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' , . , , , . . .. ...../". ~. ~ , , '., . , . , . . ~ ~ .' '., ~ . ~ ..' . ; , ',> ':.",1'100 .... .~. ~ ~ . . ~:Ij ; ',:: ,..-'~. . :. '-" ..' ~ lnt ,,~-. ~ . . , " '~ ., !\ , ./~';'."" '-: .,4. . ~ " . <<.r t ~~ ~ .. - ~<. ; , '.. ~ ," . ... ~. . , .... -', . "', " .~~ . '. .~h>':: , ~ ", . i['ll;: i;l: : ' 'j ,P , ~I . . '.. f - tfT ;j" '';:.. { 'LANE COIJNTY DEF'T ENV MGT RECEIPT ~\ 185879 DATE 062179 '-:-::i,PPUCANT GASI{ADE"'F'OOL , ADDR 3834 MAIN ST' SPI~INGFIELD ORE. . , , >1L~ 1703244,{H 1400 SUBDIV FILBERT GROVE " LOT, 3 fill< 2>.', --:-I~EW BLDG TYPE USE R NO BDRMS, 00 NO UNITS 001 NO STORIES NO :EILDGS O~l : "':: -~-:,:C()DE APPl NO 'ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE rDAYS,':- : :)~p SWIM POOL _r -t:::-:-:.; ~: ," '.BP UNDERGROUND , ';:. :-":BP. \ ' .; <BP ; ';BF.' , :' :BF.' ~:Ir LG 185&79 POOL ~.~~ NO, FIXTURES: :-- : MECH : :: :SUR . ,. 'F;CI( ':.; \1": , :,J:. . <~.. , 25.00 . t, -Ifl!l> \~~.r< , , , , NO. CONNECTOHS, MECHANICAL FEE " STATE SURCHARGE' .,.f.'LAN CHECK FEE 4.00 EACH .- .' .; . 4% 50% f \ 12.50 (:<'-" . ..'^~. -' -. . ' ,',- ,S~FO 1':tq:AK{;N BY CPI DLM WF'G P~~ Ei._EV A!l1j13 FF' ENVH 8tU 1M V,\COMPLETEP:""BY . l~OTA FEE*'l* /'lOA ',' )~' '3, , (1 __.. ... /J "y' ,n...A ,/~ , ~ ;...vyt...-:l.;- ~ '---0' /'n/YI"-""1/'-' .......... vc .. I _ ' ':"" /~5?'., C0~~?f~") o I\l ) le,,- i :::< :) o .' , \1-' . . ~: '..; : (j .' (, :- :- . . l:-""" 'cj'tc:.:. , : 37. 5~)'.l :(1)1:: . " . ..~. . . " ' .../"" ~.. ' , . ' . " . . ' . , . , , ' , . '~.~~ '" : l: ~ ~---. , L ;. -..' '_~; f:.o . "",' :"":1 . 'f).":' . , . " 'ip' Job Address 2 7/7 _ DEPARHlENT OFENV I ROW1EiHAL t1ANAGE[',lENT PSG, 115 EAST 8TH AVENUE EUGEIJE, OREGON 97401 \J:.......- '-' . l A~SP~'l cr Assigned Numbers Township, Range, Subdivision Locu<+ S+, Section, Tax Lot 1"1- ~...:. ~L,e:;,,,,,v""- SIAl; ~ "^ : "" ' Ptln I J !J4.4,/ Ci ty Sf>"';"''''' it /4071 -' Lot .'\" +,' p Jcj Block 2- Application for Structures now on the property Proposed use of property: /[/ Residential Affidavit: I. JlJil'k II:r t.1'l I, IV' . (please print) If this application is 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 no other purpose. I have the following legal interest in th'e property: owner of record; contract purchaser; lessee; holder of an exclusive option to purchase; ~ duly authorized to act for the owner, who is knowledgeable of this application. Signature/Address"77,:",1.. ---n;_J...L. (1 X'"?('J mllf)1'-VOlN ST):',1{,"?<i hlAJA1<;i. (zip) ". ~-- - ..... - - 'Telephone '/<l7-"72.ey ~ or -7<J? _ 1 q"7 "-I Date 't-. - '2 / - '7 "'I When permit is ready notify: Irv.