HomeMy WebLinkAboutPermit Building 1974-3-26
LANE COUNTYAILDING PERMIT OR MOBILE HO.SE APPLICATION (/;
PERMIT TYPE - BUllDINGsg. MOBilE HOME Dose REG.#. PERMIT::; -111- 7U
PROPERTY OWNER r , MAILING ADDRESS PH~E
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CONTRACTOR MA'iONG ADDRESS ' .. . 1 /.. , PHONE
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P)o--PERTY LOCATION -INCLUDE POST OffiCE ()-
-':"'L" ?!"'-'1dPl'.i 8~dr.A '4'1 _<ij?"IAl7h"'I,~> (/;1~j"'A/ 971.,'7'7
PROPERTY LEGAL DESCRIPTION METES & BOUNDS 0 YES
lOT - BLOCK - SUBD1V. ATTACHED 0 NO
TWP RANGE
SEe.
TAX LOT #
LIt,' " J
CODE
CENSUS TRACT
17
"'
1. 1. _ 'ILl
jc.
/lei v,./ "-'11 ./I/O I:; <:.p
,
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(9-0....
DESCRIBE EXISTING STRUCTURES ON PROPERTY If ANY
1 P,.<I /-I~P .(. '-!'"-
LEGAL ACCESS TO PROPERTY - ROAD NAME OR #
{,oJ> J.ypF;;// IIJ.\J,{ ~JV 1'1. Jo I"" "'_
- . , PROPERTY SIZE-WIDT~ DEPTH.
pT /"r
1'1 <J . 1 <;' ., a 1;. (, I;'
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ARtA
APPliCANT
NAME
AND
191 r.J. "'.."
N.
.11 Jo '" ",-,1/
MAILING
ADDRESS
FOR MOBilE HOME PERMIT ONLY
Number of Bedrooms
STRUCTURES TO BE BUILl THIS PERMIT
Connect to Existing Sewage System n
TYPE CONSTRUCTION SQ. FT.
or New System Req. D
# BEDROOMS VALUATION
.
/ 'It! S' '/;.J. / / AI ~ Ld
Ilm-ulcl fw1r
'I '" / TJ(' _ r;.. 11/ j(
;~ ,~~;~"Cl~
'-'-
( ;;J~_",/7' "'_ IN., D// "'.., J
COU\c\ \IV\;e+ ,,~k
\'''\r- f-) r'T)\A)V\
PLUMBING INSTALLED BY
SEWAGE DISPOSAL
PUBLIC D
BLDG.
WASTE DIS.
PLUMBING
PLAN REVIEW
PARK TRLR.
SEPTIC TANK Ili'I
',,"--
OTHER D
WATER SUPPLY
PUBLIC ~
PLUMBING FEES
_ FIXTURES
CASH 0 SEWER
CHECK n CONNECTION FEE
OTHER
J.uel/ YES D NO D YES D
,() SIGNATURE OF APPLICANT
{/~A.-.-J ?;, ~
FEXECEIVfs3Y Pm~'
PERMIT#' /
/
I OR SQULFEET
I /
~".
DATE
$
FEES
OWNER 0 OTHER 0 NAME
PLANS FURNISHED
FACILITY PERMIT
NO D
/
'JI 7 1 7~
"j. D.<rE
TOTAL
1<-
PUBLIC WATER
CONNECTION FEE
COUNTY BUilDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
~O~
WITH DIST. BOX: GAl.
DRAIN FIELD RE9.UIRED
UN. FT. f"). \i:;'\C,TRENCH WIDTH FT.
TYPE OF STRUCTURE
OCCUPANCY
ZONE
PUBLIC UTll. EASEMENT
BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY
USE CLASSIFICATION
~~ _ S'OE.'NT. s~[ hXT.
IT. RIA U. 0/;2 (/7 :/ANNING \~ tr
. ections to Find Property:
REAR
Dote BLDG. INSP.
f13~3-
Dote
:l 0- 'J4
,
COPY 1 - OFFICE
COPY 2 - JOURNAL
COPY 3 - AUDIT
Form # C55-12