FRAMING INSPECTI ~ ApPROVEO DI SAPPROVEO .Cl DATE ..)': r. 7 t/ I NSPECTO{ ;::II--- REMARKS /fflI!lt,;.."Y-HtnlH V-J ~ '{ll.~ ~LL '-/--11- 7 If -:Ji?t4f11 t-IW"/lr-"'~' ,I...t!..>"",,~' ",-; 2 ,7VfV' . LATH OR S~~~K INSPECTION ApPROVEO ' / ,DI SAP'11tEO L--/ RE MARK S..2.J;,n; f1J1J JIII DATEt.--I" 1 J f FINAL INSPECTION ApPROVEO ~ DISAPPROVEO ~ DATEY/ff"7tj ( REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE ~ DATE REMARKS hi /74 ..,11 /~' ~ "/ /.,/.' . ...\...,...0" Uo"C " /7tJ-7Y 11f~ //76- ~~_ ~ ~J '""",,( ~(!3 ~ INSPECTOR d ~ ) INSPECTOR 1 "., ,. , ,~ , I I BUILDI~G SITE EVALUATION . ~~~ .\t~ c.. "~TAX LOT . I~;r;~~ ~:~N6p#:/;dd, .rs-;z .L-:<?, ADDRESS ~""~ ".'i k\Bu~lding Perm i t App I i cat ion No. ( )\ Site Inspect ion . ';, ( ) ~Pre-Permit Investigation lI\NE ""COllNTY PLANN I NG DEPARTMENT \.. '\ I. '(Lo<>ing j PHONE DATE I ~-6 - /'1 - Ordinance Compl iance (Zone ~ I>-- ) Subdivision Ordinance Compl iance NOT a.;pl icable () () ( ) ( ) ( ) ( ) NO YES NAME DinE ~ 2.. -..., - 7 t./ / > -', Required Access ( ) ( ) ( ) ( ) ( \, ( . (/~ ( ) ( ) 2, 4. Building Site (Area, Width, Frontage, Setback) Other (see comments) 5. .COMMENTS: BUILDING INSPECTION SECTION 6. NOT aDDl icable ~ () () /l) vlf () () I ~) () () Other (see Comments) () )1) () (3.,~L ,.l-I6--7f ....'r~/Jf~~_I'V'~.....~..At...&~~ . , '-'- -' ...- /J JJ /1 -A ,/I ~- ~ r, ./fI~./~-y_ r:r-,./.A~ r/l J/ ,.(/ 1/ 1//\ (.A'A , ~ - ~ NO YES NAME DATE Plans Subm i tted 7, 8. So i I Stab i Ii ty (foot ings) Flood Plain 9. COMMENTS: SANITATION SECTION NOT NO YES NAI1E DATE . app I icab I e ~ a\'U.Q 4lS-/1"L 10. Sewage o i sposa I ( ) ( ) II. Us ab 1 e Area ( ) ( ) ;/ 12. Water Supply ( ) ( ) 13. Other (see Comments) ( ) ( ) ( ) COMMENTS: TO APPLICANT: C),)J-~~ l>< ~ Building Permit / Site Inspect ion: ~ Can be approved. ~ Cannot be approved at this time as indicated on item NO, ~ above, Quest ions and further informat ion on items I through 5 contact the Lane- COUNTY PLANNING DEPARTMENT. Questions and further information on itcms 6 through 13 contact thc Lanc Counlv Buildinq ;,,,d Sanitation Division. Will be held in this office until you can rcsolvc I'he problems indicat"d. Is bcing returned. Your bllildin~ permit appliccJtiun fee is being returned under separate (.u<ler. ~"6~r ~ ( ) ( ) LANE COIIN"IY I'U\NN ING DEI'/IRTMENT I]') Si)<tlo AvcrIl'" [^'t. Euyelle, (l'''9uIl 97401 "Il,'Nr:: 34l.,UII 01.211 LANE COUNTY BUILDING & SANITATION DIVISION IJIJ Sixth I'lV(;1"'" tdst, ["'Ie,,,", O,."qnn 97401 , ' PllllNL: JLJ2-1311 fliT. If'l ~\ '""M5S= 28- -----.