HomeMy WebLinkAboutPermit Building 1979-7-24
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App 1 ; ca t"i on for'
Structures now on the property 1'11/ /'I r
Ijjffl!~~,i!4Q~!lj~t'liiiiiip!l6tj* &1.!I~.j!!~ij"1mjl OI~llililWt#~I@tl
Affidavit: I, j\1/c,i'lIJu,/ ,j J..-afVIB
{111>!.~$il!itj!!M
If this application is for an agricu'ltural building it will be used for purposes allowed by the State Building Code and
Lane County Code Chapter 10' (~;ng) and for no' other purpose. I h. aye the following legal interest in the property:
. owner of record; ~ contract purchaser; lessee; holder of an exclusive option to purchase;
. . duly authOr'ize~.1Jz.a acctt f foo~r..tthhee 0 owwnnj~rrwhJ y> knOWledg;a~~eo'fth;s apPl.;catfon". . .
Signature/Address../, ~ /\/ ~ ' ,;2.0/d-.11V/JJN.o td/lV (zio) 97'177
. ., Telephone 7J.-C- -J1J.J / or '7lf~ -/2:&0 Date Vtn:.v,)..LI, jq7C1
When permit is ready notify: I~I Applicant . ~Owner I~I Contractor ~: I~/.mail I~hone .
Owner . fV7/C/..f/)eJ-. \./ LnM.J~ (zip) "'/71/71 Phone 7)..t-Ji..:l.J1
Contractor _ ~_ (zip) Phone ~'1-;20/ /
Contractor's OSR# Plumbing byo.J"::J,,T-'''' .~.{) .PM .::?//..r '
. ~-=---
OU Nur WRllc blLUW THIS LINE
# of emp 1 oyees .~ljl~iilHI,~i!ii /" .
~/-'). ?$~illi /p-r;Zisting, BP# 3',:, 81- '7.r
/~/Proposed, SI #
1/. .:III~~I~llt,.. 'II '" . Valuation
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I
DEPARTI',ENT OF ENVIRONI~ENTAL I1ANAGEMENT
PSB, 125 EAST BTH AVENUE
EUGENE, OREGON 97401
.
.1~jj'\iXt'jilii.@
I.C -)7;t~7J27'Yn!l
.. . 'A~~!ijff~!1:iijl~~n~i
Oi$liistl\'~l'
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, hereby certify ;that this information is true and accurate.
If Commercial:
Residential:
SI test holes ready
IiI j?' 'llii[t'\!llltJUiii \
~~.~~
. In x WJ ({)/1!:r;;;1(J.
Hlk.J/hCf ' IQ4 .
J
Fee
;~t.-t'. ,gs6 .
Received bY~~
Water Supply . ~~. 3
Proposed ~ Ex!s~ing
Ye-ar: Instailed
i:l:je:t:~:~12 :~
Total Valuation: $
$
$
$
$
$
$
$
each $
$
each
Subtotal.
$
$
$
$ ;:2&0-0
$j';he91)
/0 t/ )C II :2-
,rear 71 PHS-
4% Sta~e surcharge
Plans check fee '
S f)-J itAii (lJ.
.. . TOTAL
'-". _..e r.
'-"'-"::i'-- ~. -"'-""....'-..~J
PERMIT PROCESSING
Minim~m setbacks:
zonet'/f/;g H; 'Part. #
It, front / .. ,. . ;
e~~"f-
Ii. , side
.Parcel #
/Vii-
int.
Parcel Size
SI
. Comments
CP&I . Type M.l.4-.
To be typed on permit
~roup~
Fi re Zone
J7 ..
BY,.Ao~ O~e ./-;2..c;~t:J'.
:3 Use Classification ::5Ft:>/M 14-. .
r
To be typed on permit-
.