(APPl icant /:;r O\'mer (:i Con"tractor 11:..:1... /~I mail (j( phone - Owner A", ~ J'n... "'., (zip) Phone '747- 3R' 5".'" Contractor,A"", ./1,.,..."",",,,,, ~,":""'~. ."'" /:),.."'/<: (zip) Phone /'7</7-'720/.s- Contractor's OSR# 1'/ '17 9 . 'Plumb~g by (lA ~k-n" 4 t:o... J.~ I~/ Commercial C/ Industrial L/ Public . hereby certify that this information is true and accurate. 'l.- '" DO NOT WRITE BELOW THIS LINE If Commercial: # of stories _;4.;.5-'- Residential: # of bedrooms~~~ , SI test holes ready # of employees # of units SDS: C/ C/ Existing, Proposed. Fee Code / , // ... /I~,-z, / /---:::~ ~,,-v -, '~ , _ -.;?~) ,~__ __~.J _4 ____.; _..L.' l- -, ~ - -::,/'--' Description Sq, Ft, or # of Sites Unit Cost BP#::..--..77:?L:-"(;,7- SI "ii~i=.~~~~ ~"f~'":"'''''"'' Val~io~ \ Fee $ ~-~~ __ . - r $ ~ $ $ each $ each $ $ $ $ /d? 50 $..- ..... o g7.~ Subtota 1 ..--. ;' /~ C~____ ~~\-\ ,,\ I /.!/~Check # ,~ Received by ~'V\,., f\....' --' . Total Valuation: $ Plumbing fixtures at $ Sewer/water conn. at $ . 4% State surcharge Plans check fee Change of Occupancy Water Supply Proposed Year Installed /'//,/./ ./ -----.-- TOTAL "",.........- - Existing PERMIT PROCESSING Minimum setbacks: ' Zone 4A /...;-:::-. Part. '#, H)~ [ '/ -. /- (" L I ""-- [ , L, front"Y '.' "-..\ .--..../ ; 1., s'ide t'. '----:./ Parcel # By \ \ ""').~'" , ~, ~, '\ #JU 2arcel-Size, /.-17" y.//J'<:;' ; 'i~t,/'t: '/PIlt::;?e? .~, " \., J\.... - ./ Date \.n .::::::\ \ ~ ...... \ Comments To be typed on permit WATER POLLUTION CONTROL Insta11ation specifications: gal. tank; ft. of drainfield; max, depth of trenches: , To be typed on permit.,~ . '" fr..b~.~"S{~ O.1..rl I.lID'aMLA ~,'Ieu 1~f14'" ~dJ. r--r rlFP~, (A,trf: 6:rfO(]A ~'t: ~f'<a(ll .. 'i_{..~u ~. C/t,.C:lk.- clw"Y r);ffJ1I!1i,J.tlll. 7fu1!;;;.f" H:.1j.J..~ riJlO.iitlJw, I~ .ef\(a~cL ~ f':.;DnT>l-;, 41! J-nh", (l~'IO/, AI ~~-;:;l f\((fllW)1j\A ~ 11P.{!lJf----r;,... tn\i. . ~ ' iVIp, _ I Telephone (Df7-:.?ft("0 By f{fY!'v..ffl- ulIoriJ,lJ.hdd Date . [)lrArt ,.,- >~I:J'f\ t-"n.c+ "onl/'... .II.../'...IA -f:t-<o "/R-Jb. Lp\-t"~l" Uth.. t.,-(,,)~po~ r.n ( WA.Jrn.. R:"':Ar.a i?~{J /~(.1 M' '/1"..-/", R lJA .Jp..'nr-n;,--P'--f.n L....r";,...-+ 5+.\ I-I sllo....... - - Plans to? CP&1 - .Jset(s) (/Oate Hold Slip [)i.1te Date to - ~!PC - set(s) Required to pee COlllp'ler.:ed pee ~ /A/-;>C; ~/ i'\l' CP&I " 1,1' hlPC \ -A o o Pl anning Pub1 ic Works I / .' I~I Elevation C/ Address C/ n/a v I~I Facility Permit I~I Environmental Health ~~J~I~~~~~~:~~dc~ (~~j (JctJ:';2~~cJiovi av ~'/~~, ; ~ClIe.t.af' QVPII!M-it ..f-llN\.Q.... Q9t.