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HomeMy WebLinkAboutPermit Building 1975-10-22 , > ....../ ~..... -f- ~~ ,t' ~ ,L;l1 ;r ...-",... ) -- ~! - -', p ~'-,.......~... -~-;~~--> ." , 1 ....1' , , LANE COUN" '''{'\ BUILDING 0' J, \UILDING PERMIT OR MOBILE H( MH D MAILING ADDRESS 81C '.JE$T CEN'l"!i:I.JN' AL MAILING ADDRESS USE PERMIT PERMIT NO 26:;4-- l'i \ ., . PR01>ERT\' OWNER ttO~d.('f 'ol'l 1'1' LI: iSu I LD I CONTRACTOR SAME PROPERTY LOCATION - INCLUDE POST OFFICE 1084 l^URtL $r~t[T PROPERTY LEGAL DESCRIPTION - METES, BOUNDS 2ND AO~lrION TO MEADOW GP.~[N ESTATES PHONE S?R HJG fiELD OREeON Sj7trn PHONE Lor 20 BLOCK 2 TWP 18 RANGE 2 SECTION 6. },,3 TAX LOT NO CODE CENSUS TRACT APPL NAME ." "",.~ & Roc3li:rrr Ii I LL 9zog EXISTING STRUCTURES ON PROPERTY \l!ONE LEGAL ACCESS TO PROPERTY MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT lAUI1EL STREET PROPERTY SIZE - FT WIDTH DEPTH AREA ... Connect to EXlstmg Sewage System D TYPE CONSTRUCTION SQ FT # BDRMS PERMIT ron DweLLING 1092 Q 21.80 572 0 16.10 3 New System D VALUATION 02SpMo5.60 2.893.80 $35? ~o8 0 GO' GARAGe: P~~Mlr TO INSTALL SEVAGE DlsPGsaL SYSTt~ - --- SEWAGE DISPOSAL PUBLIC D SEPTIC TANK D BUILDING lI: WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER Sur\CNA~OE TOTAL $ OTHERD 1 t~11 .00 100.00 22.00 FEES PLUMBING INSTALLED BY OWNER D OTHER NAME WATER SUPPLY PUBLIC D D OTHER MIN SEPTIC TANK CAPACITY WITH DIST BOX GAL l1.m 272.01 COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FiElD REQUIRED )00 lIN FT 150 TRENCH WIDTH FT 30DEP10R SQ FT 300 t~HP ALII.' PARiS Or THE SE\!A~E DISPOSAL SVSiE[l1 100 '"E:li:T F'Rot.1 ALl. t'lELLS: TYPE OF STRUCTURE OCCUPANCY H1J . FJ FROM CTR OF ROAD RIGHT OF WAY ZONE PUBLIC UTIL EASEMENT 5N BLDG SETBACKS 1,\5 ' FRONT USE CLASSIFICATION SIDE INT 5 SIDE EXT AUTHORIZED SIGNATURE - DATE REAR 7'PUE /s/ Jo E. Boss BY, HARBAUGH St-IOOlt/SMI liAR tAN 10/22/75 DATE DU.) BLDG PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOlDENROD Call 687-4065 to schedule all required inspections. All construc- tion shall comply with Uniform Building Code, D.E.Q. standards IMPORTANT: for subsurface sewage disposal and county regulations covering plumbing. All buildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) FORM :tI C55-13 (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. 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I \..