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Home My WebLink AboutPermit Building 1975-4-1 V: -,,_..-...?),..(=~-, ~,... .'\ _'~. \ LANE CC' "TY ,-, . BUILDING PRQf'l:RTY OWNER L, V.CI\INLKY D CONTRACTOR TED SOPTELEAN BUILDING PERMIT OR MOBILE MH O(X MAILING ADDRESS 4415 DAISY STREET 039 MAILING ADDRESS 5000 PRAIRIQ ROAD "OME will/2ft; USE PERMIT PERMIT NO 7~ SPR I NGF" I ELD OREGOrJ M-l 126-'75 PHO~E 147-402e PHONE JUNCTION CITY OREGO~ PROPERTY LOCATION - INClUDE POST OFFICE 20~7 HARBOR DRIVE FILBERT GROVES PROPERTY LEGAL DESCRIPTION - METES, BOUNDS I)TH ADDITION TWP FILBERT GROVEll RANQE I)TH ADDITION SECTION CENSUS TRACT " 18 "l 11'.rl'..1. ! APPl NAME Mcl< I NL F: Y 0 IC:AO,.r.-i t:!" ". NOIJE LEGAL ACCESS TO PROPERTY & 5000 PnAIRIE ROAD 20"l7 HARGDn DRIVE PROPERTY SIZE - fT MAILING ADDRESS JUNCTION CITY, OREGDIJ FOR MOBILE HOME PERMITS ONLY No of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT WIDTH DEPTH AREA Connect to EXlstmg Sewage System 0 TYPE CONSTRUCTION SQ FT :;:; BDRMS New System 0 VALUATION PERMIT TO PARK MOBILE HOME PERMIT TO INSTALL SE~AGE DISPOSAL SYSTEM: < FEES PLUMBING INSTALLED BY OWNER 0 OTHER NAME WATER SUPPLY -, , SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER I%SUnCHARGE SEPTIC TANK 0 OTHERD I)(}.oo 4.00 PUBLIC 0 o OTHER '- TOTAL "l0.00 .04 lj4.04 COUNTY BUILDING < UN FT 150 & SANITATION SPECIFICATIONS Po/'/;{ TRENCH ~FT 3 OR SQ FT 300 MIN SEPTIC TANK CAPACITY WITH DIST BOX GAL 900 DRAIN FIELD REQUIRED TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIL EASEMENT BLDG SETBACKS FT FROM CTR OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT 9'5' SIDE INT '5' SIDE EXT AUTHORIZED SIGNATURE - DATE REAR '5' DATE /s/ J, E, Boss OY C. HAROAUGH JOHN S"OO<</~ANITARIA~ 4/1/7'5 OLlI BLDG PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule all reqUired inspections All construc- tion shall comply With Uniform BUilding Code, DE Q standards IMPORTANT for subsurface sewage disposal and county regulations covenng plumbing All bUildings require a certificate of occupancy before being occupied (See Detads on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, OEPT OF ENVIRONMENT~L MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 ,ORM -= C55 13 '. .. 'LANE COUNTY ENVIRON,_ATAL MANAGEMENT Name 'lnd Add ress of Owner PLO'j PLAN \'~~PhO:>~~ _______ The bUlldlng belllg constructed under this p<.cmit will be used for Date thls property was purchased Do you now, or dld you ever own property adjacent to thls tax lot? If so, please llst those tax lot numbers or draw those properties on the plot plan below Indlcate on your drawlng the location of all homes (lncludlng mobile homes) now on the property, as well as the locatlon of the new bUlldlng. - I -' -~ _ l~ _ _ -- - -~ ~ ~ - ~ ~ - - -... :--:: ~ =- - ~-~-~~~~:-~-~-:~- -I~i~ - -~~~-- ' - ---- - ~ - -_.:---- ,- 1----- .' - , = - 1 I ~~~~(- ---=---------- , --\ ' - , ----------~--- ----CIIIIl- - ~ --"i'" ~ ~ ';~~:r- - ~:~~ _.:~ . -.