HomeMy WebLinkAboutPermit Building 1976-1-5 (2)
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LANE COUNTY PERMIT FL,
PERMIT NO
MHO 617-75
CONSTRUCTION [] MOBILE HOME [X] PLAN REVIEW [] CHANGE OF OCCUPANCY [ ]
- 0 Owner A'l to". f ~AMD. 111<:; J:AC:T ~1c:.T 1:'1_,r.;1t1J1:" norr..n~ ~4~_~nl{\
NAME ADDRESS CITY ZIP CODE PHONE
,
o Contractor (t"".lI'"
NAME ADDRESS CITY ZIP CODE PHONE
OS Reg # <>
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Twn ,A Range (\~ Section - Tax Lot_"r4""l7(1 Codp
'J -
5TH ADDITION TO FILBERI
SubdivIsion r:..m,.. "'~T'llE~Lot 3X Block ~ Acreago
Census Tract
Width
Access to Property (Road Name)
J..IADttnD nDIU~
Depth
EXisting Structures on Property
f\lnu~
Directions to Property. Address
?nlR WADDnD nDIV~
STRUCTURE (# BEDROOMS)
SO FT
VALUATION
D~eul. ?^ DA~~ Mncll... u~u~
? R~nDnt\uc::.
SEWAGE DISPOSAL
PUBLIC [] SEPTIC TANK [
BUILDING
PLUMBING
3% SURCHARG"
MOBILE HOME
WASTE OISPOSAL
PLAN REVIEW
OTHER [ ]
EXIST
PLUMBING INSTALLED BY
OWNER [] OTHER (J NAM"
WATER SUPPLY PROPOSED [ ]
EXISTING []
[ ] PUBLIC
[ ] COMMUNITY NAME
[ ] PR IVATE WELL
[ ] OTHER SPECIFY
II 1"\1"'\
:12
'<0.00
TOTAL
i4,12
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN SEPTIC TANK CAPACITY
GALS MIN DRAINFIELD
HOOK TO SYST.M 'NSTALL.D
S~~TI~ T~NK ANn AT I_~A~T
UN FT MAX TRENCH DEPTH INCHES
UNO~R PFRMIT 22Qq-7~ MORlt~ H~M~ TO A~ ~ ~~~T ~~OM T~~
10 ~~~T ~~nM T~~ n~AIN~I~1 n-
TYPE OF CONSTRUCTION
MU GROUP
FIRE ZONE
STAY 100' FROM ALL WELLS
USE CLASSI F
SETBACKS F.4T FROM CTR OF r/W
FRONT 5' SIDE EXT
5
FT FROM PROP LINE
SIDE INT REAR
')
ZON"
RA
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AUTHORIZED SIGNATURES
/s/ J. Eo Boss BY
ISSUANCE DATE
MCKAY FOR CRUICKSHANK/sANITARIAN 1/5/76
DLM
8LOG 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 6874061 to schedule all required
septic system inspections All construction shall comply with the State BUldllng Gode DE 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)
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(POST THIS PERMIT ON MAIN BLDG AT SITE)
C55 \3
LANE COUNTY DEPT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX 135 EAST 6th EUGENE OREGON 97401
~
,BUILDING SITE
~UILDING
EVALlJAT'ION 1.7%~
PERMIT APPLICATION No.~ff617_"7,~
() SITE INSPECTION
.-'1-__1-.~,C
PLANNING DIVISION Not
, Applicable
1. Zoning Ordinance Compl iance: ZonE;RA-nlH ( )
2. Subdivision Ordinance Compliance ( )
3. Requ I red Access ( )
4. BUilding Site (Area, Width, Frontage) ()
5. Other (see comments) ( )
COMMENTS.
T_ J~ R O~ S 1f'2.-~TAX LOT .
SUBDIVISION:
LOT: if!5L::J BLOCK: ~
APPL I CANT
DATE
No Yes
() VT 6,
() ,)
( ) I I)
( ) }
( ) (~
CK'D BY~ 12-L.9-1~
Setbacks from c/l of road:
Front 45'
5+<:: E..L:,:r
Setbacks from Interior lines
Side ~
Rear 6"
PLANNING DIVISION ACTION PENDING: YESl ) NOl ) APPLICATION#
BUILDING INSPECTION DIVISION
Not
Appl icable
l )
~)
( )
)
7. Plans Submitted
8. Soi I Stabi 1 ity (footings)
9. Flood Plain
10. Other (see comments)
COMMENTS:
WATER POLUTION CONTROL
Not
Appl icable
( )
( )
11. Meets Department of Environmental
Qual ity Standards.