~..... ---=-.\.....,...... '---~'~-. , ., r ~ -.. ' --,-- -,?"'--\-~"'-""- ~.. L - ,- -. - ,. -_.~ -.......' "r:~~_.~~",__,_, '_"~h _", .. ..... ' \. '..1 ~~:QK~ ., .' I, ;.;m:r~ , :.~, \' '.;,'" Jr:.)r~~' of '.. < ;.. I \ "" ~~"J~' """..... .- ._-~.. ~,"-"'_.-;-,""":::.~~, - ~..,....,...~,........_-- ~_.. ~r , '" ''/0. ., . ... 1". --..,. ,~;:;-.)t;l \1 'to 'H~ "" \~Ji' ..~..."';~:- ,I \ ~ JI> 'I;"{~'~tt"t) ./":; ~. ~' ,. . f':; ,:e'..: '<:";; .:.....:..~~;;F:r;':;\> ';'\,-: :.::" ;'(' ::.-l~, ;:-;..~.' '.~. _' '-"'\~;;-":~'~.': , .. ._:" " . .:._n~ . '.'>";''-l';;'';:"''_''''~,_",~' <' 'If' "..' ........~ .4~' ~". ~..<l'-... ~ . .,.... .,'~' -.....~ ..; .;t,:">" . ! . 1~ LANE COUN BUILDING 15XX BUILDING PERMIT OR, MOBILE HL.. MH D MAILING ADbRESS . 870 \#&$1' <;:!"Yl:~'UA" MAILING ADDRESS USE PERMIT PERMIT NO. ?-~ 15 "'1 I , , P,ROPERTY. O'<<NER , ~. :'~OfUjt1 N Hit.... 9VH,P,' 1-.CONTRACTOR , S~Mr. i' ;'PROPERTY LOCATION - INCLUDE POST. OFFICE .: lo€.lt LA""a. Sy,.ell'f' <. -,', . ::.'. 11 PROPERTY LEGAL DESCRIPTION - M,ETES, B6uN~S '. . 2ND Asnuttow to ....t.OQW GnUM '[1.'."($ . ' . PHONE . S~ft'~Q ytllO ORr.eo* 97417 .. :f..t ". PHONE .~ J. :i' . /' I:' 1..(;1'20 BLack 2 .j I " ';I.TWP , 1" . I V 1 2. SECTION , TAX LOT NO. ' CODE CENSUS TRACT RANGE 'f! ." t' c " ,. \ .-\ .\ ""\,,-\ ..; l{~ .I~ _~. ., EXISTING STRUCTURES ON PROPERTY HM tE9Al ACCESS TO PROPERTY~ ' LAUfttL Sfltlt:T ~;,~ ,r\~9,r.~RTYSIZE~~,\, ' WIDTH DEPTH .\ .1 APPL NAME & MAILING '.It." H~~~\' )~--" <::.<\ - ~ .>~'- s;.:-. , _. ' . ~ ,l '. . . ~ t\ :ADDRESS t I FOR MOBILE HOME PERMITS ONLY 'J'. : No. of Bedroo~s't STRUCTURES TO BE BUILT'THIS PERMIT AREA r 'j' I ' I. '1. - r I: CAI~AU .1~ t.~1.&> ;'l2'. 16. ,a " . t,.r.'tA-Lt. StwA~O'.fI.~lI" \:~\~~~.~ ~W,,' ~'" .h .' . I\. '^ ~ . , \ \) \... '.i\. ~'. ,t \:\ ~ ., -, ,,\ , \ \.\__ ~ ,\\, ........ .~ '''' L '"........~" '.\_~ ',.).) '.,J '-,." - ~ \ - ~ \ ~~ ~\"'~itiMBiNG 'lt~iSi~L~triiY)".... ~,~~ ~ SEPTIC TANK 0 _ OTHERO .~. . \ \. OWNER 0 OHlER: NAME t. 145..00 . FEES WATER ~UPPLY '100.00 ft..OQ. - ~ '. -."'-- ';;., "" , . ':.. . .:\ <"" '. ',' :, '.'. '; ....,- . .. ~~ ~~ ~""'~"\ S\~~~-<:-:;:') ')...\\J..J.- 7\:~~. ,\;~:~,... ,....,. '. .' , . 5)~1 ~~ _ ~ \, ~ \'\ .~. \,h~ ~~>.:.;.\",-_,"--,,\~\ ~ trl'~t . \ ' \ '\ . .' '. . . .lo COUNTY BUILDING &. SANIT A lioN SPECIFICA T.IONS .3 . I New System .olJ .vALUATION $!:\.