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HomeMy WebLinkAboutPermit Building 1975-12-17 ."'-.:: t1'. "'<".~..; ,"-i~".._ '. ..~ ., . \, . " '. , , .;. \.'t'''' ",;'''''';, ....:,. ..\.,~ .t 16\ \~, "'I . . :~l . .~.t:~: ,,.,; 'V CO'NSTR UCTIO r;J LANE COUNTY PERMIT FOR. PERMIT NO, "3198-75 "I [}<] MOB I LE HOME [] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ] ,DOwner /(RlIMnllrCI{ INC. NAME ; o Contractor "SAMr NAME :O.S. Reg. #lCJ4 ',Twpl?' Range 3 " SectiQn ~B,;'lax LO~ ;:< W 2- 1ST ADDITION TO COOKS GARDEN Subdivision Lot' 2 Block P.o. Re.l! 1444" ADDRESS f'UGrrNfI: ORIOGON' <n401 ,CITY ZIP CODE .)4' r= ' 4"01" ,)- ,,\,") .' 'PHONE'" ADDRESS CITY ZIP CODE PHONE' : CO,de' Census Tract Acreage, Width Existing Structures on Property:' "- ~X RI.....T;:~^'" I AMI:' ' .No"<.. . 1/t,./'f-€11 /0 ~. ,tun' , , "L. -",,~ H~VEI'<:~VI" ......;;11. De'pth , , Access to Pro,perty( Roap Nam$): Directions to Property. Address: 'STRUCTURE (# BEDROOMS) ,PEf{MtT FOR HOUSE 'GARAGE: h~STAl.L .SeWAGEOISPOSAL. SYSTE~" ' ALL fOOTINGS TO BE DOWN'TO SOLID LJNlllStURBEO EARTH , , SEWAGE DISPOSAL:, PLUMBING INSTALLED BY: PUBLIC [ ] SEPnCTANK[] ,OTHER['J. .'1\1';10-1 OWNER [ ] OTHE:Rll NAMF BUILDING Q2.00 WATER SUPP~Y: PROpOSED [ ] ':, PLUMBING, ~5m . EXISTIN'G [ ] >,..3%SURCHARGF ~"~1 ,[ ] PUBLIC 'r<'~,'- . _ . . . .... -. ..I " MOBILE HOMF [ ] COMMUN,ITV, NAME: ,\NASTEDISPOSAL 75.00 []'PRIVATEWELL . PLAN REVIEW, [ ], OTHER - SPECIFY: SQ, FT '; '1032 @ 16.10 ' 462'@ '5.~0 VALUAT610N $16, 15..20 . 2,~4b.60 , " $19,063.00 TOTAL 1913. ,'51 , CONSTRUCTION PERMITS&'INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS MIN, SEPTICTANK CAPACITY: ' , , GALS 900MIr\(DRAINFIELD'l80';', UN, FT, MAX. TR,EI\fCH DEPTH '- ~6' INCHES PLA'C~ DRAINr-',1t:'1..0 l€)'''F'FF-T FROM PRl'H:imH't IINi=" AMO H011S~' M'I~J'MUM' 'R~srrRV~, All) ARFA FOR'IU'PLACIl:MFhlT' O~: ORA "Nt:"" 1\"1. ('): TYPE OF CONSTRUCTION J:}N , GROUP, H~.J' FI R,E ZON f= STAY 100' FROM ALL WELLS USE CLASSI F, SETBACKS. ,FT. .FROM CTR, OF r!W: FRONT' ; ltG' SIDE cXT, 5' FT. FROM p"ROP, L'INE: SIDE INT, (j'\u:...-:r:":R'EAR' rpUE ZONf= R- ) , . AUTHORIZED ~IGNf:\TURES:' , Is! J,. E:: Boss sy.,:, I:lf.\R8,AUGH 'i. ISSUANCE DATE: 12/17/75 ,OLM GRAylSANITARIA~ " -,.' ~:. BLDG, PERMIT - WHITE, OFFICE COpy -'WHITE COUNTY TAX - PINK PLUMBING:'" CANARY BUILDING - GREEN SANITATION - GOLDENROD IMPORTA~,T:' Call 687.4065 to schedule all required construCtion inspections, Call 687.4061 to schedule all required septic system inspections, AII'construction shall comply with the State Buidling Code, D,E,Q, standards for subsurface sewage disposal and, the, State Plumbing ,Code, All buildings require a certificate of' occupancy before being occupied, ' ' :(See Detai Ison Reverse Side) (POST THIS PERMIT ON MAIN BLDG.' AT SITE) e5Sel 3~ >--, -,' .. . ~ .... .~, ,... ;', ::"'" LI\NE',COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT, COURTHOUSE ANNEX; 135 EAST,6th,~UGENE, QREGON 97401 ~~--q;~ . .tJ,1 ~':'~~~', "'~~c::::. ~ ':>..;,~~,~e;;p-;:5." ,~~.....,;,--....:,' .~ ~'~ ..., <.,. '\....:.'- ~), c::a::z.. "",,=-' -,..,~~~ '""~ 6.'-:l!:..~'~ c;.:. ~~-::::7.: c.~ ~Q,~'G~~ .J-,5-\ ~ '. ." .~ ~;.. l , ,^ " 'r 'I' '\1~ ' ,',' ,,1\~:, '., ' ," . :.~;~ ".. . . ~ yC. t ';: " r I 1\ . c::::;> <::'.....~-:~~ ~ ~' .~ '" ''h ,.: , I' ., <::::::".""":' , , -.::.. \ " , .. \ 'r-\ , , I 'i. i \ c:>";> c::> ,. " '"2' "-1---:- . r(, ,- - \ ; \ \J. :} . " ID i L"':. ' \ \ /',: " + ~ ~,.~,~. i' " ' ! __ ~i : c=: ->--'->--~/! \1>'::::'- - // .; ~" , t"~--- , . h'l"c,,- _-. -- '--1 ..: I' ,I-' l' -':-'- .... .., ' ". I; , ' -.. :';'+';. .,...,:::/~...,~.:;j~, ....'" '; ;;',.':;,."'