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SITE INSPECTION ,
ApPROVED ~DISAPPROVED
DATE
/
7'- :2--/-77 INSPECTOR
C1
REMARKS
FOUNDATION INSPECTION
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ApPROVED 1 V 1 DISAPPROVED L-I DATE 7- u- 71 INSPECTOR 'Jt'-./('
REMARKS_h~ -.A~~ ~ ~ A/C --/-~/-7? O~
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FRAMING INSPECTION
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REMAR~ 5
LATH OR SHEETROCK INSPECTION
ApPROVED L-I DISAPPROVED L-I DATE
INSPECTOR
REMARK 5
IA~-
VV-
FINAL INSPECTION
ApPROVED d DISAPPROVED / / DATE-(~ 2.-<-11 INSPECTOR
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE f/ NOT READY TO ISSUE f/ DATE
REMARKS
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INSPECTOR
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NAME'
SEE
C55-08
CROSS REFERENCE
BUILDING PERMIT
NO. 76-111
18-03-02 701 PARCEL 2
HARBBR DRIVE
IfJH 16t-76
PERMIT if
NO PERMIT WILL BE ISSUED UNTIL THIS A PLICATION HAS BEEN APPROVED
CONSTRUCTION [.=J MOBILE HOME [.=J
/ ,A. ',.
l:AtUdI/J~Ju~ .575-
Address
NOTE
CJ
OWNER
Name
c::J
CONTRACTOR
Name
OSRLGII
lWp
If)
Range
/}3
Subdiviswn
Ai
APPLICATION FOR
Address
Section
[).;;-
CHANGI: OF OCCUPANCY c::::::::J
~/~d
th-h1 '71/7-//1/
Zl.p Phone
Lot
/
CJ.ty
Zip
Phone
10/
Code tJ/9- t?;V;;ensus Tract ~S-- t./ &-0
~roperty Acreage
Wldth_Depth
ACCESS TO PROPERTY (Road Name)~h4' ~ ~
Existl.ng Structures on Property rfl)/)b --/- -- .
properU::';;dd7s/DHecnons fAT ~ .M;jd-t-t'41' c:( ~,yAd-
Below ~ Office Use ~lvxx=xxxxxxxxC:f~~~~XX~yY~Z:t:Z;L=
m..;./ , /U JOT, I Sq Ft r3) - Valuation
~CI/~ ,
I
I
SEWAGE DISPOSAL
Site Inspection II
~ WATER SlJPPLY
Well Spring -
FEES
Bldg deJD
Plumbing
3 % Surcharge . /--::)---
Waste Disp ~?~_ rrn
Plan Rev1.ew
Mobile Home -3/'l f'r()
TOTAL ~c; ~ -' 2--
Existing Sew
e Dl.sposal System CJ
c::t;::::r--
-7/ -J'
/IV I I
or New System Required ~
~\
PLUMB;G
Instal ed by Own
PLUMBIN FEES
PublJ.c
Communl.ty c====J
r C=:J
Name of Communlty or Public System
Other C=:J Name
Sewage
Connectl.on
Water
Connection
;2-
::2-
II c f Fixtures
C=:J CASH
rh~
IP~~HED FACILITY PERMIT
" '~~ = 'M =_
Signature of App can ~..tA"/ ~...,., _
Fee ReceJ.ved By r Date .....,LI~-7,6
MJ.n Septic Tank Capacity Y l!FO Drainfield Requ\ed. - LJ.neal Feet
~Av.JLL- ay dAht- At.- ~~- l' $Jl\'
A.W#A~ /.....J q, f./ u$N/ ~4,1..f//
Type of ConstructJ.on
Group
Fire Zone
/S6 MaX1mu::pth Ai. ~
~ If) ~~
Use ClassJ.fJ.cation
Bldg Setbacks - from Center of Road RJ.ght of Way
Front "';S- I. 5J.de Int ,s-, ,j ~J.de Exterwr Rear "J Zone U- -IY/ ;.,J---
1.~nto/;~I<!..;fW.lJlYI~h1f.l5t;,b'<.!OUlf~<f M_Q..(a.<LVv~/':''7:JI#f1'''' ~h-uJ W~
~. .::el~u_~ ~~"-<...-f "-'-"'v1L~ ~tL-tX ~ <.A-'.Q..Jt.L q ~ n, ()(
l}ANNptG I\. DATE (J C'.N,rrptoN DATE - A. t:T _ BU 'c :~, DATE
~ cJ-~~"'-)t... ",;/...d... 'fC,'j-7? ~...._,~/rpJ .""'--/-?L.
~C55 11 LANE COUNTY ~;PARTM;NT ~NVIRO~NT:L ;;NA:EMEN; ,