HomeMy WebLinkAboutPermit Septic Tank 1979-4-5
SUbdiVision:~-~'l
Lot ."3- Block ,;)..
. " . '. fl S.1. #1(7- 79-::<.t/L.j
Job Location~(r7'2..~~~; l-o~ 1 k.;../TlO14<J..fllV ~~,. .
yon ~- ~- (r~,- .
Written Directions. ,.}-.It.Q~ ~ . -' .))Jo: 1; -TWvv-..., ~? -v-JD.~
o'bddd .J1.al~) ~.i.w'i!LVvYu J~.:t-I- '1:ll.Q--./YIO~ 1~1Cu,.A, JlcUJ-
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TRS:TI /,(~lJ 3 -;) "i-/J
SITE FEASIBILlTYREPo.RT Fo.R SUBSURFACE AND ALTERNATIVE SEWAGE DISPo.SAL
APPLICANT'S NAME AND ADDRESS ./l@~ U 1. {;)41~.PA~,_,.il~ 7.~ Ji,tn AVYQ 1 AJ CCf.' ~ (}z
o.WNER'S NAME AND ADDRESS 4/)./J'l/p -. .
Phone
/)41-:JfR/
Mail report to ( ) Applicant () o.wner (.) Prefer to pick up. Call
STRUCTURES No.W o.N T~E PR~PERTY (1LJ/'h7fl..P/I.' ~, ._
r 'Po.SED USE o.F. PRo.PERT'y /J /' ..t)dL.--r1~~ ;. ,..' , ..' . 'c
WATER SUPPL Y ~ ~ lJ:,,;. .:,(.. '''~~''':'' >~., -- ":.; .' WI~HI~:~~E'MILE bF"ni~'~~;~. ~'~:' "
Phone
(owner, e~c.) when ready.
(NO.)
I hereby certify that the above statements are true and accurate, and. that I have the .following legal interest in the property: . owner .of record;
contract purchaser; , .. potential. buyer; '. . realtor or agent. !"further-certify that (if not the .owner) I am authorizeil to. act for the owner of
record, and. that said owner jJaware,and approves of.this action. ~.. .. '.,. ..: ' .
TESTHo.LESREADY .j'J.-fl;4/~',., ' . Signature"*.JaJIZOhLA.J2..liUM/,Y'J! Datp 4"///71
.., , , , , , , , , , , , , , , r, ,', " , , '.', OF "CE US ON L Y mow T"" U NE ' , , , , , , , , , . , H , , , , , , , , , , , , ,
SITE: ~MEETS STATE STANDAHDS .GDOE~ NO,T.;MEET. STATE STANDARDS. ...".,1''''. rr.:'...., _. "qANs...U$LCQ.~ PLlANCE
. ~ ~'~ 'ft-.;.. k( ~.~:;:rtcu 'k<i~~ Zonm1 ,k"A.. I71ti .
~; o?~.u,:...." ,...... "'A'(r "'~'\.<'.,iJ'~: !Acieage'orLotSizeI?~'(/4.:2X'"q5X3{"(TOTAL)
,. <4-~,.A--o-1 ~A =tJ~ ~ ,>:>-,v,0;_ J.~ . ..... ..~, .. . /. (.) Completed
,0 . __ O.~ :...J. . , !artltl~nlOg# .~~ ~ , (.) Pending .
~~ -.. ... ~~~~ parcel#'~~...
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~ ~~-oF'f)~ (),.~", IT ~:::O:-r ~ ~1-. .
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THis IS A PRElIMIr-J'ARY BtPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE BUILDING PERMIT. ANY PLANS OR EXPENDI.
TURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK, IF SITE IS APPROVED, SEE REVERSE SIDE.
,. .
~~-i-- 4~1J-7(
.- AUTHORIZED SIGNA~E . " DATE. .
. Division of Water Pollution Control
_.--".r_"':\l.INJ"-Y_DE~ARTMENT OF ENVIRONMENTAL MANI;\GEMENT
.~eU.~' 4~5-79
AU!HORIZED ~~'fi-URE DATE
Permit Processing Section
125 EAST 8TH AVENUE,EUGENE, OREGON 97401 687-4061
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OAR 'Chapter 340, Division 7, Section 72.020(6), This report shall re'main'in effect until issuance'of a
permit to construct, unless in the meantime conditions on this or adjac'ent, properties have been altered in
any maririerwhich would prohibit issuance of a .permit, in which "case this. evaluation '~ep~rtshall be ~on. ,
. sidered null and, voi,d,.iechnical rul!, changes.'^!ill.not invalidate. any evaluation report issued pursuant .~n '
. this section.. . .
