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Home My WebLink AboutPermit Septic Tank 1988-3-10 T . for: -~jJE ..,...-----..... .. ~ Lane County Authorization ~ SEPTIC INSPECTION FOR LOAN REVIEW FOR OFFICE USE ONLY Application/ ~~~ ~~ PermJ.t It :...:J.,;.,J....; -0 cS" .. 'i'QW:;SIlIP RAllGE I SECTION I TAX LOT 27.3.2 900 I LOT/PM~.l'E:' I DOUT OF PROpOSED USE OF PROPERTY []: Residential D Industrial o CClmlTlercial D Public. 17 03 S~BDIVISION/PARTITION (if applicable) BLOCK LOCATION ADDRESS STREET IT:'!, ZIP * 1530 Linden Avenue, Springfield, Oregon 97477 STRUCTURES CURRENTLY ON PROPERTY Existinq sinqle family dwelling, shed D1RL~TIONS TO SIT~ Centennial Blvd. to (past) Centennial School to Fairview to Linden Road to site ~ESCRIPTION OF PROPOSED WORK - Be SPECIFIC SEPTIC INSPECTION FOR LOAN REVIEW DECLARED ~ VALUE " OF BEDROOMS I: OF STORIES na OF Ef-1PLOYECS to/A rER SUPPLY 3 O;,(JER'S NAME AND ADDRESS na Public D Proposed W1. Existing TELEPHONE NUMBER 747-8648 Wesle~ & Melba Moore, Same as the job address CONTRACTOR' 5 NAME AND OSR It Leon G. Bender, 2073 Olympic Street, Suite #102, Springfield, Oregon P'=:R!UT TO BE MAILED TO (NAME AND ADDRESS) Same as above 97477 TELEPHONE NUMBER 726-3030 TELEPHONE NUMBER 726-8842 I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION r'OR PERMIT, dnd ,]0 llCrU;)\' cettify thdt all in[or1l1<1tioll hereon is true and correct, and that. I have t.he following legal interest in the property, Downer of rt.1C'oro; DCf",trU{.:;, p'lrcha~er;~ut.hOrized agent. I f:.:.rther certify that any and all work performed shall be done in ..l.:l,.:oul...:lf;i, '..:1:.:1". tb~ ()c<hnance~ of Lane County and the Laws of the State of Oregon 'pertaining to the work described herein, and that NO OCCUPANCY will b,..' :naG!:' of or.; S'"ructure ....ithout tile pC'rntission of ~he Building Division. I fur- ther certify that registration with the Builder's Board is in full forCH Hnu effect. <'1& reSuired by ORS 701.055, hat if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will be use on this project. I HAVE READ AND CHECKED THIS APPLICATION THOROUGHLY. NAME (please print' ~~~ j<P/3~ DATE Leon G. Bender READ THIS SECTION CAREFULLY. 119 PLANNING/ZONING: Zone Minimum Setbacks: C L, front YOUR AUTHORIZATION liAS ~~~ Partition # CL, side BEEN BASED ON THE FOLLOWING CONDITIONS~ Parcel # parce 1 Si ze A{I/'I interic,r rear COMNENTS : SEPTIC INSPECTION FOR LOAN REVIEW: NO SPECIAL PLANNING ACTION Date: 3- '1- eft> REQUIRED. - f?f' - ~SANITATION: S. 1. # B. P. n Installation Gallon Specifications: Tank COMMENTS, ~ _./p~ SDJ 01_4/;., _7t~. t/ o PLANS EXAMINATION: Type Groun /fhA~ Installation Record Issued? 0 Yes 0 No !'1aximurn Depth of Trenches ~..t ;;6 k tkJ_"'!h ,,' ~ rJ/~~r lice, 3 /0$ ~ Li neal Feet vf Dndllfleld Use COM.'1ENTS : Dale: n \ \ 0tJ _~,~ - - a~/o-?/ -'" PE-EfM.IT....APPROvE~~~NG OFFICIAL/DESIGNEE Coer ORS 456 .B05 (1)) DATE LANE COUNT'[PEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061, 125 EAST 8TH AVENUE, EUGENE. OREGON 97401 SEE REVERSE FOR INSPECTION INFORMATION "llo._?