HomeMy WebLinkAboutPermit Building 1975-6-25
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..., BUILDING D
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PROPE~RTY .OWNER
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BUILDING PERMIT OR MOBILE\., ,.)ME USE PERMIT
MH D XX PERMIT NO. . ,,11-1
MAILING ADDRESS
91~.FAIRVIEW DRIVE $PRINGfIEUD OREGON
MAILING ADDRESS
324- 75
PHONE
746-0277 '
PHONE
, E;'ERETT SOUTHWORTH
CONTRACTOR
EMERALD TRAILER,SALES
PROPERTY LOCATION - !NClUDE 'POST OFFICE
SPRINGfIELD.'.OREGDN
r'LijfRT GROV,.'SUBOIVISION 2064 .INLAND WAY:
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
Fi LBf:RT, GROVE LOT 27 BLOCK 6
TWP RANGE 'SECTION
113
,
If,:2'~
oS'"
'. - / I
-,- ~...
~.' rAX LOTi NO:' ~ or CODE
..~ .:21ztD. '. ....
EXISTING. STRUCTURES ON
;. ~ENSUS TRACT
APPL
17-185
PROPERTY
I:-':AME
EVERETT SOUTHWORTH
NOllE.
LEGAL ACCESS TO PROPE~TY
HARBOR DR'I VE
PROPERTY SIZE - FT.
, '
,- ~,.;
MAILING
SAME
ADDRESS
FOR .MOBILE HOME. PERMITS ONLY
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PE~MIT ':
WIDTH
DEPTH
'AREA
Connect to Existing Sewage System 0
TYPE CONSTRUCTION' SO: FT. # BDRMS
New System D
VALUATION
Pit RM I T TO P AR~ t~OB I L E HOME:
P,E'R~lI T TO I NSTALL SEWAGE 'DISPOSAL .S.YSTEM: .
"
. ,J
,
FEES
-';,PLUMBING .INSTALLED BY
"OWNER 0 OTHER: NAME
WATER S.UPPLY
,r'O'.
SEWAGE DISPOSAL.
, , '
PUBLIC. D'lEW
BUILDING
WASTE DISPOSAlc
, '
PLUJ'io.BING
P.LAI\l REV",EW
PARK TRAILER
SEPTIC TANK D
OTHERD
'i0.00
.4,00
PUBLIC 0
D OTHER
'I
TOTAL
~o,oo
- .04
84;(14 "
COUNTY. BUILDING
. tY"
','
',0/: .
& SANITATION SPECIFICATIONS
'MI~. SEPTIC TANK CA!'ACITY
WITH DIST. BOX, GAL.
750
DRAJ.N. FIELD REQUIRED .
lIN: FT., . 150
..
3D~ PTH
~.".. ~
OR SQ. h:
:300 .
"/'
,i,
TRENCH, WIDTH. FT.
',WELL 'MUST. BE. 100' FROM SEWAGEDISPOSA~' SYSTEM: ,'.,
I . . .
I .' l.,t
: TYPE OF STRUCTuRE . fZu.i. .' ,. ,OCCUPANCy ~. ZONE, PUBLIC UTll EASEMENT
J . -',~" '. . ~ ."'1:.1,'.' .S~' 5 . .'
" MH :.~" fJ 10,. 't1,'"o-"",-",. ,f<"""-"rl', D. T"-'-- V
. BLDG. SETBA'CKS __ FT. FROM CTR. OF ROAD RIGHT OF WAY' .USE CLASSIFICATION
. '\ I "'I '4.
FRONT ~')' SIDE INT. 5'. . SIDE EXT, , 5" REAR . 5;,
AUTHORIZED SIGNATURE,- DATE' DATE
/S/ J.. E.. Boss BY C HARBAUGH S'IOOK/SANI~i\RIAN' 6/25/75 "DLM
BWG. PERMIT -WHITE.