'Gu) Date 8/3
,/ I'
For pla-ns information call (area inspector) ~ J'J/"J.A Phone .<70
Directions to site ()(J T. 0(){)71:t J./Y[) "ff/l'Et:;7T /N .spl'Pjiycr-li:-i../J Ta /'-/IJAbf7
uli'tJt/r /''/t1J'?/^-~/iCJM r= Pn/i?/\ OIY 6pJ/lit<I.sr.je. Jt/sr P;;ST ...l.tJl..2."'lNL..JJIY./J
Cjt-7p1'an7lc(CCP&ICC4.J{i:t(s) Date .Hold Slip . Date Oa.te to
-. wpc. - -- set'(s) Requi red to, Ree C0I]1~1 eted . pec
By
o SIFO~
.y-rP& I
Ef'iiPc
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/-:/ Planning
/~ic Works
- ~vation /-/ :n/a
~res's -' /
c/ raci I i ty Permit
.;:/ Environmental Health
.~
FOR INFOR~~TION about progress of your application call:
C74-171
Permit Control Center
687-HELP (687'4357)
f6/,
Name
LIl fr1 A
I Phnnp
Application II ~"'~t'- 'Jq m!t for
SW/l1#
WORK SHEET
,
Construction ',Permits & Inspection
M H Type. of Construction
--11.1:L- Grou p
~ Fire Zone
.6 F' D Use Classification
AfoTE: ArT AC,H-A en PlI ()~F. Pt_.OT PLAtd Tn T~ r-
I .N6.Pl=:iC. TtlR'."'\ . G I< I=.I;JV PE R M 1"1. (.().p Ii.
To B~ TYPED ON PER M IT: e.RovIOE r-OOTING:5 AN:]) PLE.RS TO
(f)M,PLI.{ uJll'H ;<;-rATF; r:;.Q!lNDAnON R~QlIlt<.EMeNT.5 ~R
MQRI/.F. \-\-oM'::.'" n (LA..... ~t=;r~M M':: ^,~,,=.I'" ~t/_Ti-ll= M.AAJUI=~LTUI2 f~
Ir1ATArcl=,AnAc..l4~D To TH1; JNf)/Dt: o~ THe Mo~{{c:: I-ft"lMS
AJ"'o P~()\JIDr=: '<"1o[1~"TINGr A.""" i=2S::r.'!\J1I;>1=.~- .;.,~,:, f<r:;.UEt2,,,,,;:
6l0f c..ote (.Au-FD /AJ:<,-pecfloAJ:=;.. ~ l)1")/.)~ 6rrF I:'"; I~AT~CL
~A t:'u"JoD ~A3AR I) .4f2~A. ~ ~/AJJMIJM ~1^)I..;,t-l
f1....ooR. r:= '-1=; \j ATICl/J r. C ~ FE t':T ,~l-+4U _ ~,::.",r:"Lut2GP
A1JO /.e:;~T\ !-IED A~ QY.nllLK.&.D F-,~ Tl-tG' eJJOf)Sr-;D
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)~ "iHl=" ~r<oU{UD Fott::..IJAT\o^-J TIiAT~14t=. MOP-IUS: HDru,e ___
WlLL R~ p( A.f',\:::;D D~:o;. P-.Q..l ()\..., -rH~ .Rr:::(;)lll(?j;;D'
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Date'
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74-164
, t~ ...... .)oJ)
FLOOD PLAIN MANAGEMENT
Department of Public Works
125 East 8th Avenue
Eugene, Oregon
687-4195
TO:
v
PERMIT PROCESSING
PER~~IT NUMBER '?.... '2.bD - i"'} NtH
PLAimING
PUBLIC WORKS
PARTITION NUMBER
SUBDIVISION
OTHER
SITE ADDRESS 'Lalo:>., Ilo..lLr........\D vJt>.Y
PERMIT VALUE IS A SUBSTANTIAL IMPROVEMENT.
YES V
NO
SITE IN FLOOD HAZARD AREA
YES ~ 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 FRor1 FLOODING. MOBILE HOME TIE DOWNS REQUIRED.
,~ SITE LOCATION IS WITHIN A FLOOD HAZARD DETAIL STUDY AREA.
1. MINIMUM FIRST FLOOR ELEVATION OF 44c),o \ U1.S.L.) REQUIRED.
2. MINIMUM FOUNDATION ELEVATION OF (M.S.L.) REQUIRED.
/~ 3. MOBILE HOME TIE Dmms REQUIRED IF GROUND ELEVATION THAT ~10BILE Hor~E
WILL BE PLACED ON IS BELOW THE REQUIRED MINIMU~l FIRST FLOOR ELEVATION.
4. SITE LOCATED WITHIN A DESIGNATED FLOODWAY CHANNEL, BUILDING PROHIBITED. %
-0
RECOMMENDATIONS: SUe,OI"\c,:>\Ot-..l t:?E:.<-,>\12IC\\ON 12E:aU\(28:'.... M\~.
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DATE
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BY
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C99-21
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DEPARTfiEiH OF 'plVI~O~NI~ErHAL/ i1ANAGE,:-"O.
PSB, 115 EAS-r:8TH AVENUE .'
, EUGElIE. ORE~OII 97401 .