&5.w I.; . . . 2..693..80,;,; .,~-::~. , .# . t3J:t906.60 7;1 , t f ~ Connect'to Existing 'Sewage System D TYPE CONSTRUCTION SQ. FT. :# BDRMS' PrftM.trea ~L~.H& :.; "l'iMU t T. o j." ~ ,. '. ' I SEWAGE DISPOS,l>.L l. ,'PUBLIC O. l '~UILDING , 'WASTE DISPOSAL jptUMBING 'P.LAN'REVIEW PARK TRAILER. , ':.'. $\iWC"*_ ~. :'J. IJ . ! PUBLIC' 0 o OTHER 1 . .~ : , 'TOTAL J: : t i t MIN. SEPTIC TANK CAPACITY ; ;'WITH ~IST. BOX: .GAl. 900 ,: DRAIN FiElD REQUIRED ~'O UN, FT TRENCH WIDTH FT. ~~""~R SQ. FT. .~ ~ ,i ,~, t:- . -: '! i TYPE OF STRUCTURE. ;'5N" . r . . . .~ BLDG. SETBACKS n.FT: FROM CTR. OF ROAD RIGHT OF WAy . FRONT. .,. . SIDE, INT. 5' SIDE En AUTHORIZED SIGNATURE - DATE :' Is/.4. (. 10M e., HAft...UG.~ . .OCCUPANCY lW ZONE PUBLIC um:' EASEMENT , ~. : I . r' . f .! i jf ", 'f .. Ii ~ J ,_: Kie, It"' ~~r$ or' T. $I,w.... '0'."'$4'" SV''flM. 1~ ,tC:f.,t\... ~ M.t.. WQ.L. t .' ':';': ~% .~~.~~~,....\~::~~.),\~~\~~\,~~~.- -USE CLASSIFICATION REAR 1'M, r 'r). .,../ '/fAN' 'fNt tAN lO/'l2.115 DATE GUt " , ~ . . BLDG. PERMIT ~ WHITE, ',' OFFICE COPY- WHITE ~.! COUNTY TAX - PINK (.. I RLUMBING - CANARY , .BUILDING - GREEN t' ~ANITATION -GOlDENROD I;.. . ......, 'Cal,1 687-4065 to schedule all required inspeCtions. All construc-; . ,;;,ti.o.~'.,s,hall comply wit.~ U.ni;form Building Code, D.E,.Q. standa~ds: IMPORTANT:'"for',su~surfC3~, ~e~'~get.qlspo~al and c.o~nty regulations covenng I " pl",mblng. All bulldmgs require a certificate' of occupancy before' beil'lg occupied.,~ .",.' t J."., I,~l I 'i \.. ... ~ (See Deta~!~:}", R'everse Si.de) \' - $".. .\ ~ h . " tA ., ... I ~. l" f. " ~:, . ~O~M ':;:c 5.13. .' .:,.3 '(POST THIS, PERMIT' :ON M.AIN BLDG. AT SITE) LANE, COUNTY.; DEPT. .OFElo:lV1ROt:'lMENTALMANAGEMENT ; . <;:OURT,HOU5E ANNEX"l.35'~A~T 6th,.EU.GENE, OREGON 97401.. ~:~"'.: :,.... -0". ,~ . ': :.-:-j "~Jh. >". :~ .l.;:-~~.:' t:~:~ ~._..~_;;~:,::~;.;,ct~:-.:,~~.~.~~_>I. '1' J .: . '....' ~- . ", .. ";~..'I SITE I NSPECT I ON ApPROVED / / DISAPPROVED / / DATE INSPECTOR REMARKS FOUNDATION INSPECTION ..- &;};" .-- /"'2. . '$ .16 . ApPROVED / IY{ DISAPPRQYED / / DATE /J INSPECTO l REMARKS () /( ~ /dd&, 1?d;1I~/1/I-J'" !f,~7!I- - / !/ f" . / FRAMING INSPECTION ApPROVED / / /pISAPPRgVED / / DATE Ii' R'M""' '-?~'/l~r ~ ~LdX' I ~. 3 II /lc I) r /1 ::I' /1 /1,1.) ~;;!' .. . __ ,~ (~~ LilY ""atV f"// (.