, OFF1CE COPY,- WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
~U(LDING - GREEN
SANITA.TION - GOLDENROD
FORM ::'C55" 13
C~II 687,4065, to. schedule all required inspections, All construe'.
tion shall comply with Uniform Building Code, D.E.Q,. standards
. IMPORTANT: for. subsurface ~ewage disposal and county regulations covering
, .. H plumbing, . All buildings require a .certificate of occupancy before
being occupied;
(See' Details' on Reverse Side)
/"), I
(POST THIS PERMIT ON MAIN..-BLD,G:/:AT SI'FE) , )(,
, LANE COUNTY, DEPT. OF ENV1RONMENTA~MANAGEMENT .:,; ~ 0' ;)
COURTHOUSE ANNEX, 135 EAST 6th,EU'oENE;",O.'REGON.,i9740l
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"LANE G:OVNTY ENVIRON},
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..'
fAL HANAGEHENT
PLOT PLAN
Name and Address of Owner -EVc'/?-td ~"-~W<heM
9!JP:/~ ,;:-~~. ~kd.- ----- , Telephone: '"7"'6:'-~.;2._-??-~~~~
,
.' I
The. building being. cons tructed under this permi t will be nsed for -~ZI;-';!f }
~ ~ :)?~h7>').
Date this property was purchased ~?I.V 1-1. 1t1'7~
Do' you now, or did you ever own property adjacent to this tax lot? If so, please
list those tax lot numbers or draw tllOse properties on the plot plan below. ~
-=1--..= .
t~
Indicate on' your drawing the location of all homes (including mobile homes) now on
the ~roperty '_ as well as the location/o/f the new ~u.i~ding.
- ~\~ .~~~~~~=~~~~=~~~~~~:~~;;~~ - - ~-
- -- - - -. -- - . -- - - - -- - - - - -'J ~ ~ "'-."" _ .
- .- - - - -. . ~ - - - - - - - -- . '".:'::. "'" -
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- 1
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Appli,cant's Interest: Buyer D Seller 0 Agent: 0
M74-99 '
-..,..,.,-:'
Hap
Tax Lot
Permit /I
O f CI-I
BUI(DIN.G_SHE EVALUATION ,'. J L/ ~ i~ LR_.1Z 'S..tI-Z.~AX LOT 'Z70'~
. ~ . ~ SUBD..ISION:
~l-' ~GILDING PERMIT APPLICATION NO..l11..If ~z..'f-75' LOT: BLOCK:
() SITE INSPECTION ~~ ~=~~ICANT 'SG'l)-t~~-rh.
PLANNING DIVISION Not
1.
2.
3.
4.
5.
Appl icable
Zoning Ordinance CampI iance: Zone.iJA--.nJ!:iJ )
Subdivision Ordinance Compl iance ( )
Required Access ( )
Building Site (Area, Width. Frontage) ()
Other (see comments) ( )
COli'lMENTS: .
No (~{'
() ~!/ 6.
( ) (V),
() (~
( ) (r/)
( ) ( )
CK'D B\l.o-liAJ7,./n h<:::
Setbac~~ ell -~9~:
Front ~ .
Side Exterior ~
Setbacks from interior lines:
Side ~
Rear ~
BUILDING INSPECTION DIVISION
PLANNING DIVISION ACTION PENDING: YESt ) NOt ) APPLICATION/!
7. Plans Submitted
8. So i 1 . Stab iI i ty (foot i ngs)
9. Flood Plain
10. Other (see comments)
Not
Appl icable
. ( )
V)
( )
)
COMMENTS:
WATER POLUTION CONTROL
Not
Applicable
( )
( )
11. Meets Oepartment of Environmental
Quality Standards.
12. Other (see comments)
COMMENTS:
'r)~J
( ) rf"
()() /JJ':/,p1 /.
( ) ( ) CK'O BY~V'~'-?f
p" TE .
No
()
( )
~ "''''JIM
tP/J3,h~
DATE
TO> APPL I CANT:
Your Building I Site Inspection:
~~~ ~Can be approved.
