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HomeMy WebLinkAboutPermit Building 1975-6-25 ."'~ . '::.r:t'~ If; ~i: tjcY -it( ," ... "..co ..~..-. '.' ..' F' .- \'-'~''''L-'''' I 'i ~~, ."',. ',LANE CO'jTY ..., BUILDING D - .... ',," .,'" , mN 3d"i-,7~:/ PROPE~RTY .OWNER ...-., 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 - '. ".:~. <;:f{~'~I~~~i,;\I'.' , , " ~'. i "LANE G:OVNTY ENVIRON}, M ,~," ..' 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 ~ ~ "'-."" _ . - .- - - - -. . ~ - - - - - - - -- . '".:'::. "'" - ~ _ __n__n --__'~(--~,~ ___ - 1 ~ ~- =- - -~~ - ~ ~ ~~ =~=~,~~~~~~= ~~ -:\ \_ IS~':~~___~~ :Ss:'~-s~~~\ - '. '.~1~i '~~~:.:.: ~__~~t~~~~=:=f;:~-- -=-1=-"~ " _ u _ --.::::::::::-....:;::. _ _ H ):: - ~........ - nn_~tr _____~-=c::-~;tl. c, -, \;e ~;;;~,;,:::... , . ..Il ' _ _-"__ _ ~ _ C''''_'''~'''_\' _;_.::::::::=::____ __ _ _ _ _~n'_ '_~.._ _. __._ _, .__~~_ ~~~~~~...::~;~~,,;"';I '-1-. - ._ _ n. ~,____ , ~ : .~s :,: .- - ~- .' t~l: '__,_ on '\. - __~::::n' -t ,~ ' -(" . \ "- '~ - .~ --- I"~ ~r--- --- , I . I ;t~~--=---=--I-~~:~~ ..:>' ::> '~S' , <:-' ~- ----"I' ------ -----:-:-- ,1')<-:~':''-'.::<,:..:,..1 " I ) -f '"' - 0- - - - Ef::I~:;;~;,::,-~~ ~;,~:;;::';:;,;:;;,;;,:)~t~ - ... c 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 ~ i( ~I : ,,, ....... . 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 , ." -I,," 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. '. '-', .'" ;i .-{ ~ '. '- , , , .. 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 i .. J" , i t" I 1" . .". .. --:.?: _I- -'. r-'\ 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 '" ,"<'$' .::~'; J \ . '.; ---.~ ! .:;~ ',. .,. .,';"~' '::i2,} \ H' , " "!';;~~;1 :n 'fl II .1 Y tl II ,., . .,,-; .1'-,'" 30.00 .011 ll-II.04 COUNTY ,,;. < i I TOTAL '.. ,'" >. , I I 'WeLL .~T.~ iOo' ,.eM S~^~(.OI"G'AL SYIT~"1 I ,~ I ' '. . /1 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 .~ ~. . , INSPECTOR I NSf;'ECTOR INSPECTOR INSPECTOR /'tl NSPECTOR Ii INSPECTOR A ..- .,..k.' , ";'1:. "~,, : " , I f- -"" .. ~'J-- J / ",',,-'. " ~ <" .:,. .1>-....;;,..: , ~ : 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' . " -. ' ~ . . < ',' 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): .- . .Feet. fr:om' . .' 'wElI "-. ,. Lot Li ne'. '.' '. 'Front I ~Jt~;;;'};?j" I ~~~~:e:i~er .' MAILING ADDRESS' . 9'j~ FAIRVIEW DRIVE.~' ; .: ," J'-, .- Y,.' ~:. .r ,FC);;;ndatio~:/D"~ ',' , Side". R'ear IFi} 1 %/. 'IFiller. Deptl).: . ,1Fi 111i'Ji' Below. < TVDe/(2 Above'Tile'=>inJTil~ .in. .e" .. "." - .. " '1' , ,".':"'t t. ,. '{. -1_" .' , ""lV, ..- .. .' . .. ';' ..~.... 7~' '. .' '.' <,. ~ ! .'~, , . f . p~- "., ..~,,,, .:. ":.~' , '}," ~ A\ ..". .. " .~. ,rf'.~':'" , . ", .