HomeMy WebLinkAboutPermit Plumbing 1978-4-17 (2)
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Job Location
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Number of sites
(owner, etc.)
INFORMATION SHEET
) Building Permit
( ) Site Feasibility Study for Septic Tank.
( ) Would like to meet on site. Call
Acreage or Lot Sizp 155" X 'DO Test holes will be ready
Partitioning #. ( ) Compl~ted Subdivision 1'f03- ).-;2. 7L '2.(0,. ;Z~-
( ) Pending
APPLICANT'S NAME AND ADDRi=C:C: D....~ 0-. C) ~ ~, 575 ~~
OWNER'S NAME AND ADDRESS, if differe~t from a~plicant's uh..L~ I.'^((....~
CONTRACTOR'S NAME AND ADDRESS ~~U 'm.~ c....J..., 57,- So.v,:K:
_Mail permit or results of site feasibility study to ( ) Applicant ( ) Owner (X) Contractor.
) Prefer to pick up. Call ?'fe-400B (owner,etc.) when ready.
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Lot
Bloc~
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Phon~
Phono
Phono
74-7-'I<!OF:
7<.l(, -zz~c;
7<l7-'1(JC~
STRUCTURES NOW ON THE PROPERTY
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PROPOSED USE (this permit) i'l/ll3 ~ ~'I.<r\NU iJ {o..u..w..JV,..)i:"
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(existing or proposed well, etc, ~e of syste
(existing or proposed septic tank, etc.) S.1. 4'
WATER SUPPLY
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Address
~ 75 $,.,w./{,.. If '1?f
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SEWAGE DISPOSAl
PLUMBING BY
,
(v1 PROPERTY IS WITHIN ONE MILE OF CITY L ~",'IJJ..lt\!
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************..************"...*******..****OFFICE USE ONLY BELOW THIS
LIN E *"f1...".* ** ***.. **.. ..** ** ** '*-....* **.... ** ***.. ** ** **
.( ) New Address Necessary ( ) Facility Permit Necessary
ON I' SETBACKS: Front . Side Facing Street
(FROM CENTERLINE OF ROAD)
) 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.
ResponsP'
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By
Permit Processing Section
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By
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DEPAFlTMENT OF ENVIRONMENTAL MANAGEMENT
Permit Processing Section
125 East 8th Avenue
6B7-4394
I"\ivision
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TRS, T'
18-03-02.2
TL 2603
JOB LOCATION
1061-78
PERMIT #.
121 OOR.'US ",'n<<",," SPRIN"",.u:;UJ U&kJU.,j
cur SCXlTH 2nd ill DORRIS 'IURN RIGHT HARBOR DRIVE FOI;IJ:JiJ 'ro
121 DORRIS S'H""""
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Partitioning #
LANE COUNTY PfRMl';"
NA
NA
,
155 X
300
Acreage or Lot Sizo
Contractor's O,S. #
) Completed
Subdivision
Lot
Block
APPLICANT'S NAME AND ADDRESC:
OWNER'S NAME AND ADDRES~
CONTRACTOR'S NAME AND ADDRI'C:C:
Mail permit to ( ) Applicant ( ) Owner
RANDOLPH A. ALLEN 575 SCUl'H A ',inU"..",T SPRIN:;FIErD <.Jl=,u-l Phone
Wl.LL.I.I\M JIoX..: liliUJ:<tili J.lJ. W!ilil.::> ::>TKl:J;T ::>t'Kli,^-",.u:;.u) Ul<tloU., Phon~
EI-lERAUJ TRAILER SALES 575 SCOTH A ::>'H''''''''' SPRINGFIErD Phone
) Contractor. ~ l Prefer to pick up. Call 747-4008 (owner, etc.) when ready.
~
EXISTlliG PUMP HOOSE MOBILE HCME
747-4008
THIS PERMIT IS FOR
STRUCTURES NOW ON THE PROPERTY
REPJ:ACEI.lli.."NT MOBILE Her-IE
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SINGLE WIDE
# BEDROOMS2
-.
# PLUMBING CONNECTION~ .
NA-.
EXIST:rn::; WELL EXI"'T.lJ...u SDS
WATER SUPPLY SEWAGE DISPQSAI S,I, #
THIS PROPERTY IS WITHIN ONE MILE OF THE Y OF SPRllG'IEID QREX.;(N. PLUMBING BY EMERAID TRAILER
I hereby certify that the above statements are true ~ccurate, and that I have the following legal interest in the property: _owner of record;
contract purchaser; _ potential buyer, VA Cllllltor or agent. I further~ that (if not the owner) I am authorized to act for the owner of
record, and ~hat said ~ner is aware and approves'o( dHS ac;tion. I hereby agree to ~myfy wi all ap licable Co e relating to this permit.
e Paid 'l: \-\\.C\! Signature. ~ 0- ' Date \-\ \\~ \'\~.
cf:!jW ADDRESS ( ) FACILITY PERMIT TO TRANSPORTATION DEPT, ) SP CIAL PMT, AREA. MIN. ELEVATION:
TATION
4t-
Minimum Septic Tank Capacity (Gallons)
Drainfield Required. Lineal Feet
Maximum Depth
BUILDING LA]\Tk' COT77..T~I'-;l' "'~~i"T" L
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Type of Construction - -r;roup
Use Classification
T:;L!:':1'~1' .1I '11<'''
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Comments:
.
Comments:
By: Date: ~ ~ Date:
PLANNING REQUIREMENTS SATIS'FIED. Bv:' ~(~ (. . '. Date: \.\~\ ~f'\ Date Issued:
~ONE: KPr- SETBACKS: FRONT ~niSID lACING STREET _ (FROM' C/Ll 'INT. SIDE YARD~' REAR .!i'
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LANE COUNTY DEPARTMENT OF'tMVIRO"N'MENTh't1.o^N GEMENT 125 EAST 8TH AVE EUGENE OREGON 97401
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~iJ'N .~;::t!--; ~POST THIS PE IT ON MAIN BUILDING AT SITE
~'1~.1 . ~~~:';f6T -~HITE' BU.'LDING -GREEN, PLUMBING - CANARY, SANITATION - GOLDENROD, OFFICE COPY - WHITE
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(FROM PILl
PHONE: 687-4394
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