"
: Job Address ~O /,J .IIV/../J/v1J LL//JV City ..f PFt-iJ
T-;;wnship, Range, Section, Tax Lot /.P- tJ3-CJ:;?,6,3-7ltf~
~/I....ANYTLn<)(lI/E-.J7N /-//)I) Lot~
, rr
J/O ...App):icatfoQ;# M It
t..(... -~'" ""V./ ./--11{ rr
Assigned Numbers
Subdivision
Block
-
~
.......
Application for
Structures now on
1'1,)/1 r
"
the property
-"
Proposed use of property: /YI Residential
1'1 Ie- H II e /...; J J.--/.11'1 a
(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 no1other purpose. I have the following legal interest in the property:
owner of record; V contractj)urcha~er;. lessee; holder of an exclusive option to purchase;
duly authoriZe? )o(act fo/ the ow~er, whois knowledgeable ot this application'7 ItI, 7'177
Signature/Address;l_ ,~A./ ~ " ;2CJI,J...J.1V1J11Y4 'AY (ziol'! '"
'/ Telephone 7J-~-?..i.J1 or l'f&-/"L&O Date VV/--Y- "''ti /7/7
When permit is ready notify: C/ Appl icant It! Owner I-I Contractor !!l'.: I-I mail /5.. Pho;;;"t-f..:l.:J /
Owner MJt:uIUJ-\./LI1/'1.f3 - (zio)"'I7'17, Phone__ ~d.
Contractor " ~ _,_ ......,~.Lz.i.ot Phorie '7'tl't ::er"
Contractor's OSRI Plumbing b;~-"";>v;;:" E'i!~J .. ~ .,..r.,~
V
L-/ Commercial
/~/ Industrial
CI Publ ic
....~
;'~"'j
Affidavit:
I.
, hereby certify that this information is true and accurate:'
. '.
. If. Commercial: '# of~stories
....:~'Residential: # of 'be'drooms 1- J ;;
S1 test holes ready
DO NOT WRITE BELOW THIS LINE
1# of employees # of units /'
SDS: /'tr'Existing, BP.-H''',3o 8/-; 1r
() Proposed. SI # "
"
Fee . \ , Sq. Ft. or
COde~"';~..../...wZi~...l~.,it i1t9-7Z.e_..! of Sites
, -. - 17
----.1.D "r;.n I.) :J+/'V'I?:l.U 0 . ' '.
. I r, J.:,71J-,i;f' 10?oJ=)
v ... - J .' _, i __\, ,
Unit
Cost
Valuation Fee
.~
$ -.
$
$
$
each $
each $
I .... -
n cashii.iti79Ob
eJ..eneck H ...,,g s'6 '
Received by L-f4~
.. r
Water Supply . ~
Proposed Existing
Year Installed
Total Valuation: $
Plumbing fixtures at $
Sewer/water conn. at $
Subtotal
$
$
$ ~ - - -)
$ ."Lvi'.'" _v
$ 6b/TO
4% State surcharge I
Plans check fee f)s u;6t/,'1I
S 11 fity.
Cha'tfgeof-Gccupancy C.
TOTAL
Comments
zone-fJ! - /JJ H
It. front hi',
P~..'~'~
'(!..l.U' cU.... ~ U
Part, #
~~'I . PERi1IT PROc'ESSING
Ii, .."",~Minimum setbacks:
"'t".' ~
t, side
IV II-cel #
int.
Pa r,ce,l Size
oS
/0 y t" I ( ...-..
~" ./?/'G
rear /. r '"
.~,.
--- -y
# n ~// ~a
By ~ Dat~..,/--'-<-Y-/7
WATER POLLUTION"CQNTROL M{-li 3- :::>,.\.)/!vI It
Installation spe~{f;cations: ~ gal. tank; Pt"I.!j,(1.Art fLfLTh4,:!infield; max, depth of trenches:
. . To be typed on p~,t.-J'lW .-h, \.,poo fl'(lrnrl Vl..Q (~~A.,I JutJ-L. .f\L;~J,~L
----1IA.A 1.0/ .fo~v OJa~aJ"'1.1oIUIJ\~iI\,r/-~q,~ el/APh, I1.::CAM ,~~~) ')t< .
tiM: ~i ~ "'" ;~'K (i . jj~1M .~ah.&+r~l, ", ..
k1r11l ktMo..... \.C'.o..JoeO", " lM,.fln9P.." ~ , -':', .
