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HomeMy WebLinkAboutPermit Building 1979-9-29 . POST THIS PERMIT ON MAIN BUILDING AT SITE JOB ADDRESS: ~ IL,C:;;F~'i.'y~~oj<:-j ~jJlL'~~A~"J, CONSTRUCTIONPERMIT# L C ^943-?9 TRS, TL: '8 - 0 'Z... - t> C . a...q It.. "3(i?) I Subdivision: This permit for the referenced property is hereby Setbacks and other conditions of approval must be strictly observed. Violation can result in revocation of this permit, citation under provisions of Lane C;ounty's Infraction Ordinance, and/or other remedies allowed by law. , . . ~747T /14D jG..",t Z~'Y ,40/<- SI"A,".vf-t".-/..d Telephone: 747--;'--18' Telephone: Telephone: Applicant/Address: 13.iZ-.AJ '''Y' 1M. o,A..<../ /lo4t! "''-<-, Owner/Address: <;"+.... ~ Contractor/Address: D..,z.o/> y C<:J''''<;''''''~<-+-;,..J Contractor's OS # I fJ tt!:J Total Construction Value: Jg 3 7#', ~ '-"'" ; Construction approved by this permit: Water Supply: P!-ANNING DIVISION WATER POLLUTION CONTROL DIVISION . Setbacks I nterior property lines Edge of road right,of,way Building foundation Wells, other water sources CONSTRUCTION PERMITS/I NSPECTION DIVISION G,4-fl-4Gf!- ,-........,0 \ . tJ/J vie... ,q.cI. J. -n.. ___ # Bedrooms: jJt./(4- # Plumbing Fixtures: -4 # Employees: ~/::l, Zoning: /Joe.. 'f- Partitioning # Parcel # Minimum required structural setbacks, from: centerline of road, front: side exterior: I J ; interior property lines: ).. 0 ;rear property line: Special Instructions: Parcel Size: ,s-O ; centerline of road, '.4 3 4 C..4 <j For information call 687,4394, Site Inspection # Installation specifications: lineal feet of drainfield required; max. depth of trenches: Special Instructions: , J 1M C)l.. ,~t::< ...,v gal. min. septic tank capacity; .... j?(~~(...( {/Lit 7c r-1J.-;lcte...J Septic Tank 10' 10' 5' 50' Drainfield 10' 10' 10' 100' For information call between 8:00 ' 9:00 a,m" ' Type of Construction: 5 -/o,J Group: Instructions: ')'e.e /Ilcrf<',) o,v M Fire Zone: Use Classification: G"l-;t....?..<- t!..p-~ 3 pL"'''''' S For plans information call 37 ~3 between 8:00 a.m. and 9:00 a.m.; 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: :;.2 """.!. < /IA A.. '.v /7c;....JJ ') 'Z... ",I.. -Iv ,j-.o ~/,""/L I2d. i) ~ F't- , C;~ /L, f- rr r Date Issued:.;Z. 9' - 5/7/)1' - "7 9' DEPARTMENT OF ENVIRONMENTAL MANAGEMENT COURTHOUSE I PUBLIC SERVICE BUILDING 125 EAST 8TH AVENUE, EUGENE. OREGON 97401 BY:~~, C55-13 \ . ----." ~ . :'PLOT 'PJ-.IT# Vie""" if l'11czp fYlA.10 s,.