- - .- I~\ l~:f' ~ r: , fL" "'/l (.-' . 1 I)' \....' - , I ,/ ---------- ! .... I , I "- 'c - C..~ \ - Ji 1 , ('~, ---,---- l \ / ~ l) f --- -=--------- - \.... - ,- , . ...~---~---~--=-=--,. ---if.- !rfJ.~. ~6'4~ I.) N. \1'; Name of Applicant (if different from owner) Address Teleph0ne Appllcaut's Interest Buyer c=J M74-99 Seller 0 Agent 0 Map \'t?~ - ~ ~( Tax Lot'-----4.~ '-t:,~, "- Permit II .-':::>.o..o-C> 0\1..-\- 1~",-f\S:- ~~ c Ii..... "'_R 05 S /!-2-2.TAX LOT_ 2.200 ____ SUB~,JISION: BUILDING PERMIT APPLICATION NO.~\..I.... \;;;"Io-"'~ LOT: BLOCK: t~ ~=~~ICANT NCK',l\lfj /s:o,d),c/11 6. ~~~~a~~~f~ 1~<' Front 45:' s...ck. :..c~.:_, . Setbacks from interior lines: Side _~I Rear ~ ~ BUIL~ING SITE EVALUATION ~ <' ), ( ) SITE I NSPECT I ON 1. 2, 3. 4, 5, Not Appl icable Zoning Ordinance Compliance' Zone .f'I4-MI-f ( ) SubdivIsion Ordinance Compliance - ( ) Requ I red Access ( ) BUilding Site (Area, Width, Frontage) () Other (see comments) ( ) PLANNING DIVISION COMMENTS: No Yes () IT ( ) (~ ( ) ~r) ( ) V) ( ) ( ) PLANNING DIVISION ACTION PENDING: YESl } NOl } APPLICATION# BUILDING INSPECTION DIVISION Not Appl icabl e ~/l ( ) ( ) 7. Plans Submitted 8, Soil Stability (footings) 9. Flood Plain 10, Other (see comments) COMMENTS: WATER POLUTION CONTROL Not Applicable ( ) ( ) 11, Meets Department of Environmental Quality Standards. 12, Other (see comments) COMMENTS: No ......-7(L 1 ()~en ( ) ( ) () () ~~~ ( ) ( ) CKID BY:J:::.J.U, . '_ J <1/-7{ DATE No () ( ) ~ CK'D BY:~\~ 3!d7r:- C ~ l DATE . TO APPLICANT: ~our Building I Site Inspection: ~L ,....(~Can be approved. ~. ?\- ;I () Cannot be approved at this time as indicated on item NO, above. :>;':) ~ Questions and further Information on Items 1 through 6 contact the LANE- :9' COUNTY PLANNING DIVISION, Questions and further information on items 7 through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION, ( ) Will be held in thiS office until you can resolve the problems indicated. ( ) Is being returned, ( ) Your bui 1 d I n"l perm it app II cati on fee_ i_s be i n.9 ~~t\l.'=.I).!td under sep.illlllp. c:ovp.r_ 'OEPARTMENT O~ ~NVIRONMlNTAL MANAulM~NI 135 Sixth Avenue East Eugene Oregon 97401 PHONE. 687-4065 LANE COUNTY PLANNING DIVISION PHONE: 68774186 C55-28 " LANE CC'.....Hy BUILDING PERMIT OR MOBILE "OME USE PERMIT . BUILDING ~ MH 0,.,0; PERMIT NO. f+t PROPERTY OWNER MAILING ADDRESS 1. :.~)t1i'1,t;V :J' 41-.1(5 Il;lfl.... 8Tnr.lt<~ DJ.) !JPA~~-ll."Ia:"O Crtc(;.:;:1 CONTRACTOR MAILING ADDRESS I'GU ::,tnat..rl0\?1 ;;:.00 ~:llliH. rh"4~O J\1UCTICI~ en., 1'.i..-:<::CS"1 PROPERTY LOCATION - IN<';LUD_E POST OFFICE ,. U0:'.\' ,',!t.4t"'?).ft t.xW~f! fii..'~'~!j~\-\~'iT~s 'Ji,~of.71:eM-;;4' if' : I ~~ 'f:)~1~.