't: _ '~elephone . ,,", "Date DI~ 7/1:-
,-Direction Slt flU J U)O(}7r1 ,,1-''',0 tJ ttf'ecrT,1'/ P/YI/Yt-/,-//;4..l)\ To r '~''''..''l'''
:'.l'?tJl/r /1//'U'iIA~ /-1171"7 t= PI?If'I'I. O/Y C-P/./LJPSI7C -./r/ST ,,/Y:n ""'O/..J....JIY~JyiJ
SIFO OJ.. m,s Tott't(p&! c.NJ,U(s) Date Hold Slip Date Date to
wre set(s) Required to PCC Completed pec
-----r-
To be ~yped on perlllit
i L,..CP&'!'
~ /_WPC
"j / Planning
L ....PI1tf1'1C Works
- --
~/.....E-levation
'-/....Aa&ess
55/ -L.
o
Permit
. /. " . v~ not ~~~ J1~~~~kt,
~oo " ~ cWo- .~ jUJ;u_ol~\ojllc1w~~\9 ~ ~~;' _
...rw' It VV1~ ~ ~~ ~ '~J~~~ dwe1t5 ' ..
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FOR rNFOR~~TJON about progress of your application call:
Permit Control Center
6B7-HEIP (687-4357)
,I
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.,
f'.'C~~!~ nDrr.nrl 9' 7f.../rJ 'J..--.
,ength of Lines-Ft.'" '('Trench 1 Total Sq
.c:S2!!'i3. 4. 5. 6. [Width..:2- Ft.3o U
'lot Plan (see instructions):
- i ~-__~,_,n'____/'~''!_~H_''_ -, --- -, 'm__.., ' - ?i'-
I.( -) II':> 1 . ~ /
",~0 \'! n, ~"
~ ~ "J ',', , ') ~ _~_':/>- '-.J!/--/? /
I ,!Ie i tiS i: . ft. ,6(1.. I" .,
'<J', 1.(' Y I \J I / - ... - -", ~ ":J'"
Q, (l -- -C" ,
\) '0 ,!I~>.:;; -:..-, "
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S ~'. :j~~ 1.65 )I"l. '/tJlY/A.-C
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CfllJtfi
Date /- ?"?_?I:>
, ,IS~LU:'R':':-;'Comp I ete top par'
.....\
'i"'~. '.._.'
INSTALLER'S NAME
Te/J ,)(JPJI3LIJAN
lo. Living Units Bedrooms
ieptlc Tank:
'to from well
Steel' 0
Ft.
Diameter
,side
"ngth
i.INER
!lIME
Dimensions:
Width
MI CHAEL LAMf3
\A I LING
,DDRESS
(')\2 Ivr ST 11 TH
PROPOSED
of form
\
PROpr~TY ADD~ESS
INA'-NO I,/AY
Baths
Basement
Ve, No
Water. Supply
P"bl ic J/ O~~~r-U~~
Ga 1. Capacl ty
Concrete IY1 No. Compartments
-'fi Ie Disposal Field:
Deoth Distribution Box: Yes ~
Other Distribution-Type
j/
/000
'No
Feet from
IIEII
Lot Line
Front
1Ft. ~etween
Li nes / 0
Foundation
Side I 0
IFiller'_IFiller Depth
Type/ -;L Above T i 1 e ;L
Rear / 0
ti Iler Below
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JAN26197G
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~ECEIVEJ
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L.ANE COUNTY
ENVIRONMENTAL MGMT.
Sionature
CERTIFICATE OF SATISFACTORY
'1/' ( ., -,,
Co~PL~ ;'o'N ,'1' :: 1"'" i:'.-',h
Date: /- ),C ..
is issued
at the above
, ,
! ~-
For Sanitarian Use Only:
In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certificate
as evidence of satisfactory completion of a subsurface sewage disposal system
loe"tgg' n.
Approved: System Installation conforms to current standards
Disapproved: Does not conform to current standards
Remarks:
r
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/--,. /p,-,< ,-"
Sanitarian's Sigprture
LANE COUNTY /j
STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY ,
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CS 5 - 11
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'LANE COUNTY DEP,T ENVMGT RECEIPT . ~ 226079 DATE 072479 ,
" . APPLICANT LAM~, 'MICHAEL' ,J" . AD DR 2012' INLAND "WAY, Sj:'FD ,'ORE . .
TL~189302i1iOl~ SUBDI,VFlLBERTGfWVE ~5TH ADD . ' ','.. .", .' '. LO,1', e<f1/BLK. 2
" NEW 'BLDG 'TYPE MH . USE,R NO' F1DRI"~ 02 NO UNIT,S 001 NO 'STORIES NO BLDGS 001. ,
CODE, ,APPL NO ACTION DESCRIPTION SQ FT, UNIT 'COST VALUATION FEE' DAYS
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cr, ,:-" ", " _;. ~..., ' ;. .
