HomeMy WebLinkAboutPermit Plumbing 1973-9-17
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LANE COUNTY PERM IT Fee
PERMIT NO.
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'CONSTRUCTION [X~J MOBI LE HOME [] PLAN REVIEW [] CHANGE OF OCCUPANCY [ ]
o Contractor
~aul r,1oser
NAME
lH)il 'Ii p 01 son
NAME
202
1132 Cottonwood Street
ADDRESS CITY
Route 1 Sm\ ;57
ADDRESS CITY
"'l'\r~~I".f:i':l'" ,1 '")r~t1(y!
~L'""' ~ d~j I \.; U I<.! \.v ~t~'J'..H
ZIP CODE
r. .: .c . ~ :'\
~pri~~L1C. ~JrC10n
ZIP CODE
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DOwner
PHONE
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J' :~'i.; -\) ..;: . ~".
PHONE
0.5. Reg. #
"
Twr ': " Range ~)1
Su~a?Ji~io~ark 1 st add
Section.:(1~3?JTax Lot iF
?, Ot}COdP
Census Tract
Lot ? ~
Block
("
Acreage
Width
Access to Property (Road Name):
r~t~~n~~~~ S~r~~~
Depth
Existing Structures on Property:
~~OH~H
...-.....--
Directions to Property - Address:
., "i ':I:)
. ..._'i,;i
f',.."+~,,,,.,...!,A S+_"'1)""+ ~:,....l.,r:.(,:; ,,'; ,; f'll!'!""""'-
-,.........._".~'~-...."''-' -"". __..... -~. ~..~.... '~II....~ l;;7' ....;)~..
STRUCTURE (# BEDROOMS)
SQ. FT.
VALUATION
,),w>: ,Ir.
~~~.. A~~~'~~~~
!'=~~i ~ .~' ~~t::n :: !!~ ~ ~ i t~o
::)~\<.~,?~4 l~f
'~~_R~.~_."!.~_ .f__ ,_"_" 11._ ~ _. r....' _ __ ~ _ _ q ". _.
r ~;lO H~ J,~ ~,v "CfJ~"t. w; .!J-.:na;i~ ..i I ;:)~,tJ:lQ I ';;3;) l,~~J~l
SEWAGE DISPOSAL:
PUBLIC [] SEPTICTANK [
OTHER [ ]
PLUMBING INSTALLED BY:
OWNER [] OTHER [] NAMI=
WATER SUPPLY: PROPOSED [ ]
EXISTING []
[ ] PUBLIC
[ ] COMMUNITY, NAME:
[ ] PR IVATE WELL
[ ] OTHER, SPECIFY:
BUILDING
PLUMBING
3% SURCHARGF
MOBILE HOME
WASTE DISPOSAl
PLAN REVIEW
"." Aft.
",,'V . ~J~J
f:o. I'.~r<-
...;le 'Ju
~ ","l
D .~~
('If: ,,,,\J?il.
....,J1.~~
TOTAL
77. ,;;<~
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY:
GALS. 'jWlf) MIN. DRAINFIELD ~~,~ I,IN, FT. MAX. TRENCH DEPTH 11:;1: INCHES
:'~;;)~: f') Tnn'" 4'rolll ?lab' t."'rW"~~ltof'I!"'O 'ali';~~ ~1l: ~~M+'" "",.t~~ ~n""."A ~~nl. .....-..1 ,r-:. .J:.....C"-.r~ .c...:'"\__ ~.~l}::: (':~'ff'I'rf'~ J'n
,:./ t7'j i1~;~:( arainl 'I YleS'.' -Stay ~lt." feef'ffuPl ~roii~r~v Hiles "'~IIHh "aTr"c:i ;;;t~ "n~ 'l:h~"J~lr;3'1~~'i <,,'1 . -:"fl~ 'V'.,'::
":f' ,;1'::::1 for re::ll,),cofllent of Sewaop. )is~!'~~l ~\I"t;'r.I~ "STAY 100' FROM ALL WELLS
TYPE OF CONSTRUCTION GROUP FIRE ZONF USE CLASSIF.
SETBACKS, FT. FROM CTR. OF r!W:
FRONT iVo SIDE EXT,
.\..;
c
...
FT. FROM PROP. LINE:
,"" PI'"
SIDE INT.:'J REAR 1..1 .,t:,
ZONF
.""'1..
