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HomeMy WebLinkAboutPermit Building 1980-7-14 .;"f.'....'''..'.....'-.''......-. ,. , . LANE COUNTY BUILDING PERMIT POST THIS PERMIT ON MAIN BUILDING ,AT SITE ~ne COUrty - " , JOB ADDRESS: 2742 . Hc;V'"v~st,j Harry L. Lane, Springfield, Oregon CONSTRUCTION PERMIT # LC 1885-80 ,I TRS, TL.:I 17-03-23, 1202 I SUBDIVISION: N/A CONSTRUCTION APPROVED BY THIS PERMIT: Single-family dwelling:. main floor, 1,608 square feet; upper floor, 1,091 square feet; carport, 476 square feet. CONDITIONS OF APPROVAL: Site location is within a flood hazard detail study area. A minimum top o"f foundation elevation of 447.44 feet MSL is required. See attached certification letter. Partitio,n completed. , Connect to the sewage disposal system to be installed per building permit 403-80. Do not pl ace any part of the structures withi n 10 feet of the .original or replacement area. I Mi nimlim structural setbacks: from center<! i ne of road, front, 45 feet; side interior property lines, 5 feet; rear property line, 5 feet. Gargage on'rear half.of property. PERMITTEE: .Jackson Kephart DATE ISSUED: ~ugust 1, 1980 BY: Hans Ettlin/Candi Hart Directions to Site: Hayden Bridge to North 14th to gravildrive beyond. ,. 2722 Harvest on left. WP 28305-5E-2 * * * * * * * * * * * * * * * * * * ~ * * SETBACKS AND OTHER CONDITIONS' OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVOCATION OF THIS PERMIT, CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OTHER REMEDIES ALLOWED BY LAW. WHEN READY FOR INSPECTION (see attached) call 687-4065. Have the following information ready: Permit number, job address, type of inspection, when it will be ready, your name and phone number, and any special directions to site. ... .. F.N'JIHO~Ji'....1l:NI^L MAN,,\(ifMENl DEPARTMENT' 125 E'SI8iH AVf.NUI EUGtNE, OREGON 97401 ____._ _ __~_ {_ . ' / 4541 DICTATING .INSTRUCTIONS CONSTRUCTION PERMIT # JOB ADDRESS: 2 TRS, TL: 3 SUBDIVISION: 4 CONSTRUCTION APPROVED BY THIS PERMIT: 5 CONDITIONS OF APPROVAL: 6 PERt~ITTEE: 7 DATE ISSUED; 8. BY: 9 WP 28305-5E-2 . ************************************************************************************* This is , 24-08-25, Program.Dll, extension , dictating a buildIng permit lor buildinq permits) on Word Processin~ Form #28305-5E-~, with 4 copies. These are final copies to be single-spaced. I will need them by morning; afternoon. I will come and pick up. Please call when ready. Just leave message. Note: Please type all numbers in numerical, unless otherwise . noted. 1 ; Capital L Capital Cspace / g~ hypen 80 (All caps TMH or MH) 2 :~ :2.7{'---- ~ncJ. L ~/ S~'. 