BP
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MH. ~C 226079~H
" MHPl NO. FIXHJRES:
MECH
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10' ,:.x 60
NO. ,CONNECTORS: .:' '.,
,MECHANICAL FEE
.STATE SURCHARGE
Pb~N CHECK'"FEE
5:00,'EACH
:= ' .
, , ~'30 .. 29 ,
,1.0.00
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~~. PLAN"'.. ELEV ADDI~
CCI!'WLETED BY
FP
ENVH .
T()lAL"~:'EE:*'*'
66:90 CK
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JOB ADDRESS:
POST TI:IIS PERMIT ON MAIN BUILDING AT SITE
CONSTRUCTION PERMIT #
~22;:0-0-;r..,=:1U
+-
2@J:;l ~ !Joy. B~l1cll.c1. C'~..l
.
TRS TL Subdivision:
, , : lr-{l~..o7.. 3.3 # i90fl ' l7illJ.!::x?ii: Girovao 5&11 ~. ll.~C l)4s Blk.~ 2
This permit for the referenced property is hereby ~ Setbacks and other conditions of approval must be strictly observed.
result in revocation of this permit, citation under proC\v'i~fifri:S''5f'Lane County's Infraction Ordinance, and/or other remedies allowed by law,
Appl icant/ Address:
Owner/ Address:
Contractor/ Address:
Contractor's OS #
,- -,
e;J
Violation can
tN"!'11'?A1 3. Lsi:::)p
=:lG
I
I
Telephone:
Telephone:
Telephone:
7~1/i'66--11.2~
~
I
2Gl2 In1l:Jcl Uo}'. S~~o €J,.._ 97477.
- .
/
Tota/Construction Value:
I
Construction approved by this permit:
J, ",
between 8:00 ' 9:0p,a.m" \7,,001.4 _~.an_~A.
, '~CI 'f' , ,
CONSTRUCTION Type of Construction: mI Group: 9 Fire Zone: 3 lpe assl Icatlon: . Sim/J;a
PERMITS/INSPECTION Instructions: ~ g&l~ asd ['doa'o m e:r::;iiJ.y ~~ otooo fl~~ ~~l!;o iZClrtr....'i:>:'!ll.e t:.,~f\ ez.
DIVISION ~ Ii:to c2a. lI:lst OleG o~i:achs:1l to eha .qnAtda of ~ l2O':)Uo 1::=. ~G ~ ~ 00 ~> Boo ....""'-"''''''' 0:1&0
or ~It I?o.... ....q...,;zcd :faapaeUcms.. ,y_ aim iB 1eesll:ed vithila 0 flcl:d ll1eml!'d erea. A EllLm. fiail.ah !l1m;;r Cl!c:;;roeun
of 4Cl9.0' oh:3U \llQ soem:cd & cmrtifieil Ile ~oo by tba ~Cload flDOO l?~ mml:. l1ot~. I'lli i:= dcCc::JWO =
For plans information call 631-3760 between 8:00 a.m. and 9:00 a,m., Ilaln.'1 Iflmgb &'~lrei!l.. l1lce attllcl:ilCl2
For inspections (see back of this permit) call 687-4065 between 8:00 a.m. and 5:00 p,m.
bne county
Directions to Site: Oclll: cm3tln 2c.il S~=i:. in Spf<1 ~ l7ilr..~ GrGV'O hi POll''- Cil Orlll.-c'!c-::::!1c joo~ ~c 2012 X"',.",,d Eo ~,. - =lI:
Date I d' ~19 - By' n= mnLco/ly
ssue . DEPARTMENT OF ENVIRONMENTAL MANAGEMENT ' , I
COURTHOUSE I PUBLIC SERVICE BUILDING , ..",
C55,13 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 ,
..ater Supply:
""-........-
...~~-
PLANNING DIVISION
~
WATER POLLUTION
CONTROL DIVISION
Setbacks
Interior property lines
Fdge of road right,of,way
" ;i1ding foundation
Wells, other water sources
1%5 Vi!.dt!lg Q la 8 GO 'i:ll,,",~ ll'~]n." ,...1;:
Stlme~OD = <i:::ll ""''-'''''''''''1/8 =
# Bedrooms:. ~~, # Plumbing Fixtu'res:
-..-.....