~ ~ 'i) Cannot be approved at this time as indicated on item NO. above.
I::J' -;..0 Questions and further information on items 1 through 6 contact the LANE-
~ COUNTY PLANNING DIVISION. Questions and further information on items 7
through 12 contact the LANE COUNTY BUILDING AND SANITATION OIVISION,
( ) Will be held in this office until you can resolve the problems indicated..
( ) Is being returned,
( ) Your building permit applica..!,i~."_Je~J-'U?ein.q ~~turn.~d....YD.ger_..gp~j:e cover.
DEPARTMENT OF ENVIRONMENTAL MANAu~MENI
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANNING DIVISION. PHONE: 687-4186
L.
C55-28
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Dote
JUNE 2'1 '197'1
Permii' No.' . MH'<24-7'i
,..::, CURB CUT
...,:., .
p. E R M IT
IN THE BOARD OF COUNTY COMMISSIONERS OF. LANE COUNTY
WHEREAS;. the attached application has been 'fully c~nsidered 'by the Board of County Com-
missioners of Lane,Cou.nty, and it isthe opinion and judgment of the Board that the said application
shauld.be. gran'hod, and that a permii" should be issued, now, therefor.e: it is hereby.
. . . .' ~ . . . . .
I
,
."
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ORDERED, that Cl permit, be dnd'is hereby is~uecl to
i="V~R~TT '_~nIIT~\Jm~.T~
9'10} FA 'IRV I EW DR I VE
or constructing the (ollawing facility:
SPRI NG, I EL D OREGON
for placing, bujlding
FILBERT GROVE
LOT 27 BL OCK 6
2094 Inland'Way,
'.
. upon the right-of-way of County Road No.. :" " , Mile Post. , , ,
in strict conformity to. the exhibjts attached hereto/and subject t6 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 regulatio'ns, law or ordinance.
Specia I Provisions:
1.
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 frqm"the
roadway and 'right of way caused by his .0 perdtion, leaving the roadway and area ,in d neat,
acceptable condition. . , '..
.2.
3.
SIDEWALKS WILL BE CONSTRUCTED IN ACCORDANC~~ITH THE ATTAC~ED SIDEWAL~
SPECIFICATIONS 'AND: DRAWING M98-49. T~E STAND~RD 'ClJRB'TpPE SHALL BE
CONSTRUCTED UNLESS .OTHERWISE SPECIFIED.
'.
'-',
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, ,
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This permit is rev.ocable. at ,anytime, and wi II. be ,.strictly adhered'to ~a'nd' no work other than.
that. specifically mentioned aboy~ is' hereby authorized:
:rhis permit shall be void :unless th'e work herein co~templated shall nave been completed be-
forp
,JUNE 2'1. 197'1
"
.~. r19~..
. EXpires'
,19~.
Inspe~ted and Approved
.Approved bABo rd OflI1ount ~issianers
B~. "
th-.
. "Director of Public Works -
"Date
By
wHrre - OFFICE .FILE .
. GREEN - RESIDENT ENGINEER
PINK - PERMITTEE
BLUE....;. RoAD.SUPERVISOR
- ORANGE --;.BUILDING & SANITATION DEPT~'
,YEllOW - REAL ESTATE
c98-79
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LANE CO._,TY
BUILDING 0
BUILDING PERMIT
MH 0 XX
MAILING ADDRESS
,. 95Q~.'AIIlVI[W
MAILING ADDRESS
.
I (',
OR MOBILE'-..,OME USE PERMIT
PERMIT NO.