3 . I'} . hyphen .03 liypen.J 3 periJ6. 1/ .2r~ ad comma space /2LJd...... 4 (.If none, just say N/A) If so, give sub name, Lot, Block.~. 5 Go to notes or appl ication. <9A Variable 6 Go to notes or applic~ion. ~ Variable 7 Applicant's Name;sp;-- / 8 (Day after dictation date) S I 9 Plan Checker/Sanitarian/Permit Processing Clerk (You must fay "slash" between names, and not all names are necessary,.see notes). .I+E./ elf r>\Directions to site, colon. . \1Ena of permit. ------- New permit. Start over. Variable Variable Variable Variable Variable Variable ~ariable NOTES: Variable 5: Variable 6~ Text: ~~vu WPC: (Repeat below if.applicable, plus text, if applicable):. Subsurface sewage disposal system installation specifications colon gallon tank semi-colon. feet of drainfield semi-colon maximum depth of trenches semi-colon period. Keep drainfield at least 10' from all foundations and J ,\ r. property 1 i nes comma and 100' from a 11 water sources peri od. Keep septi c tank at least 5' from building foundation comma 10' from all. property lines comma 50' from all water sources comma and 10' from edge of right-of-way period. Paragraph (written comme~ Paragraph Planntng: Minimum structural setbacks coloh from centerline of road comma front comma tj~ semi-colon side interior property lines comma ~~ .semi-colon rear property line comma ~ semi-colon or period (side exterlor ,']omma from centerline of road comma ) period. ~ bYl ~ I'~ ~~. Paragraph (wri tten comments) , Paragraph Directions to site colon End of permi t. NOTES AND SUGGESTIONS: Variable 2: Variable 5: Variable 6: Variable 7: Variable 9: Suggestions: If on a new SFD please look at addressing's copy of new address. If on a septic installation onlyJ there usually is not an address, just a road name. Spell out unusual road names. Spell out SDS (subsurface sew~ge disposal system) don't abbreviate. Sometimes there is not room on' the application for the construction and the septic so the clerks write it down by the fees so be sure to look to see if the permit is for septic also. Always hypen. and put the square footage. of the structure(s). Prepare this before. dictation. Sometimes it instructions (not always the regular format) (not always in order). Always say paragraph Spell unusual names. These names 0ill differ due to who is involved. One permit may be all 3 names and one permit may be just 2 names.. For septic only put the sanitarian slash clerk, building only put plan checker slash clerk. Spell names if unusual (I1cGuckin, Cruic~shank, \,eiderhold, etc.) (a) Speak clearly and say s as in Sam and f as in