'iF Employees:
-
..
l.D
Zoning: Partitioning # Parcel # , .. Parcel Size:
MinimumJf~i7ed structural setbacks, from: centerline of road, front:' en; centerline of road,
side exterior: ; interior property lines: ;rear property line: 6loo .
-.~ 50 Y l?UB
Special InstructIons: " 9
, Jnlm1l S~ is..1 ~J1...."".11mn OIi' caiL >>>l SAC
,
For information call 687,4394,
~UI;IW.I t7f'~--: 'i ~
ll.~ n ll22
(
Site Inspection # . Installation specifications: misl:a gat'fi,inl.septic tank capacity;
SIfst!ipeal feet of arainfield required; max. depth of trenches: De t>o ::;;y
Speciallnstructions:m to 1:10 p~OO c::) e1c:::0lq'1.~ 50 00 W:l crdlog~ ~ end lQ~
eo the miod08 ~iGlld. ~(,: ~ the c:aJLo~ ~ ~ c."OO fu:.3""n""'1
Qrainfiel,g.adcnr 309l"'75 Ei.:U1 ....~'-' I>> TxI ~~ ooUo~y.. ~G:il rroj?lo"''''''''''''''c = b
10' hc:::J1 dc.......3w>d 'by'_ormg is: vilfu a"'...."A. op(l ooins it :C0le~. /.l.IJ l!:Ci?ll.ooc::=1.~ ~o
10' !s ~l!:Cd by !al:7 6 h!3a at b= ~v...4 CZI tld.ci: let s!::zlnlWl i~ ~~ ic alY be !!"''''''''',
10' eo ~OOD ~ ~!H"'5..
100' For information call ('A7-,;\~O
Septic Tank
1~
10'
5'
50'
"'-
,
" .1..
;......,""'
~.)
,
"
~
/
S lTE INSPECTION
ApPROVED .c;
i,
DISAPPROVED L:::7 DATE
INSPECTOR
REMARKS
FOUNDATION ,INSPECTION
ApPROVED / / DISAPPROVED L----/ DATE
REMARKS
FRAMING INSPECTION
REMARKS
ApPROVED / / DISAPPROVED / / DATE
LATH OR SHEETROCK INSPECTION
INSPECTOR
I NSPEC1'OR
REMARK 5
A~PROVED L-I DI SAPPROVED L-I DATE
INSPECTOR
FINAL INSP;C~~
ApPROVED DISAPPROVED
REMARKS
/>/J
CERTIFICATE OF OCCUPANCY
1 / DATE
f'1~
,
7- :?-<!t3 INSPECTDR~
,.j .r1'J.- '{I c2 B-
READY' TO ISSUE / I' NOT READY TO ISSUE ,I / DATE
REMARKS
INSPECTOR
Baths
Basement
Yes No
SEWAGE DISPOSAL SYSTEM RECORD , ' "11' .'. ~M~~tHf~'
to signature and submit both copies with app cat 1:t~?...~~~~~~:btt'1J
PERMIT NO, ,2 ~~:'~'.iii' ',~if!:'ii\
<,?j~~<YJt ~~.11U
PROPERTY ADDRESS ':. ~,l'/',;!lJ1i"l'
. S~"oo ~'{,'...I~;i~r~4~
I NAt. NO WA Y '~'fj~~i'~
i"'1:LiL",~~}.
..~
Water Supply
Public ,/ Other-List
PROPOSED
,STALLER:, Complete top part of form
, ,
iNSTALLER'S NAME
TED <)' (J PI13 L/IJ.I'I
"'. Living Units Bedrooms
\
..ep,t I c Tank:
, '. "f rom we II
lS j de'
. :ngth
,;IER
i \!1E
Dimensions:
Widr.h
Steel 0
Ft.
Diameter
Concrete IT No. Compartments
Tile Disposal Field:
Distribution Box: Yes y'
Other Distribution-Type
,/
Ga 1. Capacl ty
/0(;0
Oeoth
No
t-1!CHACL LAMB
,I LING
,IORES S
p,112 \Jr" T 11TH
I Feet from
liE II
I Lot Line
Front
1Ft. Between
Li nes / 0
Foundation
,,,or'l. nocj'lll 9' 7L/rJ 1--
"ngth of Line's-Ft.' 'Trench I Total Sq
;:'S2},r;3. 4. 5. 6. lIidth..2 Ft,,-f{) U
lot Plan (see Instructions): -
Side / 0
IFille,:,:"IFiller Depth
Tvpe/;/_ Above Tile;:L
Rear / 0
~i lIeI' Below
I '1 / .
.n I e n In.