-' '3 ,,;?L<:l, , V (, " '" ~ \" \1 AJ='..... P... 'D "- .;;;~ ~Ij J K ~ J ~ :_'.'"/_,~-,, /'f5 -0 Z. ' 0(.. - ,350 ( - . N ~ df- 123"- ~(}J Ffe(.9 r- If' tJ -~ -J~ '--- --- ~ Ht7T' 'T.....s?J\ ~cf' 'J ?/Zo?ose:1) 6ffR/t6E :'.;' ~/<';'/>::<"~ '" />"/ r_- /)"' ;-. > ," "::.;:~./:>;:..~:.~.~::-~:;~~; /:~~;.~i~~ /r,. . //" f{l),m G< , //./,-/ / /".//7// _ : '~~" < (;;1 ;.~::-- : /;>-:' )";,:" /7 - /. ./,.' .'.,' <./ ~/ ,.-'. /-'~" . ,.'....,/ 1--<.;/ , " t::::l ' f. . , v' /' ' '.. . "''' '. '. . .- ~> ~)'" - ,. :. >:;.>,./ /.' " . . ,'/.,. '/ / '" , 20--7 ~ ~ " '- .'- .', . "~' .,. - }( \ N \' Z- '-e. Y frVc=', '. :._~ " , "~:l:~' .II?' '. . ~": .': '~;~"" . ., '~.'lI." " i~ 'Il'~ d ,~~~" . t ,; ',< 1~;;) !I'~ ' . ,hi rili; t . "",, '; ,,:'{'.''. :'~r.! . , ,. ,I, . I ;'.' "_r~; ,": I' ~ . , " " ..', '. :'.. .' . ,,,~ ,d ,'i " ., 'I .' '~I . . "'-'''':'''--':':~''~:~: .;~~. '.,' , . '~."~ ,., --'--~-'.Y ..........-...... ...........- ............,..._."-~.,.,,..,-.,..- BOLD SLIP lane county - APPLICATION # LC.- '2A4?:'-i1 "6\2-A-'ouc~.'-( -v M()\J.J12S.Autb.::. \ \ 4 () V~\~"~1?j::;-'1' ~\\o.\r-,t::I~_L" .Il~"-:. \ . Name Address (/'14-1/ Zip Code . The above application ;;:.reasonS:1) 'PR-cNn:)'C. , ~ ~ (.,LA-e.\~'-( ( ,1\'99\"\\ 0 l-\ 11()~De-. "".:; o~ ~ \OK I Cf/z.zlzJ !ft~ is being held by the Permit Processing Section for the following r.;..\-..l,GJ"\E'i:;:...\<- "\"e.\.Y:;.S ~_S\~"\ r-:o~:).c" I ":)9A"\ \v -J:€c\2.. '\~\wN. ~"-\::5\\1-\.(\ +\O(Y.;,1i;.. A"\D I'J CN~~"'V' \~ 1\ I?, Y~OJ\DS. O<;.:\~\l:...:':':> ~ ,~~. tJ-.&:' ~/z.?I?? Divi sion: 1",111 "" "-I (, 1:N. ~?E:C:T"\ f\~ \ 0.. cQC\.IYVV.. 'u::"I-"C Si gnature: ~ (\f\t\ It Date c\ - \ c:j -ltj '\ .-' 'q/~ 9 - '2-'6 Division: ~'i2.f\.\r\'" 1l:2.C)('~l--,":',\\o...\(, r f \ Signatu-re:'~,QI'-\r\ (()\JTDnI \.1<:::oVDate 4-\Ci.'1c, r- ~;'~"'" \ \i--"".\ 'U\~ - ,- ,^~' ~~ .;...l.:,---, " '/ This application will be held until '1. 'l(,,-'1(j . If the information required above,has not been furnished by that date your application will be cancelled.' Fees paid for waste ,disposal systems ('site inspections and/or applications to install the septic tank\and drainfield) are nonrefundable. Some refund may be made on the building and plumbing portion of your application if cancellation is necessary. In the event a Planning or some other long-term problem exists over which you have no control we will hold the permit until the problem is resolved and we receive word from you as to whether to proceed with permit issuance or process a cancellation. PERMIT PROCESSING SECTION - 687-4394 C74-139 .