\\\ PROPERTY LEGAL DESCRIPTION - METES, BOUNDS ~>II.L~~')- CJ,~C.Vltil '3VH AoDITH~" ;:7 /:1-3 ~-(p TWP RANGE ..lSECTION TAX LOT NO. CODE CENSUS TRAC! V 141 (.. J3 PHONE 74 :~!'~l)~ I !....~ ~~~ PHONE !0 1\ II 11.1f:r~ EXISTING STRUCTURES ON PROPERTY < NONE LEGAL ACCESS TO PROPERTY 2~,1 ;)ARao~ ORIV~ PROPERTY SIZE - FT. APPl. NAME K'KQ~l1..f::'t [) I~n.....t') ~A"I &, MAILING ADDRESS JO!;lC11(lf;i CITY, {l;;!:GSJl/ FOR MOBILE HOME PERMITS ONLY No. of Bedroo~s ...... ~~~ PRAtRlt ~~~~ WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System D TYPE CONSTRUCTION SQ. FT. :;:; BDRMS New System 0 VALUATION (l"..nn 10 P/llltl ~l>II.r. HOtil; :;'\: ;!l'f ,0 irn.:TALr. G<:lfAQt ul$i'l;;;.!l\. !:iYSTCNI ~ . II) H ! OTHERD / . ..4 - ,v. :_': (li:lX. FEES '$;'.(;;) '!."10 J: I fJ . '1 J bJPl~MBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY y SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER ~.- ~:_:~-~;\~,:~.!tr;'G: SEPTIC TANK 0 .,Ad PUBLIC 0 o OTHER TOTAL . ~~~3 00 J.~4 ,.,il ,:~b '<.T~. .~'* -.J' MIN. SEPTIC TANK CAPACITY . C'iJC> WITH D151. BOX: GAL ,~' COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED UN. fT l~p TRENCH WIDTH FT. L OR SQ. FT. 5(10 ..:. ~ ',;" . , " \ TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIl. EASEMENT BLDG. SETBACKS.. FT. FROM CTR. OF ~".t fRONT.! ;J ROAD RIGHT OF WAY '..... SIDE INT. ') SIDE EXT. AUTHORIZED SIGNATURE - DATE [. E'Al!!O UV C. :<ltJ~CIUIC:1 , USE CLASSIFICATION REAR 5S~ DATE /'\;1 '-~(t J~W 3nxr:fI!ll\llIT4RIAIl' 4/ift, Cl1 BLDG. PERMIT - WHITE OFFICE, COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD IMPORTANT: Call 687-4065 to schedule all required inspections. All construc- tion shall comply with Uniform Building Code, D.E.Q. standards for subsurface sewage disposal and county regulations covering plumbing. All buildings require o,certificate of occupancy before being occupied. _, \. .. ,. \~~~ .(Se'~)'qetpils 'on IReve~seJSid,e) '\-\ \' >-,~,\, \ , , , \.~~ ".,,,, " t " (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 FORM::: C55-13 SITE INSPECTION ApPROVED ~ . DIStPPROVEo ~ DATE // // /, -, /D //L.<UL&l:-!. (flu...!:" to<-F INSPECTOR REMARKS 1:...0 ~~./r / &.,.'~;.,. ~- rD / I.....---'.../-.. FOUNDATION INSPECTION ApPROVED L--I DISAPPROVED / / DATE INSPECTOR REMARKS FRAMING INSPECTION ApPROVED Ii DISAPPROVED 17 DATE INSPECTOR REMARKS LATH OR SHEETROCK INSPECTION ApPROVED L--/ DISAPPROVED / / DATE INSPECTOR REMARKS FINAL INSPECTION ApPROVED ~ D~SAPPROVED ~' / DATE _ 11. H _..i>I ~ L/-ltf~76~ / INSPECTOR REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE 17 NOT READY TO ISSUE ~ DATE INSPECTOR REMARKS " ;1 HI). 0 - 'If 1f!C';/4.-1:'-!c: ~ {),J (' llt?rklj'J-1(.'..