<; QAd.. ~ -. . ... I " . SET8;,CKS ';~D O";'!!:R CC::OITro::S Of APPRO'!;\L ~:UST BE STRIC':':'Y Ol!$ER\'ED. vrOUTle:: c,;::; RSSL'LT IN RE\'O- C;.710:: or 7!IIS P,:R:-lIT, CI':',\no:: U::O=:R PROVlStO::S OF LA;';E ':0...::;,\,':; l::rR;,CTIO:J ORO:::.:,::CE, ,',::O!OR OTHER REm;oa:s ALI.m.ED BY LAW.. IoOIlEN READY FOR I::SPCC,IO:-.l, CA:':' 687-';065. i\ ~:na:..llI:.: or ;,T l;~;,ST 2~ HOURS ,\OV/\::CE ::07ICE FOR INSPEC- TIll:. K~:Q(,:1::57::i :.;C;~T IlS G{VE:;~a':e the {ollo'",ing in:or:!llltion ready; ,cr::!it number, job J.ddrcss, t.ype of inspectlon, when it. will be ready, your flllme and ?ho~e numoer, llod lloy s?ccial circctions to site. BUILDI::G DIVISION: REQUIRE::> I ::Srf.CTlONS: 1. Found,ltion Inspection: To be made after trenches are exca~'illcd ilnd forms erected and when all'" r::;ltcrlals :or d"le touncation <Ire delivered on the job. \','hcre CO:1Crete from a ce:1tral mixing plant (commonly termed "transit mixed") is to be used, materials need not be on the job. 2. Concrete Slab or Under-?loor InsnectLon: To be made after nIl in-slab or under-floor building serVl~e equipment, concult, plplng accessories, and other ancillary equipment items are in place but before any concrete is poured or floor sheathing installed, including the subfloor. J. ~raminq , Insulation Inspections: To be made after the roof, all framing, fire blocking, and rac~ng are 1n ?laCe ana all ?lpeS, fireplaces, chimneys, and vents are complete and all rough electrical and plumbing are approved. All wall lnsulation and vapor barrier are in place. 4. Lath and/or Gvpsum Board Inspection: To be made after all. lathing and lJypsum board, ~,nterior ana-eXtCr;or~n place but berore any plastering is applied and be:ore gypsuc board joints and fasteners arc taped and finished. 5. Final Insoection: To be made aft~r the building is co~plete and before occupancy. APPROVAL REQUIRED. ::0 ,""ork shall he done on any part of the building 6r structure beyond the point indicated in each successive inspection without first obt~ining the approval of the building official. Such approval shall b~ given ~nly after an inspection shall have bee:1 made of each successive step in the construction as indicated by each of the inspections requir~d. NOTE: All building permits require inspections for the ~ork authorized, such as but not limited to: A. Block Wall: To be made after reinforcing is in place, but before any grout is poured. This InSPectIOn is required ior each bond beam pour. There will be no approval until the plumbinq and electrical inspect~ons have been made and approved. . B. Wood Stove: To be made after completion of masonry (if applicable) and when installation is compl~ Installation shall be in accordance ~ith an approved, nationally recognized testing agency and the manufacturer's installation instructions. C. Nobile Home: An inspection is required after the mobile home is connected to an approved sewcr-or septic system for setback requirements, blocking, footing connection, tiedowns, skirting, anq plumbing connections. 