HomeMy WebLinkAboutADMIN 7/3/2008 1:11:06 PM Permit Building 15687
!
NO PERMI1
LL BE ISSUED UNTIL THIS APPLIG.
PERMIT IF :2(; 07-7:)
_ON HAS BEEN APPROVED
CONSTRUCTION
~ME
APPLICATION FOR
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PLAN REV:(1W
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CIUU,GC OF OCCUPANCY c:J
c:J OWNER /l,.,U./ /l--;{;,het:<. /
Name
'~TOR /7//'A.IM ; IVUh-t
Name .t;I6'O tl
OS ReG II
Address
Cl.ty
Zl.p Phone
IA/tOo,,'/ .l/2cj'-<..~7.s
$m;y~ S:/Ree?-'Y
.5 fl1ZlA/<I..(; d/ 7 ~~I
/ /Zip Phone
II l'wp ~nge D3 Sectwn I /
sUb~~rT~ot 31<:, Block ~
l ACCESS TO PROPERTY (Road Name) ,.Jh.. .tr ~ Oil" jJ~./ V-<..-.
EXl.stlng Structures on Property ~t7~~
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Property Locat.=;7:' Address/DHections ~/.A./ N~ ;;';>1_?~ lO
?'o1 3.5 (:2&C9.:z~,i/C<:kJ~tJ/Z..~J.~.o
Tax Lot
Code
Census Trac t
Property Acreage
Width______Depth
r;// T ~If'_~ ~
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Below fo r Of f J.C e Us e OnlyXXXXXXXXXXXXxxxxxxxxxxX}J{XxxxxxxxxXXXXXXXXXXXXYvv~'VYVV~cxxxxxxxxxxxXXJrJQ(}QC\xxxxxxx:xxx:xxXXXXXXXXX1..
2 I _~s Ft IIBedrooms Valuation
<;, moO ~ J nap...r- ,TT <+ ..:J .J::;n
-"?!t'",u' ' ~Vt;#U. ..e0 tj1/t?O/ ,
Bldg
Was te Disp
Plumbing
Plan Revl.ew
.:?r:J --
PLUMBING
Installed bnJOwn r to=J Other
PLUMBING FE !- -------
10ft Fl {tures
'/ '
New System Requl.red c:J
SEWAGE DISPOSAL ,") , J L'1 7L..
Site Inspection II ""'.....,. ':"'JL..-~Existl.ng Sewage Dl.sposal System
WATER SUPPLY./' Public C=:J
Well ~ Spring Other Commun~ty C=:J
Community or PubllC System
FEES
Name
Sewage
Connectlon
Water
Connection
Mobile Home
PlANS FURNISHED
FACILITY PERMIT
1% Surcharge
.~k C]
3)) . CJ,b... ~
c:J YES c:J~O" c:J YES c:J NO
Signature of APPlican~~~~/7~~ ~~
Fee Received By pn natel_ q_? ?---r~
L)lJ -~t--... "-U~..::.J
TOTAL
Mln Septic Tank Capacity
Required - Lineal Feet
MaXl.ffiUm Depth
ql / (.}-'
, - '
,
Type of Constructlon
/
,,,ql ~J
Ii"./ 'I
/
Fl.re Zone
Use ClasSlficatl.on
Bldg Setbacks -
ell
.. '
Front
from Center of Road Right of Way
Side Int ~ Slde Exter~
/ IVI
S' Zone III - M Ij
PUe.- in.I"J ('..,Pw/f/" () -I /97-
SANITATJ'fN~tI"'> DATE /ilBUILDING J f) /)/JDATE
~ / Vt.:tiM 'l-N-1r I!r~ kJ..>d:.{'AltI/{/),r)/1!J... /.. "},";
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL ~;~G;E~T V! ~ '.-
Rear
IPA(;~~'3 )u,;h(
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C55 II
DATE