/ /0 ' .
*' ~ ~ \~': . / '. ).' ",'
{i~\ 0~?)~-~'/ ',-/;1
Iv I, l.l 'j; \\]1 1 ,~,J ->- I~' '),
; fi:i I ,,', (~' (~J~;v;c~c / "
,:;1 Vi' , 1 r. ---'-n 1101>71: CO ;'
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ief /
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"~'~ -:;1 i '" ., )i9 '~~I-}Jj ll/
I INLA/,I~'
ICI/1.( 1-/;:
late J- ") "?- 7b
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,,~.E C E ~ V E J
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JJIN:J.::> 197G
LANE COUrjTY
ENVlliONMENTAL MGMT.
Siqnature _,~(//,..,'("t'
CERTIFICATE OF SATISFACTORY COMPLETION
/' .....-h ./" I/,~ "f.'1--.
Cor Sanitarian Use Only:
In accordance with 1973 Oregon Laws Chapter 835, Section 214 this certificate
5 evidence of satisfactory completion of a subsurface sewage di5posal system
10("181 n.
. Approved: System Installation conforms to current standards
Disapproved: Does not conform to current standards
Remarks:
,- ;'
Date: ().C
is issued
at the above
/ (.
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/. .' /j:'Vi <,
~:~~t~~~'~~; s 5 i~7ture
STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY
me!1~I~~I~-'::D~dil.~~~~~~~Jtil1'\M1Mli\lJ:'ill'll'_<l!IJilllliall~<;l
c):, -ll
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.,
POST THIS PERMIT ON MAIN BUILDING AT SITE
'~OB ADDRESS: 2~i3 :rni"n'" eoYo S~icl.do C;:~n CONSTRUCTION PERMIT # 'LOc22cC-7\X;d
TRS, TL: is.-o~o3.S.J 7C~ Subdivisian: !]i.!\Xl;re Gl<=.. .5&'11 Md~ 1.Q~ 4~o Dlccl:. a . {3
This permit far the referenced prapertyis hereby 1l,...~~"'..I)~ Setbacks and ~ther co~ditions'of approval must b,e strictly observed. Vialatian can
result in revacatian af this permit, citatian under provisians of LaneCaunty's Infraction Ordinance, and/ar ather remedies allawed by law.
, "
Applicant/Address:
Owner/Address: '
Cantracta'r! Address:
Cantractar's OS #
, ,
Telephone:
Telephane:
Telephane:
~
Uic'\:2c! :f. L!ri:;bo ROl2In:l.:JaCl e'ayo O~:lalldo c...~<>...., 9':iCJrJ'
rt..~3
I
f
72&o-$l/745~12G~
Tatal ConstruCtian. Value:
I
Constructian appraved by this permit:
v~ater Supply:
~~
PLANNING DIVISION
WATER POLLUTION
CONTROL DIVISION
'-"-,
Setbacks '
Interiar property lines
"dge of roadright,of,way""
Jilding faundatian, ' "
Wells, ather water saurces'
l~liS W1ld:ln @ ,10 8 6O\)/&~o ltCl?J~""";~
..S~tux"OD 'Ct:1 Qa, t"~r;-",60JlJ. ~
"
,
'.\
# Bedroams:
~,. .~.~ ).
" _~ ,# Plu'mbing Fixtures: '
-
..
.,.,
# Emplayees:
Q
--.(...
, Zaning: . . : Partitioning # Parcel' #' .' Parcel Size:
, Minimumr;~qdi7ed structural setbacks, from: centerline af road, frant:,." '~ ;:centerline af road, lClJ, II 112
side exteriar: . ; interior property lines: 0 ;rear property line: '. U; ,
S 'I, I. """. S. 7 FOE
, pecla nstructlans, """""'<>=on."""'..... "'10 .. . ... "Tn m. ft.. "
.6"LW,;.:U. e.;;;...':l~ ~ " . ~Jl:y.t<".II'.uO.u ~ &#~ c:.J.C".
Far infarmatian call 687,4394, _
,
~~~
Site I nspectian # . 'Installatian specificatians: -mew' gal':,lnin.'septic tank capacity;'
~Iirleal feet af Cirainfield required; max, depth af trench~s: n:3 '>,'. -: ,". ' , ..