- . .,,' · .Dqte . Building . Permit # . . APPLICATION FOR FACILITY PERMIT I, (Applicant's Nome) hereby make applicatian under Rules and Regulatians Gaverning Facilities to be Permitted Upon County Rights-of-Way, to construct the following facility: Upon the right-of-way of County Road No, , at mile post on the No, So, E, W. side of the road, or (mark w;\h X) as shown on the exhibits which are attached hereto, in strict conformity to the statements of the exact nature and amount of work to be done, and to the description of the facilities contained in said exhibits, The applicant will be the principle owner of the facility as constructed, or other- wise primarily liable and responsible to members of the public for its proper maintenance, repair, operation and use, The applicant accepts all terms, conditions, agreements, stipulations and pro- visions, in Rules and Regulations Governing Facilities to be Permitted Upon County Road Rights- of-Way, as set forth by the lane Manual 50.190(2), any amendments thereto, and any other ap- plicable regulation, law or ordinance. To Permits Processing Noted Date Noted Director Principal Engineer Subdivision Engineer Signature Permit Engineer Weighmaster Address Zone No. WHITE GREEN PINK -OFFICE FILE - RESIDENT ENGINEER - PERMITTEE BLUE - ROAD SUPV. ORANGE - BLDG. & SANII. YEllOW - REAL ESTATE Phone No. c98-78 ~. .' ,,~ <J, Dqte _0 . Building . Permit # . . . APPLICATION FOR FACILITY PERMIT I, (Applicant's Name) hereby make application under Rules and Regulations Governing Facilities to be Permitted Upon County Rights-of-Way, to construct the following facility: Upon the right-of-way of County Road No, ! ." I ~ , at mile post on the I No. I So. I E. ! w. I side of the road, or (mark with X) as shown on the exhibits which are attached hereto, in strict conformity to the statements of the exact nature and amount of work to be done, and to the description of the facilities contained in said exhibits. The applicant will be the principle owner of the facility as constructed, or other- wise primarily liable and responsible to members of the public for its proper maintenance, repair, operation and use. The applicant accepts all terms, conditions, agreements, stipulations and pro- visions, in Rules and Regulations Governing Facilities to be Permitted Upon County Road Rights- of-Way, as set forth by the Lane Manual 50.190(2), any amendments thereto, and any other ap- plicable regulation, law or ordinance. .; I '*,' '...,' " To Permits Processing Noted Date Noted Director Principal Engineer Subdivision Engineer Signature Permit Engineer , .' , r . ' "", Address Weighmaster Zone No. WHITE GREEN PINK - OFFICE FilE - RESIDENT ENGINEER - PERMITTEE BLUE - ROAD SUPV. ORANGE - BLDG. & SAN IT. YEllOW - REAL ESTATE Phone No. C98-78 ~, ~,.' , P~SED SUBSURFACE SEWAGE DISPOS.S\ tIIIaller: Complete top part of form to signature and submit both copies with application. , ; .' 