HomeMy WebLinkAboutPermit Building 1975-5-22
,
NOTE:
NO PERMIT W~BE ISSUED UNTIL THIS APPLICAT~~S
APPLICATION FOR:
-
PERMIT iF I '2-~/ - 7 J r
BEEN APPROVED
CONSTRucrION ~
MOBILE HOME CJ
PLAN REVIEW CJ
CHANGE OF OCCUPANCY CJ
txJ OWNER IP,"J.,.~ L, ;t1o#,"tt
Name
J-1ST> ffa,.!e- IJ.r:J~.j(o,.(
Address City
S'J?r;"~e'td
f e ~ip
97'f77 7~6-J7.7o
Phone
c====J CONrRACTOR
Name
Address
City
Zip
Phone
O.S. REG. II
'l\1p. '7
Range 0 '1..
Section / Cf
rax Lot / I 0 I
Code
Census Tract2D-E-n:f..)
Subdivision
Lot
Block
Property Acreage
Width______Depth
ACCESS TO PROPERTY (Road Name) J4.)~ 4l_ OrcJ__ I<-,...{
f '
Existing Structures on Property: I-f.ov.rc cra..--P_~ ~/".y r"tSI~)
Property Location - Address/Directions: i....'1 Sb ~.., ~ !9"-I;Jc...e.. r.l.o ~~.
c..c..;J.- Co~",.
fLJ"':"v.h:.u
LAH~ C0GHTi S?ECIAL ?~i1.iviii Ai1.~A
Below fo r Off ie e Use Onl vXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Pd JO::J (JLJ/)J)M i:.ij .lJl2.t d ~. 8 0 gB;~ms I A _ ~:;;~tZnn
- I -,
SEWAGE DISPOSAL:
Site Inspection #
..,:7
;/
Existing Sewage Disposal System rtf--, ~ystem Required
Other ~,I' Name ~f Community or Public System
---.-.
~~
/
Bldg.
Waste Disp.
Plumbing
Plan Revie1:"
Mobile Home
1% Surcharge
13.crn
PLUMBING:
Installed by Owner
WATER SUPPLY:
Well Spring
FEES:
Name
PLUMBING FEES:
Sewage
Connection
Water
Connection
.I?L ~
TOrAL / ~~. I.a.
PLANS FURNISHED
FACILITY PERMIT
ct:::; . c,
CJ NO
CJ YES c6..0 ---
CJ CHECK
Signature of APPl~ _
Fee Received BY:~ :frD~te:!:7- ~O--'./S-
_ Drainfield Required - Lineal Feet Maximum Depth
Min. Septic Tank Capacity
(")1;( .
F
Type of Construction --:l}-V
Group-----.,-'--
Fire Zone
Use Classification
Bldg Setbacks - from Center of Road Right of Way:
". - /. ,::-
Front l..... ~ Side 'Int. _ J
Side Exterior
Rear ~
Zone .Cu G r
PLANNING:
~I\)
DATE:
.s oc.;:)O-7 ~
: S1ITATION:
,1St fu~
LANE COUNTY DEPARlMENT OF
DATE: i!ILDIN?:A . k'U DATE:
,f:.20-7,"'-, ~/~.f'-;J.,}.--7.s
ENVIRONMENTAL A~EMENT I :.
CSS*lZ
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