/'
M-i
J21t"75
PHONE
7lr,G-02n
r
",PROPERTY OWNER
J'
. EVCR[TT SIWTHWOIITH
1 . CONTRACTOR
011.1 V"
SPlllNCFtrLO
OReGCtI
1
"
.'pHONE
EM!:!'!A". T""II.I:R Sun,'"
~ . PROPERTY LOCATION - INClUDE POST OFFICE
:. f'ILlIIlIf kOyt..SlIIIllIVISION ?Q04
. PROPERTY LEGAL DESCRIPTION-METES, BOUNDS
. '.Leur &80v( lOT 27 61.0(1< G
SPllIRlilf'II:LD OAiGOM
.,
Iut.Allll WAY I
6~i
lTWP
RANGE
SECTION
18
3
11
,
TA.~ LOT N~l'.
CODE
CENSUS TRACT
17-185
"'" .
APPL.
NAME
EV(_ClT SOUTHWORTH
EXISTING STRUCTURES ON PROPERTY
No",!
LEGAL' ACCESS TO PROPERTy
HAIU.CUI 011, VI:
PROPERTY SIZE - FT.
"
I' ...&
SAMe '
MAILING
ADDRESS
, FOR MOBILE HOME PERMITS ONLY 1
t. No.. of Bedrooms
WIDTH
DEPTH
AREA
,) I
STRUCTURES TO BE BUILT THIS PERMIT
Connect to Existing Sewage System D
TYPE CONSTRUCTION SQ. FT. :i: i:?DRMS
New System
VALUATION
0'
J,
1 '
',..I
'!l
.\,
j: f'
1
PE.~'T TO P.AK Me.'Ll HOME:
i
Pt._I' TO lNST~L S~W.GE DISPOSAL SY'TI:MI
.
I ..~
j SEWAGE DISP_OSAl
I "PUBLIC '''ololClf.
50.00
11.00
'PUBlIC 0
o OTHER
>
~:I
.~ + .
.Il
~
t~UIWING
WASTE DISPOSAL
y ", .
PLUMBING
( .
PLAN REVfE\IY
PARK TRAilER:
,
FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER,' NAME
WATER SUPPLY
:c.!
SEPTIC TANK 0
OTHERD
7.'MIN: .SEPTlC TANK- CAPACITY
.. ""'''c'" -~: '
. ~WITH'-DISJ:~B'O)(";.'GAL
150
DRAIN FIELD'REQUIRED
1'0
BUILDING,&SANITATlON SPECIFICATIONS
31l1111'"
TRENCH WIDTH FT.
OR SQ. .FT-.
300
. ,I:; ;".- ,I 1( '1'"
\if
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II
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.1'-,'"
30.00
.011
ll-II.04
COUNTY
,,;. <
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I TOTAL
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,
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'WeLL .~T.~ iOo' ,.eM S~^~(.OI"G'AL SYIT~"1
I
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1 r~' U ,SlLl\7,i 'U
lIN. FT
w
,'.
.
\
1.\ "
\\
b~:
'\
1
I . . "~'.I i
i
l.l TYPE OF STRUCTURE
, Mil .
OCCUPANCY
1
ZONE
PUBLIC' ,UTIL. EASEMENT
'.'
JFRONT
; BLDG. ,SETBACKS'u FT. FROM CTR,
lf5'
OF ROAD RIGHT OF WAY
5'
SIDE INT. SIDE' EXT.
AUTHORIZED SIGNATURE - DATE
1088 IY C HAA.~V."
4"
REAR
,"
USE CLASSIFICATION
I I /./ J.t,
,
SHOOK/'ANIT.aIAW
6/2'5/7'
DATE
&lV'
,;;
Call 687. .4065 to schedule all. required ins.pec.tioiis. All constru.' c-I' :
tion shall comply with Uniform Building Code, D.E.Q. standards '.