.t.
AUTHORIZED SIGNATURES:
/s/ c"Hi'I,rb;:;;;f ~/Lv.;';g
ISSUANCE DATE:
";V'H vI "I'm i .;-;, ""I ,,\'I
.,~}",!t:' f!!~
-. ~. ~ ~ -
"'\I
,... ~ In
BLDG, PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT:
Call 687,4065 to schedule all required construction inspections, Call 687-4061 to schedule all required
septic system inspections, All construction shall comply with the State Buidling Code, D.E,Q, standards
for subsurface sewage disposal and the State Plumbing Code, All buildings require a certificate of '
occupancy before being occupied,
(See Detai Is on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
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,
C55.13
LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
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.au ij LD~ ~~ S rTE EVALUAn ON e
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~"BUijLlHNG PERMn APPUCATWN NO.
() SijTE ijNSPECT~ON
PlANNijNG DiVijSijON Not
- - ~
App i icab] e
1. Zoning Ordinance Compliance: Zone~( )
2. Subdivision Ordinance Compliance ( )
3. Required Access ( )
4. Building Site (Areap Widthp Frontage) ()
5. Other (see comments) ( )
COMMENTS:
C~~v7s'0:t3
LOT:
S CJ. 7 TAl( LOT
BLOCK:
APPLijCANT
DATE
No Ve
()
( ) ( )
( ) ( )
( ) ( )
( ) ( )
CKOD BV: fAI~g f ~0110.7~
Setbacks from -c/lef -ro~~:
Front 90
Si~"..- ~- --~-~~
Setbacks from inter iorr-l i nss:
Side ~
Rear '~t1Ir.5.,
6.
-
-~~
PLANNiNG DijViSijON ACTiON PENDiNG: VES( )
NO( ) APPLiCAliON#
BUOLDiNG iNSPECliON Di\l~SiON
Not
App 1 icab 1 e
- - -( T-
( )
( )
([>
7. Plans Submitted
8. Soil Stability (footings)
9. Flood Plain
10. Other (see comments)
COMMENTS:
WATER POLUliON CONTROL
Not
App 1 icab 1 e
( )
( )
11. Meets Department of
Quality Standards.
12. Other (see comments)
Environmental
COMMENTS:
.-
--~
- - - - -
No Yes
r) (Ja
( ) ( )
( ) ( )
( ) ( )
CKOD BV{!, )~__
~ "'"tf = 7&
-DAlr~- ----
--- --- - ---- ---
No Yes
T")9Q
( ) ( )
CK'/DJ
B~~-~i[- 2L
~ n
------~ _.~_.
- ------
TO APPLiCANT:
Yo~~Building I Site Inspection:
I _ ~ Can be approved.
~:/~ ( f Cannot be approved at this time as indicated on item NO. above.
~ ~v ~~ Questions and further information on items 1 through 6 contact the LANE~
r)~ COUNTY PlANN~NG 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 bunding permit application fee is being ret_ur:n~d_.!:JJllIer se!?at'~te cove.r__ __
___'uu, ---,- - - -DEPA~TMENT OF ENViRONMENTAL MANAGEMEN"f ." ~- -,----,
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANNiMG DiViSiON PHONE: 687-4186
C55-28
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.aUILD"l~~, SITE EVALUATION e
," .")
( r ,BUILDING PERMIT APPliCATiON NO.
~,
() SITE INSPECT~ON
PLANNING DIVISION
Not
Applicable
( )
( )
( )
(')
( )
1.
2.
3.
4.
5.
Zoning Ordinance Compliance: Zone
Subdivision Ordinance Compliance
Required Access
Building Site (Area, Width, Frontage)
Other (see comments)
COMMENTS:
T. R
sU'B'm'v I S I ON :
LOT:
S
TAX LOT
BLOCK :1
APPLICANT
DATE
No Yes
() ( )
( ) ( )
( ) ( )
() ( )
( ) ( )
CKDD BY:
Setbacks from ell of road:
Front
Side Exterior
Setbacks from interior lines:
Side
Rear
6.
-
PLANNING-lllvfsTI>N ACTiON PENDING: YESl-,-mfl ) APPUCATiON#
BUnLDING INSPECTION DIV~SION
Not
App 1 icab 1 e
( )
()
( )
( )
7. Plans Submitted
8. Soil Stability (footings)
9. Flood Plain
10. Other (see comments)
COMMENTS:
WATER POLUTION CONTROL
Not
App 1 icab 1 e
( )
( )
11. Meets Department of Environmental
Quality Standards.