~ 0, ',....:': , ,c. , ...;) i~::L"'-'" ,t~ FLOOD PLAIN MANAGEMENT '" . ",~.._' Department of Public Works 125 East 8th Avevue Eugene, Oregon 687-4195 TO: J~ PERMIT PROCESSING PLANNING PUBLIC WORKS PERMIT NUMBER ...ZC)4.::z....-.,C) PARTITION NUMBER SUBDIVISION OTHER '. APPLICANT'S NAME SITE ADDRESS 1\40 K...I t--..lTZLE.'Y /::...-....)F!::, PERMIT VALUE IS A SUBSTANTIAL IMPROVEMENT. YES t./"" NO I~ NO SITE IN FLOOD HAZARD AREA YES 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 FLOODIrJG. MOBILE HOME TIE DOWNS REQUIRED. SITE LOCATION IS WITHIN A FLOOD HAZARD DETAIL STUDY AREA. 1. MINIMUM FIRST FLOOR ELEVATION OF (M.S.L.) REQUIRED. 2. MINIMUM FOUNDATION ELEVATION OF _ (M.S.L.) REQUIRED. 3. MOBILE HOME TIE DOWNS REQUIRED IF GROUND ELEVATION THAT MOBILE HOME WILL BE PLACED ON IS BELOW THE REQUIRED MINIMUM FIRST FLOOR ELEVATION. SITE LOCATED WITHIN A DESIGNATED FLOODWAY CHANNEL, BUILDING PROHIBITED. 'RECOMMEND/HIONS: / .,1 DATE '7-'2."".,C) BY C,\'\!C C99-21 '"t .;:...,. 3: :l> -0 (p , o N , ~ I N I +:-- .. .,l -< :l> x r o . -< - ()\ ~' ,,", ,~.;." -". ~ . ""l '.'.,. .".,..,.,,,.'. \.' . ." DEPARHiErn OF EfjVIRmH~EinAL nANAGH1Ern , 'PSB. 12S EAST 8TH AVENUE EUGEljE, OREGON 97401 'l'-.' 0...' ,;{.,~ ,':, -,',. .. ':' ' ~ ~ ~~ ''7 .' <0 ,~1t~. . IJql1 /4,..,fz.leL/ AUf?- Citv 5~/ Township, Range, 'Sect/all. Tax Lot '/~_/'}"'7 _ (J&, ?,r---"'7.. ~ '- 'i l'-- -- ""::-4 . ,; ~"... Subdivision ~',.",.-::--?! ~~.~.d..,_~ La... "h,. Block I'>'L.. Appl ication for-e--.r.,..,.~~;; r.. .- De;;r;, ~ rl oI,.+rO~ - ,- - . ,. ,- .- Structures now ,on tf2.g~~r?pelO;ty 'D."-'Uj,/~ !,tI. A.p m 1-/ Proposed use of property: fKi Residential [) Commercial Affidavit: 1,'~ ~/..e'f n h1m.,,,,,p/'J..._ I(please prfnt) If this application is for an agr'icultural building it '.>,ill 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 interest in the property: ')C owilej" of record; contract. purchaser; lessee; holder' of an exclusive option to purchase; duly authorized to act for the 'owper'o, II'ho' is t;.nOl->,ledgeable of this applicati?rl. . A ./ Signature/Add,'ess ...,g..,_~p7/.,~-:;iJ~'~_ _ ~ , //#0 f<- -1?:.(,.,.,,, Av-e -;;:"~(zio) 97"'-7'7 TeieRht;~ .~ ,I ..... or Date / tl r , .' . ~ When pennit is ready notify: I-I Appl.icant' lfil Owner I I Contractor i!L: I-I mail I-I Owner 'K11G41) /I?11"rWR.