12. Other (see comments)
COMMENTS:
rr} rfJ~
( ) ( )
( ) ( )
( ) ( ) CK I D
BytJ,~~~.7t,
IDA TE
No Yes
() -c:::Y'
( ) ( )
CK'D BY:~c./~ 1)..~1H -It)'
U U DATE
TO APPLICANT:
to~Bullding I Site Inspection.
~ ~,~an be approved,
1\ (~Cannot be approved at this time as indicated on 'tem NO. above.
I; \~ Questions and further ,nformation on items 1 through 6 contact the LANE-
\/V) COUNTY PLANNING DIVISION, Questions and further .nformation on items 7
through 12 contact the LANE COUNTY BU I LD I NG AND SAN ITAT I ON D I V I S ION.
( ) Will be held in this office until you can resolve the problems Indicated.
( ) Is being returned,
( ) Your building permit ap'pllca.!.'-9.'l..fe<:._!..s.-!?,eing ~~turned under ~ar...te cover.
DEPARTMENT OF ENV I RONMENTAL MANI\l.iEMI:NT
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANNING DIVISION PHONE: 687-4186
C5 5'- 28
,
NOIE
NO PERMr~ WILL BE ISSUED UNTIl THIS APPL
.nON IIA~ flLI'N
1'1 I{MI I /I M 116/7- 75
Al'PIWVLD
.
XCJ
APl'LILA1LUN lOR
CONSTRUCTION c=J MOBILL IIOML ~ PI AN RI VII W C~']
OWNeR /2;:JA_.v-z/d~../.r' /f{s-L-<:J;rLa:. ~!!j!/'J-u.P_
N lme Address IC..lt7
(lIAI>J(>[ 01 u('rUI'M1LY I J
97><o.r
2,p
3'k? -< ~C5/ C>.
Phone
CJ
CONTRACTOR
N<lrne
Address
City
/
l1p
Phone
o S
RCG II
'I Twp I~ Range O~ i Sectwn 1/ lax Lot Code
Address/Dl rections
I - /
Census Tract
/ 7- f{ b
thdth_Depth
Below fo r Of f ice Us e Onl vXXXXXXXXXXXXXXXXXXXXXXXAXXx}',.X.1<..x.X?^ XXXXXXXXXX
Sq Ft
MI-I--
I
MA.{XX'O..Xt.AXXX_XXX.XXXXAAXXXXXA.\XXAXX1CXXXXXXXXXXXXX)."
~~~ms Valuation
SEWAGE DISPOSAL
Site Inspectlon #
IXlstlng
/
/
/
SewagQ DlfSOS~ System
Pub l1c L=:J
Commun ty L=:J
FEES PLUHBING
Bldg :::;7!l '
Waste Disp
Plumbing Cf.-
Plan Review
Mobile Home ~() - =i-
Ii' Surcharge 12
TOTAL ,11. /6 c:::a- ECK
-----
~ or New System Requ..lred CJ
Name of Commun1ty or Pub] lc System Elbr /
~
WATER SUPPLY
Well
Spnng _
Other
Olher I I Name
Sewage
Connect~on
Q
Water
Connectlon
:2
PLANS rURNISHED
FACILITY PLRNIT
~ CJ NO ...p YLS L:;::] m;--
Slgnature of APPllcantX /d/~~~~.-I~
reeRecelvedBy Ap Date 1::J-..:)Q'7S-
Min ~~ Tank Capac1tv
-/-1) :71' d-f' A?-I
~ ULJ> ~, ~
rJJ..a. A '" -C: .pI d
D~alnfleld Required - Llncal Feel
f'r..s:l<1(JQU{} l.<-wOR g., f
~ r -I ho...R a.."d cc:f,
I
Maximum Depth
'#: ';;)~q -)" . "'fYI.h.I~~
,~Dt~
~
-
TYpe of Constructlon
MH
Group
I
Fire Zone
Use CldsSlflcatlon
Bldg Setbacks - from Center of Road Rlght of Way
Front 4..s' S1-de rnt 5' 3~.....,,;.
'-'^Le~.LVr
t
Real-E
Zone ,,(>14 -n? /.1
Pl1Nf1NG DATE
rul'a-/2-2..4 -7.<'
.
C55 12 LANE
SANITATION DATE J.1 ~jUI~I~G ~.
-~'~'rl ~ 12.-Ai -7') fJ4.J~
COUNTY DEPAR~~NT OF ENVIRONMENTAL~NAGEMENT /
DATE
j'7....."If;