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,_Before"construction-isstarted.bring this fOrm to, the Department of Envir.onmental Management and apply. 'u' -
for a building permit, Exact specifications'for the sewage disposal system will appear on the permit.. . , ',.
-, .." '.
If 'the propertY'isonly.a
permit will be issued,
portion .of'a,tax'lot; a partitioning or subdivision musi.be approved before the
. . ..... ..' . ../ .: . -':..:'~~'. - -.
. ..
. "Only persons having a valid license issued by the' DepartmentofEnviron.mental'0,jalityunder~ORS 454:695 '
. '" ~ , ... ' ~.: . ' . ". . .
to Install sUDsurface sewage' disposal systems or an owner or contract purchaser 9r .hls regular.employees
,may inst~II,subsurface sewage disposal systems. A certificate of satisfactory completion will not be issued
if peiso~s. other than the above perform'the.installation. .'.. " ..'. . . '
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SITE EVALUATION WORKSHEET
LOCATION:
tV
RANGE !'\"3
SECTION' ::L . TAX LOT #
'~.J
TWP,
ZONING: PROPOSED USE: ~~,D
SIZE OF PROPERTY: AMOUNT USABLE AREA: ~~
WATER SUPPLY: COMMUNITY ~. PUBLIC 0 INDIVIDUAL 0
SUBDIVISION/PARTITION
PARCEL
LOT
BLOCK
IF SITE MEETS STANDARDS FILL OUT:
Type of structure and approximate s~wage flow: Single Family _~
Multi-family gpd Industrial
Connnercial gpd Institutional
MINIMUM DESIGN REQUIREMENTS:
Length of disposal trench
Distribution Method:
Curtain drain required:
Othe.r:
required I (if) ~d:--
Equal ~ ~e:ial D
Yes 0 No ~
SPECIAL. SITE CONSIDERATIONS OR VARIANCE OPTIONS OR OTHER ALTERNATIVES:
NAME:
A.~_
{I
t/--t/-7 'j'
DATE OF EVALUATION:
C74-l26
~k.L
gpd
gpd
gpd
/150 gal,
SLOPE .~\ :d--- % 60 . {\ / SLOPE ~ %
ir^ 'r 1/
SITE DOES ~ DOES NOT c=J MEET MINIMUM STANDARDS,
ADMINISTRATIVE RULES REQUIRE ~ MINIMUM DEPTH OF:
36 inches to an impermeable la1er
30 inches to a restrictive layJr
\
60 inches to a permanent water table
24 inches to a temporarily perc~ed water table
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I: 1 f+-: i : I tl ~' \.1': It,-I ~, : I ijlt'__f'J' -j.J-H+I+Li I !f:+i+"i+
- ::t! - -0-- += -1- -1'- , : t::r L, l..L - -1-1- , - - - ~-I-+-i-' - I - -f' -Hn' , +-
, ~ -H-- - - -,~ =-- ~l--l-l 1 -t! t I -H+- 1- I; 'it--i--f-j --H-+---
. = J:=I== -:=J:: -=fi:4HI_'~=I- 1_, ttL -t' _~' 1 ~,,~ '~_:Ij--+ =1+r-I'i-:+: i: 1--+1'::lt
__"I I ,- - +- - , 11 ' I - - I 'I I I /'+IT -1- ~ j I
1'1 :: 1 ut- -T' I' I ,i\+l-:: 'r,--+t!---t '+-1 -'I++I-t I -,
: lil"J'! "-I-,-+-I--iH::IU4::1_lllcH! ::,++-;1; 1,1 I'; '::-I-j
1'11- '_ I II ~L+ ,_ 4-W' Lt.!' I ~~J:tL" I '1+--1/11' I"
Road ::d 1_+_11 THi:t:: ,~~' ,I_t:, II qQJI::h+,-' ,I I-::H-H-I+~
- - - - m - -, ",4-f;Cffti: 'f' ::t\i- I ! 'I ! II 1+ -~" I I', Cf-t++ll- j
Test H~le ~ ' ,L='(-~_U-1+I.:tt '- -FJ't +::tl' i :1-: i 1-- lIt : : L(I ,I
- -m+-1+ti, 1'--1-: ++-I---=J= 1111111' I '11,1-,,11 I'