{J (:/4k'.f'lf'~('-/ ~.tIJI.U'j-.1 ~ '-ltl . ,7:> .(/ , 1;C I . ~PECTOR .I'1f~ LATH OR SHEETROCK INSPECTION ApPROVED / / DISAPPROVED / / /JATE INSPECTOR REMARKS,4t::di4r t)/)f -~~c?JiL,~, ';i-~~L~A1 7'J, ~ Cr' ptlir,te it.tf:.- /Y I ""WJ 1/ ~"J l/"'1 jl/ /I / --. ,/~ lIP' I .;?-- t1.V. . ~ IF I" /l FINAL INSPECTI/,,--- d1 ~ ""OHo fILl ,"",'''OHo / /"IJ,' / - 2[), 7!J.NS"fi;JL REMARKS.&~~1Z'1U4' (J&tlj J-jCI>J7t;L CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE / / DATE INSPECTOR /}/1 If) ////~~(Ij II /~~; "?" 1/' - 4 " f J ~ 9{1 ,. 76' 11 # / tJ Q 1/ REMARKS - ~ .1 ~ ,/ '\ . (5--) j a;; IJJ" If' .;. ". < . "~,5';~~;~~~~~i;;~~~ii;f;~~~' " BUilDING PERMIT OR MOBilE H _ '-'x__/: MH.O MAILING ADDRESS 81'0 .~$~':"(;l!:~7'ltt\lI~UUi' ...' . MAILING ADDRESS USE PERMIT PERMIT NO. 2894.. 75 I PROPER'rY OV'{.NER . . ~eitcit;) 'N ,,"Htot. ,StttLiU CONTRACTOR SA\\J1t! _ '~i>:!~. ~;,,":!_i~, .'.~ .~ PROPERTY LOCATION - INCLUDE"'POSr'.6'fFlcE 1084LAttnEfo SffiittV. .. PROPERTY LEGAL DESCRIPTION - METES, .BOUNDS !tljU At'>t!iU1'(M>J to MtAf>O\IG~'f;tfiS'f:$f;Al'l$ PHONE i'R.HG G"tiu.6 OR€;eQN !fl411 PHONE 1.,01 20 aL~ 11 TWP RANGE' f8 ! SECTION . 6i jf '3 TAX LOT NO. CODE CENSUS TRACT APPl. NAME .... & MAILING ADDRESS FOR MOBILE HOME' PERMITS 'ONLY No. of Bedrooms . ~lfit NU.lI.' :,''''",/,/ ,"'; :,. EXISTING STRUCTURES ON PROPERTY NQUlt . LEGAL ACCESS TO PROPERTY Ua.uun.. S'fliS!f!:T PROPERTY SIZE - FT. WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS'PERMIT Connect to Existing Sewage System D TYPE CONSTRUCTION SQ. FT, # BDRMS New SystemD VALUATION Pr.~~fT'~QR Dw~t~aNG (;ARAGt *.. ~... . lct2 t'~1,,80 .512 (i '0. 10 ::I $a~805.~ '~.S93,,8~ _~. ~7__ ._~... _. '"___ ..~_._ _.. "'''$35~908Jif P~iWHT TO .lIffll'f~.Lr.. $tWAeF. t)HiP-C$~l $V$1:f:f4 ~., '.'_ ~".~__"_H' .,_~ SEWAGE DISPOSAL PUBLIC 0 . . BUILDING' " WASTE DISPOSAL PLUMBING . PLAN REVIEW PARK TRAILER . SUIi(t8JU{~~ TOTAL SEPTIC TANK o $ OTHERO t4~..OO 100..00 22..00 F.EES PLUMBING INSTAllED BY OWNER 0 OTHER: NAME WATER SUPPLY, 1'1 PUBLIC 0 o OTHER MIN.. SEPTIC TANK CAPACITY I).. cn $ 21f..01 COUNTY BUILDING & SANITATION SPECIFICATIONS' DRAIN FiElD REQUIRED W'ITH DIST. BOX: GAL 9&J lIN. FT 150 TRENCH WIDTH FT. j&n.tPTt0R SQ. FT. 300 K'i:tp 4.t.t.. FA~l'~~' twp; Sn1AGl/l: f.H$piOSAl $Yarf€tllalQO nltl" rnc14 .Ate.. ti'tU.S: 5N BLDG. SETBACKS FRONT 4;t /s/ J. t. OCCUPANCY