12. Other (see comments)
COMMENTS:
TO APPLICANT:
Your Building I Site Inspection:
( )
( )
-
No Yes
() t)
( ) (,)
( ) ( )
( ) ( )
CKDD BY:
DATE
No Yes
() ( )
( ) ( )
CKID BY:
DATE
Can be approved.
Cannot be approved at this time as indicated on item NO. above.
Questions and further information on items 1 through 6 contact the LANE-
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 building permit application fee is beinq retu~n~d under seoarate cov~
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANNING DIVISION PHONE: 687-4186
( )
( )
( )
C55-28
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LANE COUNTY PERMIT Fe
PERMIT NO, :;:;"1;,
CONSTRUCTION [?i;,]
MOBILE HOME [ ]
PLAN REVIEW [ ]
CHANGE OF OCCUPANCY [ ]
DOwner
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\A V L1'/~ "",,\..y>;..,r.....:J (J \Jl) \__t) L'
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o Contractor
NAME
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,Y,' '11, <Y)
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(:1'~ ~_ c: ~'J
ADDRESS
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CITY
ZIP CODE
PHONE
:,..,.. I)" ':7
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NAME
ADD RESS
CITY
{~r-'~'I\T '( (~(fn.q (.._~~,....,-",-v,
"'V1'\-; :,)l HI ,LI ,,,,I; U',,,__'I
ZIP CODE
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PHONE
O.S. Reg. #
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Subdivision
Rangp
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Section
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~'II Tax Lot
Codp
Census Tract
)10()f-1(;/J'
lJ<,,)U '-.....:;\.;:....
Lot
':"('
II
Block
n
. \
Acreage
Width
Access to Property (Road Name):
(',~"'~~t)(":''''A,~/v~r i Cr~i~)..-'t"J)
Depth
..
Existing Structures on Property:
~"" r ~,((...
Directions to Property - Address:
',1 <I ("\( )
I; If-
c :(~~' \,~('::;'-'" ~~~._,,'j
(,~ \. ~r;1;0"~: ;""
C~rlf,~'/i8<-;:]11() 11 (":~' ,;:0.f"r,",V",,\
" - ~."_/ - - ...' q ,. -............I~..
'STRUCTURE (# BEDROOMS)
SQ. FT.
VALUATION
I--\,\~
,-I..
, ,
";\ :
{~>-"'f' \,...J\,.~:'1l("'10"1
"I I.. f ,1:11.. J'
r ,\, _ '1 1
-,\1 'II 1] iP;v;'
1 ii 1"(';' ':l <10'?
I,'
(I< ,.,.,"1:' :''\ ",.-.,
, " 'f,r I
~ . ... I ~ t, \, I
;"-,,,,,", ,-,;(, t',.'-'. \~,., .,&r..... (.'''-'-' ~"")./ -,.-, '~/li"'1I".I,.....,\1 ~')(\'-\""'(~~'
'>./J, d.,) "'--) ".....,/'._)~(J ~,_;.'.,;"';!, ,l.. ..JV.";,,,..../0,,)V '--,J~/.)\..)"...
SEWAGE DISPOSAL:
PUBLIC [] SEPTIC TANK
OTHER [ ]
PLUMBING INSTALLED BY:
OWNER [] OTHER [] NAMF
WATER SUPPLY: PROPOSED [ ]
EXISTING []
[ ] PUBLIC
[ ] COMMUNITY. NAME:
[ ] PRIVATE WELL
[ ] OTHER, SPECIFY:
BUILDING
PLUMBING'
3% SURCHARGI=
MOBILE HOME
WASTE DISPOSAl
PLAN REVIEW
~,~, ......,,',
(i',
_'-".i',/'-I
(\ i";--'
/t' ',f' I
)i (:.',)
i,.I U'IV"tJ'
~)~~ '",-./i i
TOTAL
--, > '".("
'I; ':
U I n,/{I
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN, SEPTIC TANK CAPACITY:
('1 r';-"-,,'\ (\ '.'" ~,r,~
GALS J,~,":) MIN, DRAINFIELD !:(j L1N. FT. MAX. TRENCH DEPTH ,.. INCHES
/' '"--,,' 'I, I...(\.I";'" ','
" ., '-j \' ,;' ~'(' l!~' L ;
/" ';'~-""f, ~........\i;nt'!,-~ ,..,t'
\_ ..,) , ~ \j~j~,),,: w\.;k',!