. ,1- p. I , \ / 0 , ' 1 \' ',,', ~l J\ ..~..:~ . I,.,?,~~::~,,)., ~.. ;~~ ~.. _ .. "ii .", .;01; , ;.... .' '.J,'; --:.~. '~':""::i.',.~:);'~ :~,:!;:;;" \ "_~'..:.,:">'''''''' ~-e.~: :::::>..~-:a.,,~~,~~"""",j'" . U>-l~ .:~~;l -'.J " "../ -,'" . .I:I~ ::~\ .N\i;\; , ',," ----f. .. "1-1: - --:..- . , .."', " _f // '- '- '~~ 6 ---L~ , " " '0. ~I- c:> . ~ c::=:> " I .1 ,-' ',' .. " ! ''t'. .:~ I ~:<S'~ ' 'I I ! . "';'"i .. I ::.,1 1 ; , , ! , .' ,{ I ; ..., ~ . , i ,! ,,/ I w p o './ " \ \ I ~ ~\ '.:~~ \ '\ t ~ i ~ 1 I; ,,' " , "'. 'OJ f i , 1 ! '--':'" \ ',' ,i,;;: .', ,. - .,.. .__..~.--'-' ~Q,!LP_I~: ~ITE iitAL,':A:ION, G-7~'~ ~j B~ILQ!~~ p~f\!1n !H~~~ l,gJ\T!Q~ N9f, is(911-~ ..0:_ _...,..._,......_......~.~, :. ...."--..._<<;"'1..0.... ~. :.__" f :; /"'R,' ,,~ s ze TAX k9T S'UB DlVl Sf ON':'" ,,_., ._ ,.~ ,>:' _'t: - ."' r," _~ COT":" ''7- - 'BLOCK:! -.", ',,~-,,---.. ,.-- ,( ) S IrE I NSPECT!'ON .. - _u ,~. ..... ,._'.. '" ~ V~V APP.~' ~A_N.T ~) :(;~ 6<."~~~~~lq;/~~~ ( ) (~~"" -"'~--F;ont'''"'' ,.. "4)1 ( ) (~ ,,' / ~~<J;~~1:~&.rte'r' ( ) (c...Y /?~~1?9g,sk"~id'efr-Qm JrI!~fr9f~,Til"!es:"" r) ( ), . ~ R~~r ~~., "~l ~~', . 'Not ~ ..,......' . ~" ,~>- -. - '",-~ App 1 i ~ilbl~' 1. Zordl}g QrQ!'1~f!g~ g~Rl !~l1g~;' ~o.neR::-r~T~J,' ~.~!-!P91 y is. 19!'! 9 fQ 1 '1~n~~ Q9ffiP. H cmo~ ,- -,- ,',> '(')" 3. R,egulr~~_ At:g~~? ' ' ( ) 4~ ,~y fl gJpg~ 1!~ (Ar~~l, ~n q~h; f.rol1~<:i~~) (. > 5., Qthe.r (~ee.~<?mmen!~) , () PLANNING DIVISUlN COMMENTS:, ' ,I:~'" ....' ------...-...-:..~..,.;:;..-...,. ->1 "=-~::.~. . '.:;.;..-;:.;,~~ ."........',~ .....""..-:~ :...-",,-:~;,,,.;~~' .........:..... ,'-"",- ,-, - ".....- ._"'- ._...~,.,.._.....~ ......'~- . ....,.;;..",""-,..- --'-.....,.~.-~-. -,,,~';"" ...;,...;.....;: - .;..--,,"-.';'. :...,....,...;.;.,,; .~,;.,..:..~~.. .~..._-----.,----.----,.---- '--..,_:~. " ',- ._'_.''''- "'""'''""''__>-:-~~'_''''''__'''''''......-;-'__~'' ~,~_,'~-"''''__'_''_' : .,__...............?_~~._"'"' .....~ "~- :~--.---------__.-.,.~-..:..,-........_.~1;O'- ..__..:~,~...:-..--.;.:, :.-~.~;.:.....~~..,.........'...-,- ..~- "'--"'--:'- "..--.~~..., ,,,,..;;,-. ..-.......- :.. .~~.. - ,,~~,~' ~ .. _ ____~~---~~~-,:;: _~~''':''..:~:..:~:.:. :':::,--:..;::,:;...;::,;,:,;..:;...:. .,.. ~C'_' -;_~-~. .: : ~'. :. '_':::.:.::," > '~"'_ , ~,';. ;:...:..:.. :'-.;,,;..':",:~ ''-''::-~:.~; ,,:,:,,~:.;"~"';~' -.;- ..~""'-~ '- PLANNI NGPtV I STON-Att'fQt-f'pg'NpTNGr='YE$ t-"' )."'Nol:""'l'~AJW'rOAtTQNlr ...._ '.".. n__"' "'h'_ ."." .,...., . --.. --------..--.. -~-- ,- ,.~. -" .....~,..,--.--.~.,.... "-'-- ~,-.'-' . - -'. . . - --.. -f "--.--..--.-,-- BUILDING, 1NSP~CTIONDtVIS10N Not Applicable ,No (1[ () {) " ~ J) () ( ), . y) ()U)' ,) () ( ) " CK'D By/1 JI~lkaJf-?f {'DATE 7. Plans Submitted .' B. Soil Stability (footings) 9. Flood Pl,ain 10. Other (see comments) , CO,MMENTS: ~'.. ~,,:. ,',... . , ~ WAfEiLPOLUTJQN 'cONTROL' , Not " AQpl icab 1 e ,f) " () No Yes ,()(W ( ) (:) CKiD BY:~.d~_ j?--g.-7S- . PDATE 1.1-. ,Meets Department of Envirbnmentctl Quality Standards..: · ' 12. th~er (see'coimne,nts) . GOMMENTS:.: . ~__'-."'~-.._._.__"~ '-_'~L_"""""_......'.. ~.=__ ...........;.,..._ ....___.._____!....-... ~". "_._............__.._._.~,......___.. .____............"w. c'.__:\ , ., , :.....:;...".~-~...."-~---------.~-",.....--.<~, .~.--,'.....,.I- :...._____ .__"____......~: " ' ~ TO' APPCI~C~NT: " ''', ' -" '. ','- ,'- Yolir Buildi,ng I Si~e Inspe.ction: ' ,,- - "~ ~()q"""Can be:approved. - .' -', ' I.1A~~. .. ( j ~:::~~.i~:',:~~rf~;~h:~ ~~~~r~~i~o;So~ii~ ~::e~ f~r.!.;~ '~iJ~~~~at t~~ LANE:bov.. , . ~ ' COUNTY PlANNING DIV,ISIONq Questions an'O tiurth"er 'nformatl'on on ',tems 7 : , ' "'Jthrough 12, cbntac;t the. 