IMPORTANT: for subsurface sewage disposal and county regulaHons covering t 1-,'
plumbi':lg, All buiIdings require a certificate of occupancYib,efore! :l
~.being o'ccupied. '\ ", ';~j
" . '!" ~t-.. '1(See~bet~'i1s"'ori) :'Revers~ \:Si~e)'''' t.~.. ',;\ .-
~ ' ... \ '.. '..." --"
(POST THIS\pE'riMiT:.'OII!"<tAA1N BLDG, AT SITE)
LANE COUNTY, DEP:rf'Q~,,:_~.N~I~?l~MENTAL ~ANAGEMENT
. ;COURTHOUSE ANNEX; 135,'-EAST 6th, EUGENE, OREGON 97401
jc;t
jBLDG. PERMIT-WHITE
(OFFICE ~OPY- ,,^,_HlTE
ICOUNTY TAX - PINK
. PLUMBING -CANARY
,BUILDING - GREEN
jSANITATION - GOLDENROD
I
.FORM ::= C55 -13
~
,;,.,- ~
SITE INSPECTION
ApPROVED .Cl
DISAPPROVED .Cl DATE
REMARKS
FOUNDATION INSPECTION
ApPROVED / / 01 SAPPROVED L-./ DATE
REMARKS
FRAMING INSPECTION
ApPROVED liD I SAPPROVEO 17 DATE
REMARKS
LATH OR SHEETROCK INSPECTION
ApPROVEO ~I DISAPPROVED ;----? DATE
REMARKS
FINAL INSPECTION
ApPROVED .Cl DISAPPROVED ~ DATE
REMARKS M H -i:1 Y?z~;;r 'l-';..q'''76''
,
CERTIFICATE OF OCCUPANCY
. READY TO iSSUE / / NOT READY TO ISSUE / / DATE
REMARKS
. A
I?JI:J~l/',)f~~ .,L;t- ~
j<o.~;;t
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. ,
INSPECTOR
I NSf;'ECTOR
INSPECTOR
INSPECTOR
/'tl NSPECTOR
Ii
INSPECTOR
A
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: LANE CCJ ITY
BUILDING'tr"
1\
BUILDING PERMIT OR MOBILE..,j)ME
MH n rJ<
MAILING ADDRESS
9'5%F' A IIf111 EI:I
MAILING ADDRESS
USE PERMIT
PERMIT NO.
e.g.,
31:4- 75
PHONE
146-0277
PHONE
.!
PROPERTY- OWNER
tV~RErT SQUTMOIORTH
CONTRACTOR
EMERALD TRAILER SAIi~iJ.'!i"i"'!P:
PROPERTY LOCATION -: INCLUDE POST OFFICE
FIL~pgT GDOVF SUBDIVISION 2Ofi~ INLA~D ~AV:
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
FILBERT GROVE LOT 27 BLOCK 6
DR'IVE'
\.
5 PR I NDf Ili,ll 0
ORaGON
.- ~:" T ii{....-ol<....~.
SPIlIOOiiG:LD Oll~coel
TWP
RANGE
SECTION
TAX LOT NO.'
CODE
CENSUS TRACT
18
1
11
'/
11-185
APPL
J EXISTING STRUCTURES ON PROPERTY
EVERETT SOUTHWORTH' NONE
LEGAL ACCESS TO PROPERTY
NAME
&
MAILING
SAME
HARBOR DAIV!!
PROPERTY SIZE - FT.
ADDRESS
WIDTH
DEPTH
AREA
FOR MOBILE HOME PERMITS ONLY
. No. . of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
Connect to Existing Sewage System D New System n
TYPE CONSTRUCTION SQ. FT. :# BDRMS VALUATION
PERMIT Tll PAUll. MaDILl HW1In'
PERMIT TO INSTALL 5EVAGE DIDPOSAL SVST&~:
SEW AGE DISPOSAL
PUBLIC D~E:W SEPTIC TANK D
BUILDING <l:
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
FEES
PLUMBING INSTALLED BY
OWNER n OTHER, NAME
WATER SUPPLY
OTHERD
'lO.oo
4.00
PUBLIC D
o OTHER
TOTAL
'W.oo
.04
$ 84~04
COUNTY
\
BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIS1. BOX:' GAl.
DRAIN FIELD REQUIRED
150
L1N. FT
. 150
TRENCH WIDTH FT. 3DE PT"
OR SQ. FT.