0, ./' , . Installer's N:rl'e '. '-;f7 ~ ;:t./ln~ No. LiVi~9 units I Bedrooms 3 (Exhibit No.1) Permit No. 1'7D-7L/ I Property Address /J J . /1 II?.. .cJ/1'YJhJ - ~J~OL- I Baths Basemeni Water Supply () / 1/ / ~2- Yes_ No~ Community Public~Other-List_ Septic Tank: Ft. from well Inside Dimensions: Length Width Applicant Name Diameter Depth Gal. Cap_aei t'{ ITile Disposal Field: Distribution Box: Yes _ No_ Other Distribution - Type Steel_ Ft. Concrete _ No. Compartments 'J/Lf-n. .).U 13~~;,?L., 4~) /lI f Feet from JI?O 7,,) (' """T ~:"'A'~. Well Address V . . i:c - /J,('). J Lot Line o? ~ ~V ~ ~ Front side Rear Length of Lines - Ft} '~';I r;- ch 1 'l'otai se;.( Ft. betweenlFilter rg~~r DePthlf:q~r Depth 1. 2. 3. 4. 5. 6. Width ft. . lines Type ~e in. t~te in. __"O':';'~~~'~~~:~1} _ ~__I= __~_ =f _ __ =-=--=~_~ = I __~__ --1-0.- _~ ___ _..~ _~ I "- _ ______.~~__._ ..._~ _ _____ _____ .__. _.'__ __,_ _~I_=I~':= -:~ :.... '~': ~5 i~ ==':==:= =~ I::, =: _:-~ - ~_ :==: "'-..-t,:4~l-, ~~-- ,~~ ~~,~ =i~:==- '-- -.-- ~.,',-,~~~~ '~- ~~~ ~:= ~= :,::: ~~ ~= =,:~~~ ~=:.~~ ~~~~~ ~~.,- .--,.---,'+'rt:+.:~ __= ~__ --)1-"-: := :____.:=: =~ '~~,~ ::< . __ J~__::~ _:. -"- .-- I '.~ ',','__::' , i I '---- ." '" , ,,, .\-.__ ..._ _ ",_"._ ,_ _,,_ _.... '"... :-:--... ,__ __._ _._, ,~_~. . _ ,__n'''__, .--' 1--..- _.::..- ~ ~, ._-~~- ----- I I!, - -~~ - I' ~--'--'''''--i._. ~-.-._.,'.... --..--_-..---;-._,.__ ~ ~..,.-._. ...._._u_ ..--.-._.. , ! I .....(;0 __.. I, / I == =~ '-'j --T~--'~~T- ---- ,-- = == -= ..-- .- -- -- ==:~ == ~I--~ = ~;~ ., = ~ (d.: -~-- ;~~;'l :.~::, , - -1--- ------ ,-_. - --- -----~_ _L ------- I j I ! I Date :2J. ~ I<;? C/ Sicmature ~ f'../~ //. ~ , Mailing Foundation , Remarks: Sanitarian Use Only: Approved: System Installation COnforms to DEQ Rules for Subsurface Sewage Disposal Disapproved: Does not Conform to DEQ Rules for Subsurface Sewage Disposal Date: 6/IL//7t{ s~~an~Qr&re Quality -...... Statil- of Oregon Department of Environmental ~r Interim Form #2 ...:' \..,) '. . . PLOT PLAN GUIDE " For Preparation of Exhibit *1 J PLOT PLAN MUST INCLUDE: 1. Legal description (Bottom of page) 2. Property dimensions 3. Direction of North 4. All roads (existing and proposed). 5. Driveways (existing and proposed) 6. Location of structure(s) on,property 7. Location of water source 8. Direction o~ slope 9. Location of trees 10. Proposed location of septic tank and drain field and replacement area 11. Dimensions and spacing of leach lines' i2. Distance from system to property lines 13. ' Location of test holes 14. Draw to scale 15. ' Location of wells on adjacent lots I I I -- jPIL~ 2./9' ". " ~ -J . plL f' '-J I " \, f- ill 1lJ", l!::~ ....