'LANE. COUNJY,"BUI,lOJN_G_~NiLS~~r1i8TjO'N_Mv.tsj:O,N. . , .- C">Yjll;'b~" held ,int:h'is'qffTce untfl'youcan i'r'e's'0l've ~th'e ip'rbbH:ims ;i'lidicated.. Cl,'Ts~eil1g,returhe'd~ "'..', ' , ' ," ,."., . .( Y You;':'_ l)l~ U;d in 9, {>,e 'rmi t'app 1 Jca.tXQ!1.} e}~__ i ~!?'el'rYq ~Itet~'fj'featl(na~, ~se'D.2!llte' cove r - 'IJEPARTMENTOF' . ENVI RONMENTAL ,IMANAGEM~Nl " , 1'3'5'S ixth fl:yenue,'East. Eug~ri~ ,Oregon' ,97401 PHONE,:68'7:':'~065. . '~,. _ "':'_"~' ' , LANE 'COUNTY PLANN I NG,'DIVI SJON PHONE: 68j..'4YB6, " "I . ." . _ \;:'- C55-28 .; 1{.... . ." '.' . . < ':. ". ~ X. "I"! ;-;.. , , .. ~ ;.) . }. , - :"" < .~f" " -:.;" ': ", ". J"_' ...., . s-<;! !'. ~.> "i 1 QR_ 71:; , ,,~,;' I";. .,'. ." ,," . CURB 'CUT' ; ',',' y~Date -< <;:. .' '. DECEt-,tsml7; "Jq7~ ,,'> ~:. .::" . 1."... . ., '.' , " ,',', '"...:,'p E,~'~ 1,~C,'p ','" , '" ," ' . . IN :THE 'SOARD OF>C6UN'TY COMMISSIONER$"OF' LANE 'COUNTY' " :". '-. '.' ~......_..._,.:.:,~:..:.t "-", ..._~.~....:.~~,~:_..~.,~ ". ". , . . ". -.~"'.' '-f~" -. - .. ..' .' ." .. -- ~:-- ~ . '- - .I -. . :; -. ~ . . ,,'"'~ :.. .. ., .. . ,,', WHEREAS; hie' atta~hed dpplication has b~en fully" cpnsj'dere:d l)}(,the Board, ()f' County ,Com- , ; .111 issioners of, ~a neCciunty, <:1nd :it i,~ tn'e opin ion- and judg rrH~nt:0f-tJie:'Bbard that the' sdid, a ppl}cation ",' ' ,,', ,,:should: be gra-nteai:;:,and tnat'ci "perm.it ,should. be }ss\j~c:J/IJO\:V;~)h~reforei it is hereby'. ;, . . ' : '" ", "" ' " , . ' , .' ,,' " 'f';~;'::" .' ' , ' , ORDE~ED~:tna,(a per'l1l:i(..be~andis,hereby' issue~ to'- ';KR~MDltcK INC. ,~P'.O. Box"144'4 ':'>:tUG~'~~E' '6~E~~~ '9740'1 ~': : ,.:.<>tcons'tructing~the :foilowiriffacin~yY,.' , '>: .' , " ,for;'plocing" building -'- . . _. <;'..' 'or-" ~_; '. ~ f --}:,.'~.:~~j :;- ",-lST ADD\1>'O,N TO"COOKS'GA'R:DE;N LOT 2' :<~ ',,'868"A~D~'RSON LANE" :EUG~:"JE ,OR'EGON , ,,-.. '-'. . . _ . r . upon the right-of~w;aY;:of'County Road No, , . ~, ,: :~:'Mile l'osF '" " . /, in~ strict conformity t.o:"theexhibitspffoched Iiereto;.and 'subjElqrtoaHterms, Gon~i.tionstqgr:eements, stipulations and 'pr~,Yisions contained: in tbeappl'icptiqn and"p~,r~i,t,the Rules and ~egu,l.ati,on?Gov- , er~ing 'Facilitie~, t0~bePer.mitted:,up6n County'Rqad; Rights-of~,Wa5"; :9!,;'set ,forth, by,the l~an~ Man- n .ual 50:19(){2):any 'an;endme'l"lts-Aheret(),',an'C1,any~ther:-appJit,a~ble regulatiolJs, iqw~or.:~prdinance" . ;, . '. .-, -.j.: '.-. ". '.... .- :," . :.~ ~- .~': "~,:"-"'".- ,:".::-;,;-~.. -..:~"""";'" ,:":- 'SP:~~.i';1'r,prO, vi~~O~:~;:~ '.,,:~ ' , _ " , , " ."....,'." ".' '.' i .. " _ ~ . _ _ - - .:~;~i\' . ", 1 ' 'Dri';;eway will, h,e' con~frud.ed,),o ,a2c'ordance whh~ }he', atfa.che,(:! . qr.iyewayapFir,b~~Ii~'~~pecifica- . ,_ ,ti9,r:1,,s, {Drawing 'M~8~5())..::,-< ~" ,', ' -,', ;" ,'~' ~' .: ,', .~ . , ",.,: .:...., , " ,2. "Pe~h,'lttee"wiJi'! 6~ r~sponsibl~'fcir the' i~ri,edi ate' r~mo~al :6f ali': ~'ud,' dirt 'ancf d~l~'ris: .ffom the ..' ',>rciadvyay aba..;ri9hfof waY>,causedby ~is 'operation; lea~ing.t.he'roadwaY',~:m,d;~r:eci)n a neat, , i~ccepJable co'pdr,t!ori. '~,.":', " ' "::',~:::' ,; . ' ,:,t ' ,,' "\"".::.' , , - (. -: ~~.:., - . '. . " ~'.. ,,. " j;" -. "3.':S I,DEWA'i:Ks,J:;Lc<S'E' C6N'~tR'UC'Tf~: iN' A~c~~i:)A~CE{;W'I';H THE A'iTACHED, S 16EWAL~'F:';,'i'; ::-': ',SPESI F'I CAT.I'ON"S::':'A~~ .D:RAw:I'N'~ ,.M98-49. 'THESi,~,N:D'A~D'iCYRI3; T,YPE SHALL ,BE:' ... " CQNSTRUCTED Uf':I~:ESSOTHtf'11~f,~P.ECIFIED: :,', ':- . . .. i ',' .::-. ,~ ,'; .,._,.... ",...... . "'-, _ _ .. ':i!' -' ':, , ~ .:. , ;. This -p~r;"it- i~ :.;~v~-~abl'e-,at~~y time" and \vili' '~e '~~ri~tly:'ad'h'e:~d', i~, ~nd ,no ~ ~6~k.:~th~~"than that specificaIlY'"i)1entioned dJ:)oy~..,. is hereby' a:uthoriz~c/; " ::, " ',.",' " ',,":.. ... '''','-,'', ' - -:. .." :-~ .