-,....do.P.t<". '(;;;UJ'_.I,J.,,; <",h"../~~-(Z1D) <J7'/77 Pho-;'. Contractor 'lJ,..~av fJ>...;;;+. /{/ (ZiD) 'j 7 'ff7'? Phone Contractor's OSR# 1'R7.- 'S('~ P,l,umbing by \r ,( Job Address ~RP1.ication ~ s c---,lu, \,\ '?--i \ \' Assigned Numbers I. i I ,[ CI Industrial () Public , hereby certify that this information ;s true and accurate. " phone ?~ 7 9'/f?! 747 7'1'i'1 .; ...-- .~ Fee Code Description OO'NOT WRITE BELOW THIS LINE / of employees # of units ~~ c.&e. ~ SDS: U Existinf- BP I ~, \ "<=---.. \ (d 'JiO,;,:::' "'";~:E ;0 ::"~ (C) "~'::""'(') / I; 1.._\ $' --..~ ! $ If Commercial: I of stories , ~~I Residential: f o~ bedrooms ~~ ;; tes t holes ,'ead)\ ( ." ....,-r. ......,.--:;::- ?"......... -, \~ """-' ~-~' ~ - W. (-Y.~ .~ , '\.7---, c. ~ ~ ,-, /" I'" I- --'-' - ---II -::::::, ( 'k-'~\-\Y Ci ~Sh~-, ~D~ /,,/ Cneck # . . R;:ceived by " -,\ \f\ 6..... - ~ Water Supply Proposed Year Installed Existing '\ lata r'fal uati orl: $ ..'$ ., Plumbing fixtures at $ each I \ I $ Sewer/wate(.conn. at each 'SubtotJl $ 4;(, State :lurchi1rqe $ . Plan'; check fee $ ...\~ Chan!"Jc of Occupanc~ $ TOTAL $ \()'c--\ , , ~. "~to :~';;, :;.:. ',-" PERMIT PROCESSING Minimum setbacks: Zonnr_ '-:1-- "ar.t,-II s., f~ont-( . .=--r\' \ ------ ".....:... :'Sy s i dec--~'=- ,_ )...;" .../ Parcel # - P.arcer:S,ize \ k.\ ~~ _~.>../J int, r \6' ""-, rear ~~'\~ \. --> "- ~-' - ) Comments To be typed on permit WATER POLLUTION CONTROL ..~ ~- By ~ -L)~Y~ Date ~.- \1\_';\9 Installation specifications: gal. tank; , To be typed on. 'permit JM.. (\ ,-., ~'^^~ ^ <:i..J ..... <l (J '-:;(1 o,,^,,-\-..,..... r~.'-V\ , M fti j,;ati~~ld'r;,..t~";:cheS~j--s # - - - Telephone \ A \I '\i'\..., 'Q~ By' d?F~r1 i?l~~ Uute -7/13,/' I..?' ': , v-. - . \ ,'rll . ""'- ~\ "cl..; \~. r <::: " ~ r---... \.-.._.1 --.' .--oo4t- c---..~ '----.\. \" '---=-_...,., ,"'...,.- I-laId Shp l\1t~'~ Date to to pee Colilplt.:trd pee - I-I SI.FO ~/{P&I---:- _ ,~/ ~ " I-,I"WPC /~/ Planning I-I Publ ic Works - - /: /J/ Elevation CI Address CI Facility site~~,....,.-\ - - -........ -.. c- C-,<:;:" ,0. - '- -, . Pl ans to: CP&I wrc setls) set(s) Date ReqlJ; red Directions to -r-I\ '~-'q/~ I; ~ '7- ~(I, d-D CI n/a -.f2..t..Q -.::; F/ -. PermH ,..1 C/ Environmental Health .< ~,"'ri!~>~:\'i, 1: ~, I', '. /.74 ;0 ~\\\ ' FOR '_:!."..:.~,:,;.:(~',.:;" " , INFORI-1ATION about progress of yo'ur. appl ic?ti.on .call: Permit Control Center 687-HELP (687-4357) ". ..'1 .' " ~ , , I. . ..~ ";-", " ., ~ -, > .: ,-..,' ,';. . .', . ":': ;v'> ~;,_'..