( . . , Date 6PR 11 1. jQ7'i Permit No MH 126-7'5 CURB CUT PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY WHEREAS, the attached application has been fully considered by the Board of County Com- missioners of Lane County, and It IS the opinion and ludgment of the Board that the said applICation should be granted, and that a permit should be Issued, now, therefore, It IS hereby ORDERED, that a permit be and IS hereby Issued to KENNETH W rLARK 20~7 HARBOR ORIVE EUGENE. OREGON ( P O. Box 2017) for plaCIng, building or constructing the follOWing foCI Iity FILBERT GROVE SUBDIVISION 5TH DIVISION LOT 23 BLOCK 6 upon the right-of-way of County Road No , Mile Post In strict conformity to the exhibits attached hereto, ond sublect to all terms, cond,hons, agreements, shpulatlOns and provIsions contained In the oppllCatlon and permit, the Rules and Regulations Gov- erning Facil,hes to be Permitted upon County Road Rights-of-Way, as set forth by the Lane Man- ual 50 190(2) any amendments thereto, and any other applicable regulations, low or ordinance SpeCIal PrOVISIOns 2 Driveway will be constructed In accordance With the attached driveway approach speCIfICa- tions (Drawing M98-50) Permittee Will be responsible for the ImmedlOte removal of all mud, dirt and debriS from the roodway and right of way caused by hiS operotlon, leaVing the roadway and area In 0 neat, acceptable condition 3. SIDEWALKS WILL BE CONSTRUCTED IN ACCORDANCE WITH THE ATTACHED SIDEWALK SPECIFICATIONS AND DRAWING M98-49. THE STANDARD CURB TYPE SHALL BE CONSTRUCTED UNLESS OTHERWISE SPECIFIED. This perm.t IS revocable ot ony time, and Will be strICtly adhered to and no work other than that speCIfically menhoned above IS hereby outhorlzed This permit shall be VOid unless the work herein contemplated shall hove been completed be- fOTf' APR "' 1/ lQ76 19_ Expires ,19_ Inspected and Approved Approved by Boord of County CommissIoners By Date /J..J' /a-",~ By Director of PubliC Works WHITE - OFFICE FilE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUILDING & SANITATION DEPT YEllOW - REAL ESTATE C98-79 ~ , 1'// . .. LANE CC' '-!TY BUILDING 1=' BUILDING PERMIT OR MOBILE "OME USE PERMIT MH 0'.1 '-- PERMIT NO ," MAILING ADDRESS t, -~, c.: ~i) .....'" It 'If SVnr.r:V..;if S":)nar....nF'.eLO O~~C~'t MAILING ADDRESS ",r.:o JI;l\lrlO r~:lt\O JU..CYlU'l C...... 01~CO'~ , ~2(>{j PHONE It -'"' '.", L.> Jc:.of ,~~, ~ PHONE PROPERT'f OWNER ~ ....tl;~ti:V D CONTRACTOR '(CO !JU.>7eil.{'Clrl PROPERTY LOCATION - INCLUDE POST OFFICE . -:P7 ,:AQ~;:) I);: tvc r 1!.'l1'''~7 :'~!;t,f'D PROPERTY LEGAL DESCRIPTION - METES BOUNDS (,Tu flDnt7 ~Q;J i !l. ~l''''i' (;.~(hJR,) ,",V, 0'lna '. :t." TWP RANGE SECTION TAX LOT NO CODE CENSUS TRACT :v ';\ ; 1 .=11 G NAME & r~e" t t",\.r"V f) k..r........~OJ PilM EXISTING STRUCTURES ON PROPERTY ~:Qr;c: LEGAL ACCESS TO PROPERTY 2C~7 lA~,G< ~~t~r PROPERTY SIZE - FT APPl 50~O P,lllt'llC ~CA!:I MArLING ADDRESS FOR MOBILE HOME No of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT Jur"-;:YIOC;l Cl7V, PERMITS ONLY ,1'lt:1,O:1 WIDTH DEPTH AREA Connect to EXIsting Sewage System 0 TYPE CONSTRUCTION SQ FT ;::;: BDRMS New System 0 VALUATION Pcr!'rll; '!'