HomeMy WebLinkAboutPermit Building 1984-9-6
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Lane C!nty Authorization
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READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION HAS BEEN BASED ON THE FOLLOWING CONDITIONS:
o PLANNING/ZONING: zoneC'\.Q ~'-- I Partition #I Parcel II: ~ Parcel Size
Hinimum Setha'(ks, CL, front ~ ~~ cL, side interior~' \ear "
COMNEN~\F. Of 0a.J.. Q"\ lr1.!;. "'a.'S,EID es--.-... ~ ~lV'\fn;"''''c;.
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\.! \"'PF ""--'~.' &~ O$'C,.... ..D~ \0<::' :=>r-{'~ ~'<7m~." to"'...., ,. _
~ 0t} /"ft\V ~~ '\ \"\ \.\Q Dar.;:" s.r.. S)_;:;J w
o FLOODPLAIN: In EE ATTACHED SHEET. Date: n
LITATION' S. 1. # Installation Record Issued? 0 Yes 0 No
Installation
Specifications:
) ~ /1l1ecl ~r()
I~ON' Type V'.#J'
.,
COMHENTS ~~ t!!l!IfO//?I:>r> t!JAr.= ..cxJ:S. .. '-
~tJrf.~ p(.U.l c.~..I"~ ~eta.t~ VOtD 3/"/Ji'G
~ A ~W fa. ~ PU.}l ~ WILt. P:E
~;-~.~;..r~fb ~#~/f';
TOTAL ~A~~N'~~~ CONSTR<<CTIO~ AUTHORIZED BY THIS PERMIT
COt-U>IENTS: .
Lineal Feet Maximum Depth
of Orainfie1d of Trenches ~
, /~7J .,i:.~~ /~~~I bA~
~ f ./-.ta, P~4~ -q.",.", d....r,hL
10 -et1,9~ 41 sdeth.. Date:?j- ~~7- .. IA
J --r fJ''; ~~ 1/" CJ1!EY.
Group.e-2 Use II} lZe"mlL. '5A1.E:~
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'DawaL :r1.'l
Date, ")~/84-
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F=i::J;; 'f7~!!9~P:~ED BY BUIL::G OFFICIAL/DESIGNEE {per ORS 4~t-!
Fixed Fee'/
Unit Cost
Floodplain Fee $
Subsurface Fees S .. rh
B!l.ildil;!,. ~ee G.2~/4;:-';-
Irfch/PT.;;'bg Fee 53 $ g'i.. ~
P'ans Check Fee~ ~,,' ~~
State Surcharge ~~: ~~
DEQ $urch1!f8~ $ l."J ..
TOTAL FEE $$ ~"'''''''-..''i...
N/4
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Z!l{f!.
23.40
~I&.M DATE
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
C 14-25
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SETBACKS AND OTHER CONOITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVO-
CATION OF THIS PERMIT, CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OTHER
REMEDIES ALLOWED BY LAW., -- ~ .
l:1HEN READY FOR INSPECTION, CALL 687-4065. A MINIMUM OF AT LEAST'24 'HOURS ADVANCE NOTICE fOR INSPEC-
TION REQUESTS MUST BE GIVEN. Have the following information ready: ,permit nu~ber, job ?ddress, type
of inspection, when i~ will be ready, your name an~ phone number, and any special directions to site.
BUILDING DIVISION:
REQUIREO INSPECTIONS:
1. Foundation Inspection: To be made after trenches are excavated and forms erected and.when all
materials for the foundation are delivered on the job. Where concrete from a central mixing
plant (conunonly termed "transit mixedU) :is to be used, materials need not be on the job.
2. Concrete Slab or Under-Floor Inspection: To be made after all in-slab or under-floor building
service equIpment, conduit, prpIng accessories, and other ancillary equipment items are in
place but before any concrete is poured or floor sheathing installed, includ~ng the subfloor.
3. Framinq & Insulation Inspections: To be made after the roof, all framing,. f ire blocking, and-
bra<;:ing are in place and all pipes,. fireplaces, chimneys, and vents are complete and all rough
electrical and,plumbing are approv~d. ~ll wa~l in~ul~~ion and ~apor barri~r are in place.
4. Lath and/or Gy~sum Board Inspection: To be made after all lathing and gypsum board, interior
ana-exterIOr, 1S 1n place~t before any plastering. is applied.andbefore,gyps~ board joints.
and fasteners are taped and finished.