~ IJ)~ IJ) 't - f-I:~ <1'1'-:- I fill 1li It (l " c" ----~.s-~c)"" . -<$' " "~ III ~ _J ....:I~CJRAINFI litO !. RE'PLACEI<1J;..,'" A~EA r~-,L - - ----, ~___\._____J , TEST PI, _/) .. eo' LONG. . ,,;, '~ll' 80' ~~_. -' \ .~ - "0' r--... ,.,// ~,"': r- .- . --............. 11.,gl' , \o~/./ ,0157'''''..'81.J'7''ON _!!."-~~ "000 GAL, // . -Tf?tCE;;L ~ .__ s/:p ~/C -rANI<. <;WELL t f f ~ r~~;~~tSj( ")j - lj ~ I '~' I .: WE'LL ON S p/L.. -7 N'""o. . -'~~~AceN"" LOT " DRIVEW"'''' iJ1 Of N ./ \... " II.. LINDEN L..ANE/'} (PROPOS 1:,0) _p t- A t;j , SCALI: I ~ "0 Section 2. T. T3S R. 2. W. W. ~A . Tax Lot or Account No. 2./00 Interim Form #5 LANE COer BUILDING r BUILDING PERMIT MH 0 MAILING ADDRESS OR MOBILE IME USE PERMIT PERMIT NO, PROPERTY OWNER PHONE CONTRACTOR MAIL1NG ADDRESS PHONE PROPERTY LOCATION -INCLUDE POST OFFICE PROPERTY LEGAL DESCRIPTION - METES. BOUNDS TWP RANGE SECTION TAX LOT NO CODE CENSUS TRACT APPl. NAME . MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRtJCTURES TO BE BUILT THIS PERMIT EXISTING STRUCTURES ON PROPERTY LEGAL ACCESS TO PROPERTY P", slt'e-FT, WIDTH DEPTH AREA Connect to Existing Sewcge System [J New System D TYPE CONSTRUCTION ~6 FT :: BDRMS VALUATION . FEES PLUMBING INSTAllED BY OWNER n OTHER: NAME WATER SUPPLY SEWAGE DISPOSAL PUBLIC n BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK n OTHERn PU sLle 0 o OTHER TOTAL s MIN. SEPTIC TANK CAPACITY WITH OISl. BO)(: GAl. COUNTY ~UILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED tiN. FT TRENCH WIDTH FT. OR SQ. FT. TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTll. EASEMENT BLDG. SETBACKS FT. FROM (Tit OF ROAD RIGHT Of WAY USE CLASSIFICATION FRONT SIDE INT. SIDE EXI. AUTHORIZED SIGNATURE - DATE REAR DATE 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 0 certificate of occupancy before being occupied. (See Statement on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, 8LOG. & SAN. OIV., COURT HOUSE. EUGENE. OREGON 97401 fOAM := C55-1} . . " , SLAB FLOOR PLUMBING GROUNDWORK ApPROVED Cl DI SAPPROVED /I DATE INSPECTOR REMARK S ;),':;C; . GAS PIPING GROUNDWORK ApPROVED Cl DISAPPROVED L / DATE INSPECTOR REMARKS RDUGH PLUMBING ApPROVED fSZ:1 DISAPPROVED Cl 'DATEQ-/?-7r INSPECTOR~ U REMARKS ROUGH GAS PIPING ApPROVED Cl DISAPPROVED Cl DATE I N5PECTQR, REMARKS FINAL PLUMBING DISAPPROVED Cl DATE$-/1-;,'t I NSPEC..." u # {),,?? ApPROVED ~ REMARKS FINAL GAS PIPING ApPROVED Cl DiSAPPROVED /I DATE INSPECTOR REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE / / DAT~ INSPECTOR REMARKS I- ,. . INSTALLER: INSTALLER'S PROP~ SEWAGE DISPOSAL SYSTEM RECOR-~J ,.' - Complete top part of form to signature and submit both~es with applicatlQn. ',~ PERMIT NO. I?tt)-?'J'f" NAME PROPERTY ADDRESS 6,pEc7ll Bedrooms ....;;' 1/f)l(td No. Livi~ Units Septic Tank: Ft. from well Dimensions: Width Ro~r\ 11. RIO \,u&'.i C'Q:II.kV\~lO ADDRESS . I 00 (' .....t::1.f;a C..