1. Footings and piers to comply with State foundation requirements for mobile homes or as recommended by fSe ~mariiifacturer~.' . - --- 2. ~!obile home minimum finish floor elevation shall be certifled when required by a flood- plain management letter. J. ~obile home tiedowns, when required, and skirting shall be installed and ready fer inspec- tion within at least ]0 days after occupancy. Tiedowns and skirting shall be installed per enclosure. D. SwimminQ Pool: Below grade ~hen steel is in place and before concrete is pour~d. Above grade wnen pool-rs-installed. APPROVED PLA:,S :.ttJST BE ON THE JOB SITE AT .\LL TIXES DURI::G WORKING HOURS. '!'llIS PER."IIT WILL EXPIRE If ~'ORK DOES NOT BEGIN WITHlN 180 DAYS, OR IF WORK IS Sl:SPENDED OR ABANDONED FOR ;.;ORE THAN 180 DAYS. SUSPENSION OR REVOCATION ~~Y OCCUR IF THIS PE~lIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORHATION. ANYONE PROCEEDING PAST TII!;: POI::T or REQUIRED INSPECTIO,lS WILL DO SO AT THEIR OWN RISK. SUBSURfACE ~ ALTERNATIVE SEWAGE DISPOSAL SYSTEMS: 1. Permits shall be effective for one year from the date of issuance. 2. Upon completing the construction for which a permit has been issued, the permit holder shall notify the Lane County Department of Planning and co~~unity Development by submitting the installation rccord form. The Department shall inspect the construction to determine if it complies with the rules contained in this division. If the construction docs comply with such rules, the Department shall i~sue a certificate of satisfactory completion to the permit; ~older. I f the c.oti!l tructio"h 'docs not" comply~wi th -such -r\tl'os', the. Department shall-not i f1' "{he perml t holder and shall require satisfactory completion before issuing the certificate. Failure to meet the requirements for satinfactory completion wlthin a reasonable time const1tuteS.o vio-. . l<ltion of ORS 454.605 to 454.745 and this rule. ,. Setbackn - Subnurfacc ~ Disposal P:om: I~terior propert, lines Edge 0:. road rl<:;i:t-o;-way Buil<ii.nQ ioum:<lt~on ~~lls. other w;lter sources Septic ~ 10' 10' S' SO' 10' 10' 10' 100' Drai.nfield r (,4dcPt-e-s) _ _1 JJc-"1,4;'. . /..!1J'~^' <-(CT'. , ) :,J 5',hl ~~dJ,;o'e7 C?: i . _.. ;. ... . ~ N I .$ r.:),.LY' J\- -:-: I P . <:l "- ":;j... '\:) ...... if<! ~ "( (Ib'~ ,IV 1< .34,70 { I ,- .- I u~ , ..JL. ,I 'j 1- I { I .. -AS ' ~ ~ ,;1.'/' , .. YO.?4 (L. I ~dE~ -'I. :,.., 7\' " ;., '''i--- l'c) .- l' i , ~lL t:t -"i ' 67ree-T) . -r , ... .._~ -. ,- ",,! . : ~-! .--i..-. --;.- -;.- -:._-- ;.. . ~ _:- _..~ _..: -_.: ..~. - q~ ---, - --~ ,()' : '......,' .......-. ~._-,-~_. .,- ..- .- I I _ j_ _. ~ _ ._. _. _.h__ .~ -- 'j U'l'-- T-'.' -i ..--..-..-;..-. -:...... " "T ._-..- ~ i . -~'r "i j- '--"--"", - I :n. -"'-'~""i-"--":- I . , ,., I T-' . 