I" . ~ ~~,...., .. ,..., ,.. ^ " " ". J"'l f) ('
"'1'-:-"')" ~'''''''''''''''''j\', (.:-------,. ,l.'~~~'1 '"'\)~"""- -r.llk'""''l ['1.1' f\' I ".}""r~(,\, rOt (',r,r...."'.').'",r,,..' 0,'_:.),":....,..,' ,(\.,/.rj ',',,"',, ','"
',.^',
(' '." 'f I ,j:",.\, ,,,rt.. i I.<i,(.'. .; ":''''!I' ~\.'j/:'f._" .,~ \ ' ! 11:' I i'''!I''-j .... 1':.;1. ,...1.. 1. '
. ~\I'_-' 'I"'." I ~:'-"'I \)!(.r,~-"~~ \;"'-)'v,-, \1)'j1 <.,.,."...~-'. ";:r--.:", -, :"'..::'?....\~'--:'A.~)...,f't) "{(i'll,"'I"- ,.r~Llr;'-"I....\';f\; ~-,..., f~~" '-I:'~()
\:/1l.-,,~J \,v:"'J~1 ".,',.:J0~iJu'lJ,....~./<.)U 'f\/...\.'/ UI,,/ v\..~~--"\.) ~I,;~h~ j:J{llj):>....~U~\:,:..;~/ ('VL4'\__~J ~.j\lJl1l:J ~JIJ '..-,>-.U'L)(} \',L;
~;;'.>1 " ''-,,:'' '...:~.'\'i;~~)0".~;..~-'.':;' ,,,</ ~)(~'J'")r'>:,' :,'''.'(~--'';-~r;J.,u ~':~.~~<\"y.--.",
, \/...., ",I L, ,~,;, ~^._.;., \) IJ", "''''''''''6_._ J~ i" ....1 J C.-: ,"'. ....,...JJ c,__'. V~) \'1.........; I
",:, Ii ~I
TYPE OF CONSTRUCTION
GROUP
FIRE ZONF
STAY 100' FROM ALL WELLS
USE CLASSIF.
SETBACKS, FT. FROM CTR. OF r/W:
FRONT ;, I SIDE EXT.
'.,
..,
FT, FROM PROP. LINE:
(, :' j (" ;'.,'
SIDE INT.:) REAR ,) nL,
ZONI=
, "
.~~jj:'
AUTHORIZED SIGNATURES:
/s/ ;', r,""i",(,:1"'n""r;. ~/!: "/~,C'('
"_>'/,,J....,," L/"-"'......:: 'IV;'''' ,--",j(;..)
ISSUANCE DATE:
:'\I""~'1l,p,~ ~'nr>)lv",
\...tf C\ '(I! 0.....)\1 ~ l:<:>~J U" ,Ld
;~}; ~ lill:;
~~.,
, :,Ii
"
BLDG, PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT:
Call 687-4065 to schedule all required construction inspections, Call 687,4061 to schedule all required
septic system inspections, All construction shall comply with the State Buidling Code, D,E,Q, standards
for subsurface sewage disposal and the State Plumbing Code, All buildings require a certificate of'
occupancy before being occupied, '
(See Details on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
"
\. ,;\ .,
C55.13
LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
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e
SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED /
/ DISAPPROVED /
REMARKS
GAS PIPING GROUNDWORK
ApPROVED /
/ DISAPPROVED /
REMARKS
ROUGH PLUMBING
ApPROVED /
/ DISAPPROVED /
REMARKS
ROUGH GAS PIPING
ApPROVED .I
/ DISAPPROVED /
REMARKS
FINAL PLUMBING
ApPROVED /. j 01 SAPPROVED .I
REMARK S -1JtJ ;:::-, /If ..,.L
FINAL GAS PIPING
ApPROVED /
/ DISAPPROVED /
REMARKS
CERTIFICATE OF OCCUPANCY
/ DATE
/ DATE
/ DATE
/ DATE
I DA TE <)"-/1=...9&
/ DATE
READY TO ISSUE I
I NOT READY TO ISSUE /
REMARKS
/ DA TE
e
INSPECTOR
INSPECTOR
INSPECTOR
INSPECTOR
I NSPEC1;.oR~~
INSPECTOR
INSPECTOR
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.