() ?t'r... '~OElII.(i 'laM!;: 1~.-ClIV VI'\ Cr::,TAI.Il. 5CtJAC: Den CEl'J. hilDY, 11 ,\ FEES PLUMBING INSTALLED BY OWNER 0 OTHER NAME WATER SUPPLY SEW AGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAilER .. '.. U~lC JC'l ~n: SEPTIC TANK o I OTHERD <jfl,GJ [s.c~ PUBLIC 0 o OTHER TOTAL 1'::.1:1 .0l} ; 'J.n', COUNTY BUILDING & SANITATION SPECIFICA nONS I MIN SEPTIC TANK CAPACITY WITH DI$T BOX GAL ~OO DRAIN FIEl~ REQUIRED LlN FT .5~ TRENCH WIDTH FT 3 OR 5Q FT " ". , . , TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTn EASEMENT BlDG SETBACKS _ FT FROM eTR OF ROAD RIGHT OF WAY FRONT ~/.)' SIDE lNT :, · SIDE EXT AUTHORIZED SIGNATURE - DATE hI J. . Rono f\V c. 111l2DIlUC:l USE ClASSIFICATION REAR 5' DATE JC;t'" S~-:OC~/O!4tJllA~'~tJ l}hhl !. SlDG PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule all required inspections All construc- tion sholl comply With Uniform BUilding Code, DE Q standards IMPORTANT for subsurface sewage disposal and county regulations covering plumbing All buildings require a certificate of occupancy before bemg occupied (See Details on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 FORM'::= C55 13 SLAB FLOOR PLUMBING GROUNDWORK ApPROVED ;---? DISAPPROVED ;---? DATE INSPECTOR REMARKS GAS PIPING GROUNDWORK ApPROVED ;---? DISAPPROVED ;---? DATE INSPECTOR REMARKS ROUGH PLUMBING ApPROVED .Cl DISAPPROVED ;---? DATE INSPECTOR REMARKS ROUGH GAS PIPING ApPROVED .Cl 01 $APPROVED ;---? DATE INSPECTOR REMARKS FINAL PLUMBING DATE~ -- 9-7FINSPECTO~./ /7- ApPROVED /)('/ DISAPPROVED ;---? REMARKS FINAL GAS PIPING ApPROVED .Cl DISAPPROVED ;---? DATE INSPECTOR REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE ;---? DATE INSPECTOR REMARK 5 PROPOS SEWAGE DISPOSAL SYSTEM RECORD INSTALLER: Complete top part of form to signature and submit both . -. INSTALLER'S NAME PROPERTY ADDRESS copies with application. PERMIT NO. MH 126-7~ JS rE.D jOPT!3-I-EAf'I No. LIving Units Bedrooms 2037 HARBOR 0lI VE Baths Basement Water Supply Yes No PublIc!/' Other-List Sept I C Tank: Ft. from well Inside Len9.th OWNER NAME D I mens IOns: Width Steel 0 Ft, Diameter Concrete ~ No. Compartments Gal. Capaci ty 1000 Depth Tile Disposal FIeld: Distribution Box Yes V No Other Distribution-Type McKINLEY/SOPTELE~A HA ILlNG ADDRESS ,000 PRAIRIE ROAD Feet from WEll Lot Line OREGON Front Total Sq. I Ft. Between Ft..'100.... Lines I D+ FOlJndi'lt I on Il") JUNCTION CITY Length of Lines-Ft. lTrench I I Z12.1,s3. 4. 5. 6. Width7-! 'iot Plan (see Instructionsl: Side I D IF 111 er :.kIF 111 er Depth Tvpe / :1- Above T I 1 e;2. Rear I \) IFi ller Below InJrile 6 In. rn1I 5'1 -+ ...