Frank for those type of letters that sound like other letters. (b) Always say comma or period if there.is one; also parenthesis. (c) If you make an error ple~se see Dictatioh Instructions sheet (d) BE PREPARED. Hava all applicable notes ready. You do not have to write down everything you areigoing to say, on sheet just write "see app". Just be sure you have the papers in order to dictate from. vari es, and the bet\veen such as the septi~ setback requirements. different texts. ~D~_~~;r;~!!ill;~Ig.';\~.~~I~~I!imm~h.IjI~~ ;..' '_ .. / I \ ,--~. --...,,~_.._.__ _ ---.-_____. '. " '" .' . /,,' , -._--~ -----~--- ~ ' t . , , I \\' . I. _ ~-__ -. y_ . / /i . \ / I"~ / ,-'-; -- ':"::-:~-, I !t". .;.. / . I. 7" ' . / ' - ! '"Ix; . /.. I r' ',.:' .,'. "!, I. -~ /... "lIf .'::~- . ~ :.. .,P" I;:'" '".:: '.. :," I! I : / I ,.\ 2\1 1././ 'I.. ,,.:::'.:; ,"";, .'j f ;i 7.~;'. / I . \ /""", ,r, ,. f , I' .. I' I ' ',;': ' "; " . /: .,1 I I I . ',' . .. ; 'I'! /\'I_._c-~ .'I,.i,:' "". '.';.".j.l I!":./' . '>V;:-;r :.-' @ I' ,,;: . , ','-'Lv::. ' ./ . ; ;' :;(',/:/ ... : ;', ! i J, / / (f( ~\ I/. ",." '. //1 ! .'~ '! .4:,) "r" I ",' j / "f I~~.\ ,!' .' ... .'''. r / ,/ 'I' ., , f \., I ' "/ i ' . ii" .'.,' ':, I! /' ...~--.----_ :!, ".; ,". .;", . / t / / /. -----.--.--.r ; L .,.' .. ; 'I",',: Ij ! /'/1, ....I:i;7;~~~::c:.:=-:.2,~.l / _/_ I r . '-"-. .~," 'r '--. -_', ""_ ,I 1 J I C. ....... ."'_.. _. ' -,.j . f/.. " ,'. '- '--..,10.,._. V . '1 /' ,I /, .,.., , f c --[" :'1 ! ' ,. ,-. r ,I I !, " I 'I / / .,1/' f } ;, I / 11"= \\ ,c".'D~ . L;:...'):\. j I ! i "",--. . ~" .-..~\); \ l ,J I ' ...'-', . '.::v.. . (, 'i I j ~~~. ~ /-.". ! \'.~~:::;;:'" '\ \\ ) ' " ".'5~,>/.\'" . '\ ~ \ ,I :;>--- '/ .. I\i ...\'\ 6-;,. ;':'1i ~. ~\~~~,\".",::.':':,:~,:\. \p'~. .;1 6,.:f::.:<..:: ~:'<:-:':;:~"" :,' :"\ \ \ '-jr ~~:~\;:,~t;~:::.;'.:~.:'\~~~~ \,':.,',,:,-<,,::"\"\' ., / (\\.:~'~~'/>>.< . -::(\::,> .\":.:'~:.:: . \ \ \ i " .-\;:'::\~\>::::.\"":.\. . .<:;:. >.~.,. \ i \.. ,.:""""...,.,.\,.. ,,//.,\ \ I \ -~:~':".-~:'.'.;,~...:\';'.': .:". ,:..\/. ':;.... " .~~.:,.....~\...\\ ~ ~ ....:..- ~.'.: '-:......~.. Yi .\ ". ,,( -.,-: . \,....':' ~..., .,,',' \.. i " :.,::.<":..;'. ",,~ " ", \,'.' '-' / '- ,.:.}, ~;;.: c' .-.\.. ':,. , ., ,..'... , .' "';"--1' i " '-" './:~" '" \. ,.... l .. '/ ,r. \ '<,'I', .: " '0\' ',/' -:.../ ~ 1 1 '\' . ," . I J ~Vl' .~. ,. _____.J, .j ,---------_..-\ ...--- - /" ' ---- // ..,'- __-- ___1" / I , , I , . j i , i i / , ; , i ;:'0 .' (.:, .,1, !,~\ :~j I I j r f , i: .~ '. ~., ~ \.