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HomeMy WebLinkAboutPermit Miscellaneous 1986-5-5 ''-' ~e ~#-/52C'" General Land Use Application ;;;;;00 1Zf'L.-// U-:-/ZZfi-c/fZZO/V - 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 - . . .) 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. - N111le nUll! 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 /~ /Z6:/f U--/ /7/:.r c- 98-239 R&+ e'/ A"" n ~L/~/J/'7 5-s--e~ Fire Dist. ,- ,,~ ". School Dht. ,- """er Uate Date Zi p Phone //A.:?.4-.?/l 7A"/~ h/~'7/ 'PL~"d/-<,,",Q~/A/ @~ P~A?dJ//- r;";dLIC WORKS 'DEPARTMENT, LAND MANAGEMENT DIVISION COURTHOUSE~PSB 125 E 8TH AVE. EUGENE, OREGON 97401 . .. .. .-1 . . ~ 'I ., , . ",. . .I~ iD I:il .r ~ ~ !i: . e:, . ~ ~ . eE Ii! rl .~ .. . e~ ~ - . i" ., . . .~ ~ 5 5' . -~ 3 . I"~':. - .: . - ., .. 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 . BP I:il '.BP . ~ ,'DP i -".'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-'~ ~ . . .CATG': . APP :: SLQU: .TAKEN BY f~I...H EST. COMPLETION DATE TOT AL FT[l'l*' 1 ~) . 00 C,< .~ o . ~ .1 ~ o ~ eoi' < f~A FP SDS SI PCK OTH ISS , . Department of . Environmental FLOODPLAIN ~1ArIAGEMmT . Management/125 East 8th Ave., 687 -43~7 ./) By ~ - 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. P4 /3 2/-Bc.. " _> H'-~ COMM. [J ~ ~ [J [J 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... r 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 [J [J ~**************************************************************************************************~ [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 = o I, :l: '" "0 , (MSL), "- ~ '(r4SL). ~ I (MSL). UJ ~ (\l Other W lAi Reference Bench Mark No. Location Signature SEAL Date -l r- 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 t ~ ~ .. ~.I. '"