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. PROPOS.SEWAGE DISPOSAL SYSTEM RECORD . ~
INSTALLER: Complete top part of fo to signature and submit both co s with appl ication'~',
" '.~
PERM IT NO. 328-76,,,
INSTALLER'S NAME \ PROPERTY ADDRESS
rvn~ Gve..~ ? 5e'1'"'-g Cottonwood Street
No. Living Units Bedrooms Baths Basement Water Supply
Yes No Public~Other-List
Gray
Septic Tank:
Ft. from well
Steel
o
Concrete [Z) No. Compartments
Inside
Len'1th
OWNER
NAME
Dimensions:
Width
Ft.
Diameter
Depth
. Tile Disposal Field:
Distribution Box: Yes
Other Distribution-Type
Gal. Capacity
If; PI?
No
P;:llll ~nC::j;)r
Total SCI.
Ft. t./An
Feet from
, WEll
Lot Li ne
Front
Ft. Between
Lines iu
Foundation
MAILING
ADDRESS
~r~;~~r
Length of Lines-F't.'--- Trer'\'ch
lta52. 3L/JJ4. 5. 6. Width~
Plot Plan (see instructions):
11 ~L...Co.:t.t.o.n'nnrl ~+~oo+
Side Rear
Fille~) Filler Depth Fille~Below
Type/ v..,_ Above Ti le 7_in. Ti le IG.' in.
,
- -------
-,
- - {
~E(GE]VEll
~ "'-""-"-" -,
....- - ~--~--
-ViR'cycSEd lVE~Iv'
8",; Id 1\' 9
t~AR 2 G 1976
- - .-
.- - - -
k4Hg cgU:NTY
f;twl~~MgNfA( MGMT.
-
\
\
\ I .3D
- -
I -- - -
I ,-/0 -I
I '.
bDI I "0' f '0
\ ! t 1- I D-I
I I -
\ Llo -:::-
-
-
- I
\ 5~1 '-.-1
I.:)
-
-:;- -
Date
J I
..; /. 2~ /7CL.;l
Signature f)1rl'1.<?~1"- I't'2 <?///----.
CERTIFICATE OF SATISFACTORY COMr fl~ "
For Sanitarian Use Only: ,!) ate: 3-.Jo-~
In accordance with 1973 Oregon Laws Chapter 835. Section 21 this certificate is issued
as evidence of satisfactory completion of a subsurface sewage disposal system at the'above
locatjon.
~ Approved: System Installation conforms to current standards
c::J Disapproved: Does not conform to current standards
Remarks:
1:'. .,
C55-11
~~
Sanitarian's Signat~
LANE COUNTY V
STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY
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CONSTRUCTION [] MOBI LE HOME [] PLAN REVIEW [] CHANGE OF OCCUPANCY [ ]
~
e
LANE COUNTY PERMIT FOe
PERMIT NO.
DOwner
NAME
ADDRESS
CITY
ZIP CODE
PHONE
o Contractor
NAME
ADDRESS
CITY
ZIP CODE
PHONE
O.S. Reg. #
Twr
Range
Section
Tax Lot
Codp
Census Tract
Subdivision
Lot
B locI<
Acreagp
Width
Access to Property (Road Name):
Depth
Existing Structures on Property:
Directions to Property - Address:
STRUCTURE (# BEDROOMS)
SQ. FT,
VALUATION
"
SEWAGE DISPOSAL:
PUBLIC [] SEPTIC TANK [
BUILDING
PLUMBING
3% SURCHARGF
MOBILE HOME
WASTE DISPOSAl
PLAN REVIEW
OTHER [ ]
PLUMBING INSTALLED BY:
OWNER [] OTHER [] NAMF
WATER SUPPLY: PROPOSED [ ]
EXISTING []
[ ] PUBLIC
[ ] COMMUNITY, NAME:
[ ] PR IVATE WELL
[ ] OTHER, SPECIFY:
TOTAL
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY:
GALS MIN. DRAINFIELD I,IN, FT. MAX, TRENCH DEPTH INCHES
TYPE OF CONSTRUCTION
GROUP
FIRE ZONF
STAY 100' FROM ALL WELLS
USE C LASSI F .