1- -. . ~ "j-- , -'--''''-'1-' ...-----; i 1 I ...-. .- - I , _:___;__..._; 0-' _'__'___"h ____.__..'{'_. ,- . e '1'\ '1 . . . ..-' e . . ,... ' , . -If it e .~ ~ ,," '1 . , , . e~ " "1;: . " . .: '. \!'" ~ '" ~ . .' . e. . . , . ~ < . e! . j . .~ . . .. , W: 5 LANE COUNTY DEPT ENV MGT RECEIPT ~ 53588 DATE 03048ia . APPLICANT M01JRE, WESLEY ADDR 1530 LINDEN AVE., SPRINGFIELD, OREGO,.:r' TLI 1703273200900 SUBDIV LOT BLK ~I' .NEW BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES ~BLDGS 001 PHONE 747 8648.. . OWNER NME MOORE, WESLEY ADDR \530 LINDEN AVE., SPRINGFIELD. OREGO~ CODE APPL NO ACTION DESCRIPTION. SQ FT UNIT COST VALUATION FEE DAY~ ~ ~~ .;1: ~ ';1 EP . ~~ .~ I , PL ~FIX/BATH: ~ECH SUR PCK elR LC 53588 SDSV SWR: FT. WTR: MECHANICAL FEE STATE SURCHARGE PLAN CHECK FEE FT. RAIN: FT 60.00 e~ ,'" ~ I .. .~ ~ ~ , 5r. 25i:: . ,'f I .CATG: SEQU: TAKEN BY . .. - APP 1 RLH RA FP SDS SI PCK OTH ISS 3 DEPOSIT ** l~f 60..00 CK .~ .~ . , ";" ~ e: 2 EST. COMPLETIO~ DATE . _'.~~~ty - . . ACTIVITY INFORMA TION SHEET Ei\ID' , ?:.:' -, -.. ..-~:. '. ',~ ~ ' -.. ". .." -... L'-"O......,.,..._on,..,..,...,.... u.-.._.~ I~~_ _p', Plea so complele all lIems above dolled line FILLING OUT * LINES WILL GET YOU INFORMATION ONLY *DATE.3 t Y trY * PERSON I ACTUAL lifa~~ST.L'......-nJooo"l c.. 13c-.,d/-/ ~~O:E~TY W~-S /~ '/ J... .... r1&;-/,b 4 AODRESS_~...2-rJ",,-r?IY__f"2t, 0,7' _"..,l',/OU!1DRESS/.r...?C) ~,....d.,..... -1-,,/ CITY .J'~ STATD,.....c.. ZIP 9J'()ICITY J''}/t;tJ"CJ./'-fC STATEdi'--< ZIP 97<';) ? TELEPHONE (BUS) 7..1.(" ""'?/1,1 (J (HOMEI "):J..(d ~n-v/ TELEPHONE (BUSI(HOME)~/?-r' ~ *PROPERTY ADDRESS A r/~ t'J .l. _ JL........ 4.....". OR MAP & PARCEL NUMBER (Found on tax maps in the Assessment & Taxation Dept.) STAFF WILL DETERMINE_ cg ,oR U~ Zoned Hoo "c.- J7 ()3 ;;2 7 '3,;;2. 9&0 Township Range Section Tax Lot Flood Plain Township Range Section Tax Lol Zoned Flood Plain Township Range Section Tax Lol Zoned Flood Plain TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: ACRES *REQUESTldescrlbe what you wanllo do) ~,' ~~ d~~-€~" ~Md. ! S' f--!) . ?IfEb - -/ -- b;f- . ' z: .. 0 C">-J Fc--t I '?- J .s~ '-roo ( Directions to site FA-I'r v , '/z.-..J ~.~ '/ c-, 1;'~ / If /0 z=- ,<, .....a,/,,-. d-v00- ....................5ta" Use On~.................... Comments: Land Management Division, Public Works Department 125 E. 8th Ave., Eugene, OR 97401 phone 687-4061 c;,G .D\\ \) . .. I FOR OFFICE USE ONLY Lane County AuthorIzation for: 'APPlicatio~C:?~ 1:)/ J I J Perm~t # ~(1~/,-~~ SEP/.Le ...w(,~/7J L/~~/.-.0'Il/DTwo Copies of Plans ' DThree Copies of Plot Plans roW:;SHIP /7 I RANCE ./')::<' I soey.Q>f7 ~ 21 T~./'?~ OF DMech/Plurnbing Checklist t:./ I..J c::::::::'1~:;;;, _ r 1'/_( / DLegal Interest Document ""BOIVISION/PARTITION (if applicable) I LOT/PARCEL I BLO'974/77' 0 Plan Check Info Sheet 7~ ,LZ;;"~E/1/ 4~ S;-e-77?tb~J) ~ lJTR RES CURRENTLY ON PROPERTY ~ ' , I .,' ~e:-L/ .b2 ~ yo u~ _€;;;-;;;;//~L ~~_ / t'/ 4#~~A:J '&4C ///C/O -:& ~LL> ~.z:-6#r r?!7J $t9//L? ~C/-/ 44. Y/?z;e:1~-e" ~ Lr-/7t2.F/?) ~E ~e;r;(t:~V;r~;:; //E~JI0-~/2./!