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PERMIT # Q)f!;)/ /
JOB LOCATION
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LANE COUNTY PERMIT
Acreage or Lot SI70 Partitioning # JrJ.::;l/lf 7(7 ) Completed SubdivIsion
Contractor's 0 S # ~ th .- /J "'l Lot B loci- ./ ..,
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APPLICANT'S NAME AND ADDRESC: I\'.P.-J f pi ~A .6!I'p;r #7 1 ft:J:~ '-1".- ,,0 ~ (j. r;-7WA./,W~ )lj~hone o/z(~ - 7Vb /
OWNER'S NAME AND ADDR"C:C: T., . _ Phonp
CONTRACTOR'S NAME AND ADDR"C:C: --"'7/ AI ,It (fp 1./ ;J1.I-r- _ 7 . . . Phone
Marl permit to ( ) Applicant ( ) Owner ( ) Contractor (l))~refer to pick up Call ~/(1t, -/' /'-Ih -j (owner, etc) when ready
STRUCTURES NOW ON THE PROPERTY f' (),/J./ /~.{;1 -r M /C'/6-;;;; &~
HIS PERM'IT IS FOR ni IJ (/l.A'_'~ /"A/rz..., '\ 02~~BEDROOMS_#PLUMBING CONNECTION~
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WATERSUPPLY ..i2-r./,,((~/ SEWAGE DISPOSAl ;;2~/)t:.-7~
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THis PROPERTY IS WITHIN ONE MI LE OF THE CITY OF
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PLUMB ING BY
SANITATION
-,,!~h.~ M,nimum Septic Tank Capacity (Gallons)
Draonfleld ReqUired - Loneal Feet
MaXimum Depth
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By -......</ ~<.,....... Date ..-h--..J7.77 By CL R~-1 /~.G. ..A5ate L_ 'Z-y- ~~
PLANNIN(J REQUIREMENTSSATISFIED By '-...k:;~/I.AL:: v/Date /....-;71'" 7"'1( p Date Issued'/'1'u.J,'t p.,#; /iJ71
ZONE P A fl1 LJ.. SETBACKS FRONT .IJ~f SIDE FACING STREET _ (FROM C/~) INT SIDE YARD (""I REAR~ ,'(~RO-M PILl.
I hereby certify that the above statements are true and accurate, and that I have the followong 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 owner IS aware and approves of this action I hereby agree to comply With all applicable Codes relating to this permit
Fee Paid <l: di" =3 n . Signature 7f..,,~ ,.r~ ~~ .h~...J,I~ Da'o
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( ) NEW ADDRESS ( ) FACILITY PERMIT TO TRANSPORTATION DEPT ( ) SPE'9IAL PMT AREA MIN ELEVATION
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LANE COUNTY SPECIAL PER11IT
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LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE, EUGENE, OREGON 97401
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PHONE 687-4394
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POST THIS PERMIT ON MAIN BUILDING AT SITE
C5513 SLOG PERMIT - WHITE BUILDING - GREEN PLUMBING - CANARY SANITATION - GOLDENROD OFFICE COPY - WHITE
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SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED /7 DISAPPROVED CJ DATE INSPECTOR
REMARKS
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GAS PIPING GROUNDWORK
ApPROVED CJ DISAPPROVED CJ DATE INSPECTOR
REMARKS
ROUGH PLUMBING
ApPROVED / / DISAPPROVED CJ DATE INSPECTOR
REMARKS
-
.
ROUGH GAS PIPING
ApPROVED CJ DISAPPROVED CJ DATE INSPECTOR
REMARKS
FINAL PLUMB I NG
ApPROVEO ~ DISAPPROVEO CJ DATE ;I,'~~J'~ INSPECTOR
REMARKS
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FINAL GAS PIPING
ApPROVED CJ DISAPPROVED /7 DATE
INSPECTOR
REMARK 5
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CERTIFICATE OF OCCUPANCY
READY TO ISSUE CJ NOT READY TO ISSUE /7 DATE
REMARKS
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INSPECTOR
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Job Location ..--S, -
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Wr~tten DJ.rect~ons
INFORMATION SHEET
) Building Permit
) Site Feasibility Study for Septic Tank Number of sites
Acreage or Lot SIZe Test holes will be ready
partltlonB# m S1~~ ) Completed Subdlvlslon~'.8.> .L- O'/)t..""-'. ,
1) /I f tl P J) I ( ) Pending n, I
APPLlC NY;'S~NA'MEA-mn.DDRESS u?u.J.,"-4 flI2\MVVV - f<,L,<;/, I.fr.J,-"""Ar
OWNER'S NAME AND ADDRESS, If dlfferen~a~~nt,;s "\ A
CONTRACTOR'S NAME AND ADDRESS .( 1..f1' / tJ J/-^"7-:r--
- ~- -.