5. Final ~pection: To be made after the building is complete and before occupancy.
APPROVAL REQUIRED. No work shall be done on any part of the building or structure beyond the point
indicated in each successive inspection without first obtaining the approval of 'the building official.
Such approval shall be given only after an inspection shall have been made of each successive step
in the construction as indicated by each of the inspections required.
NOTE: All building perm{ts require inspec::tipn:;> for 'the work a.uthorized, such as but not limited to:
. . . . . .......
A. Block Wall: To be made after reinforcing is in place, but before any grout is poured. This
rnspect10n is required for each bond beam pour. There will be no approval until the plumbing
an~ electrical inspections have been made and approved.
'.. B.', ,Wood Stove: To be made after completion of masonry (if applicable) and when installation is
. . . . "complete. Installation shall be in accordance with an approved, nationally recognized testing
')_agen~~ and the ~~ufacturer's installation instructions.
C:. Mobile Home: An inspection is required after the mobile home'is connected to an approved
sewer or septic system for setback requirements, blocking, footing connection, tiedowns,
sKirting, and plumbing connections. - ..
1. Footings and piers to comply with State foundation requirements for mobile homes or as
recommended by the manufacturer.
2'. Mobile home' minimum finish floor elevation shall be certified when required by a flood-
plain management letter. ~.
3. Mobile home tiedowns, when required, and ~k~tin~ shalt be installed and ready for inspec-
tion within at least 30 days after occupanjY~ 'T~Zdow~~-~~d skirting shall be installed
per enclosure. . ('-: ..:1 f (,,'"
O. Swimminq~: Below grade when steel is in place (ahd b~~oJe co~~rete is poured. Above grade
when pOOl 1S installed. . J (~&(" ."
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.APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DU~ING WORKIN JlO~S;' lTHJS PERMIT WILL EXPIRE
" IF WORK, DOES NOT BEGIN WITHIN 180 DAYS, OR IF WORK IS SUSPENDED OR '.{I\l>NDONED1Fq,R MORE THAN 180 DAYS.
SUSPENSION OR REVOCATION MAY O~CUR IF THIS PERMIT WAS ISSUED ON THE ~ASIS OF I~~~PLETE OR ERRONEOUS
. INFORMATION. . """~ ..
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~!,NYONE PROCEEDING, PAS,T THE POIr:T or REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN 'RI,Sj1'_ ~
SUBSURFP>.CE M!.2.AL1ERNNI'IVE SEWAGE DISPOSAL SYSTEMS:,.; : ~ '" 6- t,
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2.
Permits shall be effective for one year from the date, qf issualfce. , .\. ' ,
~ ~ '.-1'~' ,.."j'f"' "'! 'J."....,..J.. ..;,.~. ~'_\ "t, . "".
Upon complet,i,ng the construc.~~nf,or""'hic;h. '\ perm>",. ~~~ ~~en A~su:%~ ,~~~ ,feW{- ,illl.l~er _~_a~j
notify th~ L~l1eJ,~ou9.tY.~peparitIn.e_nto..of*'PHlIfn:ing,,'"4nd conun'Qn~!:yJD~el~pgJen~,'oy sUhmliB;iOg~pe.~,
installatiqn record form. The Department shall,inspeC1:;, the con!3t:t;',~ti.iUo "determine 'if. it
complies w~,tb:' tl1e :.t:ules contained i~{~hh)!~iS~.cm. ~ 'H."'V;'qop'~.UPtijl"l1oe"JCqW~ly\Wi ~,ht!.uch
rules, the'Department shall issue a certifica,biPaf ~~tis~ac~o~Ylfomp~tion t~ ~e R~~t,hqlder.
If the construction does not comply with such"f'l.Iles,~ the) Oepa.;> tment Jh'ail, z:1otl.i~. t:.;.h~1P~.r~,L~
holder and shall require satisfactory completion 'before issuing the cer~~f+~ate. Fa1lure to
meet the requirements for satisfactory completion within a reasonable time constitutes a vio-
lation of ORS 454.605 to 454.745 and this rule.
Setbacks - Subsurface Sewaqe Disposal
From:' ,. ,in.terior ~toperfi lines
~..' ~ge of road right-of-way
. 'Boilding foundation
:~,Wells, other water sources
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Drainfield
10 .