-\ j;;: r I. 1"'/5 FLOOD PLAIN MANAGEMENT Department of Environmental Management 125 East 8th Avenue Eugene, Oregon 687-4357 TO: j,/' PERMIT PROCESSING PLANNING PUBLIC WORKS /8/1 '-J- -80 APPLICANT'S NAME PERMIT NUMBER PARTITION NUMBER SUBDIVISION OTHER JAr j.t <:;1'1 V K/: PI-JAP 0 2742. J..IARf< y' L LA-uP SITE ADDRESS ~ PEID1IT VALUE IS SUBSTANTIAL IMPROVEMENT. YES ~NO SITE IN FLOOD HAZARD AREA YES V NO SITE LOCATION IS WITHIN A FLOOD HAZARD APPROXIMATE STUDY AREA, EXTRA PRECAUTIONS MAY BE APPROPRIATE TO ASSURE THAT THE BUILDING SITE WILL BE REASONABLY SAFE FROM FLOODING. MOBILE HOME TIE DOWNS REQUIRED. / j/'"SITE LOCATION IS WITHIN A FLOOD HAZARD DETAIL STUDY 'AREA. ," I 1:' MINIMUM FIRST FLOOR ELEVATION OF 4 4 ;7..1:. 9,(M. s. L. ) REQUIRED. 2. MINH1UM FOUNDATION ELEVATION OF 447,"-){4.' eM.S.L.) REQUIRED. . '. ' . .... . 3 . MOB ILE HOME. TIE DOwNs' REQU.IRED, IF; GROUND ELEVATION THAT MOB ILE HOME WILL-BEPL1\cEI)'ON"IS 'BELOWTlIE REQUIRED MINIMUM FIRST FLOOR ELEVATION. SITE LOCATED WITHIN A DESIGNATED FLOOD WAY CHANNEL, BUILDING PROHIBITED. RECOMMENDATIONS: DATE. .7-/4 -f?d BY /r'~/K . . , C74-189 - ...... ~ ~ h::J "- '-.\ J ,Ill N ..N H ~ r-< o H "- ~ ::J \'l . /'<:,..;~.:.....,.." i-~ .'r ", r. .\}J \ ....f ,; ,. 'f DEPARHiENT OF ENV I RONI1EiHAL t1ANAGE1'1Ern PSG, 125 EAST 8TH AVENUE ~~:"~'1/'" EUGEIIE,.OREGml 97401 , jOb Addr~ss 2/1 (f 7 _ /I {lA.,' " t:. .f~j.. . ~ l~d; ~::;;Jt(~.I./: t> ~ Township, Range, Section, Tax Lot" /"/- 0 3;::",..G( ~ - /21) -;t.;;1..: . /I} . .1-- Subdivision _ ~J __ Lot Block Appi"ication for ~,..,.__ Stu r/, J:-.A~.Aillltl f-!"_~4 '.... ;tructures now on the propery I_~/f_~~~ (,11::..t.:J.) Proposed use of pr;:operty:. CI ReSide1ial, /lL/ c,~;ial . CI Industri~.~.i ...L/;.. ~UbliC_. Affidavit: !, ~.2 en... d/("/?4.('J ~Y' . hereby certlfy that thfs informa,tion is true and accurate. ..-.', (pfease,print")---': ~ If this application is for an agricultural building it will be used for purposes allowed by the. State BUlldlng Code and lane COllnty .Code Chapter 10 (zoning) and for' no other purp'ose. I have the followTng legal Tnte~re5t Tn the property: ~ owner of reooro'; contract purchaj r; lessee; holder of an exclusive option to purchase; dulyautho1iz{d 0 atJ)for the oyter, who is knowledgeable of this,rp~l:~ation,_ c. / . ..It . ~ Signature/Addr{/ :,-t ,1/_ _ _ /tJ4_, ///10 So,/L A C IJ,/Ld",j {114-,/ (ziD)7'1l{1'l y . TeiePh~e )/TqJ;::d..v.~ or -.', JI D#.- . . " When p~rmlt is ready O.tifY: i:'; Appl ifant 1//.$( Own'er lJ! Contractor _. _~ ,- Owner ,!~.It ,it ~ At.. kk /14 A r (ZiD)4~-11 Phone /)(/ L ~(/"":I 'l Contractor Kf(A~jJ ~}.,I..1a /E . (ZiD) . jho"e ) /Contractor's OSR~ 1'J1t.' -, . - - - Plumbing by (~.1 ,0:' c::..