~+ . ". -:"''''' :'~..: .~. . ". ~~~~:-, t.r ",-;. _-':'.~--~.. "., '..,"~ ..>.',.-' -p _ ..; , . -', .This permit 'shall be'void ,u'nless the work herein con.femplated~,shqll, hd\feb~en:~completed' be,- '.. .". .'''''' .".~~-:.::.,_:~- ':"'-:'"~~'-~l-;~' ~.' . .....'r . ~-- . :, _: :';,.'fo",r~::" DEC:EMBER, i7' :, 19 '76. ;.' 'Exp(res,: i '" , ",--1,9 _ . ., " t ~' ;~ 'iI . r.. . . .' _ : Apptoyed \by:Board of County' Commis~ioners By," ~ "<~ "":"""';',",'_'" .' :,',,'- '" :: ...~A:-;/J,', ,,' .." ~ ~,'" ", ,:'," ,", .,;.:~.~...~-- .' . ~ ~. ", ' ';::.i~'~~~cted'arid Appt6vetf '~,', :;',', '.:,', ,.- . .'-' '. " . - ~ . .. Date " .j' ....;..'.- .., .~~- . '. . ~ -', -..' J" : By':: "", , . '. . ,~'..' :~.: . w'o." '. <. " .' ',WHITE-'OFFICE 'FILE:~,,;, ," ;':_~B[U'E -'ROAD. SUPERVISOR " . ,GREEN,":' RESiDENT' ENGiNEER' ,~:._, ORANGE ~ BUILDING," & SAN IT A TION DEPT:' '.PINK-'PERMITTEE i" " ';',YEltOW~'REArESTATE " -- - " -.' "".\.' 'Qirector' .,of POblic"YVorks. ......,.; C98-79 ,.:.... ''"'''~'.:.J!-'''..II':.,.~~: .:,. ~.r:"-~.~''-\:.o,.._..l.-li.?i.. "':'~' "-"{'.,'"'''''f>-''"..., ;",- ,. ~~ ( ~' .' '.' ('-', / '~ ~\;)lL~ n "-.j Permit No. ":_ * \:;i~ :1;; .. ;;..''''''' . ~. .,~~::' , .~,~ '0~Date ,UJtC:t:~t';fZ:1i1 t'? '" c' CURB CUT P' E R M I T IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY WHEREAS, the attached applicatiqn has been fully considered by the Board of County Com- miss.ioners of lane" County, and it is the opinion a nd judgment of the Board that the said application should be granted, and that a permit should be issued, now, therefore, it is hereby. ORDERED, that a permit be and is hereby issued to ~ltlPtiJH':Ii.:i, Hit. P.O. BrlJt t44l4. O,1r,tfjC~9M 97~or for placing, building or constructing the following facility: hrr ~Q~f1'.OI"; r:Q.!:'::l;H;) Get: :e.f.'N lor ~ ?.4Jt;, ~\~:!;tt:fl$#H LAM' LtNf:"'~: (,E1t1.l';~~,i upon the right-of-way of County Road No. , Mile Post , in strict conformity to the exhibits attached hereto, and subject to all terms, conditions, agreements, stipulations and provisions contained in the appl ication and permit, the Rules and Regulations Gov- erning Facilities to be Permitted upon County Road Rights-of-Way, as set forth by the lane Man- ual 50,190(2) any amendments thereto, and any other applicable regulations, law or ordinance. Special Provisions: L Driveway will be constructed in accordance with the attached driveway approach specifica- tions (Drawing M98-50). Permittee will be responsible for the immediate removal of all mud, dirt and debris from the roadway and right of way caused by his 0 peration, leaving the roadway and area in a neat, acceptable condition. 2, ., ;::. ~; t O(WAt,t'i$ w t Lt. tJ;c ~'i).\$i11 ~W::1:'H~i Ht ..eCO!li f,lA'~,~~,r, :"T~.~ .(tit Jt'\'1'-''';';nf.: G GI d:lr.WIL,;', ~ ~,,' ,- r" .1'Ptc;.t'\1(A"~I.:mtA~t!l Qn.A.',fH~'l.f t'ft;;I,;-f4\) H:(; ~,'tJ~:\"~i$H) (:ilitl'i)l 't~,*t ~,~aAlJ. i'W ~t),"'atiwt1't~ WJt.t::l$, orH.ff':H:;;;:~ ~!~J;;'QrH.t): 1;(10 I~~ '3-lfl.~ 7/? This permit is revocable at any time, and will be strictly adhered to and no work other than that specifically mentioned above is hereby authorized. This permit shall be void unless the work herein contemplated shall have been completed be- Ut.t;I;Hlf('9 l'i" (6 , 19 Expires , 19 fore Inspected and Approved Approved by Board of County Commissioners By Date By Director of Public Works WHITE - OFFICE FILE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUILDING & SANITATION DEPT, YELLOW - REAL ESTATE c98-79 '" . ,. ./: ,. t LANE COUNTY PERMIT FOR. PERMIT NO, j~::D"'i~j I ..1 CONSTRUCTION [~] MOBILE HOME [] PLAN REVIEW [] CHANGE OF OCCUPANCY [ ] .0 Owner ~;'~UHfUE(:ff llit. P"Q. Box tJf44 ~)~ffl~>it (if(H,~(jH J?401 ';1~;!.