300
WELL .MUST BE 100' fROM SEI:IAGE DISPOSAL SVSTE~:
[I
,
TYPE OF STRUCTURE
MH
BLDG. SETBACKS __ FT. FROM CTR. OF ROAD RIGHT' OF WAY
FRONT 45' SIDE INT. 5' SIDE EXT. 45'
AUTHORIZED SIGNATURE - DATE
Is/ J.. E. Boss av C HAR'eAUGIt
OCCUPANCY
ZONE
PUBLIC UTIL EASEMENT
USE ClASSIFICATION
5'
REAR'
SHooll/oANliARIAU
6/25115
DATE
OL"fi
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUilDING - GREEN
SANITATION - GOLDENROD
IMPORTANT:
Call 687-4065 to schedule all required inspections. All construc-
tion shall comply with Uniform Building Code, D.E.Q. standards
for subsurface sewage disposal and county regulations covering
ph..imbing. All buildings require a certificate of occupancy before
being occupied.
(See Details on Reverse Side)
.
FORM:::::: C55- 13
(POST THIS PERMIT ON MAIN BLDG, AT SITE)
LANE COUNTY, DEPT. OP ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135. EAST 6th, EUGENE, OREGON 97401
SLAB FLOOR
PLUMB.! NG GROUNCM10RK
ApPROVE-O /7 DISAPPROVED .c; DATE
REMARKS
GAS PI PING GROUNCM10RK
ApPROVED /7 DISAPPROVED /7 DATE
REMARKS
ROUGH PLUMBING.
ApPROVED
~I
/7
DAr/! 1,,/-;7)
DISAPPROVED
REMARKS
ROUGH GAS PIPING
ApPROVED .c; DISAPPROVED .c; DATE
REMARKS
FINAL PLUMBING
~' ......
.,
INSPECTOR
INSPECTOR
,.
INSPEC~rr
INSPECTOR
ApPROVED .jY / DISAPPROVED .c;
DATE9-1"t-7C INSPEC~O~~
REMARKS
FINAL GAS PIPING
ApPROVED .c; DISAPPROVED /7 DATE
REMARKS
CERTIFICATE OF. OCCUPANCY
READY TO ISSUE /7 NOT READY TO ISSUE / I DATt
REMARKS
INSPECTOR
1.NSPECTOR
,~III;
~" .
. . . "PROPOS SEWAGE DI'SPOSAL SYSTEMR'ECORD . ":.' .j;;;', J'
'I~STALLER:' . Campi ~te sop pa.rt oeform to ,s i gnature and submi t .,both .cop I es. witn' ,app neat i o~, ~
... .. .' ~;. ., . .: '. '. .... '. PERM IT NO, MH "l24-7'i
INSTALLER'S NAME .' . :.' . PROPERTY. AUURESS." ......
, .t.f')I7/,... )))O:'.L ..~.~1;;.HA~~~R[)RIVE
/". /L/h::PA),A./ /-"'MJz/" ~/F ~ " . _ _, '"
No. Living-Un'li:s Bedr:oi:>1ns' ii'aths Irasemel]t. .. !later .?upply . ',,,.
.,.'1" .~' i Yes... No Y .~, Other-LfSf<.
Septic Tank:.. .'. . " '.. ~ . . ..,.
Ft: fr;0b~~SteelD . c<?n:c.r,~~e g.NO. cOmpa,7me.nts.! Gal,.~a::a~)~I'./O'
Inside D.imensions.:. Ft.. ' . '.Tile Diiposal Field~
Len..\)th Width "'Diameter: ...,DeDth . :Oistribution 'Box:' (YesF' No
OWNER '..". ., Othe.rDistribution-TyPe
NAME EVERETT ~:rouTHwoihH'
.