-r;:=;-. PI;;;"b J;,IL... . V - "" ---=,-7 .~.7/ /' 00 NOT WRITE BELUW [HIS LINE I ,--'...~ ~,.. "I" ....,rf".. ",.' 'lq, \ AAP:':'];);S--.!20 . Assigned Numbers (. . ,( If Commercial: Residential: ;:;z # of bedrooms --;;;;;:: SI test holes ready~ # of stories # of employees # of units ./' 505: IvExisting, C/ Proposed, BP # 51 # c,/03m r . I ,\. ~ ... Fee Code. De_scription ~ ~...,A , / ../'/fi.."-.J.-./' Rf---y,-.h:-';/ .d'/'A.c/ 71;ZL.a; /'i.,~ -.. ,....- - 1 1 , /7_ /r. _ _ . (.!)::;.c.,v(,rt /L.e't><./f C/ Cash.......... ,c::-?") 7 . ~Ck#/~. 4_ . Received by'//--?'A"4'//I Water 5UPP;;~-"~ /~ r Proposed _____ Existing _____ Year Installed 5q. Ft. or Unit # of Sites Cost...... _VallJation____" / (c () S( E :5'5. ;;;;..~<;. $ ',f7. ~'7 Z? ~V. ~ ~$ , i./ -f /',' 7:::r"'" if J"-:::- $ I ~ '-1',. $ Fee Total Valuation: .$ each $ each $ $ $ $ $ -' hi? .fr::)-- '-- I Parcel siz.3t/4/'9- . ~Siifi" i f .0::1.:::1:" ; lnt,"___..,; rear ~ y .,.. '::;" ?:;-/ $ at $ at $ I;:;'" Plumbing fixtures ~sewer/water conn. Subtotal ...... 4% State surcharge Plans check fee Change of Occupancy TOTAL . /J A PERMIT PROCESSING zone~( I\~n;p'art. #k 2>;--77 Parcel # Mlnlmum sgt;; cks It, fro4l ':I" : It-, slde .J' """""--... /I ., _./ Comments. '/:Z;'../ ~ &-v. / /.a-.uL;;?:2C~.A~t/ ~P'- To be typed on permit By Date WATER POLLUTION CONTROL , :..~~J;;f~stallation specifications: gal. tank; .. ft, of drai fielD; max. depth of trenche.b: ;}~'!:3~{.' '" .. To be typed on permit ~tlA/7i a )(};/I/IJ'.. . ~.t?~~"'r ;1P6(7" .'tr(.ll!liQI/h,ll #1P.tf 3.,0 -y,1::;-I?t1 . C/lll /lW m/b a ~ 0/. '/ ~75//'?#-7 //K~'7- . - r /~ ,/'/,w -/.h (M/p/p,ml 1M ./J~kJl,;yflM?? rYr:?#<8-cJ U () 0' 1/ ., . . rf" I ,;r e I ephone....., , -!l~ A1 ~R2k~ '. /Da te M/-.& /<"" ....98"<L. Oirec;;.;cons to slte / ~j..A' /,,7':- rv~~/ ~(9 . Lf( / /. /V 1. L;(~&a J J/ d~/./A f /lRhl--u /"{/:::X7'"2 ~~~~~ L/L-;if-hL:l /' , <Pl'~;;<to(/, CP&I ~set(7) . -~" bate Hold'S1ip Dtt"e-/ ,wrc _ set(s) Requlred, to PCC Completed , I~'ro /,--17&'''- I!!/ WPC . '. . . I-I Pl'ann i ng -=.... ---- I I Publ~orks [JlElevation' /~/ CI Address C/ Facility Permit /~/ Environmental Health Da te to PCC .. "', nla '''I ,~f ol;;:~ . ' ." ., \ ...".. ;" .._-...-:,,:~:;;, ." - i. : . _' ~'. ,;.. , . INSPECTION RECORD . . -- 1. Site Inspection 2. Foundation Inspection . . 3. Framing Inspection 4. Lath or Sheetrock Inspection . 5. Final Inspection t.', 6. Slab Floor,~lumbing,GrounclwoT.k 7. Gas Pi pi ng Gro~n'dwork . 8. Rough Plumbing ,. 9. Rough Gas Piping 10. Fi~!l.l .P_lumbing ... 