'~ail permIt or results of sIte feasibility study to ( ) Applicant ( ) Owner ( ) Contractor
) Prefer to pick up Call . (owner, etc ) when ready f
STRUCTURESNOWONTHEPROPERTY' ~ f' AA <O~ S
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Lot
_ Block
Phoneah- 'Ii/I.. 7
Phone
Phone
Contractors O. S. #
:If, RPrlr(1("1T1C:
PROPOSED USE (this permit)
WA TER SUPPLY ~ .!.iU ./
SEWAGE DISPOSAl
PLUMBING BY
(existing or proposed well, etc If public, name of system)
r--?000-7~tlng or proposed septic tank, etc) S I #
Address
) PROPERTY IS WITHIN ONE MILE OF CITY (
...... ** ** ** ** **** * * ******* *** * ******* ** **** * * OF F ICE USE ON L Y BE LOW TH IS LI N E *** * * ** ** * * * * ** * *** ** ** ** ** ** * * * * * ~ * * "l- * "l-~ "l- *
( o~~e~'f!!ess Necessary
- SETBACKS
) Facility Permit Necessary
Front Side FaCing Street
(FROM CENTERLINE OF ROAD)
) Specla I Perm It Area
M,nimum Elevation
Interior Side Yard Rear
(FROM PROPERTY LINES)
To Plannlng/B ulldl ng Inspector/Sanitarian/Surveyor
ThiS applicant appears to have a problem with
Your assistance will be appreciated
By
Permit Processing Section
Response
C5512
By
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
PermIt Processing Section
125 East 8th Avenue
687-4394
DIVISion
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JOB LOCATION
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LANE COUNTY PERMIT
Acreage or Lot S,7P Partitioning # h1 c;cj(f 7{:; l Completed SubdiVIsion
Contractor's 0 S # fW,I,('d J _ Lot Bloc~ 6 :3
APPLICANT'S NAME AND ADDRESC: 0~1'J h...rA YII?;' "', k.~ cJ.\o!s if) ~;;-/~L/ )/JPh: UJ'ljk.- 7V{,)
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OWNER'S NAME AND ADDRESS . / . ,. . Phone
CONTRACTOR'S NAME AND ADDRESS '-y'y / A A_( fg 1./ )fJ~)-r- . J.. , Phone
Mall permit to ( ) Applicant ( ) Owner ) Contractor ( lLP.refer to pick up Call ~JUt. - r J'I{-- -L (owner, etc) when ready
STRUCTURES NOW ON THE PROPERTY (l If A if-/f2A -I- tf4..J C '16 - ;;;2 ?~
'HISPERMITISFOR rn f.j. (/J./A/'7r3f/'t2..,')- c2#~BEDROOMS~#PLUMBINGCONNECTION5-
-WATERSUPPLY. m./~(~Y tf----./ SEWAGE DISPOSA' :J.~/)r;:.,-7~ SI #.
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TH IS PROPERTY IS WITH IN ONE MI LE OF THE CITY OF PLUMB ING BY
I hereby certify that the above statements are true and accurate, and that I have the followong legal Interest on 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 owner IS aware and approves of this action I hereby agree to comply with all applicable Codes relating to this permit
FeePald$ di.~~ n Signature 7[.'h~_..::fn.-:^i~()~) Datp
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) NEW ADDRESS ( ) FACILITY PERMIT TO TRANSPORTATION DEPT ) SPECIA'L'PMT AREA MIN ELEVATIONr ~"":"""~'/ ,_
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Fire Zone& .'