10'
10 I.
100'
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.SePtic Tank
10 I,
10'
5 '
50'
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COUNTY
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T~CTION RFCORD
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TRS#
OWNER'S NAME
Robt. Otten
CONTRACTOR'S NAME
17 03
33.1.1
200
DATE ISSUED: 9-6-84
PERMIT# 84-1 - 84
PHONE NUMBER
none
SET BACK REQUIREMENTS
CL, FRONT 50 CL, SIDE
WORK AUTHORIZED BY PERMIT
CoN~TlUJC.T SALES Sl-IOP
DIRECTIONS TO SITE
Centennial Blvd. to Spfld,
PHONE NUMBER
# PLUMBING FIXTURES
INTERIOR 5'
REAR 5 '
cross 1-5, turn R on Anderson Ln., left on
Kellogg Rd.
SITE ADDRESS
Jt'o:30 /C.E:L.~'l &'.J SPI2.WtS,FIE.W
FOOTING I FOUNDATION 0 IMOBILE HOME PLACEMENTD INSPECTION
Approved Date ICorrection Date Inspector
PLUMBING GROUNDWORK INSPECTION
Approved Date ICorrection
Date
Inspector
UNDERSLAB PLBG.[] /UNDERFLR PLBG.[] INSPECTION
Approved Date /Correction Date
Inspector
-
SLAB INSPECTION t
Approved Date ICorrection Da
ROUGH PLUMBING (TOP OUT) INSPECTION ~ ~l '
Approved ' Date ' ICorrl(7on~ ate
FRAMING INSPECTION /.\y.,,' ~pS?
Approved Date _ tPrJti~ ~llt)
ROUGH MECHANICAL. f f'Jr..~ F.J.,.' \,qf ,
Approved Date-v'" /COMction \ Date
INSULATION I VAPOR BARRIER INSPECTION
Approved Date '/Correction Date
Inspector
Inspector
Inspector
Inspector
Inspector
LATH / GYPSUM BOARD INSPECTION
Approved Date /Correction
Date
Inspector
FINAL MECHANICAL [] /WOOD STOVE []
Approved Date ICorrection
FINAL PLUMBING INSPECTION
Approved Date '
Date
Inspector
/Correction
Date
Inspector
FINAL INSPECTION BUILDING [] /MOBILE HOME [] lAG PLACEMENT[]
Approved Da te . ICorrecti on Date'
Inspector
CERTIFICATE OF OCCUPANCY []
Approved Date . Insp,
TEMPORARY CERTIFICATE OF OCCUPANCY [)
Approved Date Insp.
N74-197
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lVIEMORANDUM
Mf~ lane county
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DATE 9-6-84
TO Robt. Otten
FROM Land Maniloement - Gwen
SUBJECT Permit #841-84
Your permit for Retail Sales Building is ready at this time. There is
an addition fee due of $102.71 at this time and you may pay that when
you pick up your permit or mail the check to us and we will return your
permi t by mail. Pl ease note the permit number as "fees due" when you
come in or mail your check.
Thank you for your assistance,
g
-HOLD
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SLIP
bne county
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APPLICATION # _81:I-A4_.___
LOCATION /1:090 K.E!-~.QD.
Roef:&LflLL~__ ____ _____ _____ NAME
G:.Qc.e:ox 105 ADDRESS
B~'LG.G::i:7,O/2 97/07
-ZIP CODE
I,
The above application is being held for the following reasons:
:~l1~:~W ~~U?:~~~~~^~~j~ ~f~~
A~ED 51-\ ~ 'flf:>itJfM i'i~:D~ __, . _ __ _____.__ _~
GrIZE6y -
CoM,lI( €JJT POT<..
~rrZ!..J70^, IS
W RoKJGy. I+E: IS
NOW PROP()Srp.J~
gESTI2roM cLJlJ/Jt:0/ t:j/
W SFD 5Y5fE7"( .
fj)(j:)
rb/8/~
p l.8+.s e:
JZ-eYl~
tr - ~AIJ\"C CD/eo/84
(J!S)/$ Q:ltoI.M~
~~ Pw""I!!>'^,~)
v-.%L"b
'SIGNATURE
AVAILABLE BY APPOINTMENT ONLY (NO WALK-INS)
4;/(0/84
, DATE
6B7-4061
PHONE
HOURS
This application will be held until ~;f~;I~ . If the information required
above has not been furnished by that date'your application will be cancelled.
RETURN THIS SLIP WITH THE ABOVE REQUESTED INFORMATION.
BUILDING & SANITATION / PLANNING & COMMUNITY DEVELOPMENT DEPARTMENT
125 East Bth Avenue / Public Service Building / Eugene, Oregon 97401 / (503)oB7-~051
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ME~RANDUM
.