~ A~ MA"v I OECIARED S VALUE II OF BEDROOMS,,?? I" OF ~:;O~~E - It OF EMPIJY'S I WATER SUPPLY ~ Q ~r~sed '-1 /V, '/l w //f' /'l7;J.:z::77A'tJV.J J ~>sting ~//;$;~s"/k&#.e':rA1 '. s:4//?c,,4 . 0';4~ff5: 7~1Lr :J~R;?;2M- -~~#E .~5A~E < P"\:4~~O'~AN~~#,C I~"~~;;F . . ,,'.' - PROpOSED USE OF PROPERTY ~eSide_ntial 0 Industrial D Corrnnercial 0 Public. I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICA~O FOR PERMIT, and do heroby cLrtify that all infOrlllation hereon is true and correct, and that I have the following legal interest in the property: owner of record; 0 contract purchaser; o authori zed agent ....ith evidence of authority attached. I f~rther certify that any and all ....ork performed sha 1 be done in accordance with the Ordinances of Lane County and the La....s of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I fur- ther certify that registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORB 701.055 will be used on this project. I HAVE READ AND C$S;;;~Hh#~~~ f.~ V'Vr. ~ - NAME' ipIease print) SIGNATURE' if} ~DATE 'If- CONDITIONS! ~ J ~ Parcel Size ~~ , ~ ~ /&?~?-f1/ '*-, )f,SANITATION: S. 1. # . Installation Gallon Specifications: Tank COMMENTS,. ,)4-- e;p:;;;r;::tA./ ~,l'\<:'. "'ff04},/0 ~ L~, {':A,a;-~ ~ .~~:;/1YL<f - _JVAJ!L~ Z;:_Rj (7,~ >>.,,~~ /lo:6J!l/A'h-4 A'/Ih, ~ Cli~~.L& ),. I Date, /(?-d;P-~~ ~_ o PLANS EXAMINATION: Type READ THIS SECTION CAREFULLY. /~)R~THORIZATION HAS BEEN BASED ON THE FOLLOWING o PLANNING/ZONING: zone~ Partition #0 Parcel If C C . . te ' L, front L, s~de l.n r1.or /k/M//Z77k &/.LvHJ AE-f2d..ZA'!?E:P- Minimum Setbacks: CO""ENTS'~~ rear Date: Lineal Feet of Drainfield Installation Record Issued? DYes D No Maximum Depth of Trenches B. P. If GroUD Use COMHENTS: Date: TOTAL VALUATION $ CONSTRUCTION AUTHORIZED BY THIS PERMIT Description ( )E~/.L(J _ \'J1:/C/7/ Fixed Fee./ Unit Cost Floodplain Fee Subsurface Fees Building J;ee 101:;ch/Plmbg Fee Plans Check Fee State Surcharge DEQ Surcharge Sq. Ft. 'f/EL:;L r:.7"Z?.r4/ ..LL/A/ HL L4Ald TOTAL FEE n :l"S~"" $ $ $ $ ....-~ $ 0- $$~~--'" '. /'L. t.,) ~".-' R'-. (.' /0 - fft-/1. --- '--.PERMIT APPRO\ol€D\~UILDEl FFICtAL/DESIGNEE (per ORS 456.805 (l)) DATE LANE COUNTY DEPA ENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061, C 14-25 1 5 EAST 8TH AVENUE. EUGENE. OREGON 97401 SEE REVERSE FOR INSPECTION INFORMATION . . .' ... SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVO- CATIDN OF THIS PERMIT, CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OTHER REMEDIES ALLOWED BY LAW. WHEN READY FOR INSPECTION, CALL 6B7-4065. A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE FOR INSPEC- TION REQUESTS MUST BE GIVEN. Have the following information ready:. permit number, job address, type of inspection, when it will be ready, your name and phone number, and any special directions to site. BUILDING DIVISION: REQUr'RED INSPECTIONS: 1. Foundation Inspection: To be made after trenches are. excavated and. forms erected and when all materials for the toundation are delivered on the job. Where concrete from a central mixing plant (commonly termed "transit mixed") is to be used, materials need not be on the job. - . 