SANITATION
....~;hv~ MInimum Septic Tank Capacity (Gallons)
Draonfleld ReqUired Loneal Feet
MaXimum Depth
omments If7. 7/.w~~..e.- ,....., ~<...- .,10;4/
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By -4/ ~~~ Date -L,-J7. 77 ~y Cz J{.... _ A j~.(2" .....A5ate L_ 7_<:;:_ ~::;;
PLANNING REQUIREMENTS SATISFIED By '-...Jt/Al...rL '?-Date 1...-;::;;1'0_7-1(-'" Date Issued /'<[111/' ~'fh.'lq'i1
ZONE fc/ A 171 U SETBACKS FRONT ;Jc:f SIDE FACING STREET (FROM C/L) INT SIDE YARD c:/ REAR"-" ,,(f.,RO-M PILl
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE, EUGENE, OREGON 97401 PHONE 687-4394
G Cu f7 --;t,,-;;)"'7"3 POST THIS PERMIT ON ~AIN BUILDING AT SITE
C5513 SLOG PERMIT-WHITE BUILDING-GREEN PLUMBING-CANARY SANITATION-GOLDENROD QFFICECOPY-WHITE
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BUILDING
Type of Construction
Use Classification
Comments LANZ COUNTY_SPECIAL
Group
P ER~i[iT AR.:iA
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SITE INSPECTION
ApPROVED Cl
DISAPPROVED Cl DATE
REMARK 5
FOUNDATION INSPECTION
ApPROVED 1-/ DI SAPPROVED 1-/ DATE
REMARKS
FRAMING INSPECTION
ApPROVED / / OISAPPROVEO /I DATE
REMARKS
LATH OR SHEETROCK INSPECTION
ApPROVEO 1-/ DISAPPROVEO 1-/ DATE
REMARKS
FINAL INSPECTION
ApPROVED ~SAPPROVED
INSPECTOR
INSPECTOR
INSPECTOR
INSPECTOR
Cl
DATJ." U - 7 ?NSPECTOR
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE /I NOT READY TO ISSUE /I DATE
REMARK 5
INSPECTOR
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PERMIT #
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JOB LOCATION.
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APPLICANT'S NAME AND ADDRESC:
OWNER'S NAME AND ADDR~C:C:
CONTRACTOR'S NAME AND ADDR~C:C:
Mail permit to ( ) Applicant ( ) Owner
LANE COUNTY PERMIT
Partitioning # hJ S'f.1 7K~ ) Completed Subdivision
'/~ ."' ,-... Lot Block
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) Contractor, ( LLP.refer to pick up, Ca,II ~/{f/:':::...' j(/f'..':? (owner, etc,l when ready,
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SEWAGE DISPOSAl ;J /;. /) L.
# PLUMBING CONNECTIONL-
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S,I. #
Acreage or Lot Sizp
'Contractor's O,S, #
STRUCTURES NOW ON THE PROPERTY
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THIS PERMIT IS FOR j;' i I-/- /./.j
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'WATER SUPPLY dr.-, I' I I (," -'
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THIS PROPERTY IS WITHIN ONE MILE OF THE CITY OF
. PLUMB ING 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 ti:lat,sa,id owner is aware and approves of this action, I hereby agree to comply with all applicable Codes relating to this permit,
Fee Paid $ .?/ /~ ., ~ n Signature .-;., " "r , " Datp
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( ) NEW ADDRESS ) FACILITY PERMIT TO TRANSPORTATION DEPT, ) SPECIAL PMT, AREA, MIN, ELEVATION: 1:/.. .
.SANITATION .'
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Minimum Septic Tank Capacity (Gallonsl
Drainfield Required - Lineal Feet
Maximum Depth
BUILDING
Type of Construction
"se Classification
Group
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Fire Zone" .
Comments:
'Comments:
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LANE COUNTY S:i?ECIAL PERMIT AREA
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By: ',_ _ Date: .J.. -, 7 -1--;1 By: (.