-,-11 1"I'f' -H+tL..L I ,L \ --11-++-,\, I+-Ti-i I II': III i 1'1'1':':
~ 7. Slope -'~+'--'II ::1~1'-'-J=:t::-- - _'__,', ::::', I L JJ'_--t,_,_~J' I 1', I IT-
:: ::+tH-tt1-t:: f $!J - -,-+- - ,- - - =l= :wt -H-t:t::i::::: = ::1- '. _'_ ! +;- - I !tl I
Cu t Bank I I , U.LI I -1+t It" - -1- $ -rl+ - - - - - - t 1. - - - I I
;;#;" ==::TI-H+-q::-l+:-~'~---~ ~:::-,-,-, :-:..=ffr~-::::::I~:'i-::::=FI-I II! l-ftul
:e:: )C-)f :::: - ::illil :::l:: ~ t ~ ~ T.I ~i- t~-'j~ ~ =j= n+ - ~ -f:- =':::: ,~- =p~:[, l' ,11 =
'- --~=Rt::=l::=::::~:'L_'- __, I i 1>::-11+ -:::: - ~=rl-+-: - ,_1__
*i--I-:II' :\1-++-i ~t~tl-+i\~:f=U : LU;-- -Lj-Tt I \11 il i-~-iT'-li-:l;,=-l
-: , , H+, ' " . ,-H-+f,\-t,: :. :-+ +: ,': II ! :- ,,-1-1, ,II "Tj
.# 1 T EST
-.
PERCHED WATER
Predicted
Observed
Date
in.
in.
SATURATED ZONE
Predicted
Observed
Date
in.
in.
Restrictive Layer An.
Impervious Layer ~ in,
Mottling~ \ill~'~n,
o
o
o
o
OTHER REASONS FOR DENIAL
PLOT PLAN:
Stream
Drainage or
pond
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J;'ROFILE
In'ch
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24- i;..r
31
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#2 TE .-
PREDICTED WATER
H 0 L E
PROFILE
Predicted
Observed
Date
in.
in.
Inch
12- ~r,
SATURATED ZONE
/
24-~
Predicted
Observed
Date
in
in
!
36 -
/
Restrictive Layer ~
Impervious Layer~- in
Mo tt ling ,.:.-y..r in
48 -
60"'~/
ON YOUR PROPERTY THE DEPTH
~:.
inches
inches
inches
inches
J
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.----.
,-----,I
DEPARTrlENT OF ENVIRONi1EiHAL I1ANAG~I'1FIJ.T
PSG, 125 EAST 8TH AVEfIUE
EUGEitE, OREGon 97401
Job Address .!J.11-? ~ T~ 1_ ~ j h)",,!
Township, Range, Section, Tax Lot I c;.._ .1)"7 d.., -'-- n
Subdivision ",,;._.....,.. IC.#t..... "'1..~7::f;'-J) . '.~ Lot ~'"l Block t:l
Application lor _(...n 7="~ it..:- ,.,=--- -./1./ ~...iLn~-:"~ "....../..;,h~
Structures now on the pr4,erty ~ / A.. d:iA__ ;-
_ ,........ -'r - .. .
Proposed use of property: /~/_Res'idential L/ Commercial
Affidavit: I, ,AlILJuo;,.,,: { t.)4cr2.""""_
, (please print)" . -....
If this application 1S for an agricultural building it will be used for purposes allowed by the State Building Code and
Lane County Code Chapter 10 (zoning) and for no other purpose. I have the fal lowing legal interest in the property:
owner of record; ~~contract purchaser; lessee; holder of an exclusive option to purchase;
duly authorized to act for the owner, who is knowledgeable of this application.
Signature/Address.~;c_,~'_, ft1f:...0A_:_. t'~?3_.J;,/....,../ ~u
Telephone /]I/"} 7.YP1 or DaJ6"
When pennit is ready notify: tLl-Appl icant /~/ Owner C/ Contractor Qy: /i1-mail
Owner (',.._ ___ ~L_-_ (zip)
,. -:4' ' '" (zio)
CitY_(iP"/I~
t-.1J~/cI
''.I
Appl ication if
t..C --79_.:2 C/ /Z
Assigned Numbers
() Industrial
LI Publ ic
. hereby certify that this information is true and accurate.