2. Concrete Slab or Under-Floor Inseection: To be made after all in-slab or under-floor building serV1ce equipment, cQnduit, pIPIng accessories, and other ancillary equipment items are in place but before any concrete is poured or floor sheathing installed, including the subfloor. 3. Framins ~ Insulation Inspections: . To be made after the roof, all framing, .f ire blocking, and brac~ng are in place and all p1pes, fireplaces, chimneys, and vents are complete and all rough electrical and plumbing are approved. All wall insulation and yapor bar~ier are in plac~. 4. Lath and/2E. GYl?sum Board Inspection: To be made after all lathing and gypsum board, ;.nterior ana-exter10r, 1S 1n:pIaCe-ollt betore any plastering is applied and before gypsum board joints. and fasteners are taped and finished. 5. Final Inspection: 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 permit~ require inspections for the work authorized, ~uch as but not limited to: A. Block Wall: To be made after reinforcing is in place, but before any grout is poured. This inspection is required for each bond beam pour. There will be no approval until the plumbing--- and 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 agency and the manufacturerls 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 skirting shall be installed and ready for inspec- tion within at least 30 days after occupancy. Tiedowns and skirting shall be installed per e,nclosure. D. Swimmin9 Pool: Below grade when steel is in place and before concrete is poured. Above grade when pool-rs-installed. APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WITHIN 180 DAYS, OR IF WORK IS-SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION. ANYONE PROCEEDING PAST THE POINT or REQUIRED INSPECTIONS WILL DO SO A~ THEIR OWN RISK. SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS: 1. Permits shall be effective for one year from the date of issuance. 2. Upon completing the construction for which a.permit has been issued, the permit holder shall notify the Lane County Department of Planning and Community Development by submitting the installation record form. The Department shall inspect the construction to determine if it complies with the rules contained in this division. If the construction does comply with such rules, the Department shall issue a certificate of satisfactory completion to the permitlholder. If the construction does not comply with such rules, the Department shall notify the permit holder and shall require satisfactory completion before issuing the certificate. Failure 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 Septic Tank From: Interior property