TO Robt. Otten
FROM Land Manaqement " Gwen (687 ~772)
SUBJECT Permit #841-84
DATE
q-Iq-Rh
lane county
(a
, ,
On 9-6-84 we wrote you that your penni't was ready with a fee due of $102.71,
-...
Please call us and let us know what your plans are. If you do not intend
to go on with this building plan it is possible you would want to apply for
a return of part of the fees you have already paid and cancel your permit.
Thank you for your assistance.
g
11-.2 7- <-(
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e. .,j.;<4' 4-r-
/71 ;;t;'L; ""-'1 ;.J--/
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lane county
MEMORANDUM
TO Robt. Otten
FROM Gwen Tapp ~ Land Management (687 3772)
SUBJECT Permit #84H4 DATE 9-19-34
Fees Due
Since we have not received any word from you in response to our memorandum of 9-19-84
it is assumed you do not wi'sh to go ahead with your plans for a retail sales build-
ing,
If we do not hear from you by 11.28.84 your permit request w'ill be cancelled. If,
however, you do intend to proceed wlth your building plans please notify us at once
and return your check for $102.71 for, the remaining fee due for the permit so that
you can begin your construction plans,
Thank you for an early reply,
g
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APPLICANT OTTEN,
't::,,~, 1 7033~~ 1100200
.~ EW BLDG TYPE
OWNEF! NME
, CODE APPL NO ACTION DESCRIPTION
~'P f(ETAIL SALE AHEA
1 "IBI'
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, SDS
L'ANE COUNTY DEPT ENV MGT HECEIPT'~ f.l41 f.l4 DATE 040~!B'i
FWBERT ADDR j 690 I<ELt_OGG RD., Sf'l:nNGFIEL'D, OI\EGOt'fn\
SUBDIV LOT BLI< .
USE C Bnr,MS 0 UNITS 001 STORIES' '~BLDGS 001 ,PHONE 999 9999,.1\'
ADDI,
S(~ FT UNIT COST VALUATION FEE DAY~
39614.07 5571 ' ,~
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LC tl4'j B4 ClAD
NO. FIXTUHES:
NO.
CONNECTORS:
MECHANICAL FET
STATE ,hJRCHARGE
PLAN CHECI( FEE
,
5571
15.00 EACH ",
56.5(,
4%
c) 5 i.:
. :~.. 26 ~
.
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.
:56.'13
SREF
.
AF'f' F!A FP SDS SI F'CI< OTH ISS
0 1 2
BY F!LH EST. COMPLE::T I ON DATE lOTAL FEEl(.l(,
.
1 B
95.49 CI(
.
~Or
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. CANCELLATION/REFUND AUTHO.TION
NAME (PLEASE PRINTI ert Otten
. ADDRESS 1690 Kellog Rd., Springfield 97477
APPLICANT ( ) OWNER( x) CONT~CTOR( ) '1?LAiVIf6j)
REASON FOR CANCELLING PERMIT (OR APPLICATION) 7 .
F'A:c...ED To /VI/'lTcR'/R/./;:::e .
PERMIT # 841-84
TRSfTL# 17 03 33. 1 . 1
200
p .
FrtVfiIYC!JNG
SIGNATUR( Ra-f'~ (!, ~~~ DATE; :;411(. )'2 .(9BS
FEES PAID FOR WASTE DISPOSAL SYSTEMS (SITE INSPECTIONS AND/OR APPLICATIONS TO INSTALL THE
SEPTIC TANK AND DRAINFIELD) ARE ORDINARILY NONREFUNDABLE. SOME REFUND MAY BE ON THE
BUILDING, PLANNING, OR PLUMBING PORTIONS ACCORDING TO THE AMOUNT OF THE PERMIT/APPLICATION
PROCESSED.
FEES PAID % REFUND
_/;f.4t 11::50
jPJ. DA I~P) 0
(') 0
/l~
~O~0-
% Flood Plain Fee $
% Building Permit Fee $ 12,.9.~
% Mobile Home Fee $
% Plumbing Permit Fee $
% Mechanical Fee. $
% Plan Check Fee $
% State Surcharge Fee $
% Septic Disposal Fee $
% Site Inspection Fee $
% DEQ Surcharge $
% Land Use Application $
% Planning Director $
% Recording Fees $
% Partitions $
% Copies & Ordinances $
% Surveyors $
Minus $25. for Processing Fee $ -Z5.00
TOTAL AMOUNT TO BE REFUNDED $ - CJ
~L.(~ DATI' 1- / 7~5JL
/ . .