\ ?-:\tg.'1l'7>~ Length of Liribs-Ft. \H [TrenCh J To~1 Sq. . 802:7a. 4. 5. 6. Width21 Ft..~ 'lot Pian (see instructions): I 10' , ,.-1_-74- Inside Leng.!:h OWNER NAME MAILING \ _10 I I ,I 40( I I I I I t ~ Baths / Wl~ Basement Yes / NJ< '~-'M.'\"n Water Supply Publ icX Other-List Steel 0 Ft. Diameter Concrete ~o. Compartments I' Gal. Capacity Tile Disposal Field: Distribution Box: Yes)( No Other Distribution-Type /a-m':) Depth .JIII Feet from WEll Lot Li ne Front 1Ft. Between Li nes 10 Foundation /t'; Side 1/9 Rear /6 IFiller;; IFiller Depth IFiller Below Type 17.zJAbove Ti Ie 2...inJrlle ~ In. I 1\_--:- MW)t:', I __-10- I io' I 4{)1 ", - -- I 10' I /-- - 10' t. ( I 1_ .J... ..30' - -- -'- --- ...3D I :3' ':'. '"to.;! ,9 i'" B " ~ n I;, \;, " i' "'\" &J.I ,. . kJ MAY u 6 1974 t", " .....1l.-c!J unt Si~ature d "~' - C:;L ~ n-"-. CERTIFICATE OF SATISFACT COMPLEft0K7 ..I .J For Sanitarian Use Only: Date:5/1'I17L/ In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certificate is issued as evidence of satisfactory completion of a subsurface sewage disposal system at the above I oca,.p2' Approved: System Installation conforms to current standards c::J Disapproved: Does not conform to current standards Remarks: Date C55 -11 ~~ ~~. r S' Itarlan sIgnature E COUNTY STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY 11":\ ItJ LANE COU. BUILDING PERMIT OR MOBILE ~OME USE APPLICATION PERMIT TYPE - BUilDING i\I MOBilE HOME Dose REG, # PERMIT:#: /. 70 -,7~ PROPERTY OW~ER / '\ MAILlNG ADDlJSS A ,I _/J _ PHONE ~.t:.?/ ~ ';1{. 6'1 tJ 1/-1 ~ LbvtA./..-...__'/ .i Y ~eI CONTRACi3: _ MAILING ADDRESS / . / ~ONE ,-.:; --: < ~ ~ ? 4/4; - 99/ t, PR~v_lnr:lo.TIOtJ\.-INCLUDE POST OffiCE --l.1L7 .;-~) ./ J /J-x d1 JX../ PROPERTY lEGA. DESCRIPTION .... . / j /. -rJ. / ' L/ lOT - BLOCK - SUBDIV, ....:J/2a of? pr.P<.-- //1./-<1--<< AA.4 X-1/../~_ TWP RANGE SEe. TAX lOT :# (ODE- i! (jU1ll -I')' ~PPLlCANT , - NAME ~~-L- - A -d_~ 0' -" /. / / --t:' ..L ,g. -.2.-." METES & BOUNDS 0 YES r~. ,pi -.0..'7 ATTACHED 0 NO CENSUS TRACT - AND MAILING ADDRESS DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY '77 ~~ LEGAL ACCESS TO PROPERTY - ROAD NAME OR # li!.v-.,u;(-L-d--- ___d-I-. PROPERTY SIZE-WIDTH DEPTH AREA FOR MOBilE HOME PERMIT ONLY Number of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT ~A/YJ:t, /' /::J,~ - tf~ - },I..47,.t9,.. d.. r./ r.-n)./Ad fUh;, ~~d-I ,d"d!..? SEWAGE DISPOSAL PUBLIC 0 BLDG. WASTE OIS. PLUMBING PLAN REVIEW PARK TRLR. , SEPTIC TANK if .;:;>;t 00' .3?J, () 0 :-3/. 