lines 10 l- Edge of road right-Of-way 10~ Building foundation 5~ Wells, other water sources 50' Drainfield 10' 10' 101 100' . . . ACTIVITY INFORMATION Idne county :,r 1 I ^ ) ^ OOrlA~1 ~Q.t>>k'~, " - - .ljRSO~\ MAKIt~\ REQllEST IK,~{) ~~ ~~L,OJAILIN~~D~ CfQijJj r t~ITY . - -ST~TE ZIP CODE I _J1ll7-~bcjq BUSINESS TELEPHONE # HOME TELEPHONE # (I 1JJ~!Lv ~ (1Mffzf PROPERTY OWNER ) '-:;-"3 () cLA~1 rJfiI-L .. MAILING ADDRESS :S-fv..wJi~f) (D A.MtiA q1tfIJ1 ; CITY 10 ST~'fE ZIP CODE 14 !I--'j' & t/ ~ HOME TELEPHONE # SHEET COMPLETE THIS SECTION. I NCOMPLETE FORMS WILL BE REJECTED! BUSINESS TELEPHONE # 2 PROPERTY ADDRESS (IF DIFFERENT FROM MAILING ADDRESS) 3 MAP & PARCEL NUMBER (REQUIRED INFORMATION) (from tax maps in Department of Assessment and Taxation or from tax statement) ca .;l ~~:? J Cj r1 () RANGE SECT, ON/ ~X LOT(S) OR PARCEL # ZON'I NG ~ ~ ()J/' 'P"HP ~ > .... /OWNSiHP 'RANGE' SECTION TAX LOT(S) OR PARCEL /I ZONING ~ ~l Jl:\~ TOWNSHIP RANGE' SECTION TAX LOT(S) OR PARCEL # ZONING TOTAL ~G~OUS PROPERTY IN SAME OWNERSHIP: ACRES" ) 4 SUBOIVISION (if apPlicable)r:J\/I.~A.~JJ'J Q )d(.lA 1Jh.A) , LOT 10 BLOCK ~') 5 REQUEST~(state exactl.y what ;OU plan to dO)'V~~, h WL (l Jk.f~..) . /j, - u A1J ~". I . ',' ~:~TIGSTOd~~~H~~~it~oZ~1. ~I f;; I . I' . V [/./ " J1L~f ~ .., I"A',;,,,,<+, d~'1 J)I_.ill-?}*~ORSTAFF.USEONLY_i* . NUMBER ;ti (["I"vrv li! fI'-'0 ., /11--..,'" ~11 U, I ~ ~o c::I~tW.!,.~ ' - ~ ZONE/LAND USE: DATE ~ BY: DATE: TIME IN: OUT: .~ LAND MANAGEMENT DIVISION / 125 E. 8th AVE.. EUGENE, OR 97401 1 687-4061 "/ - ----- --j'-- .----- . . - - - - - - - -- -- -- -- - -- - --- -------r---- v~ \ OW\~ . I _! d I J____ _,,\~~r; i-- , " -/ ,__ n . ---- ---f..4T\TJ -,-,- - - ------ --- ---- --,----\ -- ,~--_: - -.- , -- I f I 1 , ~-~F16-u_~ I -1- r--~- "----- I -- ---- - -~- - +----------. _I - - j -- -- ' __,n .---- .. , I - -- - - -/- - / f / --- -,. - - - -<-" '-- -- --- "c, / '__ -------- -------'--=1-: , , ~-)J((_/J-EJf A-rr-- . . , . . rl '1' ~e ~ ..; :!! ~. 0 ~ < ~. ~ ~ e 0.. ~L '1 , , 0. J ~ i ~. . , 0 v . . . . . . , , . . . . It! . . . . . M,,!. . , . . II I, , .. (~F'I"'L I C(~NT H(iWOfnH, 'fL; {'703273200900 ,! \::W ElLDG TYP[ · DI~NEI'~ rmE . ' CODE AF'PL NO ACTION DESCRIPTION ,-::1:" HI" 8F' .... 'M ~.~{F' ~ IJP 'LANE COUNTY DEPT ENV MGT RECEIPT I WILBUR ADDR 1530 LINDEN AVE., SUE:))IV USE R BDI'~MS .) UNITS 001 STORIES ("DDI'~ SQ FT UNIT COST VALUATION IBLDGS :~~t)37a4 DPITE 100(?D.<'e SPRINGFIELD, OREGON LefT BLI< ' 001 PHONI:: 74'1 f.l64B. r.:.";ATG: 11 "Fell)' ~ ..) ... ".. . -,"-["'1(["" ~ I i'l . I~ , ~. A 1"'1'" , BY I'~LH I'~ (.1 1"'1'" SDS SI PC!( DTH ISS 3 TOT(~L FEE'lHf FE:E 1M Y .s~ !'I,~ . '. . . 50.00 . ~:>.. 00 I'll . ,(. ~;~5 ~ 00 CI< . . P"1r 1 ~,,;'i~ NO.!'" I XTUI;~ES ; ~ I1[CH . <, UI'~ l '~:CI( .:~ I'~ L.C 2B37B4 SDSV ; '~IJP e I.'. "- ~~ NO. CONNECTOI'!S; 11ECHANIC(.11.. ,FEE . STATE ~URCHARGE PI..M, CHECI( FEE , :' " 00 EACH ", / 4;{. Il:"n; Q"),,, ') 4,. EST. COMPLETION DATE , , , v .