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Home My WebLink AboutPermit Building 1984-8-20 ,.. -.,.,,~~:;,". ,.r . .' '. ." ........ ..... .". .,. .' .' ; " ' ,.' ,~.." ;-:,~t:. -;\ - SANC~~'LATIONiR~F~N~ 'AUTHOR-IZ~TIr' , --- 'PE~MI'T # acl?;b~'X~' 'N;~i (PLEASE' PRINT)'-<, ~I"l~~ r:" e:". 'Du..<j do Ie ' .... .... TRS/TL#' I ')0.3:2 ~ ~ " 05 '/00 . ADDRESS 4-f.al.c (v\ 6. 1'\~.{2 i eJ. d . ~ r . S 0'1 ; no '.(::/ eA d Dc. q 7 'f 7 7 '. ,'. ". ,J . . . APPLICANT (V) . . OWNER C.....y, . CONTRACTOR ( ) ... .'.. ..... , .' . . . " ' REASON FOR'CANCELLING PERMiT ,(OR J.\PPLICATION) Ar(',h;l-erl-ura( J)e<;.,'a'n 1)42 1'6",", urull;;/r:., . , . ' ' . ~- . iD :5u'n01',...J. .'~ ~A~Ke . ,h:)oj:.'w ,:;'It.;"u~ 1'6~J~),;a (1yBr6 si:LJ';..t /b-/b~ 0/ 'f/)?i l" 0/$0 , , : . -., , c7 . '", :5lJtlYlj of aC/ZZOV f7...tJ~es . !o()~YCU~ ,c;"., ~f-n!)n4 .JM.#o.Y6." A/eed ~ re.turn ~I..a/!s ::. ~IGNATU' RE ~ cres.:.;r pr /\ -~,. ,,~~/.. t:4- . e(:/)r)si.L-'tlp':;/-/'o-~ ~ 77'JOATE W~ ~/j/ reStJ:.6,/??;"rd ,///-e.~~, /7_. . If J.../..s# " _ ... . . d/....d .::::1,-1. 4".,/ FEES ,PAiD FOR - WASTEDISPOSAeS~~T~EMS. (SITE INSPECTIONS AND/OR' APPLICATIONS TO'INSTALL THE . SEPTIC TANK AND DRAINFIELD)' AREORDINARILYNONREFUNDABLE.'SOME REFUND MAY BE ON THE BUILDIN~, PLANNING, OR PLUMBING PORTIONS ACCORDING TO THE AMOUNT OF THE PERMIT/APPLICATION' PROCESSED..... .,!. C\~/\ c: ~JLtJ;'PDATE , -" , / .L-/ " TO DEPARTMENT OF FINANc'E: .5:8". " Building Permit Refund $ O?~7 "24-17.;.88/Acct. 42120/Prog. 060 . State 'Surchar:ge Refi.mo "$ t7....8:'2.. 24-l7~88/Accf. 42124/Prog. 060 Septic Disposal Refund '.' $ 24-l7:..'88/Acct. 42l'~3/Prog. 060 Site Insp'~cti!on\ ,Refund . r---- 24-:-'17-88/Acct. 42134/Prog. 060 .Land Use I~p~lif<ations $ 24-l7-88/Accf.42l50/Prog, 060 Planning\Diljedtor . $ 24-17':'88/l\cct.. 46202jProg. 060 .' Recordi'ngfFe;~>~ .$ 24-l7.-88/Acct.,462l0/Prog,060 . Partitions r / . $:', 24-17':'J3.8(Acct, 48474/Prog. 060 . \ ~ - 1. J .j; $ - , " Copi es '~ 0r9'i nances. 24-:17 ..8~IAcct;" 44419/Prog, .060 Recei pt# >surv,eyor,.3/' r . $ . . 25,O.(i-74/AccL 4445l/Prog. 0.10 Receipt# ,TOTAL \AM0UNT REFUNDED $ 305:, i9.. ". ,\ I . -; '. " PLEASE>MAKE .€HECK PAYABLE 1.0,: . ./'" ~/ . ..;;\NfMEJV~&~'//>~~~~h .... A' , . /! -" /1', I . e:\,kQDI{ESS#k,~ ~;%i%M;~~' ~~g#"A~~ /.&~/7/.-/'77~/ '.. \) . , / .. - . . j/ .- / . /~. : ,,-::~. ' . .. .:/ - ',' I LAND MANAGEMENT DI.VISION/ R(lblic,Works Dept. / l25'[,,8fhAve..Eug. OR 97401 (503)687-4061 ; ., ".' , .... -, (::~. ;''-'. ' '., " ;, , " ;...' '-.;: ," .,....,.... '1' ...,t.', r , . FEES PAl D . %. , REFUND . I~ rn ,M J ; iI, iOOir. ....; 1,.01'" .' %. .ll3ij % ,- % f /'J-r'J % .' % /CW.%" , / 07) . % (. '--.' .- .. ,,'\ ' : ,,\ .". .' . "Jii,.,.. --' '\ ' Ilt:;, IH) ~ -'. ....>..~.. ;:1~ 7,0t[ '71~'~ . .' ;.... .,/, % % . '. % ,'. . .. ,'0'1., ., . .' . ":,' , % '% ,% ,.%',.... . '." % % ; SIGNATURE , ,;, Flood. Plain Fee.. . Building Permit Fee Mobile Home Fee . Plumbing Permit Fee;' M~chanic~l .Fee : .. Pl an Check ,Fee. . , . State Surcharge Fee. SepticDi~po~al~ fee Site Inspection Fee DEQ Surcharge :.: ' Land Use Application, : Planning Difect6r ' Record; ng Fees., Partitions .... .L.., Copies & Ordi~an~es . . , S~v>ey.0,lZS'~':::": . ~ -.', , ~ - , ," . Mi nus $2,5 ..for ,p'rocessirig Fee TOTAL' AMOUNT :"0 Bt RgFUNDED . $ $ $' $ '$' '. $ $ '$ $ $ $ $, $. $ .$ $ $ $ ,< , ' ',., d' f. , }, I /7f) ,,5'0 '. " -2 L;, h1'l :-', 1.~'7.. og 7, >< ~ " '~ _3 3(). 4n -- :;.5'r oV ~. [) C:-, 4-1'}' . , " I I '( . , '1 <j/~~x4 i .,. i r' Receipt# Receipt# Receipt# Receipt# Receipt# Recei pt# Rece.i pt# Receipt# 111'[0 / / t'1'1() , . , ' , I ,. .1'. i',' ,.' ,~ ; , "" . ,Jo'