~ "B:n:rt~.:~' . J:' -,' ~ '; ?l~j ':;~..,./ .0 /.", ~~~-j.. ',',. ...: ~el('\~' ~ ' l ., ,,~.. I r '\ . .:; '~~~V\}~ ~ '~":-i~~"!.;'~ \.\ ' >, I' :\;.. 'Il ';" "'" ._ ._ , .. '. .j IN.... ~..~\':i.i:). '.. } f/lc~ . '. J}\3\1..:, :: . , . . ..E'. , .'~ . "'7i'J I .. .,~. ) ... ... . .'. - '" ..r. .- ....':.. .~. " .>.~~.~~)t .' ~~ - I . . Date __ . _ ~'_, 5 i Qn ure. . _"'" . ,. :, .... . . . 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. . " '," J ~ . ,.'-. "... .' .' -.. - ;, . .. ~ ; ._'.' I . ". ....-;:-!'.t'..": ,"-' ",,-', ,. .' .,~~: : SllN 1'flr I an.-).S Ign. atur.e LANNOUNTY. . 0." ENV I RONMENTAL QUAldTY' '. . . - r ~ . . ""oi" '.-~i' ~_. , .~' . '\ .. f;. ._,:' ',I ., .... -' .- .....j/' " C55"11 .; STATE ,OF....OREGON DEPARTMENT OF. CONSTRUCTION c=I' 'MOBILE lioME t:::ZI PLAN REVIEW c=I' , CHANGE OF.:OCCUPANCY 'W ~$?di .-frn-1d1~, 7"'~('f);..1?~v ~JV'J~ fl'if/7.7- "7Y?027] . Name - -- . ... AddrE;ss . - City' -, Zip . _ Phone. .:' . ~ONTRACTOR '~J1;U)Ai~ \....-~,Jft-'jJ/<-e,,~ )_.J~"p/j;j tJ7d Ylf1'1- -'7v';Noo'K ~ Name \ '~ddre~s : <Ci~ ..... Zip ?Phone ~ ....---. ../, ~ OWNER c::::=l O,S. REG. II . Twp, ji'. .~w~ '~~', PERHIT ..iLL BE ISSUED UNTIL THIS APPLIChL~ON HAS -f~ NbT!l: NO BEE!, PERMIT ,if J11-f ~ if?t:. APPROVED -- ,.~ APPLICATION FOR: , Range ~ 1""7- /~ // ,.j . ,/ jl WI . ' Subdivision .-j-~ Ai..~ .r:J/~ Lot ACCESS' iq P.R~PERh (Road- Name) llci'A1...-.... ~ Section Tax Lo t Code .. Census Tract. -2-7 ,7'\ . I J'LL.tA.....L.. t. Property Acreage Width_))epth Block .' Existing Stru~tures on .Property:~~~-,~~~ . Property Location - AddreSS/Dire(jjJ:~1n /"....1- _ jl2-t~ ,..PL (I-O~~J:""';~, I' . ' ~O, ~ 11~-!c;~~ ~~~C, Below for Office Use o;llXXXXXX. XXXXXXXXXXXXXXXXxxxXXXXXXXX:XXXXXXXXXXXXX-Y~iY~~YVYY'-':XXXXX:XXXXXXXXX. xxxx.. xx. xxxxxxxxxxxxxxxx " .. H rr-' ." Sq: Fe I:" 'f!tr "'\:, Valuation .. '-- WATER SUPPLY: Well Spring SEWAGE DISPOSAL: Site, Inspection # FEES: Bldg. Waste Disp. Plumbing Plan Review Mobile Home 1% Surcharge TOTAL ' LdJJ i' , / . / f)n. ---'" : tJ" - PLUMBING: h,"H~ Ifr PLUMBINr) , . , . / /I of , /- ~ -- Existing ~ewage Disposal System c::::::::J Public ~ Other Communi ty c=J Name of Sys~em c:::=J q Other Name Fixtures. .~ Water .C"onnection . 3<1'0</ . .. .rU~HED .' :ACILI/Rl-1IT; . /. .c=JCAS~ ' oh ~ c::::::::J~'YES c::::::::J NO ~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 J (;(j , Drlinfield Requir / / / ./ -. \ <., Type.of Construction fl,P/,' ~' 8ldg Setbacks.- Front~' PIf'NNING: . --J,.lfAh Il'!~ C55-12 Group 1 Fire Zone Use Classific'ation . .j> " from Center of!Road.Righ~ of Way: Side Int.' .&;' . Side Exterior' - 4-6;' Zone QA- M \-\ s' " ~ear DATE: h' ..\~ON:h j!2.1/7t" /!f!~f//~T~ r 'P6~ COUNTY: DEP~ENT OF ENVIRONHENTAL I1A~GEHENT I ,LANE