~ !<.!f~lirUldl' b cu.tf &w-. ~~ Pb't)L~~~j_ , ~ %ORr'~ou~WeCsq ~~'cation call: ~ P_~~~it Control Center 687-HE.LP__. :(6~~-~357) '. :'. froc.eece to 2'"71'7 'z.'oC:..l-t st' st." -- ., , J .j..' .. ", I.. 7 \f ~rp OEPARHIENT OF ENVIRONI1ENTAL llANAGEI1ENT , . PSB, 125 EAST 8TH AVENUE EUGENE, OREGON 9740l ;~H~~.dress'0'W"~~~j~:;;flfai[~C~! 1-/-' :J4, 4. I': J7t1J)Jj: ,.;~Jl'e )cf i~iJ~wr,'?"":~";::G:~';;';> a . ' Mil;)! .3 iijjilil@ 2- APPlicatio~' for SW; ""'n. :" '1 Pool Structures now on the property \/ iiiHlilfllflillHblll,illti>i1!1lkiilFilll !71 IImllfiJi\lMWkll Otmmililllilidm 1_-1 F.l. j\d.i......,.@.t."t..;j~,J,!1,., 1_-/I.Il.....!l...'...iti...'...'.....l..r.i,.,$,.,i,; ';;;::::;;:";,:1Ji;.k.j; ;;i~~~:l~imir - ."'" ,.. . "ww ,herebYC~~~i~y , tha t thisin;~rma ti on is true and accurate. If this application is for an agricultural building it will be used for purposes allowed by the State Bui'lding Code and Lane County Code Chapter 10 (zoning) and for no other purpose. I have the following legal interest in the property: owner of record; contract purchaser; lessee; holder of an exclusive option" to purchase; X. duly authorized, to.ac~~or 'lfe owner, '?O;s knowled.geab\e of this aJ~'plicat~on. ',"' Signature/Address"77t/.J... "lJd~1 (1.Y 30 !!Jf1t2.):'ioN 57)383<1 /n1J11J J<;T. . (zip) . Tel-';Phone '7'17-72-'15''' or2-.~7-lq7~ Date--.6- 2.1-?Cf When permit is ready notify: !l(APPl icant ./Z7 Owner CI Contrac'tor ~: CI mail' IR/ phone Owner l3en' LOb(2 '2 ' , '(zip') Phone 747- 3&' 5",3 Contractor C'..o..:s'ka~dp.. :<::;'A': Th"., ;YO(;-o A"ls (ziy) Phone'l'l7-72'1S- Contractor's OSR# 2. 1433 Plum~ng by Cowkn d <>_ A" I.:>, ,'-" u0. ,il~jll~~~.IL t''F\.'f~' .\ cr r~};fjijnijWNUrobit$! ~:S~:::~~;~l !~IIMI.ltli' if , , SI test holes re~ !Filii! . tllim / i\liire'iil'aitKWi /J /7 ,./j./~~~/ r~ '(?Y~.-/::fA.._',e) . DO NOT WRI fE BELOW THIS LINE # of employees 'lit~li1!~~~1! ' ip!li.l!;/_1 Existing, CI Proposed, ilil~s*IJa~~'.i i]JiHi,1 ,,'.O,",~'L ito$.t:i BP #j 7,? 2.-<./ sltC~~~\.A~ I c..c ~ ~-t Valuation \ Fee - ~ $ ..::/, "} - $ $ $ Water Supply Proposed Year Installed _,..,."'....,."'...,.,,.,,'~~' ,,' i, I I 'G" .' - j,.dd# \ 1-;"''g\lW, R;,ce i ved b; ~ '<V\.f'....... . &~~g/ Total Va,luation: $ l.tllt~~"~II~1 : ~ : $ each $ $ each By Date Use Classification ;::st.; PM D\n'\ $ $ $ /c;;<. 6'0 $"""'-- ') ~ #~~"'/e' "'~_ /:!/t:"~ ; int j:, PilE; ar... ~, ."\ . . . / ' . .-/ \'7.:::....)\ ~ Pc9 0- L.. Subtotal 4~ State surcharge Plans check fee Change of Occupancy" TOTAL PERI1IT PROCESSING zon~~ 'i.'?ntY Part, ~ "-.\:;L; ~ Parcel Minimum setbacks: Corrunents To be typed on permit Z-, r .. 