"
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. <
','
S PRi NGF IEL o. OREGON
),fng.~ of L ines.~Ft '. t T fench
CI/o (2) 3. ,4. 5. 6. Width
'lot-Plan (see. .instructions):
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. ,. :, .... . . . CERTIFICATE' OF SAT IS. FACTORY. COMPLETlON'<. .' .' .... ..' .' /./ '.
ForSanltarl'an-Use Only:./ ._ . , " . . Date: --;.-
In accordance with,'1973' Oregon. Laws Chapter 835','.Sectio.n 214 this cer.iificate-Ls issued.'. .
as. evi dence of s~tJsfac~ciry complet io~ o( a subsurf}.ce 'sewage d i sposa I' sys'tem ,~tttie: above ','
loca~' . ;.... ,.'
J2S..J Approved: Syst~m.1 ns'ta II at i on 'conforms' to .current 'starida'rds
D Di s~pproved:,.. Does not conform. to curr.ent s.tandards
Remarks: . Co.
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ENV I RONMENTAL QUAldTY' '. . .
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.; STATE ,OF....OREGON DEPARTMENT OF.
CONSTRUCTION c=I' 'MOBILE lioME t:::ZI PLAN REVIEW c=I' , CHANGE OF.:OCCUPANCY 'W
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. Name - -- . ... AddrE;ss . - City' -, Zip . _ Phone. .:' .
~ONTRACTOR '~J1;U)Ai~ \....-~,Jft-'jJ/<-e,,~ )_.J~"p/j;j tJ7d Ylf1'1- -'7v';Noo'K
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~ OWNER
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O,S. REG. II
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PERHIT ..iLL BE ISSUED UNTIL THIS APPLIChL~ON HAS
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PERMIT ,if J11-f ~ if?t:.
APPROVED --
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APPLICATION FOR:
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Subdivision .-j-~ Ai..~ .r:J/~ Lot
ACCESS' iq P.R~PERh (Road- Name) llci'A1...-.... ~
Section
Tax Lo t
Code
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Census Tract.
-2-7
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Property Acreage
Width_))epth
Block
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Existing Stru~tures on .Property:~~~-,~~~
. Property Location - AddreSS/Dire(jjJ:~1n /"....1- _ jl2-t~ ,..PL (I-O~~J:""';~,
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Below for Office Use o;llXXXXXX. XXXXXXXXXXXXXXXXxxxXXXXXXXX:XXXXXXXXXXXXX-Y~iY~~YVYY'-':XXXXX:XXXXXXXXX. xxxx.. xx. xxxxxxxxxxxxxxxx
" .. H rr-' ." Sq: Fe I:" 'f!tr "'\:, Valuation ..
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WATER SUPPLY:
Well Spring
SEWAGE DISPOSAL:
Site, Inspection #
FEES:
Bldg.
Waste Disp.
Plumbing
Plan Review
Mobile Home
1% Surcharge
TOTAL '
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PLUMBING:
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PLUMBINr) , . ,
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Existing ~ewage Disposal System c::::::::J
Public ~
Other Communi ty c=J Name of
Sys~em
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Other
Name
Fixtures.
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Water
.C"onnection .
3<1'0</ . .. .rU~HED .' :ACILI/Rl-1IT;
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~4...()J ~ \ S' n~ture of A~plicant:' /, -7Zi:' ,~
. I. . : f ee R~ceive.d.BY: _ . Date: (-,-'17~ 16
MaximumDepth ~
Min. Septi~ Tank-capacity~~
- Lineal. .Feet
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Drlinfield Requir
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Type.of Construction fl,P/,'
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8ldg Setbacks.-
Front~'
PIf'NNING: .
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C55-12
Group
1
Fire Zone
Use Classific'ation .
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from Center of!Road.Righ~ of Way:
Side Int.' .&;' . Side Exterior' - 4-6;'
Zone
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DATE:
h' ..\~ON:h j!2.1/7t" /!f!~f//~T~ r 'P6~
COUNTY: DEP~ENT OF ENVIRONHENTAL I1A~GEHENT I
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