11. Final Gas Piping' , Remarks: ]2.. Certi fi cateof Occupancy: '. ' ",.: \, '.,.: ~ . . ' .. ready to issue; ~. Qot ready; . ,. .4 ,.. I' Approved . Di sappr:oved ", ';'. _~", 1_ , . , - r_ \... ~ ~ '...1 date; [)ate '" .. Inspector \ - " .', , \ '.' .. . . , inspector. .' ., .'. r o n )0> -< ~ o z " " ", ^' 3: ~ -< "" '. ^. 1 ...! 3 , ' .2. , .....i. ,. :" . '... . , . !l >,'" ,~. .~. ;. t. . \,. 1 ):0' , .~ u ) : / ,;"" , "1' ',- '~ ", :r.'~'~' t " ~~ ;. . .- ~".",. ~"~"'----" .... ..... -:. ..! J!. 12 14 " ,18. ,U r~ ,. ~ " ',. ~. "I'" "'1 't, , .~. ' -,- ,. . "',' '(, -.~ ~:.'. . , . :1'0 - : ~'~ ..' '. .' .:.. '. " -~ ., .: , ' "." ., .., ,"':' " :u 1jJ " , " :", .~ ;>- 22 { ~..; .... .' . - ,-:;, ,'. ,. , " " .~. . , ' ~ \ \ j . \ ",' 't '..... 1~ _.'.: .' . r' " -' ~.., ]. " '. \; 'U J ,. " "I '. ,. -J '.l _ .; ,.. .. , '. " if;j '.l ",. >,J I'. ..~C.II".ITV . _ " ..I'il. .': .L;: .)1'( . -I :~F)01:ICANT KE:PHAR:r, ~JACKSONC'~' TL~:: 1"'r()3::.~~~~00(!1202 SUBDI,V., . ~. '. NEW ~LbG TY~~ SFD BSE.R 'Nd~DRMS'03 ,CC)DE: (.11';1"''-. N.o M>TION DESCF:II':',:i.HJN . Bi" . f"IAIN FL,DOF! ElF' UFFEY:'.. BF tARFoRr , - . . DEi"T ENV~MGT RECEIPT ':.I.)D"". ',;Cl(.) q.ji'I.I"..! "/, ".' j Ll .. f\ l;~ I ,. "''''_ I, . t.'1 .} ~: iEJ8Sd6 .DATE 071180 :,PI:<Il.1GF:lELD. '. ,. . 'Lor BLK NO UNITS 001 NO ~TORIES 2.NOBLDGS 00~ SQ (if UNIT COST \/r-,L.UF:'"fION i'T:E: DA .~~--~.(~'()B' '. . 3~:>".2~:~:. ~56():3? - .<(69-1 . ". - 2{:" 32.J ..2(rl '1 ~:;' "_.A7(.1 .4...7:>', " 2,::,:~'(::'1" '~ L;! 1 ~.' .:. BP Bp.... Bf" BI"'. 'L.C F':' 1...' 'ND" MECI.r Sl!I~ r-:'Cl< ,':'-' .~....- ." ~:'> ....... ,. , 1 e8~:;B(; d n,l I'; ,., (J >CTUI:;:ES, ":~(2' '';'. ND.: C(JNNl::CTOF~S: '1.:'" - , . ,'iECHr;N I cr~L. F~EE, " STATE SURDiARGE ... ,.' ; r't:JiN: CHEc':J{ FEE:: ~) ,..(.)(-)" a7t.;,~:;::~ ., E,clCH ,co, . ::~63" 0() .70.00 ':- " . 4''- ./, :~~ 0 ~~.; '.. ~ j ~~" 32 i 62') ,', ~:;() " C:tlTC: t~pp SI:::(;;U,:. i.. r AK,.EN B~i .cH '. '. 'l;:f~1 . ., , , l . i~ " '1.0 V12 -~ U 5 11 0 . ': - ..~ I ';: l\;. .. Cl<7 -,~ 6, : l11: ~ . " ," . . , , . -' J-' ~.. ..j.... ".'-- 1"1" SDS . .5'rI .F'.C~I< [}TH .:ISS.' ,../ 'w.' , ~ ,:' 2 -. 2 _ . . :~(, EST~~CGMPLETION DATE' .1' '. TOTt\L. FEE;Hf . ~:>f2..H2 , . t ,I ., ( ~ , .'"": -3. o . o . . o . " , " - , ~; . , ," . ~ . " : ~ , .. '......- " ..'-...:.:......... 1: Iv .~. . ( . /J. c.. 7--. lA.' 'OEPARTI'iENT OF ENVIRONI1ENTAL t1ANAGEMENI r L -, .PSB, 125 EAST 8TH.AVENUE , ", . ': . . \. . ~~..' . / ,/:.,EUGENE' O,RE~ON 97:01 ~~'" . . vf' . / Job Address 2.1J'<J.' ~ ai.. ~ ()~,' ;':9JfMI /'>.Y; /p d . ......'w....w.........w....... 71 (') ~5 /.::1..0 . II J 111111111~1'~llr4[ltl.~~;gft!!i.i~&!!i*E "...