HomeMy WebLinkAboutPermit Building 1971-7-26
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";\---RtCE I PT No.
.J-bk7 'yccJ\) 7Oef7 7/ic B I
, / ' ...' TWP. /7 RANGE f). SEC2:fu24
" ' , ,', OcJt;6fTAX' LOT NO~ qt)/ CODE
REQUEST FOR SITE I NSPECTION DATE Cf(1).tj I ~ 1.97/
MAIL ING ADDRESS 1:Z775 )1ohdJAll!h,J, No. 79-7--34LJ.
- . , -',S.t>r/h~-f'lefd ~~
OWNE~ OF PROPERTY'A/}'/jJ'0 H-ifJ;~IZE OF PROP.;6-1X IJfJ' LEGAL' ACCESS? J-hAlk
CONSENT OF OWNE:R? "V;S;. . '1"l'!nROPERTY CONT I GUOUS TO ANY C I TV L I M I T?~ 'n;'
Ex I ST I NG STRUCTURES/ ON PR.OPERTY ^ nMP
';7~(
,/. t/
?;43Q,'1
BY 72581/) Ii> t'b Y h 115
[~
SOURCE OF WATER SUPPLY: PUBL I C X- SPR I NG
WELL: DRILLED
DRIVEN
DUG
DESCRIPTION. OF SITE (DIRECT~S, =ANDMARKS, HOUSE OR ,BOX NO., IFANV): ,EiLG0 ha.fF
crf~~ L '~'Ol ,~ '6~0-L err 5th o~ ~den 8rtcfJ~ ~_ sorJth
9'd~r- 'af;tzC0hed Je ~}~Y-I i:;!dn ' ,
PROP0SEb USE OFTE (E.G., NUMBER~F DWELLINGS, CMMERdL OR INDUSTRIAL USE, SUBDIVISION):
One.. Jv.;eJ h ~0
...."
APPROVED
PLAN Nt NGOFFICE
B,Y /J/l1l ~ ~ (
-, :5- 7
DATE -r -2--~
FEE:
No . 0 F S I rES I
No. OF ACRES
TOTAL
$ ,~-oo
$ (5TJO
~. URBANIZING AREA.
I / SPECIAL PERMIT AREA.
. '(r,(TCr
RESULTS OF INVESTIGATION:
-1 I .I OJ- l.s ~ CU f j" t /~
'~$d'; on -1111's <S( ~ '
dtf.~()t;pl S)lole~'
/l ~. ~wCL-flL, 1
':;ub - surl-e;. c.e .., 1/
for 1h e.
I nS i-~It lc~ (p I- ();'/~
au;h~ ~~ dwcd::d--"w-cU a-~f4?/~~t&t-c.:~T(
THIS 1S ,A ~R~LIMINA~Y, REPORT WHICH DOES NOT INSURE'THE ISSUANCE OF ~ FUTURE BUILDING '
PERMiT. ANY PLANS OR E~P~NDITURES MADE IN RELIANCE ,UPON THIS' REPORT ARE' AT YOU~ OWN RISK!
'BEFORE CONSTRUCTION IS STA,RTED BRING THIS FORM TO THE BUILDIN~ AND SANITATION DIVI ION AND
MAKE APPLICATION FOR A BUILDING PERMIT. IF THE PROPERTY IS A PORTION ONLY OF A T X LOT, A
'METE~- ArND,'BOUNDS DESCRIPTION OF THE PARCEL MUST BE FURNISHED. -EXACT SPECIFICATI NS FOR THE,
SEWAGE DISPOSAL SYSTEM WILL APPEAR ON THE BUILD.lNG PERMIT. TytOSF.TS OF THE BUI ING PLANS
AND PLOT PLAN WILL BE REQUIRED.
LANE COUNTY BUILDING AND SANITATION
c::J_ C ~' '
p'i BuiLDING INSPECTOR
D~IVISION: '
, r ' I /
..~J,-:" ~~~~~-
SA N)t' TAR I AN
-2~ 14 //
(/ D A;T-E
TH.IS REPORT IS NOT 'COMPLETE WITHOUT THE SIGNATURESOF THE BUILDING INSPECTOR AND SANITARIAN.
C,,-091"'O-'
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