HomeMy WebLinkAboutPermit Miscellaneous 1986-5-5
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General Land Use Application
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FILE NO. P2/<f'.C'
I. PROPERTY LOCATION
Township_IF Range t:J 3 Section02..?f Tax Lot 1>7'iPtJ ZoninQ
Plot #
Site Address /rfh.? .27l?~O #k+: flk1~a;ize
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II. IDENTIFICATION! OWNERSHIP
Applicant:
1. Name /Af)If/l174 15d~
AddressS..-?7?7e- ~ A.rA'//~
City Zip
Phone
Tax Code
Owner:
Name
Address
City
Phone
')'~'e-
Zip
2. Legal Interest Title Holder Contract Purchaser
Other
REQUEST/PROPOSALfi~ ,~4A'2Ze- /~:J//7r--:-
Present Use
Existing Structures~~~
, /
Abutting Property Owned
Map
Lessee
~t:?6'~ /~~;?r'?e ~~~
Acreage
Tax Lot(s)
State
County
Publir.____Easement_____
Power Company
Road Status
Water Supply:
Public____On-site Well____Community System
Sewage:
Public On-site Septic Community System Telephone (:0.
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I (we) have completed all the attached application requirements and certify that all statements are true and accurate to the
best of my (our) knowledge and belief. I (we) am also authorized to submit this application as evidenced by the signature
of the owner below.
3.
Agent
Agent Address
4. Comments /~
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c- 98-239 R&+
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Fire Dist.
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School Dht.
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Uate
Date
Zi p Phone
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r;";dLIC WORKS 'DEPARTMENT, LAND MANAGEMENT DIVISION
COURTHOUSE~PSB 125 E 8TH AVE. EUGENE, OREGON 97401
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.. L.ANE COUNTY DEPT ENV MGT RECEIPT ~'1 ~~2H!6 DATE 05028,'
APPL.ICANT BURK, L.ADONNA ADDR 1863 INL.AND WY., SPRINGFIEL.D, OREGON
TL.11803023304100 SUBDIV " L.OT BL.K
-NEW BI..DG TYPE 'USE I:~ BD'~HS 0 UNITS 000 STOl\IES, '~BLDGS 001' PHONE '199 9999-
OWNER NME BURK, L.ADONNA ADDR 1863 INLAND WY., SPRINGFIELD, OREGON""'
. CODE APPL ND ACTION DESCF<IPTION SQ FT UNIT COST VALUATION FEE DA)k.' .
BP' I~
BP iD
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'.BP . ~
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-".'l. SPEC USE: FLOOD PL . .~o:.
~FIX/BATH: SWR: FT. WTR: FT. RAIN: FT -
MECH MECHANIC(.ll... FEE E
-F,~.UCII:;'<' STATE SLlRCHAI\GF: 4% . ~.'
PL.AN CHECK FEE 25% ~
PAD LC \ 321 86 PADF 10. 00 I-'~
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.CATG': . APP
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.TAKEN BY f~I...H
EST. COMPLETION DATE
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Department of
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Environmental
FLOODPLAIN ~1ArIAGEMmT .
Management/125 East 8th Ave.,
687 -43~7 ./)
By ~
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Eugene, Oregon
Date
To:
S""-S--Bk.
~ Permit Processing Permit No.
[J Planning Partition No.
[J Public Works Subdivision No.
Applicant Name L A.z:;b;<.uv.4 /.B.w.l2A::
Addres s of site / /3 ~.3 .:z:7J L.+-N p w 4 t-(
SFD AG ~ ADD.
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COMM.
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Approximate flood hazard study area, extra precautions may be appropriate to
assure that the building site will be reasonably safe from flooding. .
Detail flood hazard study area. Data Source ~.n-7''>'7U'u,,-~ ?4-AkPc...
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Mobile home tie downs required. ~ -f-.I':)-.s-q/ .o/Z-
Substantial improvement.
Site in regulatory floodway channel, building prohibited unless it is demonstrated
that the cumulative effect of proposed development will nJt increase the base
flood at any point. Contact Floodplain Management for more information.
BASE FLOOD ELEVATION + l' = , (MSL). Certification at or above
this elevation required as checked below.
OTHER
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[J CERTIFICATION OF ELEVATION
, a Registered Professional
in the State of Oregon, do hereby.
certify to Lane County, that the following elevation represents a survey
made by me or under my supervision.
[] The foundation elevation (including basement slab) =
[J The ground elevation that structure will be placed on =
[J The first floor elevation = I (MSL).
[] The elevation of the top of.floodproofing =
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, (MSL),
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I (MSL). UJ
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Other
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Reference Bench Mark No.
Location
Signature SEAL
Date
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Original to be certified and returned to Lane County
Floodplain Management
1st copy with application/inspection
2nd copy to applicant
3rd copy to Floodplain Management
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