~',,!nSY:~ , NAME ADDRESS CITY ZIP CODE PHONE , "0 Contractor O.S. Reg. # SAME: NAME 1134 ADDRESS CITY ZIP CODE PHONE Twp rii Range :, Section ~~1 Tax Lot ~~1' "'OOiTiON 'TO {~,O~~;~ (~j!r~~nI , ' Lot"; Block Code Census Tract Subdivision Acreag" Width Access to Property (Road Name): eta ANDC~'O~ tANt Depth -"-. ,I r' Existing Structures'"on Property: \, ,~, ,ci,l,nJIt .~; \ Directions to Property - Address: "1;[:: Ii I.. Qt;J(;.l "fNQttt.:'$~ "",,!.t STRUCTURE (# BEDROOMS) lffttH~ 'S rClI1' !\OU$~; ~:t~ii'i.,:aI3., , lft!f~~ i",t.L ~'IWA.i: Ot '",fiAt. tS Y$TIt.. ~,.J F OJruUl, l~ ~E, OOWN TQ ~,ot, W UlIDISTUI'fJEO f.Ak?1H fp~~~: H';" tti fH~ L ';). .$~J VALUA110N tfa~jtp],.~ ~ ~ lf4IC'. L,'(.;' ;:9"'e~ . Ai .!.~ ~I'~" U~:'5 ~t:<' SEWAGE DISPOSAL: PUBLIC [] SEPTIC TANK [] OTHER [ ] NCII PLUMBING INSTALLED BY: OWNER [] OTHER [] NAMF WATER SUPPLY: PROPOSED [ ] EXISTING [] [ ] PUBLIC [ ] COMMUNITY - NAME: [ ] PR IVATE WELL [ ] OTHER, SPECIFY: BUILDING PLUMBING 3% SURCHARGF MOBILE HOMF WASTE DISPOSAl' PLAN REVIEW ifi.!..OO .Fi;..OO ~'" a; J 7ll) '" 00 TOTAL 19j.~1 CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS MIN, SEPTIC TANK CAPACITY: ' GALS, 900 MIN, DRAINFIELD 100 L1N. FT, MAX. TRENCH DEPTH ;,lLACt PII....NtUtl.U 10 flif;l' rm,.t t'iiI'()P.';,tiTY t.-l"(' ANt) HOUSt ".fOU('~ i~t~.t>l;jt ....N .R~A VOR ttt:pl..,.CrHt:vef ~J!' 1}fUUN"~(L.Ot \~{i , -~ 'INCHES TYPE OF CONSTRUCTION 5t* GROUP U1.) FIRE ZONF STAY 100' FROM ALL WELLS USE CLASSI F. SETBACKS - ~J~ FROM CTR. OF r!W: FRONT SIDE EXT, '::;; FT. FROM !3JF,{.L1NE: Itput:. SIDE INT, W " REAR , ZONF R.. J AUTHOR IZED SIGNATU RES: /s/ "f.. ~: !JoltS.1 H~~'.HJfQ,H Gr:;,.V!fUHttAf; '.r.: , ,ISSUANCE DATE: t~lrv 15 Pl.M BLDG, PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY . " " BUILDING - GREEN '. . " \- - ',,:'0'- \ SANITATION - GOLDENROD ~- J ", 'v ~ ' IMPORTANT: Call 687-4Q65 to S~hed.uie,all,regu,ired constrJction inspections, Call 687-4061 to schedule all required septic system inspections, 'All construction shall comply with the State Buidling Code, D,E,Q, standards for subsurface sewage dis'posal, and the State Plumbing Code, All buildings require a certificate of, occupancy before being occupied, \ ' ': :, ' ','~--l \ " l~ '(s';e'betiil~'OQ Reverse'Side) \ \ '~ --- ,;-.. . (POST THIS PERMIT ON MAIN BLDG. AT SITE) C55-13 LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 ,y ~. , .. ~:- p .; ., , . .... SITE- I NSPECTI ON ApPROVED I I D I SA'PPRDVED I I I DATE' I I I INSPECTOR REMARKS, 'FOUNDATION INSPECTION ApPROVED I," .,/_ D,ISAP,PR~~ED I ;,/7 DATE, ./7" INSPECTOR REMARKS '(J If :t; (fUjff(j J~~ccA'ttlif2/~ l:" ~ y~ 4'-i., / l I f I I I , /") , ev., ;; FRAMING INSPECTION/ / ApPROVED I L/f DISAPPROVED I' ; I D~TE2~/t)"'7t " ,0 I "., /'1/ u; I NSPECTO~,,~, ' /! ' (.~/ 4~ REMARKS i ! I LATH OR SHEETROCK INSPECTION ..///' ApPROVED'1 ~/ I DISAPPROVED J. .\ , /fZ/'? I DAT[L:../~ 1k I NSPECTQ{.-A; 6>1 , REMARKS FINAL I NSPECTI 0/ / ApPROVED ~ DISAPPROVED I I. . J . Lj/7/ #1) 7 DATE '-{, '- / if ~ NSPECTOR~, tl-~ ~I r I' L..,y ,. REMARKS .1lf...,lf CERTIFICATE OF OCCUPANCY READY TO ISSUE I I NOT READY TO IS~UE I I DATE INSPECTOR REMARKS ...... ) VI // 'I ~ /Y. t.'f //fl ufy/~~("t.!' (J../ "I/{/.,.yr,,,/\,,".:'I y .7 " 3 /' C( ~,~ 1lf /t/;-~#tJJd< 1, jd..,r!l <r{; ~/ , ,", &~ _.-T. .... ,,' 4,.