0~.p:,.. .I/').~ By ),.}-S4 c:; '(J' Date tP-fl'j..:-) 9' For plans information call (area inspector) U . r A.~ Phone '':;>-/&' ( / , Dlrections to Slte;;k Go ~J1 '" :... -C" 2!{7b Le!\-t tl~ 6:zg-ili.. fJr~c.-", p.dJ -to 1rLA.iJ,..g'h 8r,'d~p /?,,/: f",<;tDyt ~,d,,"~ RJl.d. /Prnceo,J. t:11 LhCI&L+ s+,~ I I SfFO Plans to~ CP&I set(s) Date Hf,ld Slip Oate Date to ~ ,WPC == set1s) J;e')u,t.ed",,--' to PCC Completed PCC I"f(!CP&1 ~- l5Iwpc j, } 2CJ fj Planning ./ / CI Public Works I~I Elevation CI n/a CI Address CI Faci! ity Permit /~I Environmental Health CP&I Type To be typed on permit ; Group~ Fire Zone /.1.{.,q ~~~ Afl1~"P. ':--A \( FOR I NFOR~1A Tl ON abou t progress of your. app 1 ; ca t; on ca 11 : Perm; t ,Con tro 1 Center C74-171 froc.e.eJ.' Co 27/? 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" " " '.,.' .t.,. " , '. ...... "" " "-,. ......t , < ' , " . ,~,' < .- , " ~ " " ,:- " , , 1, ~ .' . l '''. '" " ' ..' u Iv ~ j DEPT ENV i'IGT F(E~;EH'T '0 i 05780 ,DATE 042480 . '~lDDJ~ 424:> HlL:y'-,RD' ST., EUGENE, ,ORE' " '. ,LOT:3 BL.I< 2 00 NO U~jITS 001 UO STORIES NO, BLDGS' 001 , S(;! 'FT UNIT i~oST. 'VALU,HION FEE DAYS .. 2G9' 3'5~2'~> 1(;)187 LC i (;)5780 I',:EPF~ ND. FIXTURES:' .';:;.' WF'C, PLAN , l! SIl"O CP I., 'Jbl'Tr-,I<EN BY SI< " " ~ " " " ' """'. " .., NO, CONNEC'([)f(S: MECHANICAL FEE" , STATE,SURCHARGE PLAN CHECK, r,p: 10,1137 EM:H 56.,.00 :;.00- - " '4-% :;0% :.? A24 ~]8. 00 ELE\! ADDR ,FP:' COMPLETED BY , ENVH 'TOTi-\L' FEE*'" '86.24 ;.. .. ,-- J ..~ ~ o o o · , o '. r , . o " . CI<:'12 .' ~~ 11 0 10 ~ tj o . o : 1 " ~/t...?, : f,_' 'co, . .~; Job Address~71( t..!(if:.,IA.s,'/ .2:,1>',.' ,i.~J~lij Spf./J,It J:;Ji;;o O/),f. ~ ,no" ,','.,.,.,.,.,' /7- ' ,;;z (/1 ~1 / 0 ) or 11:11~,~lili~lrn~"~~~m'I~~,~!.. .~~/f,-.- 'r - iti!~i -: ~ . ,ijji!~~'''?.. ..' . :~~~~~:~::nn::\nth~r~p~/L:!,,~~'rP6~W)1!;~h~~1F>..w..... .' 11 i.jtrwwllN:iWg~'6iit6iiih!&J /lf~ii~J#i!~:tt~M . CI;!I,ffij!~rl!~~k C/!ti!llij~tr:l!ni! l-:dllilbHE!!. ".. Affidavit:l, 138A:T, H; ,r,IJP.;.r/{j/(' . hereb~ ~ert.ifY that this ,.information it'true a~d'~ccurate:' , ., '. Ip}!I[$W!\tlnM,. . ' ' '. . If th.1s..application is for an.agricultural build,ing it w';ll be use1 fOF:purposesallowedoby the State, Building Code. and Lane Cou'nty Code Chapter 10 (zoning)'and~for no other purpose. I.have the following legal interest in,the'property: " owner' of record; . contract purchaser;' ." ,lessee; . holder of an exclusive 'option to purchase; Y,.:' dU,lY:au.'th~r,ized to~S!. for the.owner,"" .w.wI1"(}iis knowledgeable, of th;sapplication. " " 'Cl'7' Signature/A~dress. ~Ll' H"t~ ,U';1~,'LJ../It-.yAl1.!J ST, (;'/Jcrt/I-/OI1J" (ziD)) t-/OS " ; '. ,. <, ,,' "Telep,hone4?S-Ob4J........or'?