HomeMy WebLinkAboutPermit Building 1978-2-28
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JOB LOCATION
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Subdivision ,--7.k-(' t/--U( r -#L,....~ _
, Lot S' "'-..::>, Bloc~ ~'2" f
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(owner, etc,) when readY'~
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Acreage or Lot Si7P
Contractor's O.S, #
APPLICANT'S NAME AND ADDR~c::;-m~-~.J.s 0~-1.....-
OWNER'S NAME AND ADDRESC:: ' I
CONTRACTOR'S NAME AND ADDRFC::C:: I r
Mail permit to (t.)"'APPlicant ( ) Owner ( ) Contractor. ) Prefer to pick up. Call.
STRUCTURES NOW ON THE PROPERTY rn.p{
OHIS PERMIT IS FOR (.'~Jl--4..--..)/7.../>.J (J. Ov-,i-")o'>,._~-1../ cf:)LJO /:?f"
. WATER SUPPLY ~ I'YI.L~/~h/u SEWAGE DISPOSAL
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THIS PROPERTY IS WITHIN ONE MILE OF THE CITY OF
Partitioning 4'
LANE COUNTY PERMIT
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/1/ / 7 ( ) Completed
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# BEDROOMC:: # PLUMBING CONNECTIONS-
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PLUMBING BY
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, I further certify that (if not the owner) I am authorized to act for the owner of
record, and that said o)IVner is aware and approves of this action, I hereby agree to comply with all applicable Codes relating to this permit,
Fee Paid~. 1 r-] t' / b 7;;l.... \ . Signaturp /7//,a,. . ,...... A;u)~ Dw..2. -.2) - '/1'"
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( ) NEW ADDRESS ( ) FACILITY PERMIT TO TRANSPORTATION DEPT ( ) SPECIAL PMT..AREA. MIN. ELEVATION:
SANITATION
. ,Oomments:
Minimum Septic Tank Capacity (Gallons)
Drainfield Required, Lineal Feet
Maximum Depth
170-1' ~&~
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BUILDING
. "l A./ Type of Construction 7r;roup
a..'A A - ..11 j'~n'----'Use Classification
Q;~;n;s:' cr- '
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Fire Zone
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Date: ;;t..,~ 7. '7(" .By: cJ: ~ ~ G.r.I! Date:'...:J .::.2-,;;'- 7;1
, PLANNING REQUIREMENTS SATISFIED. By: '--k7.L/h.( ;/-. / w-;- J/ Date: o? -d</-1Vd"" y Dat;lssued: (;)-05-78
'ZONE: 1~/J-fY7 AI- SETBACKS:...FRONT ~' I SIDE fA91I>1G,STREET - (FROM C!Ll . INT, SI~RD51 REA~S / (FROM P!.!:l
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LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE" EUGENE, OREGON 97401 PHONE: 687-4394
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POST T,HIS f'ERMIT ON MAIN .BUILDING.AT SITE
BLDG. PERMiT .:-WHITE; BUILDING .-;=-GREEN; 'PLUMBING - CAN;'RY; SANITATlON- GOLDEN ROr::'; OFFICE COPY -. WS::!.!l.~~~"'~ ~ ,". ,..:.~ ..
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Job Location
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( ~ng Permit
) Site Feasibility Study for Septic Tank, Number of sites
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( ) Completed
( ) Pending
APPLICANT'S NAME AND ADDRESS ~ Au 1;{,J;.eC I... J ARNcl<- ,,2(J7~
OWNER'S NAME AND ADDRESS, if differentfr@1_apF,lir;pnt's-LaJYY7 (l -' '/
CONTRACTOR'S NAME AND ADDRESS ~
Mail permit or results of site feasibility study to (~pplicant ( ) Owner ( ) Contractor.
(, ) Prefer to pick up, Call (owner, etc,) when ready,
Acreage or Lot.Sizp
Partitioning #
Test holes will be ready
Subdivision c7!-;/ t.,A-' -ii.~. ~
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7;7:l.aA'.d,~ LOL~-J Blocl< Z-
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V Phono' .
Phone
STRUCTURES NOW ON THE PROPERTY ~
PROPOSED USE (this permit) ("" ~<-r ~II V'
WA TER SUPPLY
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Contractors O. S. #
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(exist'lng or proposed well, etc, If public, name of system/
SEWAGE DISPOSAl
('existing or proposed septic tank, etc,) S,I. ;:
PLUMBING BY
) PROPERTY IS WITHIN ONE MILE OF CITY ( Sf'rl~'7~':" /.{
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Address
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**************************-ll:**************** OFFICE USE ONLY BELOW THIS LINE iHf**********.*-IHI-*********************ll-****r
( ) New Address Necessary
ZONF
} Facility Permit Necessary
SETBACKS: Front _ Side Faci ng Street
(FROM CENTERLINE OF ROAD)
) Special Permit Area,
Minimum Elevation-
I nterior Side Yard Rear.
(FROM PROPERTY LINES)
To: Planning/Building Inspector/Sanitarian/Surveyor.
This applicant appears to have a problem with
Your assistance will be appreciated.
By
,Permit Processing Section
Response'
~b \ By
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Permit Processing Section
125 East 8th Avenue
687-4394
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