HomeMy WebLinkAboutPermit Plumbing 1976-8-31
o OIlNER
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f'7l CONTRACTOR (f/-e tll/JOl/la.
/.....* Name
O.S. REG. 0 ~
l'wp. 17 Range () ~
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NOTE: NO PERMI&aE ISSUED UNTIL THIS APPLI.&S
. / APPLICATION FOR:
CONSTRUCTION ~ MOBILE HOME 0 PLAN REVIEW 0 CHANGE OF OCCUPANCY L=:J
Citrrlt 6Jnnellv '678 ildI(J~118t.J(J, S.Pt/mh-R/J. 7.2~-7/S"'<)
-J . Address" City ~ I Zip Phone
Red:> Co 2 S Ocd~~.eUI /lldll ~/a. 57V1J/ j>VJ;. Y rY7
./ Address V City 1 Zip
~ . \~
PERMIT /;d \S d ~~1
BEEN APPROVED
Phone
Section 2. S 'Lf.l( Tax Lot 2.. 000
Code t\ \ c...-Q--\ Censua Tract
Subdivisi~.. .... ~.. Lot Block
ACCESS TO PROPERTY (Road Name)_N(l.9t!~tT {3rlgt ~ (
Existing Structures on Property: ~ /~ c e...-. - hCUJ -e /
Property Location - Address/Directiona: I tJ 7 fI' N-zr'f )~14 ~k,I2J.. ,I
I ~1 tlrJ ('j IV 0 di Ll 0 , J E (1-r.,1-e-..5. I"
Lol ~ 8/t;.r;,k .,7 I
Below for Office Use OnlvXXXXXXXXXXXXX:XXXXXXXXXXXXXXXxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxyVVVVYxxxxxxxxxxxxxxxx
\ Sq. Ft. / flBedrooms I tl ~ Aa~~a tion ~ Q)'
~_~~,"T:r'" ,~.. .;:)p,X ~\ ~'P~\Cl.i")\~.- \..-tl-\l,.,\",-
~.pA.~ ME'\;)~c,~ & ~"-'\.,.'"
j I
~':-J"f 'E'){'S.-\'y,.G~" ',\~."",.. I
SEWAGE DISPOSAL: \r'-,. ('0, -....) ~ I
Site Inspection fI , ," Existing Sewage Disposal System c=J
,
Pub lie C:::1J
Community eLl
I
~.~~~~:~ by Owner c.=Jl Other c.=J Name
~UMBING FEES:
~~U of FixtjU es Sewage
I Connection
/' I
dzf CASH\~
c.=J mECK I
Property Acreage
Width______Depth
or New System Required c.=J
WATER SI1(R-Y~
Well ~~~pring
Other
Name of Community or Public System
FEES:
Bldg.
Plumbing
3% Surcharge'
~';>.~
Q. ",0
\. E\3
Water
Connection
Waste Disp.
Plan Review
TOTAL
~n -.:J. 53
PLANS ~ED FACILITY PERM:T~
MYES c=J NO c=J YES 9(;NO
Signature of APPr;:t: ""'tiu 1i"1/;J.j:J~1Q!j (;
Fee Received By: Y"'V'"'v.,- _ \ Date: ~Z.f' 7'
Mobile Home
Min. Septic Tank Capacity Draibfield( Required - Lineal Feet Maximum Depth
-.oc d^,7~J.- _at./fY'J~ .d.;~r~r"Z .,In-'';..I..<~..O!'''- f4~
'i?-'...'.d;; J/j ~ 4/J"...AJ ~1 /vJ;-=.~'
\ /
Type of Construction ~~
Group
:I
Fire Zone
:::r
.....,
Use ClasSification~.
BIdg Setbacks - from Center of Road Right of Way:
Front Side Int. Side Exterior
Rear
Zone
C55-12
SANITAJr~:d
1YJ ctG, AAI_ ~ J
LANE COUNTY DE"~1MENT OF
,
PlANNING:
DATE:
g'2 7..~!: r:.#ABUI'!ZY~J
ENVIRONMEN~ MANAGEMENT .
DATE:
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