~:b-0I;h'l " Datel./! ').'1!'W ". When'permit;i,s r~y ~otifY:,''':t..:~./,:.APpli;an,t_ .: () ,Owner \ . p(/'c9ntractor " '.~: /~/ mail ~'phone".. ~ Owne~ ,.r...FJJ.J'A""I1J'r:~/'t...Op8~,:. ,.'..' ,(ziol"171-J-??, Phoiw!l!:i-9-3fc:.,'i Contractor f:;1)fI,<;TRrI\JI},--Cr1rvsT"II~fJlI;'; 11'),4[;H/J~.yAP'f) : (z;o) 07'1 M Phone/.rlC-ol,'1 L .. 'Cont,ractor'if'OSR# -M" f)::J- ,', ",' Pr~mbing by', , .', . T'N\ DEPA~Tf.1E~T, .OF 'ENV'IRONt~ENTAL 'r1AN,l\GEMENT .' ">...PSEi,'125 EAST 8TH AVENUE .. " .. ,.EUGENE, OREGON ,97401 fa," "',;;.',iijE~."'~. i..'.il..~,.g,ii,' lC- -=/275"?):='?"O ..ft;i~@E~1Ift~~~gr& . "~-. " , ' If .corrunercial: .. , . Res,; den t i al : ... ; DO .NOT WRllE BELOW # of employees "", ~ ,51 test holes.' re.a9Y ~ " THIS LIN.E: , '"tilfM!t'i!~1i, : .~~~:ji;)~5xisting, BP # .:. "', . 1c.1 Proposed, SI # 111Z-~ F *."' . , "'I. .,., ,.. . ~ " '-,Flit;' ",',' '. .. , ',,'.. , .I~i~tjlijr , ,tiil'j.t: ~~~J#~/7U/.t~:o~ SI:;;89~tost < , , ' :. d.ji.: " '0: > "', ... . Valuation Fee " '::.-. ~I~~<' [ill/" Receiv~d by ~/., ',' ,/,) '.J /1 ,,.. V~~ 'c' . .' '~ " Tota,l Valuation, '$,' ,': ',I.II~~~~i~~lil':: ,: '$ $" $ , $ :' $ - e+ach $ 'each' $ ",_...- , . .' ',.' .r' ' .Subtotal" ,~'" $ " $ . < $' $ ,$$~Fp(1 rar;;, #, Parcel S!ze /C/7{,! %~, " . ; 1., side. ,~I'? ,; int,~1' ,; rear' ,,-,c;, .~ : -( /.".( .LI..o-mAfJ..U~~, '., " . ~~% 5t~te surcharge '~Plans,check fee ...... . ' ; Cha~ge of O~~upancy ",'." Water Supply'," Proposed" :' Year'AYls tall'ed .... . Existing'~'. ," , , TOTAL . . . ~..." . ' PERMIT PROCESSING. ' t-linimu~ setbacks~:~. : zone,~~ ;~. Part # J;p~~~ ' Comments F. , . Group '" l< ::-.~ . Fi'r:e"Zone ~ /? . By ~ . Oat! ..:..;,~~rq--grO; , 'Y,se ClasSlflcatlOn 7PO'.~)f;1f), -fJrJHq .' . U. To .be~ typed 'qn perm;:t ,~-".: ", -'..... . .:"--'., I ,'CP&I ' Typ,>' ".t.;,I},J ' . " -'. . To be (yped 1,~~permi.t.. ,', " .' ./ " -, ~.. " " ..1$;. ...... '''. ,'~ For 'plans, information..'cail. (ar~a Direct,ions to s;te-' ,. ... ~. ,. inspector).'- _ ;".t ~. '. t: ;"~". By" 'T.T. ~/~ L:AJII\~ .' . Da te 6=-1!:; - i?t) P.ho~~ ~-r "':,31 (,,'1:. , " i......, c' .'j , " )~I SIFO i9""fP & I /5r:fIPC' Plans .to:, CP&I 'setls,) :WP,C' - set(s) " Date' Req~ i re'd Hold Slip to PCC . ~ Date ....Completed Da te to PCC' , ,CI Planning C~ P~blic' W,orks.., ~'~ .' 'i'I..Elevation ,/0/a ~i "Address . ..C/., Facil ity Permit "f::/. Environmental He~l th. ; <' :r ~ - .., .,. ,. ' .. 'h '.'