(a""~~({iD) ?P~7?
J't a~'h4' . ' ,
It/ (r,o~"
Phone
Con trac tor
Phone
Contractor's. OSR#
Plumbing by
DO NOT WRITE BELUW THIS LINE
If Commercial: # of stories
Residential: # of bedrooms
# of employees
# of un i ts
SDS: CI
CI
Existing, BP #
Proposed, 51 #
Unit
Cost
Va 1 ua ti on
Fee
Fee
Code
SI test holes ready r-?.I" _ ~j
,--- p
Description
Sq, Ft, or
# of Sites
/.
7~0??
$
$?'5/dr)
$
$
/7 ^
~.z; ; ~1"':!.:U A?h/r .;C./.-A--7 ___
-/ ,/--.0'./,0'7-' i' 0??A4/tp'J '~~
7 ~" .... - - --- , ... - ".. -
[/
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TOTAL
$
each $
each $
$
$
$
$
$,~,~
Size 1J?t. X' J tJ,2. \('9.<:-.(35
,
C/ Cash
I~"i..eneck #
Received bv
~X7'~
~J~
A.o{h J '."
Total Valuation: $
Plumbing fixtures at S
Sewer/water conn. at S
Subtota 1
Water Supply
Proposed
Year Installed
Existing
4% State surcharge
Plans check fee
Change of Occupancy
PERMIT PROCESSING
Minimum setbacks:
zone1( tJ...../J1 jj.
G..,fr~nt' 'f
part. #
Parcel # .
Parcel
1., side
into
; t'ear
Comments
To be typed on permit
By; --1.:: / A"~
Date L/ -.:2- 7 q
7 - , /
WATER POLLUTION CONTROL
Installation specifications:
To be typed on permit
gal. tank;
ft. of drainfield; max. depth of trenches:
,.
. Telephone _ By. Date ,
T Directions to site.~hA_..bh""A' 7':-, ,!2~Af.,f- ~jI_ ---4tA~, A/~./+-5l-t1-Z;:;
Jh.A ~ , '~'TJ/J/.AA & - -I7'/A,-,"" , /L./-?L--~ ..(h,/.-d1.......~AI /R./H'./,V''/''~
~-~ ~-IF~ - - P1an~ -to~ CPtl s;t(s) - - - - toat: - - Hold Slip . - .. Date t1 - - Date to
- wrc set(s) Required to pee Completed pee
i;'/ CP7
10wpC L/ /.:2 -,z
1:/ Planning
t:/ Publ ic Works
CI EI eva tion CI n/a
CI Address
1:/ Facility Permit
I~I Environmenta1 Health
FOR INFOR:.lATlON about progress of. your appl ication call:'
Mk-~~~ .
Permit Control Center
687.HELP (687-4357)
OEPARTnENT OF ENVIRONIIENTAL rlANAGEMENT..
PSB, 12S EAST 8TH AVENUE
. EUGENE, OREGON 97401
1;';1111~tjHlJHt!iB
t..C ':''''::3J.c,t~
. L~~!"~~;i~jjm~m:~,\
I'fu~~;~;d~:'~,~n;;~~~i~n;',[~~~~a 7 t- t> ~ir '{~ct-II ~JF$fJfr; ~ ~ {, ~ M
I:::~:'::,:~~~ Z'lhNt..:~~"'/~/:::~-<u~ p!~~~!;!-~
l~~;~~[ij~,i;i?i;~~~~~ir~ !!tIit~t u. ";5L\.~;;i; ,. 0 fj~fimfD1Wlil. 0 ~~ijp0
Affidavit: I. MA Li R it'. J:... ,f/~)1~ Ne-a . . hereb~ certify that this information is true and accurate:--'
lM~~~!lLl!nlntl. ..... '. . . '
If this application is for an agricultural building it will be used for purposes allowed' by the State Building Code and
Lane County Code Chapter 10 (zoning). and 'for no other purpose. I have the following legal lnterest In the property:
owner of record; ~contract purchaser; lessee; holder of an excluslve option to purchase;
. . duly author,ized, to ac~ for the ownert w~O is knowledgeable of t~ ~PPlication.~.
