HomeMy WebLinkAboutPermit Plumbing 1973-8-3
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LANE COUNTVtIL9/NG PERMIT OR MOBILE HOaSE APPLICATION - . '.,
PERMIT TYPE - BUILDING IT'" MOBILE HOME D GSC REG, # PERMIT # J {;'o 7-73
PROPERTY OWNER ~G ADOR:'?p PHONE
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CDNTRACTOf / .' / . MAILING ADDRESS PH-ONE
SEC. TAX LOT # CODE CENSUS TRACT
~~ /00 /;'-0/ .~ S- - I <:~ n
DE~BE EXISTlN~ JTR..,UCTURES ON PROPERTY IF ANY
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lEG!l jCCESS TO PRaPtRTY - ROAD NAME O.R #
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- ~ PROPERTY "'SIZE-WIDTH '- "1>EPTH AREA
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~UCT~. ,/ oce AN"CV lONE - REAR YARt) V PUBLIC UTILI EASEMENT
v' ...... ___ /
BLDG. SETBACKS - FT. FROM eTR. OF ROAD RIGHT Of WAY USE CLASSIFICATION /
FRONT SIDE INT. SIDE EXT. REAR
,;?!J/k -rr.,'):; PLANNING, Doto BLOG, INSP. ~ C ~ ~, J R' hl?:~
Directions to ~ Property: /J/;;-;".i/% n-?; aKT lJ.f/;4/IRt<'.. G-<<A~'rldA/ ,.,/ NiJ~
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PROPERlY LOCATION..,.. INCLUDE POST OFFICE
PROPERTY LEGAL DESCRIPTION
LOT - BLOCK - SUBDIV.
TWP RANGE
/ J ,,;L
APPLICANT
NAME
AND
MAILING
ADDRESS
5{tff71/
"< /K,
...;
FOR MOBilE HOME PERMIT ONLY
Number of Bedrooms
STRUCTURES TO BE BUilT THIS PERMIT
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~
J
i?'~-7
Connect to 'Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT.
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P. 7~. '7"'1
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S:'d a....,
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SEWAGE DISPOSAL -
PLUM,BING INSTALLE~ BY
OWNER ri OTHER 0 NAME
PLANS FURNISHED
OTHER YES~O 0
. V- /Y' ~ o/GNATURE OF APPLICANT
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,. ~ F~E~~ ~
PERMIT #
PUBLIC 0
BLDG.'
WASTE DIS.
PLUMBING
PLAN REVIEW
PARK TRLR.
SEPTIC TANK 0
$~_...
, ;lo, Q)
;}" 0 U
OTHER 0
FEES WATER SUPPLY
PUBLIC 0
PLUMBING FEES
_ FIXTURES
CASH ~ SEWER
CHECK n CONNECTION FEE
PUBLIC WATER
CONNECTION FEE
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED'
lIN. FT.,:;}~ TRENCH WIDT.dl,;;z... OR SQUARE FEET
TOTAL
2-7_ 0 jJ
MIN. .SEPTlC TA~K CAPACITY 4- )
WlT~ DIST. BOX: GAL ~
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COPY 1 - OFFICE
COPY 2 - JOURNAL
COPY 3 - AUDIT
Form # C55-12:
METES & BOUNDS 0 YES
ATTACHED 0 NO
or New System Req. D
# BEDROOMS VALUATION
>>-
,
FACILITY PERMIT _____
YES 0 NO ~
DATE
~-/-7 '{
DATE
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