SETBACKS, FT. FROM CTR, OF r/W:
FRONT SIDE EXT.
FT. FROM PROP. LINE:
SIDE INT, REAR
ZONF
AUTHORIZED SIGNATURES:
/s/
ISSUANCE DATE:
BLDG, PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT:
Call 687-4065 to schedule all required construction inspections, Call 687-4061 to schedule all required
septic system inspections, All construction shall comply with the State Buidling Code, D.E,Q, standards
for subsurface sewage disposal and the State Plumbing Code, All buildings require a certificate of
occupancy before being occupied. '
(See Details on Reverse Side)
(POST THIS PERMIT ON MAIN SLDG, AT SITE)
C55.13
LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT
, COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
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SITE INSPECTION
ApPROVED / / DISAPPROVED / / DATE
INSPECTOR
REMARKS
FOUNDATION INSPECTION
ApPROVED
/ / DISAPPROVED /
,./ i!
to /r ,!;,I /.. fj~lIt:t
/
/,-j
1'('/, /"
f\.........:./'
/ ,PATE .'
1,~2 . ,~~ j;lZ..~
J t. J -r.. .....(,. "~:J ,,71,-n
II .
l
I
INSPECTOR .'"
,1 - .).(} , '7~'(<{
REMARKS
FRAMING INSPECTIQ~
/'
ApPROVED /4' i DISAPPROVED /
{) /~
/, '~'
I" :J '
I NSPECT0i.8~ (.) ,;:
/ DATE ,I".A/J//i
I
REMARKS
LATH OR SHEETROCK INSPECTION
ApPROVED /
/ DISAPPROVED /
INSPECTOR
/ DATE
REMARKS
/'l
FINAL INSPECT '7
ApPROVED /,. / DISAPPROVED /
/ DATE 6/ 'i,;). / J 71t1 NSPECT R
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE / / NOT READY TO ISSUE / / DATE
INSPECTOR
REMARKS
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PERMIT if
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NO PERMI~LL BE ISSUED UNTIL THIS APPLI~ON HAS
APPLICATION FOR:
NOTE:
CONSTRUCTION I X. I
cO A /) L
Name
CONTRACTOR ?/I I L '- I P
Name
PLAN REVIEW I I CffE OF OCCUPANCY I
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City,,' Zip Phone
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. Address . 'ghy Zip Phone
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Block (;j,l Property Acreage
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Below for Office Use OnlyXXXXXXXXXXXXXXXXXXXXXXXXXXXX~XXXXXXXXXXXXXXXXXX
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SEWAGE D OSAL: . ....---
Site Inspection # Existing Sewfge Disposal System I~l or New System Required I
WATER SUP~ j Public I I
Well Spring Other:1 COImnunity I I
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PLUMBING :'
Installe by Owner
O.S. REG. II
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MOBILE HOME
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Address
Range
- 0 ~Section ;; I
Census Tract
Tax Lot
Subdivision-^1cNLo Pi1RK. 1ST "'~i)Lot
ACCESS TO PROPERTY (Road Name)
,
Existing Structures on Property:
13
Width 7 B' Depth J 70
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I' ~'1 2
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Property Location - Address/Directions:
t) F' ;::
FEES:
Bldg,
Plumbing
3 % Surcharge
Waste Disp.
Plan Review
Mobile Home
TOTAL
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c ;?S.C 0 , :b)ek('~ Fee Received By~p~Y/~~ Datei3~r9~r:~
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Septic Tank cafacyy (1ft> 0 DJainfield Required ~}lfal Feet ;;:2 L( 0 Maximum Depth ..J C?-
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Type of Constructio (J) GroupLtff '.1 Fire Zone
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Valuation
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Name of Community or Public System
Other I
I Name
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PLUMBI, FEEI2iJ 3
l / II of Fixtures
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Sewage
Connection
Water
Connection
PLANS FURNISHED
FACILITY PERMIT
Use Classification
Bldg Setbacks - from Center of Road R~of Way:
Front If 0 Side Int. !::> Side Exterior
I
5'
Rear {A ((J U.6zone
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PlANNING: {)A 1lo
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DATE:
LANE
~, SAN;TAT;9~ DATE:
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COUN~E;ARTMENT ~ ENVIRONMENTA
..BUILDING: /1/' ~DATE: ,,'
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MANAGEMENT