SIGNATURE
TO DEPARTMENT OF FINANCE: V
Building Permit Refund $
State Surcharge Refund $
Septic Disposal Refund $
Site Inspection Refund $
Land Use Applications $
Planning Director $
Recording Fees $
Partitions $
Copies & Ordinances $
Surveyors $
TOTAL AMOUNT REFUNDED $
PLEASE MAKE CHECK PAYABLE TO:
NAME
ADDRESS
24.17-881Acct. 42120/Prog. 060 Receipt#
24-17-881Acct. 42124/Prog. 060 Receipt#
~4.17-881Acct. 42133/Prog. 060 Recelpt#
~4.17-881Acct. 42134/Prog. 060 Recelpt#
24-17-881Acct. 42150/Prog. 060 Recelpt#
~4-17-881Acct. 46202lProg. 060 Recelpt#
24-17.a8/Acct. 46210/Prog. 060 Receipt#
~4.17-881Acct. 48474/Prog. 060 Recelpt#
~4.17-881Acct. 44419/Prog. 060 Recelpt#
~~74/Acct. 4445l1Prog. 010 Recelpt#
LAND MANAGEMENT DIVISION / Public Works Department / 125 E. 8th Ave., Eugene, OR 97401 (503) 687-4061
9-28-84
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~obt.--.Qft_enJ retu(ned ~ call to him regarding his fees
due on permitVf41-84~
He stated he is anticipating sell ing a piece of property
and t hat he s till <in.tena5::fo=p:i:G:KUp=tti"i s-perm i't,' before
the 6 mos. time. He will come in and tal~o counter
people about this if he cannot make the six mos. deadl ine.
His new ~s-is:1'i1 - If}'?
\. 'i \ 1690 Ke 11 ogg Rd..~ _ ____
~pringfield 97477~(Ph: 741' 1830)) ~
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s B~~ks tcurht the rrorp.rty
-3nrl ~r]d ;::-;'vel. t~~ :-:pid
]n,000 y~rd5, 1965 - 3~,OOO
". ["lllrl"f"' ",'''p,tlr'l hp.,
~/~. ,-;1 !T:\~t. :~...r\'t~l !"rrf1t
c:; ~pc "!':!:'liC~':f'
1 I~tcr,,<-tianal Truck
1 r;~,e\'Tolet TrucK
2 r0tnrh!lt (20 yd)
?2 :: 3UCYTUS (1/4 \'d)
~:o:;el 104 :,'or'tinJest
CrC':'le (4 yd)
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~n f~vrr rf aa,,~~,with t~e
It ;;nd t~,(>y h<::d to ,let dOl./rJ
NR~ :'lot ,-tn~red.
) r~r~~~t~. to ~rh~ P!eedcn
It two en:::!':!'~ r''lnts 'n,
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kme county
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N\<NSHIP / 7 )
SUBDIVISIUN/PARTITION
~3~1..
AGRI~LTURAL PLACEl\4t:NT
AUTHORIZATION
FOR OFFICE USE ONLY
AUTIIORIZATION 5///7 P/}
NUMBER ~ ~~--~ ~
[]TWO COPIES OF PLOT PLANS
RANGE
t:/",3
(it applicable)
[] PLUMBING & MECHANICAL
CHECKLIST ATTACHED
ISSUED BY:
DATE:
~--' ~~JL.-
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67f_/
. It OF.7LOYEES
~lE NUMBER
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DEFINITION: AGRICULTURAL BUILDING is a structure located on a farm and used in the operation of such farm for the
maintenance, or repair of farm machinery and cquipJrent or for the raising. harvesting, and selling of crops or in the
fee g. breeding, managell'Cnt, and sale of, or the produce of, livestock, poultry, furbearing animals or honeybees or for
dairying and sale of dairy products or any combination thereof illcluding the preparation and storage of prOducts ri.1iscd on
such farm for human use and animal use and disposal by marketing or otherwise.