-j"~ffi"ol{.;,":' '.-~.'.. :Z'".;~;. <"'~' :';,i',_ ~,;,~:,.. : ' . ".,-, . ~'. . . .....,. ."-",.' ....1.0< r. .' .~ u SLIP lane county ,. BOLD APPLICATION # u:-'2cH~'1{l i~\2 A.-VL-c:. '-( D t'-'\ ()\A) k: f;: I\I.)~ \ \ .L1 0 ;(~\I.\'< lWl....,t .1-'(2,1-\(-. ~1t;".L,,(,Lt:::.. , Name Address 41-4"1"1 Zi P Code ' The above application reasons: i\ In v (OG-O\!I1,)S is being held by the Permit r~ ~...\{,! "-\~ ;~ ~ ... "'i!,..J">'J Processing Section for the following ~'''' .~\I",\-\ i ~\~ ,:'1., .1\"\,-\ t> c:...L^CI~1' ~\-'i:)\...I(\ \ C ~\ ~~ '" '--- 'c' \.lJ ~ " J,,:.~?S.\;>' \i-- .'_ !.' ',)T", ",..J I . \ d..J ,. ,_ (\ I '.) Y\-~ !..J-J\\ .-:-..... '\ "'...l-' \ j _ 1'"" ,1'\\\_ ) Di vi si on: r. 111 1,,"1\.1 (, , f . \ \.;. , '" 1 (t :\ ("\ \ 1: N.',,":>::"L."\-\(:l' LJ;'", ..:1\, Si gnature: I .r,..,. ' " \..c\,-"",\.'\ Date (i - \ I - lCI ~ ~ "j\h ITI-\\\u"-\ is ;:::.;.\...'E;--.JA\I Dr-...\ ~:i2.t\..\ r\ Si gnature: 'p::.12.r\.\ rl (GI-lTQnl Oi vi si on: :r-'\2cf \=:_ r ""'_'J \ \\...\ (, \ GJ= oldlate q .. \ (I . "lei This application will be held until "! - }(, -1'1 If the information required above has not been furnished by that date your appllcation will be cancelled. Fees paid for waste disposal systemo (site inspections and/or applications to install the septic tank and drainfield) are nonrefundable. Some refund may be made on the building and plumbing portion of your application if cancellation is necessary, In the event a Planning or some other long-term problem exists over which you have no control we will hold the permit until the problem is resolved and we receive word from you as to whether to proceed with permit issuance or process a cancellation. PERMIT PROCESSING SECTION - 687-4394 C74-139 .OEPAfnnCIH 01' [NVIROIil1ENfAI. 11MAW,CNT psn, 12" EASl 8TH AVEIJUE EUGE;~[, OREGOH 971101 ,}': \:.. c- , Job 'Address d.!l.h /4.-,ft~v" /Jue. . lem! s;#t:l ~11~1~~~[I~r(!g~~i?~KRrg'~B~-A ,~.:t: .L/O{' 7>~~~ ~~j6tM_~ Application for/I~/]; ,.... Dee&> €Lridl ft()AI _ Structures now on the prope.,(y , ~.blLW.uie.. 'Y11 t-I .~ J i~!YPii~~~,4~ilibJTjlr<ipilft9!i ~ '~ilgj~l\il!tilj; {} 1~9ii#~~HU; 0 lliiilV{tr'l!ill O'~4~jJ1W; f ' " . Affidavit: I, ~J~)fPJA~;;P~~~~/'- . hereby certify that this infor~;tion isl true '~nd accura~e: If this application is for an agricultural 9uilding it will be used for purposes allowed by the State BUilding Code and lane C9unty Code Chapter 10 (zoning) and for no other pUlpose. I have the following legal interest in the property: J<: owner of record; contract purchaser; lessee; holder of an exclusive option to purchase; duly authorized to act for the owner, who is !