*' " :\ .;y:.' ~~/7':'" ""'%..., , /~"""'v' , ~ :t: I' . , o LANE GOUNTY PERMIT FOR:) .," ....~: PERMIT NO, 3l~ f9 .~ . ~.o~ lbx 1!J44 ADDRESS PLAN REVIEW t ] 'CHANGE OF OCCUPANCY [ ] . ' @'14oi ~~~...~~ , ZIP CODE PHONE ,n:tJlS2~1E On~~~~ CITY, ,CONSTRU,CTION [)t J o Owner. t{gmM041i:~tt trJC.. , NAME i, MOBILE HOME [,] '.0 Con{ractor , 3tlt$U: NAME ADDRESS CITY 'ZIP CODE , PHONE O S R . 1(1)~ ., eg, # Twr n Range' 1 Section a6 tax Lot - 8 G'i' ~fi)~' 'it t ~ro vo Ceen:o G~~~lt~" Subdivision " L~t ~" Block Codp ~ensus Tract Acreage Width , " ;Acces~ to Property (Road Name): 6tii6 A~otQ;t:lol'4 ~.At:lrll Depth Existing Structures on, Proper.ty' 'r~\'i. ;", Directions to Property - Address: , ' 86B A.rifGH\";jOM~ ltlt\Jij; .. . I ' STRUCTURE (# BEDROOMS) ',<' ~ef'!c,H'f t@r;: H~$e ,Ji, I~QA<l~ t ~j~U'l\t.t ~~A(&n. f)8~f'QQAt. $'ifDTlt~, t~lt"FnOfHCM ro Gl ~ rn OOU0}U~~~S~l) ~R'fW . " ,SQ, FT, i! 19~ @ UIl<'.10 ~ {3 5.1W VALUAT.ION 4H 5~ ~.~5.1;{} Z.D~O.W Q~910~3.~~ J SEWAGE DISPOSAL: PUBLIC [ ], SEPTIC TANK [] OTHER r ] BWILDING ~~"OO PLWMBII'iIG' " ~lJ60 3%'SURCHARGE. ~.Iit~ MOBILE HO'MF WASTE DISPOSAl 7~.OO PLAN REVIEW 'Nllt1 '. TOTAL , V~,,5~ CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION'CONTROL SPECIFICATIONS MIN, SEPTIC TANK CAPACITY: . '" GALS ~ MIN, DRAINFIELD lSo I.IN, FT. MAX. TRENCH DEPTH , , Pa..tleu: OOAO~? Hl2..6 .0 Iflta;T "f,z@C:3 C>E:ltWmn'W'f l HJi.! tl~1!l ~1@Y~fi::' J'.'jQtJRC4$ro ' "" ~trlteN'Vit AtoJ Abllt:A tfO'Q fil!Pttle~~C;!'ij' $V OO.f1HJ!" l fllO: 16 INCHES TYpE OF CONSTRUCTION 5N GROUP RliJ FIRE ZONF STAY 100' FROM ALL WELLS USE CLASS I F, SETBACKS -Afu'" ,FROM CTR, OF r/W: FRONT SIDE EXT, 5) ~~D:~~T~~~~L1NE~EAR 7'~rr: , ZONF ~~Q ':" , '1-.., AUTHORIZED SIGNATURES:' /s/ J. [ B0tl$ SV M~fJAtJQ~ f!J3.AV/O(!,rob"AQl'A~ , I' "ISSUANCE DATE: 1 ~11/75 tlt.~ ~:.:'r-" - I, '; ,,'\ BLDG, PERMIT - WHITE , OFFICE COPY -WHITE COUNTY TAX - PINK PLUMBING - CANARY , BUILDING - GREEN SANITATION - GOLDENROD IMPORTANT: . , .' ":1 . _. . _, . . . . ,." Call 687-4065 to schedul,e ,all require,d construction inspedtfon's')fCal1. 6137-4061 to schedule all reqyired " septic system inspections, 'All construction'shall comply with the State Buidling Code, D,E,Q, stanoards' , for subsurface sewage disposal and the State Piumbing Code, All buildings require a certificate of: occupancy before being occupied, ' . I , (See Details on R~verse Side) \. , . (POST THIS PERMIT ON, MAIN BLDG. AT SITE)' C55-13 , , ' LANE COUNTY,'DEPT:OF ENVIRONMENTAL MANAGEMENT' , COURTHOUSE Ar-iNEX: 135 EAST 6th, EUGENE, OREGON 97401 , " .~ >: "~ i", . .::,..,",~,;'.-:.;, ,':'..,:~~., c' {:, ..' . ::..:..'~.-; i~1....,..._ . ..:;-..... - _.....~ ".".' - ;-:.<.. ., ".~ ~ ~:~."~ I. ,J.;:''''~ .' .~~~ '.-.- , ' , ,;~'11.... ,,"1<.'.", ",' . " '. SLAB FLOOR PLUMBING GROUNDWORK . ApPROVED IVI /" DISAPPROVED I I DH'~/-$-7tt INS~ECTOR.~-~ ~~7 . r;;.,< REMARKS GAS PIPING GROUNDWORK ApPROVED I I DISAPPROVED, I I DATE INSPECTOR REMARKS ROUGH PLUMBING INSPECTO~~ ApPROVED f/I DISAPPROVED I I ,DATE 2- :1'1-7 ~ , '\ I ., , (/ , REMARKS I I r r ROUGH "GAS PIP I NG ApPROVED I I DISAPPROVED I I DATE INSPECTOR REMARKS FINAL PLUMBING ApPROVED / I DISAPPROVED / ! DATE~-ff}. 9& RE~ARKS-A.l.o F;IbAJ.. INSPEC~;<~J I I ~ ' I FINAL GAS PIPING ApPROVED I ,! 0 I SAPPROV(I;)..i'~,I; I DATE INSPECTOR, REMARKS :",,..,.',',,.,, I I: CERT1FICATEOF OCCUPANCY .~:{ READY TO.lss'UE I' I NOT READY TO 'ISSUE' I I DATE \ INSPECTOR REMARKS' J' ,.~ I';' .'.~ _. ( :\~ .\?-:....':!-. ... ..~,.- - - ,. ,~~~:.. ,.::).',-~~, ',""'" c:; ;_~:;;"PROP,-,~Q','S,E~A~:~,;;:gi ~~O~~L.,:,~Y:SJ~~j~~~ORO _ :: ~" /,;. ::,,',' ::f-'~ r~. ,': '.' ,J ~ST~~~;,R~ ,:,'~0Ete.te., ;~~~:c.