~ . "~'6 't; I> I ,II ,. , ,', ~'t' '. ';. " . ., ~ . , .: FOR (NFOR~'lATION a-bou"f py:6gress 'oFyour' appl i ca t ion ca 1 J : ':C7.4-~7.i.., "~.:,~> ','," .', ,'; ': " '. " ,'Per.mit" Control Center 687.HELP (687'4357), .' .. , '.. , , . .' . '__J /~- . ; \,J lane co~rty:, -: /. -~, .'!' ... BOLD SLIP APPLICATION # II !()C::;,/-gQ , IV',I? , P'+:/?T H. enPNVJL. Name 4-?4-<'=y . i-+IL\IA9 [J c:.., Address 1::--' )(~""I. ~'? . nl2.P. q 1M c;, , L ., ' Zip Code The above application is being held for the followin ~:. \)12(:--j1 De f:X.\ Sfu-Jq t-itJ vr;/~ D-::'L 00 /2... ~u-\N i ('JC-L-V f}1t--k:::r P-PO 11Iort~) ,{~':QS- OF f:;AC H c;opPLe -'7I1AlL !7r:: I0:)1sD o;~ -v:jc, PL.AN. DI(V\n,l~IC7'l /Of 0e,c\.(. e. I OPC'_,01 t-.Y/;f/~e ";, I [71 i2eCTIDN of Vct?I<- <Si,uII\.l0r I ere... SHALL-, BE o'N}'Tl-If:;. pL,ArV' 2. SPF-L I r::\~ ~ ~ I tJq' sysTt:: JlIl (F'ACI u -rf6--=>) C~F~';{.6 Of (v\P-lt.'i ),,1 (\II I\.Y-T f", f2'eoM '-ref.-,\p~p..weE: C)~~lodP AI A e::1 ::.II '5 Ft:tl ~UE.. 1He- PLcz:;>12... jlJ;}-\C1::;JIIIGI.) CQ :nJ 0 0e CAQ.Q.. (V\~ 6YL 6- I -I?Q ---r: (\/\ . Division (" .(J1I1"""\fIAnl()I\\~O^,\ n--4 ~ I"Y~::F(1To"'5 Signature ---r;l/.JtY/) /u/r)(l,p Ie... Date e:; - J- Sn f-' . - Telephone hg7-4-::z.,Q I , . This application will be held until G-/{crR(J If the information required above has not been furnished by that, date your application will, be cancelled. Bullding,fees paid for permits cancelled under these circumstanceS will be prorated according to the work that has taken place as of the date of cancellation. - ~. ~. ;.. ,', - -~-.""..,^t.JAGEMENT DEPARTMENT ------...t:\.IU.Q74IJl - ,-- ._, -. ----. --"\-_.....-. ,..,."' ..- ...-.----' ~~\{!\ r-'EPARHlENT OF EilVIRONimHAL rlANAGEI'lENT t ) PSB, i25 EAST 8TH AVENUE '-..J EUGEiIE, OREGOrl 97401 r---:"" U ';0; ; APPlication~#.~~ L..{!,-/OS? ....110' Job Address ::J., '7 /7 t. 0 c..u..ST /:;1'" , City SiJJ!lN'i t:/F.J..iJ /';/It.., Township, .Range, Section"Tax Lot /7-0 3-,:;L<t..-~/- '/C/OO I . i Subdivision F I L- a.~'!?:V€ . Lot, ~' Block ?.. "';)"'\",::11 Application for j.--AM IL"/ f<J}/'lM /J/')VITIO';/ " ", Structures now on the property . 3 RP-OR 00]1'1 H () I/C,F Proposed use of property: iN Residenti-al I-/. Commercial /~/ Industrial /~I Public Affidavit: I, 13f:AT-\ 11, (1,,~RI/I-c...r( ,hereby certify that this information is true and accurate, (please print) If this application is 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 no other purpose, I have the following legal 'interest in the property: owner of record; contract purchaser; lessee; holder of an exclusive option to purchase; . )<. duly authorized'to act, f~rJ the j;wner, wh~ is knowledgeable of this application, -.., Cl7 Signature/Address ~.;::r n, (~ 11'J.11..'5 J..IIt..'IAtlh ,q{, 6: vert/I- )01<(.. (zip) I t.j()S Telephone t.41,C;-ObY)..' orl)-;;J/,-;")iJ,'f, Date wI?", I'l,D When permit is ready notily: I~/ App,'icant () Owner ](.1 Contractor Ei.: CI mail.' J{f' phone Owner f?.fJJ::rAWlIN c.,' t..OOSz.. (zio)1:)74-,1 Phone ?t-j'?