Speciallnstructians:url' to be DlBdoo ~1p'(J~, r:u!::\ 5-~ to ~1GI::i.z~,<'J t:Sl1t end 10'
" i:o tI:lo adri~~!oL!. ~~ -to t/# cnio~ ~tan 'O~~ tJ:::J w.o~::.1
Drainfield!CEm' SfJ3l-75lrm1 a~ Co In r-=~ ~fc$zUYa Re~ 1:'a!?lC<'r-'l~1l: aroo il
10' bero (!coggOf..,a by ~g it tlith ~ qnd ti;l1ug ':9.1". ffor ~a"..tJ rtr,llclJ:a:l(l'llt =-~
10' 1.s'~i:ad by,!c';7 t.,'twJt'.oe'~..",~v".J en ~ t::~ 1.l1."!l':3!dll.i goi1o :11;'00)' be n~
10' , ~. nh'",dnu ~b d::::1lUng.' '. ,.'
100' Far infarmation call (.m'-39:;O between 8:00,9:00 a.m., rr_M f'l<1r-o'!"""'?"nU
,
Septic Tank'
10'
10'
5'
50' "
J~. .
CONSTRUCTION Type af Canstructian:!o!3 Group: mI Fire Zane: 3 ;,yse Classification: " ' Sr?Dlrm;;{.
PERMITS/INSPECTION Instructians: ~ f~ !l:!2d p-la:;ro \:l3 e;r.::l!jIly \:l2t:b al:ol::(S:!CW(Q~ rct;i<fL.~!:D fCllil' Cf.)Jl.lo he::::lS Oll: .
DIVISION by ~ rUB. \:I::l~ area aetD.C!~ to ~ 1nsUa H ~..:) =b:l.la l:r~ f"C<:It> ~r~oo milt&~ OS l!'~lt~"SE::;) ~...v........,a aUla
fiT ~tr f(')'i" ~ fu.~~.l!Io '!crrm; site' 1'.0 looa"..ed tr.l.thiln, 0 f!i:;cl ~ ~e:lo ,ll dm. Ucl..cll ~ clC!V'alWm
of M!)~O. c;1tall be ca..........3 r. ~~ltcl C3 ~:\"':ea ~ &h2 c:Jcloc....-:! eloc::1l?!oSo,l:7.z::12. lot:~4 rn f~,->o ,t1clo:liOO =
Far plans infarmatian call olJ7~37GO between 8:00 a.m. and 9:00 a,m., I.bla..') l1tt'ogh . requilrod.. Se<:! otto~
Far inspectians (see back af this permit) call 687-4065 between 8:00 a.m. and 5:00 p.m.
bne county
Directians to. Site: 0t12: =l:Il 2td S~=t. :ID. 13pfd tt!l Filbert ~ t3 1hm\I 0':) Ci.:ll=d0-.J3C j~~ j;l:::3t 2012 rnll.cnt1 5 _'" -" ~ =i:
. ~79 ' 8 ' ll:1'ro t:ll3itt:o/l:' , ,
Date Issued, DEPARTMENT OF ENVIRONMENTAL MANAGEMENT y, I
COURTHOUSE I PUBLIC SERVICE BUILDING
~r;55-13 1?1; i=.o.C:;T AT~ .o.V~Nlll:: l=11r..l=P>.li: r'll:u:r..nM 07An1
.r.;'
. ,
.'
..:-- 4.
,
;"'.,
.
SLAB FLOOR
PLUMBING GRQUNOWORK
ApP'ROVEO
C/
DISAPPROVED.
~
C/
DATE
INSPECTOR
REMARKS
GAS PIPING GROUNDWORK
ApPROVED ~ DISAPPROVED C/ DATE
INSPECTOR
REMARK S
ROUGH PLUMB I NG
ApPROVED C/ DISAPPROVED, Cl DATE
INSPECTOR
REMARK S
ROUGH GAS PIPING
ApPROVED C/' DISAPPROVED C/ DATE
INSPECTOR
REMARK S
" ~_ ~~'7tY};J"~I~ ~~L~'/.-
. a;v~C/ DISAPPROVEO. C/. DATE 7-F'-5r3> INSPECTOR~
~ _J.~ .... " '-.LlJ MJ u~"..I ~ ,,1.~ _ fJ-/ I- ~tf .f!./-
1/. , ^ -J:;J 0 /).
~J~.-(l.r'I./~~ f1~
..
REMARKS
- t!l A_
'1..-~-~"':1
I -
FINAL GAS PIPING
ApPROVED .cJ. DISAPPROVED.' / / DATE
IN~PECTOR
REMARK S
CERTIFICATE OF OCCUPANCY
lREADY TO ISSUE C/
./--~,,,\
NOT READY TO ISSUE ;---?
DATE
INSPECTOR
REMARKS