~:.~.~' :~f. ,~:9,r:~':~p,~,r~.~t~t~~l~. ,a~d', sub~ I Lb'oth: ":CO~I,~S';~~~~'~fa~~:1'~8:V5~G;\<,~:i~" _."~ , ,INSTALLER ~S . NAME " - . '~:'.:':, '.~'" '.-' 'PROPERTY, :ADDRESS ' 'd, ' I~~':'~<(\")~'/)::I^_:: .. ,,',~<~~'e'~-~'\",,~, ",:':868' i~~\R'~O:~::'~ANE:..':" ' ' "",',GG." , ., l\ v\.....,r-.-.: . \.L).... . ' ,', ..\ .', '." "," ' , . '~ .' ':">.;}i,?~.,' tJt'i~9, u,_,',n",'i,ts, .::'-,~~!:Ir,<?oril~~:.>._B~tns,- ~asem'~nt '., ':,': \.~a,teCS,ue.P.ly-,: ~: ' '" . ~-\';~.:-.::.~~:' r~:- " '--~":'-" . . - . ~~ . , .' .''les:~. No"- ., ~ . - Pub ll-c A. ~~ Other-L i st- ,'S,~pJfc: T:a.nk::: '(" ':,,:',:;:,,:'~~:~.,,':<:',' ~;:.':::",,' ".f':~,'.>' : .,.'" " " " :' ;,:~t.~'}r:oni', we 1:f ';-', :. ::St7e:~'~]~l~ .,'~CO;~c,~,~:~:~i.~'NO;: j~~a,~:t!~~~\~",: .:,~~~~ G/i>bO.d"~t~:, , , " J n$;i'9'f:!; '~:i,:~en~'!?~~?f, ::J:t ~".';.;,' 'c':i/ X: ,":'L;'.:':-~':j,.,/.:.', T~::lle;.'~j:~~:?~~.!, Fi,eJ,d~,'""", ,~:' ',; ~>,'.J ,.:, ',' ", . . ,Length',,:,.;. ,'WI a.th<:-,,~ ,.0 .;ameter' :' ".Depth,,:', -0, ~t-rl but l'onB,ox: : Yes ",' :'No',., ',' ',' " ~~~~R", , ;:K~:JM[kt~~C'k'-JNC. '. ..,~:t:1~,: '~~J~c~i',bu.ti.~n~}ype~,~, ~:'",".;:' ":"'~:':"" :'." MAI:L :,~~~f~:'~'.:oi~}~:6-~fJ 444::: :, ,,~~~~: fX@:~- ,. ..,. F~uhdat.i 6,1""., ADDRES"S':", ':,; .~i:', " - .. ,,",' Lot! Lih'e'" . ,.. , 1 . " '.' ~ ' " I' ..::' :' " '.,. ' . -, ,~.EUl?E:~s,,9,REGON '."r ", .' 'Frail't.>,"', . <..;Side:' ,:Rear-:.;':": ~', l, -~9.t..~Sl.t~',i, rl,,',,~s_;","', F,t"., <,.,: T~~:n.C:,tg," ~T. ~ta,l':$q,:.:,:"c~~~:I,~,~f~,:~e,eri; ._: F,J+J~e,',,~rl/, F, iJl er' ~'~,P~h ". f, !,,1:1~r~ ~7,lc;jW",'_:' 1 J~J~.'~,.,4.:.',s.' 6,.'. W,dth~~.:Ft. Q{/O..L. nes" t(5), "'-.rype:L/~~~Abov.eT,l e...L. n.lr:1e 0, In.' . , P1 otP:lan :lsee;J:hstn.ict ions}':<'o:"~;, ,.:'? '. .' ",' ':' ,', ' ,'C':- ':" '~:.,' . ',' ,: ...' '. ,}, . 'J, -. ~_. ." -. - .. .- , , ~'" .~. ~ -. -:.::. . ." : . ~ .' . " ,.5;~':'5' ~. '.,X ,j' VI":,;". ,', . 'J. r}~J#:t ..-.1 . :,dl'2.~/;~:, ,'_ ", ,I .. . ~ . ,:.. =;"I~"J::\',':,~,/ '~:\:~,:::}:" . ',' ~./'::~,; Sf '\' A~-'';''';''~'' - . ',,. " C'. ": ...... . -;P~I O. . .t:, ):J'?~~::' " ," , C~:,~:' , ,.~ < " ,'. ' . . ..... _ ;; ~....' :. .' :' ..:...... ~.'.' t~' . . :: , -'2_ '-t-- . - '. - --- . ,\. . . :.'- ,'ri.o.;. _;" -;" ,.. ~ ~ - ~- ." . --. ." ~'. ~. - ,'. .,-", , :~~')t1;~": . , ': :~: :;' > .': ,:' '7~~~;::'::;.[("" ,.' :,':.,, ",":::~:::Q.7\' .... _",;"::/~~~;..<:~, ...... ;(~~~(r~'~.,,_~'.;~,:.rs, ',e;>:,' :..-',~::, .-:::.' :,~: ,: ,\<~.~' ~ .' u.".. ..~. .//'\"1) ol:....k . , " 'Y:".i_ li~'.~~;;t~.-.":.;,- .,(,/:.\ .... ~um, ""::0 ~ :,': "i.,' , '~g'\~ :l~~,'.}<_:j;'r u,".. .. ...~~, \~': ..'.;i>'/ ,;:' Lf'. '., .i'C , ~ -<: ,0) . \"" ",,"" "Q 1 ' , " " " ,:.~):~::~:.,:.:..- ';'::"Q'i},," '~'~".7/"~~,~':" . ."~' :J'~,<, ' , " -.~ r.. r ~:., ~'f ',' , ,..,. , _ ,S/', :': I' . 'f.":O,' , " ~ ,":-r ." _ j;_." .~ . -~ :.. ' ii, f' . ~'". .;;.. .. ~~ ',:: ;.'," "". l . '. - ~. '. -" ,.,,' r:. - " ..,' :<",., :"c~~:' '.," .'"~,,); ,. ".;,- It' '. ,:-~:-:-:.-L..'- - . :-':'.~".".~ '-,~',"',. ..' ,.:!._:-":_ .-_ ....: .',"-" ,',. -,' ~:~. .-....~:....--_.,... ',.~.'-:_'-'--:..-.~_- :>' . -,." -'-~:"---'''-''~' :...~. ~ '. ,Date, -'~ .,I~", - J.W ' ,'. , S.qnatur.;.e, ,.f PI. .:f~""b:r., ~". 0,." ,..,'. , ",. ",' .F-:,:,": ,:~' ":'~:" CERTIFICATE OF SAnSFACTORY:"~" L~EI' " .,'.,', ,:' ;",'" '. ':'.., "', '. , F~r:,Sarii t.ar {a~ Use'::6hly:~:,\: ",:,"u' : "",'" ,: ,::",:, ',;~)'-'~';f: "".\::.-:': '<..::';':: ,,";/..;': ;';D.at~:;a'J~i7:....7;t . Inacc_ordan'q~:w'i th:'1973:()h~gor(~La\;'ls; ~hapJet ~835.