-:.nowledgeable of this application. .'. . Signalure/Address ~-",--,/:!~~~~-<J /F/o f<-" kt-e.v Av-e ~#iP) 97'177 Tele~e ' (or Date " j' I . When permit is ready notify: () Applicant IN Owner ,() co~~~or .I!.Y..: CI mai] "1/) pho~e . Owner _TI~ ~e...del<' ft't'DJ:A.,I,.kY"'rOK6-1IiP) 17'177 Phone .7'17 9'19'1 Contractor ~K-(.3V J..DV\<77; / (lio) ~ 7 YF77 Phone i?'t} 'fYi'1 Contractor's OSR# /~(.,'ii'3 Plumbing by '" . . . . ' '~AIll.'lj'4~~fill;; .. riqC\.'......; '-\:q, 111\~$.!s'li~1f;!~lim~~&l1 , t' . . .. , t: /"" .... If Corrunercial: Residential: ~ DO NOT WRIIE BELOW THIS lINE . # of employees ready I . SI test holes , BP # i: ~~~~ ,"" ~-~~ . ~\-I. \0 \-~"-\ 'Fee. Code 'o..scrlot1on' . Valuation Fee / ~ c--- -.,--r. 'v r. ('<, f' f:\~:::'-> ~ ~'FV~ G \....\.C(~~ -\/~ ' '\~c.,-<:::-,~ ( .' ~.' , , 1'-/. "'.tc.....'~'.....<...........x; ~\f "l. at:-.... I~'~ ~ R~cei~~~;,;- \. '\ Do,,/'-...., I r '-\. ') , '; <....:oC) $ $ $ $ "- (=' ) fOJ F~u::::' (":::;'')c...,() / "\ / "l..Tof,t.a,~:,v,~tlu.a't,."o n: $$ r _ ng. x ures at $~a...a"'~onrt': at $ ,,;;I.lll PROCESSING Minimum setbacks: Zon(1(,..,":1-- . , Pa~' - t, fron; ( . ""=--:Y:\';'.:"j:.:.' ,side \ ,-..,... ,. .... ',~. \. . . . '----.: . '.: <' ",' " ---- Parcel # $ each $ each $ $ .- $ . $ , $ . $ \ ()~ ~. , eleu,; \...\.~ ;.-.:;. int,~ r~~~~0' \.. 'I' ....J I . . ".. . . .i.' Subtotal Water Supply Proposed Year,Installed , . 4% State surcharge Pl ans check fee Change of Occupancy ~~ . Existing TOTAL '.0nunents 'II l)(> typed on perm; t ff~ Type fa be typed on permi t Group ".Fi re Zone By n_ ,-G'C\~ Use Classification Date C\ - \.~__\ -\9 , , ," .:f By Date !' plans informatio~.call (area inspector) _ ,'c.:tlOns to sita~~'" ~_ <\ 'l. \("-0, Y'oo l..J _"""r, c::._'Y~ ~d \ 'i'.'--+ s/cl Plans 10' CPSI _ set(s) Date ~.7'V. WPC ~ set.(s) Required ILler. C WPC C)/~ () Planning " --- CI Pub;5< Works . 1]( Elevation CI n/a 9/'-4.~C; CI Address F' () Facjlity Permit /~/ Environmental Health "Soo+ '--..... Phone " ,-'\C..l.< . "" ?-.-~ I".~ c:s-Y"'\ ~:::::;z ~,,~+ .. . I~ 'Date to." ': PCC , ., ." . , ' Date Completed Hold Sl ip to pce ~Jlol/7 4 ~1 FOR c74-171 lNFORr~TION about progress of your application call: Penni t Control Center 687-HElP i{.,iL ~. "dl'l <,f:1tt~; " . .'t'~~J!t. ".... "-'.'l;:~V 'r': ." .::'>4.