t&J _ FT. FROM CTR. OF ROAD' RIGHT OF WAY SIDE INT. ' 5. SIDE EXT. AUTHORIZED. SIGNATURE - DAlE ZONE PUBLIC UTll. EASEMENT TYPE OF STRUCTURE USE' ClASSIFICATION aO$SB. HA~aAUGK REAR . ltpu[ S.t~/$A\NltAR GAN 10/22/75 DATE Ot.M BLDG. PERMIT - WHITE OFFICE COpy - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD IMPORTANT: . . Call 687-4065 to schedule all required inspec'tio~s. All construc- tion shall comply with Uniform Building Code, D.E.Q. standards . for subsurface sewage disposal and county regulations covering . plumbing. All buildings require a certificate of occupancy before . being occupied. ,..i' . . '(See Details on. Reverse Side) FORM.:t:!: C55 -13' (POST THIS PERMIT ON MAIN BLDG: AT SITE) . LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135. EAST 6th, EUGENE; OREGON 97401 .\ SLAB FLOOR PLUMBING GROUNDWORK ApPROVED / REMARKS / DISAPPROVED / ApPROVED / GAS PIPING GROUNDWORK / DISAPPROVED / REMARKS ROUGH PLUMBING REMARKS ApPROVED Iv" / DISAPPROVED / r .... ROUGH GAS PIPING ApPROVED / REMARKS FINAL PLUMBING ApPROVED / REMARKS FINAL GAS PIPING ApPROVED / REMARKS / DISAPPROVED / / DISAPPROVED / / DISAPPROVED / READY TO ISSUE / CERTIFICATE OF OCCUPANCY / NOT READY TO ISSUE / INSPECTOR REMARKS / DATE INSPECTOR / DATE INSPECTOR / DATr/J -y-?~ INSPErroR -y;(,K 1/ / DATE INSPECTOR / DATE INSPECTOR / DATE INSPECTOR / DA TE BUILDIN8~SITE'EVALUATION ('~\jI~~ING PERMIT APPLICATION NO. \, -' () SITE INSPECTION ')~/0tr ?-f-rdt-7S PLANNING DIVISION Not App 1 icab I e )(~k- ( ) ( ) ( ) 1. 2. 3. 4. 5. Zoning Ordinance Compliance: Zone Subdivision Ordinance Compliance Required Access Building Site (Area, Width, Frontage) Other (see comments) COMMENTS: - T / (Y _R tJ ~ D~TAX LOT SUBDIV. .ON: LOT: ~ BLOCK:; c;r-o ....., ~ APPL I CANT DATE No Yes () (vJ 6. ( ) ( L,- ( ) (..-, -- ( ) (y, ( ) ( ) CK1D BY: ~ ,/4 tJd7 S- Setbacks from ell of road: Front d r S i cI.e--e....,~,~: "'~ Setbacks from Side Rear interior 1 ines: '"' ,., I PLANN I NG D I V I S I oN'Acri ON' PEND ING: YES { ) 'NO { .. )' APPLI CAT I ON#' .. BUILDING INSPECTION DIVISION Not App 1 icab 1 e ( ) ~ ~ 7. Plans Submitted 8. Soil Stability (footings) 9. Flood Plain 10. Other (see comments) COMMENTS: WATER POLUTION CONTROL Not APD 1 icab 1 e ( ) ( ) '11. Meets Department of Environmental Quality Standards. 