Slgnature/Address ~/i L_Jo_ ~, ...f' ~ '//.l/IA,.:. ~ _~.Jl"" _7 .1.._.:/-.:__"/ ~y
... Telephone '/} Y-? ;2tf"1'1 or . Dal!'e
When permit is ready notify: ll/-A!Jplicant () Owner CI Contractor !!l.: ~i1
. Owner S ~..... d- C L!:?.{......;.......,-. (zip)
Contractor ., "t ." (zip)
Contractor's OSR#
{;>~I,!~~('iP)tPf? ;?
ft?1~9'
Itl tt,one'
Phone
Phone
Pl,umb i ~~ hy
If Commercial:
Residential: ~
51 test holes ready . J:.A/~
~Fl@ r
t&iii .m;~l\H!iii1i!li' .... ,
~O~
7UU~' ~r~
DO NOT WRITE BELOW
# of e~p 1 oyees
[HIS LINE
!i~;j~l!j!,%
i~O$if I~I Existing. BP, #,
I~I Proposed, SI #
fII~;
Valuation
Fee
:~~~~ni:i.
Subtotal
'$
$76/ cJ'r.}
$
$
$
$.
$
$
$
$
$
$ ,%7..tfr)
size/36 X 1</,), X rS)"3S
'each
'.each
'/
75/00
rl "cuw!??' .
:::-,~....,..,........"...,......~.."........., ""l
l~tiii2~{* &r;. .,,- . .'
Received b ~..
,.
I?r.-/~
Tota] Valuation: $
tr~J!~~n0~~~~;~ : ~ :
Water Supply
Proposed
Ye.ar Installed
Existing
. 4% State surcharge
Plans check fee
Change of Occupancy
TOTAL
PERMIT PROCESSING
Minimum setbacks:
Zone -:ii-ll-- /Iil 7J Pa rt. #
c . '.
1.., fron t. . ~;
Parcel #
Parcel
<t. side
into
, rear
Corrments
To be typed on permit
CP&I Type
To be typed on permit
Group
Fire Zone
-'
By ...-1-" / ./7,~
Use Cl ass i'fi Ci}t-j().1
Me -.!/ ~..;J.::..7 ,,,9 .
By .______-"--___~_,
For plans informat~'on all Jarea lnspector),' ~~.n
'. I ~
T?ir/''l'ons)o s,te. __-.z?7 i(!/7U(. _ _ I
~/ ~-.=hh/Yl..l ~
>1 SIFO Plans to. CP&I ~ set(s) '" Pf,at;. Hold'Slip
- WPC ~ seds} Required t.o pee
Date
. cP/1ol')e -~- ~-
, . lj "'-~r'
Da te {;LL.' Oa ~~'~~--;--
Completed pee
~/
C/ Planning
C/ Public,Wocks
CI Elevation CI n/a
C/ Address
/~/ Fac il i ty. Pennit
/~/ Environmental Health
LI / ,:;,-z...
"
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FOR INFOR~1ATlON about progress of Xour dpp11catlOn ,ca 1 1:
&:;J~~~~ . :
Permi t Contl"ol C~nl;er
EB7-HELP (687-4357)
1977
I
~~."..:---~"
MAY JUNE JULY AUGUST SEPTEMBER 'OCTOBER NOYEMBER DECEMBER
, T W T F SSM T W T F SSM T W T F SSM T W T F SSM TWIT F SSM T 'W T F SSM T W T F SSM T W T F S
234.56.7 ll34.1.2 12.345.6 '.11'23 1 .12345 1.23
, 10 11 121314 5 '6 7 8 9 10 11 3 4 5 6 7 8 9 .7 8 9 10 11 12 13 .4 5 6 7 8 910 2 3 4 5 6 7 8 6 7.8' 9 10 11 12 4 5 6 7' 8 910
; 17 18 19 20 21 121314151617 18 10 11 12 13 14 15 16 14 15 16 17 18,19 20 11 12 13 14 15 16 17 910 11 12'13 14 15 13 14 15'16 17 Is 19 11 12 13 14 15 16 17
I 24 25 26 27 2S 19 20 21 22 23 24 25 17 18 19,20 21 22 23 21 22 23 2425 2627 18 19 20 21 22 23 24 16 17 18 19 20 21 22 20 21 22 23 24 25 26 18 19 20 21 22 23 24
o 31 . 26 27' 28 29 30 . 24 25.26 27 28 29 30 28 29 30 31 25,26 27 2829 30 23 24 25 26 27 28 29 27,28 29 30 25 26 27 28 29 30 31
31. . , .. I 30.31 .
