HomeMy WebLinkAboutPermit Miscellaneous 1974-5-10
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Rccl!Tvcd by Code C.T. Numucr Soccial Pcrmlt Area Urbnniz;n', Aren
TltlS,,1S A PRELlHllIARV',RE.,PORT WIIIC~D ESA-lOr II/SURE THE ISSUANCE OF A FUTURE BUILD ING PERI1IT.
PLANS OR EXPENDITURES HADE IN !\Ell I CE UPON THIS REPORT ARE liT VOUR OWN RI$K.'
,.,. 3rd Au. P lEA S E P R I N T (3f/( 5 (/-25-;2')' .-i
.1/ Subdivision - IInme; HI. 1Id-t"fU7f., Blk'2. ((- 11.)81Ii/(g"J.(D)ot Ii?; : Block 1/ J
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(y;S) 110 '" ~
Owner's Consent
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Township Range
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Sect ion
Tax Lot 110,'
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Owner of Property
Rt--dc.a.. F','f No, of 5 i tes I a
Name
J.:L'fFf r;(fE:f{/-lA/dra:./- La'/~ No. of Acres 4-'
Ha Illng IIddress
Sbh"7f:.c:f/ Total
I' /7 ~ ' . Cash
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Telephone /I Signature of Applicant Date' ./- ,
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Owner Sellcr
Proposed Use
of Prop,erty:
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Applicant's Interest' 'Buyer
In Property: Other (Specify):
Rea I tor
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Property Size.) Legal ACCesS - Road Name
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Existing Structures on Property
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'~s Property Within One HUe of
r~s .- What City? ~
City 7
Proposed Water Supply
Publ ic V Olstrlct:
Spring Well Other (SpeCify):
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Property Location (Directions): /../z!!fi c/- irdS/,zr li'd
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When Will Test Holes Be Ready?
HARK TEST HOLES WITH OUR FLAGS
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(Date)
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Location of Test Holes on Property:
Draw diagram of property
these landmarks:
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showing location of any landmarks ~nd relationship of tcst holes to
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HAKE CHECK PAYABLE TO: HEALTH AND SANITATION
HAIL TO: LANE COUNTV BUILDING AND SANITATION OIVISION, 135 E. 6 th Ave., Eugene, Oregon 97401
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TEST /lOLe RESYLTS
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