12. Other (see comments) COMMENTS: No Yes ()U> ( ) 1 ') ( ) ( ) ( ) ( ) CK1D BYtYt~/;{)-/~ .iJ . f DATE No Yes () ( ) ( ) ( ) CK1D BY: DATE TO APPLICANT: i10u Building I Site Inspection: Can be approved. ( Cannot be approved at this time as indicated on item NO. above. Questions and further information on items 1 through 6 contact the LANE- COUNTY PLANNING DIVISION. Questions and further information on items 7 through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION. ( ) Will be held in this office until you can resolve the problems indicated. ( ) Is being returned. ( ) Your building permit aepl ic~.!.~~_n_Je_~J..s bein9 returned...!dD.d.~.L sepc:l..r~te covera _ ufPARTMENT OF ENV I RONMENTAL MANAGEMENT -.." "" 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4186 \O/1,ct~ C55-28 INSTALLER: PR "ID 'SEWA~l'lSPUSAL SYSTEM REdo' Complete top part ot .orm to sig.nature and submit bot.. ~opies with application. -. PERMIT NO. 28q4,-~?l) Sl:1ook PROPERTY ADDRESS . INSTALLER'S NAME Perreo No. Living Units 1 Septic Tank: Ft. from well Bedrooms 3 Baths 2 1084 Laurel Street Basemeo_~ 'Water Supply f",~" X . X ~es '-~nO PublIC Other-List Steel o Concrete (!j ',:~~. 'Compartments 1 Ga I. Capaci ty 1000 - Ti Ie Disposal Field: Depth l) Distribution Box: Yes X No Other Distribution-Type Inside Dimensions: Ft. Length 8 Width ~ OWNER NAME Diameter Robert N '" Hill Builder HAILING ADDRESS 870 11)1. r.Antenni~l Springfield, OR 97477 Length of Lines-Ft. Trench I Total Sq. le52.653. 4. 5. 6. Width2 Ft. 300 'lot Plan (see instructions): Feet from WEll Lot Li ne .'Front Ft. Between Li nes 10 Foundation 10' Side 10' Rear 10' IFiller1 Filler Depth Filler gelow Tvoel2"RAbove Tile2 in.Tile in. -' __ -1.5~ __ _ - ,d.9> T ~ -.....,.. .,- """ \~ i.451 Jo$" 1<' -- .- ~ -- =-- ~ ( ~I "Ox ~ 1 -: ~,--. \ [r;.1L I I I '~ ~ \ -.::.-- 6> I t: :"'-~ ~' ~~~~~ I'~ 'I I~ I b "n ~,\_:" <,~) .\(.. J A NO 8 1975 ~ ()r~~: \ - t.-OvJ rtJ ~ rJ -) Date 1_6_76 Sic0ature \'Q~~ ~^I;WJ CERTIFICATE OF SATISFACTORY CbMPLETIO~ For Sanitarian Use Only: Date: /-1-7t. In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certificate is issued as evidence of satisfactory completion of a subsurface sewage disposal system at the above location. c!tl Approved: System Installation conforms to current standards ~ Disapproved: Does not conform to current standards Remarks: 'f C55-11 -4/ ~~,- sanTtarlari's SrJnature LANE COUNTY