~.~1 .".0' ':"'1 .,.'-,:,I!. ..1. . '~:-1.,_.' "J 11 -t~~"'j~'~",/~~' (687~4J57).,"';" ' , : :j'j!V'J , 'll'1.'I' r '1,; . :i. ~ ' , , . ~ ~'. LANE COUNTY BUILDING.-PERMIT OR MOBILE HOME';USE APP,L1CATION P!'RMIT TYPE - BUILDING 0 MOBilE HOME DO'SC~EG# ...PER~IT :#: MfI,!o/---;t/ PROPERTY OWNER MAILING ADDRESS PHONE me.&.d/-t;/<<; ,'/JO/fMc.Ll . LIe. / 8/'7'xL/3(//I-'.''-..)A.7L1cJl...,' 7(/7~,PhtJ.t) tONTRACTOR.' :. , o' " . .- MAILING ADDRESS 77. PHONE' V~ ,','~ Rei' zf; ~{j &.// V;4~~/J C'(<-'l~tf?P?8P() ~ it: , . V. C/. ..' " - METES & BOUNDS .0 YES ATTACHED [] NO , SEC. ,X.;;>,<--/ TAX tOT, # ,9")D / , ~ CENSUS TRACT ,'/9:':0_/, ., 3 '5 - ') 5z,.~ DESCRIBE".EXrSTlNG STRUCTURES ON' PROPERTY IF ANY ,'ZJ~,~ Lt:.trAL, ACCE,S. S. fo ,p.ZO ERTY - ROAD NAME 0.' # J,/, ",,*" ,. . , n ~/.3 'L.L/ ' P~OPER~Y _siiE-=~D~~ r. _ DE~TH 'CODE /rf ' 'D:::2. APPLICANT .' " NAME AND, MAIli"NG ;rL/..t~.J ~ ;-',' ': AREA ADDRESS . FOR MOBILE HOME 'PERMIT ONLY Number 'of Bedroo~s ('3 l_ STJeU:S;" ~;;;Z'~_L' L~ . ": Connect to'EXisti~'9.s~wag~: System :\/ ~r New System Rea,'. 0 T,YP~ CONSTRUCT~ON. ,_ '-: SQ. F-T';','4 . #. BoEDROOMS VALUATION ~- ? ~(l;f,,;t;, .' ."ji/$~ ('~'<~;jdfl//~. \ , ---/ J?d~' J J SEWAGE DISPOSAL . , -. PUBlIC'D .', SEPTIC T~NK . ~ . BLDG. . .t. , ~- OTHERn .. 6WNERn ,'.,OTHER n NAME' FEES . WATER.SUPPLY:, . PLANS, F,kf.Jre FACllITYPER^:\IT 1/ "PUBUC 0'--' OTHER.~ YES'ki NO 0 , YES 0 NO..er . .~PLUMBJNG F~ES" . s1G~ATURE j>}tPPlICANT ~ . ./ 1 DATE, /,,;/ _FIXTURES',' , . AY~..j/?1//~ 4-//~7w, , 'CASH~ SEW~~ ..:'~- -. .'fEE~ RE]EIV~ BY -. ' ". _JAi~../ ' CHECK n CONNECTION'FEE Y 5:LA-.L.' L/ -/,/,. 77'". . '. ~~~~E~tj~RFEE' 1f'lTio/-; tij / COUNTY BUILDING & SANITATION, SPECIFICATIONS: c' /u - D~AI.N ~_FIELD.~~QUJRED . .' /. lIN, iT, .,,,"'" TRENCH WI~~;FT. , C',:SQUARE F~~T ,- ,', / / "c';/; /, '., PlUM~I~G -INSTALLED_BY WASTE "DIS. PLUMBING PLAN REv-rEW PARK TRLR. 4. CJCJ ~ 'TO, otf!) '. . d~ {)() TOTAL MIN. SEPTIC TANK CAPACII:'.' WI1H D\5T. ,BOX: GAl. , TYPE OF. STRUCTURE. , , 17 /-1 FROM OR. bF RtJAD"RIGHlOFsWAY . OCCUPANGY. J ZONE I' /. '~;A'D . , PUBLIC UTll. EASEMENT ", , , BLDG. SETBACKS,...- FT. FRONT ~. , USE- CLASSIFICATH?N SIDE INT. SIDE EXT. REAR PlANNING Date' BLDG, ~,' y.-/t<_""~,' , / INSP/l~k ~.;&;U L/~/? __D~ r~7 './ ' '. / .--. . .... .. - . -." - '. . I ,~~ ,if 1r7hrDa:' ,(), , Directions to ,find Property: ,- , COPY T'- OFFICE. COPY 2 - JOURNAL COPY 3 ;- AUDIT' Form #' C55-12 '.