00 OTHER 0 FEES WATER SUPPLY PUBLIC ~. PLU~ING FEES FIXTURES CASH 0 SpotER CHECK ~ONNECTION FEE PUBLIC WATER CONNECTION FEE :>""'Jl =- /#3/ I PLUMBING INSTAllED BY n OWNER n OTHERJ'{NAME I./..fi/,t (l,.U"~ J. PLANS FURNISHED' C' FACIQ}f PERM"rr~~ YES iX NO 0 YES p( ..I'O"'EJ SIG~~OF AP~~T---L.- /~";;A DATE )( /)'/t"?' r~JJ~.:f/;b/74/ '~V:D BY' / >>-t1?/?'~ PERiM/#//?/-?-/ ,. . COUNTY BUilDING & SANITATION SPECIFIC,6.TlO~ DRAIN FIELD REQUIRED L./ lIN. FT. 1%0 TRENCH WIDTH FT, z: OR SQUARE FEET ~ (, 6 Connect to Existing Sewage System 0 or New System Req. n TYPE CONSTRUCTION SQ. FT. G1MDROOMS VALUATION ''/1 <--;t-....d.--r>-o--<- ~~X #_--> "':1';:2 ("...3 ) /~ ?>3', tf/ <? (f?:?) , .:;23 )( tb e,::j' / 7:1. '7 '7X~ MJ ?', OTHER e'd,,I.,A) ~?,1!1--iJ ,;(. tJlAf TOTAL L';;;~. ".... ,:{,u MIN. SEPTIC TANK CAPACITY WITH DIS1. BOX: GAL. 1DO frY 01'5. TYPE OF STRUCTURE S N OCCUPA;CY ZO~ REAR YARD BLOG, SETBACKS - FT, FROM CTR, OF ROAD RIGHT ,QF WAY' ~ USE CLASSIFICATION ;/ OS' r- IJ i I 7 I FRONT o-rS SIDE INT,;::o, SIDE -,I UT ~R P'U1e.-- ,. 1'1 _ ~~CWl 8/;8/;; ~ 2.-7-0;1 BLOG.INSP, ffJ tri-d1 ~71..~:I7'f Qections to Find Property' PUBLIC UTlL. EASEMENT COpy 1 - OFFICE COpy 2 - JOURNAL COPY 3 - AUDIT Form # (55-12 ~ I-Single or Multi~Family per dwelling ~(jm1DNI ~ (::c{8 L":) Service Included: Items \ A ~OtITlm'~ 06-2 C l j \~ ,(~:~ ::'!;,;::::!!: permit~are non-transferable and: expire thereof if work is not started within 180 days Each Manuf'd Home or of issuance or if work is suspended for Modular Dwelling 180 days. Service or Feeder 225 FIITH STREET ~ SPRINGFIELD, OREGON 97477 ' INSPECTION REQUEST: 726-376~ OFFICE: 726-3759 . ~ 1. r~~Y~ OF ~()(\fru1 ') 2. - CONTRACTOR INSTALLATION ONLY-- E~trical Cqntra~tor ,J Addr~' ./ Ci tv ~ Phone/ Supervisor Li~ NU~ Expiration Date X ~ ~ Constr Contr. A. SI'JIINCJ:I[;:'LD B. -Services or Feeders Installation, Alterations Relocation: 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only uni to Cost Sum $ 85.00 $ 15.00 $ 40.00 or $ 50.00 C() $ 60.00 $100.00 $130.00 $300.00 $ 40.00 L C. Temporary Services or Feeders Installation, Alteration or Relocation Owners Name <t1Q J1.uro.D \~ln~' Address \ \ l ~ rlYmrt Q ^ ) City~rt ~ho;e~{)~ 1[)~lq OVNER INSTALLATION The 'installation is being made on property I own which is not intended for sale, lease or'rent. Signature: U)~ D~~;~----~~-~~r-r?-~~~-)-~-~---- RECEIPT It: : ~,oI.,'-1VJ( ) RECEIVED BY=( L -./ -:- - 200 amps or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts Branch Circui'ts $ 40.00 $ 55.00 $ 80.00 see "B" above New, Alteration or Extension Per Panel Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm One Circuit Each Addi tional Circuit or with Service or Feeder Permit E. s. SUBTOTAL OF ABOVE 5% State Surcharge TOTAL $ 35,00 $ 2.00 not included) $ 40.00 $ 40.00 $ 20.00 S 36.00 ~~.~ b~~,-)/ )