HomeMy WebLinkAboutPermit Plumbing 1974-3-12
LANE COUNTY BUILDING PERMIT OR MOBILE H~~E
TYPE - BUILDING Q MOBILE HOME 1&OSC REG #
OWNER MAILING ADDRESS .
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t&t~ / MAILING ADDRESS
USE APPLICATION
PERMIT == A-1J1 ~,~ - 7~
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PERTY LOCATION - INClUDE POST OFFICE
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PROPERTY LEGAL DESCRIPTION
LOT - BLOCK - SUBDIV
TWP RANGE
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TAX LOT :#
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APPLICANT
NAME
AND
MAILING
ADDRESS
FOR MOBILE HOME PERMIT 9NL Y)
Number of Bedrooms ( .2..
STRUCTURES TO BE BUILT THIS PERMIT-
METES & BOUNDS 0 YES
ATTACHED 0 NO
COpE
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DESCRIBE EXISTING STRUSlfRES ON PROPERTY IF A~Y
3~-M -IL.-.t~ -/9'Ct.U:r-R..&
LEGAL ACCESS TO PROPERTY - ROAD NAME OR #17 #
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cfROPERTY SlzifWIDTH - DEPTH
CENSUS TRACT
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AREA
Connect to EXisting Sewage System )S( or New System Req 0
TYPE CONSTRUCTION SQ FT # BEDROOMS VALUATION
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PLUMBING INSTALLED BY
SEWAGE DISPOSAL
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PUBLIC 0 SEPTIC TANK ,X OTHER 0
BLDG t FEES WATER SUPPLY
WASTE DIS PUBLIC ~ OTHER
PLUMBING ~ 6--U PLUMBIN'G FEES
PLAN REVIEW FIXTURES
PARK TRLR ,'10, ~ CASH ~ER
CHECK CONNECTION FEE ,;:td--()
J-~ o-v PUBLIC. WATER ~.~,.
TOTAL CONNECTION FEE
COUNTY BUILDING & SANITATION
MIN SEPTIC TANK CAPACITY --Il--)
WITH DIST BOX GAL rJ AI J:;tlI/
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BLDG SETBACKS - FT FROM CTR 'OF ROAD RIGHT OF WAY
DRAIN FiElD REQUIRED
L1N FT
FACILITY PERMIT
, DATE
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DATE
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SPECIFICA TIONS
TRENCH WIDTH FT
OR SQUARE FEET
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FRONT S- 0 SIDE INT g--- SIDE EXT - REAR ;;:;--
SANITARIAN Date PLANNING Date BLDG INSP
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Dlr:ctlons t~ a Property . r . /
COpy 1 - OFFICE
COPY 2 - JOURNAL
COpy 3 - AUDIT
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Farm == C55-12
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REAR YARD
PUBLIC UTIL EASEMENT
USE CLASSIFICATION
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Date
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