HomeMy WebLinkAboutPermit Plumbing 1973-4-20
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LANE COUNTY BUI~G PERMIT 0 R MOBILE HOME USE APPLICATION
PERMIT TYPE - BUilDING elf" MOBilE HOME Dose RiG # PERMIT # t,t7o/---7.3
PROP~Y OWNER MAIL!NG ADDRESS .. 3c;C10 PHONE
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CON~TOR MAILING ADDRESS /] PHONE
Jim BRA.J)Y _ _, /~~OV6b
PROPERTY LOCATION - INCLUDE Pr6ST OFFICE! frl~t:9!A.. kLt.\
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TAX LOT # IO<''? CODE CENSUS TRACT
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IO~' ...:.' v 1O~'dESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY __ ~/1
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~ <c;~... LEGAL ACCESS TO PROptRTY - ROAD NAME OR #
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PROPERTY SIZE-WIDTH DEPTH
METES & BOUNDS 0 YES
ATTACHED 0 NO
PROPERTY LEGAL DESCRIPTION
LOT - BLOCK - SUBDIV
TWP RANGE
/1
MAILING
AREA
ADDRESS
~oC"6'P
2"..cV
/""
rn/' OTHER 0
FEES WATER SUPPLY
PUBLIC [jj/ OTHER
PLUMBING FEES ct:
FIXTURES _
CASH ~ SEWER ""'l
CHECK r-; CONNECTION FE ...< ~
PLUMBING INSTALLED BY
OWNER 0 ~OTHER 0 N~
PLANS ~~ /'
YES r!f /l~ NO iY"
~R/PPLICANT
FEE~ BY
71T#
PUBLIC WATER
CONNECTION FEE
COUNTY BUilDING & SANITATION pECIFICATlONS
DRAIN FIELD REQUIRED
FACILITY PERMIT ~
YES 0 NO ~
DATE
3-2.:Z..-73
DATE
.J'-22~3
SEWAGE DISPOSAL
PUBLIC 0
SEPTIC TANK
BLDG.
WASTE DIS
PLUMBING
PLAN REVIEW
" PARK TRLR
t.
TOTAL
_22-; 00
MIN SEPTIC TANK CAPACITY
WITH DIS1. BOX GAL
L1N. FT
OR SQUARE FEET
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TYPE OF STRUCTURE
OCCUPANCY
ZONE
REAR YARD
PUBLIC UTIL EASEMENT
BLDG SETBACKS - FT FROM CTR OF ROAD RIGHT OF WAY
USE CLASSIFICATION
}i~;'~ ;m~ '~:~S_;;EA:LDG
Directions to Fmd Property
INSP YfJ
;' H.t &.r$ II -z.-O-.~
Date
COpy 1 - OFFICE
COpy 2 - JOURNAL
COPY 3 - AUDIT
Form # C55-12