-:.. . . .; ~ . ~\ilitJ ., " ,:alJl~~; , . " APplica,ti~n for J!--:,..r- ,S/M15h~! I( ,rb~ql'-,~'~- ... . :~;~,=:~C'.~~ ,",f;"~~~," "'~; '~' ,,,"',, If~ this application is for an. agricultural building it will.be,use.d for purposes allowed by- the State .Building Code and, Lane eriG.nty Code Chapter 10 (zoning) and for no other purpose. I.have the following legal interest ;n the property: ~-~owner of r r. "; contract purcha f; lessee. ' I,older of an exclusive option to. purchase. . . duly aut f'; do a for the..oj/oller, . i jledgeable'. ! thiSltpP,.;cat.o'r-....c. .'~, [" .11....' . Q'. Signatu~e/Addr ."F /"j ..,' I, I.Mo (ZiD)71.Y1/f. Teleph~ne otify: '/j( APP.~.i .~nt_.. 'l! Contractor . ~ . U _ ~.' '(:iO)t::f.t;lf-11 PhO~C(),!t-q.~?r /c.... . " .' ", .(Z1D) -,' lhp.e . : Plumbing bYV A."~; c:.. -/1;";-: ./CI(l'tf~i/JU, lHl.S uNt I f':\i"f'liriitj{; ."..-- '. h" 90..-'l '. . snS:" "/~isti~g. BP # YU':::> /':SL./ , C/ Proposed, SI. #. ': '. i~\n;ij~':if,~'ifi ., :'Wi'lJ . '#:~t,j~:~ )?"1JJ! =:i":v3Kn ~jX'q,7p~.~~ 'Wr;pr- Cf. 7~, '~i!:~ " .Contractor . . ./,~ont~a~torls '. . ... ;::;:2... -. . DU.NUT WRITE ~,LUW :~:s~:::~:;~l':(~ji[(~ill.'i~,-s', .# of emplo>:ees 51 test ho'es.re~dy jIf~,Ij '-- ".,...'....~':<,..,'<~:<,.,......... COlle. ~ . ~cidiJtion '. ~7!:i .~ '1 Ja.u1; . . ' ~- I . j; '/ Fee.' $ $ $ $, o llr.:.~.,;;i!!j:!l. I y.?i;"7. . -- 4ll@ii1iIl/ O:L/ ~.. ~f;i~~d:;;?~.#" A"~ -:--a.. '. . ' water'SUP~lY~~r ~roposed . , Existing ~ Year Ins'falled';- , "'-' -.~ . Tota'l Va.luation: 'J %JllIllll~iii~l~i:~ $ $ $- each 'each... $~ I " $ $ . . $ $ $ $ . ,hP~ Subtota 1 4% St~te surcharge _Plan~ chec~. f~e " _." Change of Occupancy .. ... .~ '. ~.. .... TOTAL . /7 A " 'PERMIT PROCE;SING, ~O~~;L II part,,#~g--7/ ~~r,c~l#' -,~ Mlnlmums~ks:..'.,.lj~:.~~~;-r~ . .'.. c~mments~&,.r ./.!~.://f.;.. '. -. r ~ To be .typed" on permit . " - I. __. P~rce'l Siz~~.('9- . , .~ l -:'f.cJ--". . ; lnt. ' ___;r~ar ~ y- . ..::>' ~/ -. .. ~or ,plans iriformati ~sj; . 'pi~;s By. , , . I CP&I 'Ty~e . Gro~~,p , F'r~ Zone . Use ClJ~ific~lon ..' .,To be typed,on permlt~_ ~~ /..,,;. .L.'.L~'/:O'_:/ ~ h~../ ~ ~i5: 4AUl 4 ~,UYb~ '~~---:Z-;rQ.Q7('" . :t,7, ~4..ff( ~.5'~).-:~.!J~!~ - '0~JU_d~~ .~......... ... -. -. .BY~V'(~'liate.7/U/ea sp..ctor)~~~~~ /v17 :2{~-"t/' t9" r( ~?.:2.~ . .. '~ ~h./l / J to#CP&I-----:-.:~et(s) Date, Hold~lip rle. .Oateto , WPC, ~ set(s) R<;quired to pce Com~lz:ed PCC . . '7/z-9 .'.. , Date " ../~, D ya-r. .6wpc o -0 'l'. . :" " I.. C/ n/ a C/ Address (:1 Fac) 1 i ty Perm; t /~/ En~ironmental Health - . '. C74-171 , . , , " , . , , . .. 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