~3'i,c;.? Contractor SIJH.~r'U~'tM t:.dNSTfivc..T/p"; /.I').I{~HII..VAP.D (ZiD)tl7I-/oS PhonetJQr::-I"'JI.J1 L Contractor's OSR# A~" 0 ~ Plumbing by , ,- .. Assigned N~mbers~ If Commercial: # of stories Residential: # of bedrooms SI test holes ready DU NOT WRITe BelUW IHIS LINt # of employees # of units SDS: )~ Existing, BP # /cJ5"7~8"C /_/ Proposed, SI # Fee, ,Sq, Ft. or Unit Code ,__ ;P' 4~ ~~_ .;- Descrioti?n" ","? # of Sites ., Cost. 1':/ ~~~r ,t:f..:v'fU~?).,-u..-fL../~'7K./ 0787- ri) -A/' /7 {,IV' (/ Valuation Fee Subtotal $ $ $ $ $ each $ each $ $ $ $ $ $ ~:?~,2 tj 1-/ Cash /~rcheck # L t./7 / Received b'l ~~--<-<Jt-yf./( /.J /! /l Water Supply pr-~~~~~ Proposed Existing Year Installed Total Valuation: $ Plumbing tixtures at $ Sewer/\oJater conn. at $ 4% State surcharge Plans check fee Change of Occupancy TOTAL PERMIT PROCESSING Minimum setbacks: Zone Cl..-1/C Part. # ~, tr.ont/' 4...s-:/ /-;;\ ~(..{....-L-{---: , Parcel # Parcel Size /07 X. /o_S-- 1., side. ,.c:::;-CJ "; int, b'~ ; rear ~'/'-:::11::' //",( LO /-fl],4UL/J-t/; ri!v-e...., Comments To be typed on perm; t 1/ By /~~;r--r:.--- Date '-I~,p, </-KO WATER POLLUTION CONTROL Installation specifications: gal. tank; To be typed on permlt -\.,..'.-,----. '_ ,.--(IA..,~ M~~'--<S1...O-'M"~ rlA_.' -JG.b._:.. .- \, , , Q \ ~ 1lUJ.. ,..f: ft, of drainfie1d; max, depth of trenches: c." 0 _ \-..c,__,;..; (h..A:' ~r\' .........~,.A_ =. Telephone By C~I'_:.~q""'~Date L~~"),,\":0 Directions to site CI 5[FO Plans to: CP&I -set.(s)' I' WPC ===== set(s) Date Requ ired 'Hold 51,ip , to pee Date . Compl eted_ Oa te to jPCC I~/"'CP&I /,<:rwpc I_~I Planning I::! Public Works () Elevation C/ Address /~I Facility Permit I~/ Environmental Health '\ 11;/<;;-- ..~. , I .1 ... (~J ' \ )j .!... . FOR INFORI,jATlON about progress of your appl ication call: Permit Control Center 687-HELP (687,4357) ~. ;~\ ~~<:e'D, :1.. ' '- uJ . 'j ,. I p::, '-'r>" l 'I~, 7 let ..-t j ...:1.. . i ~'~;"j.i~1n~r'l:;J'~" I' ',,' ~': i~,:,:..}/t~":~ "'_'j \1~' q~, . -- ..-~~~. ,.;~.~1t"}~i~~t;"f"_'1 ~~, _ ~ .t:::r;:':?,~iq-:'" ~',i ,": ,! '~~ ,<I...,)..:.;., .~ .", .._, '" ,~' '!'~~~t- ':I~';;II'" ',I .~~.~_ . ';," ...t"' '1.. {- ,_ :,', i/ '., \: .. . 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