AGRICULTURAL BUILDING DOES NOT INCLUDE; (n) a dwelling; (b) a 1ltrueturo used for a purposc otllcr than gro..ring plants in
....hich persons perform more than 144 hours of labor a week; (e) a structure regulated by the State Fire Marshall pursuant to
QRS Olapter 476; (d) a place used by the public; or (0) a structure subject to Sections 4001 to 4127, Title 42, United States
Code (the National Flood Insurance Act of 1968) as amended, and regulations promulgated tllereunder. (ORS 456.758)
I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION, and do hereby certify that all information herein is true and correct
ar.d I further certify that any and all work perfonred shall be done in accordance with the Ordinances of Lane County and the
Laws of the State of Oregon pertaining to the work described herein, and that NO CHANGE OF USE will be made of any structure
..,..ithout first obtaining the proper permit(s) from the Building Division.
I HAVE READ AND QlECXED THIS APPLICATION THOROUGHLY AND I FURTHER CERTIFY THAT I HAVE READ 'n1E STATE DEFINITION FOR
AGRICULTURAL BUILDING.
I understand this application in only
property es, and related facilities.
~ NAME (P~./
for the purpose of locating the structure to assure proper setbacks from roads,
R ~ ~~A~ OF ~I,:-z
r
4-;e-rS"?-
DATE
THIS IS NOT A BUILDING PERMIT. Call for a placement inspection prior to
pouring concrete, setting~l~or fr~~: l~~erify location of)/..;~e ~~:o;.osed
structure on the site. ~I L//~~/"r /~~~'
MINIMUM SETBACKS:
Road center line, front
Property line, interior
, Z:;-/J /
,AI//-
center
line, side
5/
sr
rear
FACILITIES:
Proposed construction will not increase sewage flow.
~~:~:~M SETB~A: 5,feet f~om se tic tank; 10 feet
\~~sposa a e s.
AUTHORIZATION BY\. '" \ y()
---' -
DEPARTMENT OF PL~NG
DO not park on or drive over drain'
LANE
COUNTY &
125 East Eighth Avenue, Eugene,
from existing and r~llacement se~w_e
DATE ~ - d.. . E::;
COMMUNITY DEVELOPMENT ( /82)
Oregon 97401
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~TIVITY INFORMATION
SHEET
la.ne county
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COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
;1. ({~ ~ R~~Jt...
PERSON MAKING REQUEST PROPERTY OWNER
p: C. ~ 10S .p, to. rf}." j!. 10S-
MAILING ADDRESS MAILING ADDRESS
,~ a.lt .~, 97/07 ~. ~
rJCITY {J " STATE zip CODE ,~ . rUfv (1,'
~ ~, 9ro-.~u. t77~
8USINESS TELEPHONE #' HOME TELEPHONE # 8usrNESS TELEPHONE # HOME TELEPHONE #
2. PROPERTY ADDRESS 1(P'jOK...q.P~'I3-~~.A.Jb"./J ~. f>7-977
. (IF DIFFERENT FROM MAILING ADORES) -, T--ri tY ,-,
3 MAP & PARCEL NUMBER (from tax maps in Department of Assessment and Taxation
(REOUIRED INFORMATION) or from tax statement) C:Sr1r-.
17 03 33 t:loZOO?~
TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL # NG
~. '17/07
STATE ZIP CODE
TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL # ZONING
TOWNSHIP KANGE SECTION TAX LOT(S) OR PARCEL # ZONING
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: ~1J..l!tI"'. Ye. ACRES
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4 SUBDIVISION (if applicable)
LOT
BLOCK
5 REQUEST (state exactly what you plan to do)
PJ/~ - /'LL-Y-~ .d.JJ,. 'i-~'S
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.6 DIRECTIONS TO SITE: ~~ ~_:f:r Vi''''1f~ef, ('"..tH/...Ii-v~ J X-s:o '
: .....:... ~.J) :~e. ~. t i~ __ 0-..2-. ~. 'Of ~ :'2- 1'.. .2~J#o_ KJ..P~ """
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VI ** FOR STAFF USE ONLY ** NUMBER B1
ZONE/LAND USE: DATE
BY: DATE: (TIME IN: , OUT:
YvL\D ,,-l(,) ~\t:_ or Ct~J. ~'1csAt lr-l"
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LAND MANAGEMENT DIVISION 1 125 E. 8th AVE.. EUGENE, OR 97401 1 687,4061
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SPRINGFIELD, OI~EG(W!tl"
LOT f.lL,.I<.
001 PHONE 999 9999
UNITS 001 STORIES IBLDGS
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SQ FT UNIT COST VALUATION
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CONNECTORS: ,
MECHAN I Cr~1.. FEE
SHlTE SUI~CHARGE:
Pl..AN CHECK FEE
SDS
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~ST. COMPLETION DATE
PCK
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15.00 EACH -
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