~ '- . ,-r If lOot ~ -2J: . ... \ IDf /Nuf'ZTH' \ t p'\.. J-'( X ,. 12-SJ s"S -1- <::> \/ ..... ~f<.()r~"''J''( ~/NfJ, ,^O Y3 /1--/3- t+ 0 (V\ f- ~~EC['VED _ APR 0 71975 ItANE COUNTY ~IJONMENTAL MGMT. f \ *' ~ !tI ~ ..... ~ ,~ .~ ').b17I-1AP-[!;OR Dr< lye Date 1./- ~-"15 Signature .-lI:/(f!;~.J~~7ld6A#W CERTIFICATE OF SATISFACTORY COMPLETION 0'.,. 4 pI) 5 For Sanitarian Use Only: Dat~ ,-,.v-7 In accordance With 1973 Oregon Laws Chapter 835. Section 214 thIs certificate is Issued as evidence of satIsfactory completion of a subsurface sewage disposal system at the above location. ~ Approved' System Installation conforms to current standards c::J Disapproved: Does not conform to current standards Remarks: Wjl.-r~~ D (,K ~~ C55-11 S~~s Signature L~ COUNTY STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY NOTE NO PERMI' iLL BE ISSUED UNTIL THIS APPLIC PERMIT 1/1\\\\-\ cON HAS BEEN APPROVED \~\o 'i\ CJ APPLICATION FOR CONSTRUCTION [=::J MOBILE HOME ~ PLAN REV(EW CJ CIlM(.!:.t. OF OCCUPANCY C=:J OWNE~<::'~ ',\..,~~. \\.>-\'\~ ~c""<A SA ~~ ~. ~~ - ~ . ~Name Address ~--..... Cl.~ Z"rp'z; ~ Phone CONTRA~ ~''\. ,. \-(:>C\ '" "'.:::>oc...., ~_"" 0' ~J., ,'~ .1_ C)~~ro Name Address C1ty - lip ~ Phon' ) ~ OS RhG II Twp \ r:\ Range~ SUbd~' \. ~~, l Section \ \ ~ '6"""- _---1.."""" Lot '"- Tax Lot Code Census Tract \f-/~b ACCESS TO PROPERTY (Road Name)....!l ~'--, ",,-'" Exi,ting Structures on Property ~".... <:L... , Property Locat1on - Address/Di~tions d.Q(>-,'>-\ ~ __C"',-,~ ~,- ,>-,- d':J.... ----r Block ..J. Property Acreage ~a'-ls,.<>~ 'Q,.. Wid th______Dep th - ~-'-~ ~,--\, ~Ic-.....'-.......... s.~.....f::h..Q \ .. _. - - I!." Bel~ Of f ie e Use OnlyXXXXXXXXXX!QXX.-1<XXXXXXXXAXXXXXXXXXXXXXXXXXXXXXXXXXXJQL'OCXXXXXXXX:xxxxx..axxxxxXXXXXXXXXXXXXXXXXXXXXX ~ \\ t ~"" r, Sq Ft flBedrooms Valuation~: ...... ...~~-~ ~c.S. ()e>-'-<::. ~ l-\......~ .J..... #' ~=,~ ~ _ ~'--{....~ S> " - c;:::",6::--s. ./ /" /' ,--... SEWAGE DISP~"-- J SHe Inspect~ \{ ~ u"4 WATER SUPPLY Well Name of Spring Existing Sewage Disposal System Public L&::J Other Commun1ty ~ c=J FEES PLUMBING Installed by Owner c=J Other [=::J N/f BIdg Waste Disp Plumbing Plan Review Mobile Home 1% Surcharge <2D c::e:- \4~ PLUMBING FEES (I of Fixtures ~ Water ~ Connection TOTAL '?-r,OC> ~ p~/ FACILITY PERMIT C~-'-\ CASH \ Qt /. ~ ~ YES [=::J NO 1.-'\ I YES NO e-.H (,4 ~\~CJi s/ ature of Ap,<:,:cant f..A,~ 'i:2 ~ ! /: e Received By ~ _v-v-o. _ Date ~ \~,\ Ci\S; Dra1nfield Re( uHe4/ILineal Feet J ~(} Maximum Depth ~ // V Min Septic Tank Capacity Cl17() " Type of Construction Group Fire Zone Use Class1ficat1on Bldg Setbacks - from Center of Road R1ght of Way Front '1s' Side Int 5' S'L.:.:. ......~.:.-H~~ I Rear 5' Zone ..{//4-III# ~fHgh5 I ' DATE ~~~T\rION / fDATE ;1 06 BUIIWNG /J DATE i~ 3/2'1; 7~ {~e.;: 3-'N-7.5' DE' R1MENT OF 'ENVI~ONMENTAf ~NAG~NT C55 12 LANE COUNTY