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JANUARY
SMTWTFS
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22 23 24 25 26 27 21
29 30 31
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3 . 5 6 7 1 ~ 3 4 1 2
10 11 12 13 14 5 6 7 8 9 10 11 3 4 5 8 7 8 9
17 18 19 20 21 12 13 14 15 16 17 18 10 11 12 13 14 15 16
.. 25 26 27 28 19 20 21 22 23 24 25 17 18 1s20 21 22 23
" ~VU~W ~~~VU~W
31
AUGUST SEPTEMBER
- -.- - .--
SMfWTf-5~MIWI~~
123 456 123
7 8 9 10 11 12 13 4 5 6 7 8 9 10
141516 17 18 19 20 11 1213 14 15 16 17
21 22 23 24 25 26 27 18 19 20 21 22 23 24
28 29 30 31 25 26 27 28 29 30
OCTOBER
SMrWTFS
1
2345678
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30 31
NOVEMBER
SMTWTFSS
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6 7 8 9 10 11 12
13 14 1S 18 17 18 19
20 21 22 23 24 25 2B
27 28 29 30
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STRUCTURES NOW ON THE PROPERTY
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TH IS PERM IT IS FOR t.--<' Y~''-.', r--< ("-'"....J (, ," r-r ~./ .c:;i (.. (r>
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THIS PROPERTY IS WITHIN ONE MILE OF THE CITY OF
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I hereby certify that the above statements are true an~ a<;curate, and that I have the following legal interest in the property: _owner of record;
contract purchaser; _ potential buyer; _ re~ltor ,or agent. I further certify that (if not the owner) I am authorized to act for the owner of
record, and ~t .saidr5'wne/i~ a'^:~::Jand.:pproves of this ,i!~tio'1.:. I hereby agre.(,to C?mply with :" appliJa~le Codes relating t6 this p~rmit. ,.
Fee Paid $ Zd (; ~....-?,; <-''''; ~ Signatl1re/I,.0!~ /j 4J~-'\ Dat~ .< - 2)- 7./
( ) NEW ADDRESS ( ) FACILITY PERMIT TO TRAN'S.PORTATION DEh. ( ) SPECIAL PMT. AREA. MIN. ELEVATION:
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LANE COUNTY PERMIT
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APPLICANT'S NAME AND ADDRFC:" 11")O..-u--"<',,/ .CA'......J.:::
OWNER'S NAME AND ADDRES" ' ,
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CONTRACTOR'S NAME AND ADDRESS
Mail permit to (Z)"APplicant ( ) Owner
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Comments:
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Minimum Septic Tank Capacity (Gallons) \,'
Drainfield Required. Lineal Feet ~.
Maximum Deptl) "i
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Date: ..:;....".;, '..7;/ '. ,ByG"t 4e,-,.-4 J h :;I.w;e Date:'07 <28'- 7'%
PLANNII~'-G REQUI REMENTS SATISFI ED. By: "-Ia.-~/ 'If G?/ Date:"':< -OI~ ?<r- Date Issued:O! -dO-It>
ZONE:I<::/lmH SETBACKS: FRONTb1b" SIDEF~e-INGSTREET- (FROMC/U INT.SIDEYARD~I REAR"':;-I (FROMP/L)
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LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
PHONE: 687-4394
POST THIS PERMIT ON MAIN BUILDING AT SITE
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REMARKS
FOUNDATION INSPECTION
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LATH OR SHEETROCK INSPECTION
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INSPECTOR
REMARKS
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FINAL INSPECTION
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LANE COUNTY DEPT. OF ENVIRONMENTAL MANAGEMENT
Construction Permits &. Inspections Division
EUGENE, OREGON
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This buildil"'!9 or structure does not conform to ~ane County building regulations, ,ordinances or codes
as noted below:. . i
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C55 -7 3 RE-INSPECTION REQUIRED I~spector ~ ) ~~ -- Lr Datel:, - I:, -79
FOR APPROVAL I -
Building Permit # tlJA..h. ~.r- 4...4/ -7R'
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