V'" STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY NOTE: NO PERMIT l Ci~ BE ISSUED UNTIL THIS APPLICA~ ~1:~ cf 7 S- , HAS BEEN APPROVED CONSTRUCTION I X I MOBILE HOME I PLAN REVIEW I I CHANGE OF OCCUPANCY I , OWNERi~i p, 1/;& cIJ~L rfliJ y, ~J;J;;;wM~/ ~~d 7JY7/- , /) jName' " /.2 ..... Addre~s - CHy ~ jI tI Z:(p Phone CONTRACTOR1I),I.,h) J? /../d/ g).-tul"~ ~/.J ~LU7'O ,. I Name' Address CHy Z~p Below Jjr Off ~ce Us e Onl YXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXl.QU9CXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX ,~~ /oq~Wd/.O'O'?~"') ?-~u~;;S.(:,O - ~? ,c;ttL~ ~~D ef:.nl1?-9:J '.1 ,.nt.a C?!-~-<~, . s ~ (6) st~ri l ~ ~ If~ ~ eO ~ ~-7f t:2..1./ , :s\ /J..s '\I- . ~.d-~ ~ <; .$l..L~c...,..r--. ~ ~ i4 -.;:G:..---"o' SEWAGE'DISPOSAL: - - - -- - -- - I . - --'.J ~ SHe Inspection II Ex:l,.sting Sewage D~sposal Sys em I I or New System Required I I I _ WATER SUPPLY: Public 1/ I 3.s; Cj 0 e. b D Well Spr~ng _ _ Other comm7Uity ( I Name of CommunHy or Publ~c System FEES: I' (S O-U PLUMBING: , ,... ~ ~ ~ Installed bYaOwner V \ Bldg. _/l ~..<', f;-.n PL~INr;FEE~ '- Waste D~sp. II tJ V " ,~ Plumb~ng ~ ;;) L(){') /: ';//" of F~xtures Plan Rev~ew ~so A / .."../. ~ 7 I U~SH -'~8'-/ .!1/ L~ "'J-72~ 0 I Cf -0 0 Drainfield Requued - L~neal Feet APPLICATION FOR: O'S':J}1G' ,f' / ,? Twp. Range :2--sectlOn--!~ ;;r,,:t !:2tJ -JV} . Il) jl Q+ ' Subdlv-~slOnhl u..tVF~... ~7<._ ~Lot I - ~ ACCESS TO PROPERTY (Road Name)_cyo~( ~Ld- /~rn~ / ~J - Property Locat~on - Address/Direct~ons: ~/? df~ Tax Lot ,.::) 0 EXlst~ng Structures on Property: Mobile Home 1% Surcharge TOTAL M~n. Septic Tank Capac~tv Type of Construction KrJ Group J~:r F~re Zone Bldg Setbacks - from Center of Road R~ght of Way: Front I/,(~ S~de Int. ,"-- S~de Extenor (..) ~ V\!fS~G} t1' (;d.J~DATE: C55-12 LANE ~ /7"~ jJj/t Phone Code Census Tract Block ~:J ~ W~dth7f.):JDepth kId -!J Property Acreage /1 (~vu./ jj~Mt .J Other , I Name Sewage Connect~on Water Connect~on ? 2-- PLANS FURNISHED FACILITY PERMIT .' . _____ I I t----rYES I I NO I I YES I' I .Iv S~gnature of92an~/v~ (Jv.r cfid. Fee Received B' ~ 2A Date:! o-/'f-? c- ~ -' . --...) J~ Maximum Depth .3 () Use Class~f~cat~on Rea;J I fit ~ . J;'i :-t"ON: DATE: JJ JA BUIUJING1f DATE: \}\ . to .../ h - 7 ~ I fliTj f'A/J~/.l /0;", I 0 -1/ 71 -~ ~ I II' ff"'" .. COUNTY DE ~TMENT OF ENVIRONMENT4:L MANAGEMENT