-, (Se'.c:~{dn~,~14 , . rs'c:~~~dJi cate, r-~,j-ss,:,ed, ,: ' : :..,':, ". :,'as. e~id~Hi'ce;-'o.f 'sa't:tsfacforY'~~{:OOlp'1 eti o!,'~of as4bsudace :sewcl.ge 'di sposal :sYs~~m:at,-;~he::~bov.~'. :" ' .' l'oc'a't"l'(in~:~~:' ~j.~-~~:' .. ~~..-:~:_ J.,"_:' ~~J ~..:. -~~.r.' . _' ~~:' "". ':. :'~ ,. . ~ "" _ .~ .' ~- . . ~ '. .. . ._ - -'.~- 4- ': - '.- ,,:' '. . ~4t0 ~pprove4~:.'~y:'stein' Ins.t~lla~,i9~"c~,~.form~)o'cut~~n't '~ta~~ard_~, _" __ . p?'"( Q i'.sappro,?~(;:I ,:, '. QO,es:, not' coriform:, tp current 5 tandard~ ,-'" ",' Rem~ir:ks :,\:-:,'::;,:, ". .." , ,. . ,,' ,'- - .' .....'. - :'-. . .. .r_ \ . 055-1-1':' . - - .. - ," .; :.::.,'~.' , "/~~,,,,',""'~,:,' .,' - '-' - ~ -:.' ..- , .'" ", ";,"', , , ,', ' .. "'Sani.tir i an IS:,~ i gnatdfA . .~.t.. - . -.~ ~"#" lA'NE" COU'NTY".- ''';~::,::.~-., /.V':-.'" OF~'O~'E:GON 'OEPAR;MfN;r:'OF';:ENVl R'O~MiNTA~'QU~L.I'TY"" " I" ,'- ", ' ., .' ~ .t.~ ~. . -" <.. - . - .... ~ . "i ". _. .; - _- .. . .' ~ ... .. ....-.... '.r '"... ...... -.;. 'STP. IE '..-' ..:--...... ~~G}'NOTE: N~ PERM~T, ~LBE~SSUE;PL~;'~N:~ AP~+__JN HAS ~ . :':,~ ' CONSTRUCTION I YIMOBILE'jHOME,--I' PLAN REVIEW .1';'_, CHANGE 'OF OCCUPANCY IJiV/nd~b/,)~d ./tJ /f/~j/ ,'. , , "Name ~, ' ", ~;'.:',' Address '.' '>9di~:/)-, .' Address , "311J!-7'C--' PERMIT # , . ,~ BEEN APPROVED , :1, I -' OWNER ':j;G-??/~ iCi~ ' ;) " :. .::r " '. "j '\.,l. .' JY'Fr3;?S- ,Zip Phone . \. ". .\ , . Name', i. 3~~p > , . ~:CitY,:... Zip Phone' I I COl.'lTRACTOR 6~s', REG:tl. /5?9'" T;'p. /1, 'Range '=? Section,', 2, ~~ Tax Lot SU~~iv~sion I~~ 'cOCJk~o+k~~' ,2- ' ,'Blo9k ACC~SS:TO PROPERTY (Road Name) .'~'jJk~;"'C:/7~~: 1 . Code Gensus Tract .1.' .; , " 'j ., /: '. ,,' , .. '" /' ~lJ.r: :~dedtM'L~ - " I P?opeih'Acreage 1-. ..... , Width Dep,!:h .' EX:l.s:ting Structures. on Property:' , , . '.':,::/;Y/:}/P/tP ~' , ' , " - , pr~pei-b Location -: Addr~ss/Dir~c~ion'~: Below for Office Use OnlyXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX , , ' ' Sq~ Ft," /), /., ~," ;,:/' oj,llBedrooms '. ' " Valuation ' ,;;~hI.'::;~ " ' /032.. (jj/ C 't, ::5 .' Ie; h/-..5 -; .:2 0 '.' '1'4i~~ J :,' ,-1't::Z,g: .J;cy " :, '. ~~~-hJ k,j;g~~w~.j)~~~~~j~" " /i~~3i~V / SEWAG~'bIS~POSAL: (, ,', ' .' . ~ '(' ,'., - ' ,J ,~. Site flnspection II ~xi"sti~g Sewage Di~posal System "I" or ~ew Syst~m Req~~red , ~ ' " . WATER SUPPLY: " ,- ", Publ1c I 'r ",'. ' -', f), ,;Well Spring' " Other" ,Community l!:><l: Name of Community or Public Sys,tem '\\V~_.-~J '.'/' '" . '. .r , , c; 11 Uf?". c."O ':}%.Surcharge .PUNS ,FURNISHED "" - ,-"",'; ~ ""~~: NO h YES'" 'I NO "Signat~r: Of.,'AP~, a~t~J";J~// _ _ _ Fee Rece~~ed By. t/.ll..lT -Date:,/;;;'-;/-~ _ .. t - Min.' septic:, 'Tank capaclty" Cj/r"O: ~ Dr~infi~ld - ReqUired:'-,.LZ~eW Fe~t" ~f~~~' '7ximum D~Pth~" _ , ',/J/ ~,', b"A_:/ ,/;U 7J6 10#.a.~~. '. ~ X"f;w"/.",-',''''',~'-rd,..A _ ~~ 7YI~"_h,~0 ~ A,' /7.,#:.C-'Y~"" Ii ,,() ......~.. ,...' 0..).1 ", ./. '. ..;, d .//J " ~.v-e-.' a~f"~ ~ ~~ d;jL" ~4/~ " ' V J r' V "" - t/ -,' , , ,3'07 ; Bldg. Waste Disp., Plumbing , Plan Review '9';),OD '7 L;i:/O .:> I~-: () 0 PLUMBING: ,~ 'Installed by ,Owner ~,~her; I~'~,;~".e'- dL~', . ' FEES:, PLUMBING ,FEES: , ,'[ ~'" II of Sewage'" Connec tion, Water ;).... Cmmection ~, Mobile Home ~FACILITY PERMIT ,/ TOTAL J ~~-;, ~J ,'" ":" Type of Construction, '( J) ft/ "Group J~ ii." Fire.Zon~':: -.. - -- . .. , ::', USI? Classification, ...., " Bldg Set4{)Ck& :- from Center' of Road, Right, of Way: , .' " . Front." ' Side Int. ~ -, ,~Ul J,,~~,~.':',_ ." . ~. ( Rear , 7 'PIJt Zone e-I '';I'' ~P~tING: ',' (l"Cil" I ,.,-0-1& . ~C55:12 ' ~ " DATE: ':':,4~~. COUNTY DEPARTMEN~F ;~;)T~JJ..M::;~tf2Lj~TJf~t { ENVIRONMENTAe~NAGEMENT /, ;] LANE