PLANNING REQUIREMENTS SATISFIED, By: ..........;6,~ I r
ZONE: ,{fA J"n J SETBACKS: FRONT J./cf SIDE FACING STREET
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Date:
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: ~ ._/ ,. " Date Issued': ~ " f:, Aih ;'1"'7
INT, SIDE YARQ. <::-; REAR'-' r:' ,(~rROM P/L)
PHONE: 687-4394
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LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE" EUGENE, OREGON 97401
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~,' j /-' 'Ii.....''''.. / _ POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. PERMIT ~WHITE; BUILDING - GREEN; PLUMBING - CANARY; SANITATION - GOLDENROD; OFFICE COPY - WHITE
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!4.'~ ~ . (-, -LANE COUNTY PERMIT FOR '\ PERMIT NO
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CONSTRUCTION [] MOBILE HOME [J PLAN REVIEW [ CHANGE OF OCCUPANCY [ ]
DOwner (1 nJ/lAt71 AJ_ ~(J;ftA ~~./ ,"17t:;' .J/J. /.). ,1.0...1/'/97</77 1t/7- c1(}oF
- NAME - - ADDRESS 'CITY '{ iI'
o ContractoQ.1-i' ~) <:ALn, / ~ '. )
(J ~ 7~ NAME"- / ,- -
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/ PRange ..3 Section ~
ZIP CODE
PHONE
ADD RESS
ZIP CODE
PHONE
Ir7 5qt.f. 7(;,
Twn
Code
Census Tract
SubdiVISion
Lot B lock Acreage
Name) rliJAi-h/l) I)A./~)
I' ..-- -
Width
Access to Property (R oad
Depth
EXlstmg Structures on Prop~rty ----;Jr A'rM tJ ~
Dlrectlons,to Property Address cih,,~) 11../:,,).~) -../r...t' Q,.L';-A2<.~ t1!-:f-'
.oAt f7J OAf,." . 77, l4..-j /J!.Yl./l-l-f rh .h-},A...i? ~
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ST~RUC;f~!5E (# BEDROOMS)}
f.. J.Y r 1.1'1'171 / ~ ...A t7 ./ 1 1/l t? 0
---- fI-
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VALUATION
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SEWAGE DISPOSAL 7/,. - 7b G
PUBLIC (] SEPTIC TANK IlJ:"'-OTHER ( ]
BUILDING
PLUMBING
3% SURCHARG C
MOBILE HOMF
WASTE DISPOSAL ~?;::;-IT (")
PLAN REVIEW
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PLUMBING INSTALLED BY
OWNER (] OTHER (] NAMc
WATER SUPPLY PROPOSED I ]
EXISTING [J
l><j PUB L1C
( J COMMUNITY NAME
( ] PRIVATE WELL
( ] OTHER SPECIFY
TOTAL
_'1 C 1f7)_
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CONSTRUCTION PERMITS & INSPECTIONS AND'WATER-POLLUTION CONTROL SPECIFICATIONS
MIN SEPTIC TANK CAPACITY
GALS qnn MIN DRAINFIELD lR:n UN FT MAX TRENCH DEPTH---3.t.- INCHES
R''''6A,AJ n_ ILI\,~ J"'^ ....'d"...d~"-:r 61 ./i1.,-,~..t:,o./J. f{.,~- {!)....,'!h....11 "",j
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/..,;p<~ W\R.ti(..O '"to LIR- 101)' fr'-'(JWo.. ~ , STAY 100' FROM ALL WELLS
TYPE OF CONSTRUCTION GROUP FIRE ZONF USE CLASSIF
SETBACKS J}.FROM CTR OF r/W
FRONT ./ """ r SIDE EXT
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FT FROM PROP LINE
SIDE INT ~ 1 REAR
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AUTHORIZED SIGNATURES
/s/ '7/Y"..AI'?' /t':J~'!!2.0 /.".~
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SLOG PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBiNG - CANARY
BUlLDING - GREEN
SANITATION - GOLDENROD
ISSUANCE DATE
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Call 6874065 to schedule all required construction Inspections Call 687 4061 to schedule all required
IMPORT ANT septic system inspections All construction shall comply with the State BUldlmg Gode 0 E Q standards
for subsurface sewage disposal and the Slate Plumbing Code All bUildings require a certificate of
occupancy bel ore being occupied
(See Details on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG AT SITE)
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LANE COUNTY DEPT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX 135 EAST 6th EUGENE OREGON 97401
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APPLICATION # .f!2k,<?L- 7h
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Name
Address
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The above appl1cat1on 1S be1ng held by the Perm1t Process1ng Sect10n for the follow1ng
reasons
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D1V1S1on
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Sl gnature
D1V1S1on
Sl gnature
Date
Th1S appl1cat1on w1ll be held unt1l If the 1nformat1on
requ1 red above has not been furnlshed by that date your appl1catlOn w1ll be cancelled
Fees pa1d for waste d1sposal system, (slte 1nspect1ons and/or apol1cat1ons to 1nstall
the sept1c tank and dralnf1eld) are nonrefundable Some refund may be made on the
bU1ld1ng and plumb1ng port1on of your appl1cat1on 1f cancellat10n lS necessary
In the event a Plannlng or some other long-term problem eX1sts over Wh1Ch you have
Vno control we w1ll hold the perm1t unt1l the problem lS resolved and we rece1ve word
from you as to whether to proceed wlth permlt lssuance or process a cancellatlon
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PERMIT PROCESSING SECTION - 687-4394
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