HomeMy WebLinkAboutPermit Building 1974-7-23
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APPLICANT J:
NAME '-g..----La~c.a.yr:/:p
'AND ;, 1.:l'r/~DaJ-tot'j~~ Q'r__ '
MAILING.,..... J' _, "",,-
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STRUCTURES TO BE BUIlT THIS PERMIT
40 rrl'wt
LANE COUNTY buiLDING PERMIT OR MOBILE HOM[E APPLICATION ,I
. _. _" .. PERMIT TYPE - BUILDING D"'- . ,!,OBILE_ HOME i LO~5= REG. /I ' , , PERMIT 11: ~,!!,:!;{- 1.'1'
PROPERTY OWNER MAlLltJG ADDRf;SS PHONE
J,JLCf1ml?-;)u..,;;f. E, ._ "l?tL~____Ei2rC107_,()k Ja.h~h1tL ~..?~4.,y',~__6J.8'. -.:;46.2-
,~~;;O~~~ -=!N'wDE'PSTO'FlCE ___..::'NG.:'DRESS _V___ ____,__~_,_,____ PHONE
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~~~P~R~:~~~A~ ~~~~~~TlON F / L 13 eR., t G 1Crn) e-. L of 1- ,(j [/( ~ ,MET~STT~CBH~~NDS B ~~
RANGE-'---SEC,- TAX lOT '* CODE 19,-(j;:L-CENSUS TRACT :$S"=-"f- (;Q ,
. " I'r>) I' Cay 04,I"ft:la.f .hn'f Id /'na_
DESCRIBE 'EXltTING STRUC1{JRES ON PROPER!V IF ANY ~'.
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LEGAL ACCESS TO PROPERTY - ROAD NAME OR :it
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r~I,__t>r-."-. _,-I!....~i:7 ~~,
'\ PROPERTY SIZE-WIDTH . I)EPTH AREA
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14' ,
..? . 8,,2
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Connect 'to Existing' Sewage System D or New System Req.
TYPE CONSTRUCTION SQ. FT. # BEDROOMS VALUATION
3.:1tJ ,tiJJ ~,J'~. c?9~
D
x .;), 0
fe:(ly
/%
TOTAL
SEWAGE DISPOSAL ~
PUBLIC Cl SEPTIC TANK 0 OTHER 0
BLDG. $_!'/' tJ() FEES WATER SUPPlY
WASTE DIS. PUBLIC ~
I PLUMBING FEES
/ __F U E
, / CASH Jl!1 SEWER ~
_,/, tJ 0 L_ CHECK D~ONNECTI
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PUBLIC W TER
..1, r/.- =--- 'CONNECTION~~~..,
COUNTY BUILDING & SANITATION
LANE- COUNTY SPECIACPERMIT -AREA
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PLUMBING IN')A'IED BY ~n 0 fi>ia n s rr:!9,tI. I r'e
OWNER 0 I ~>jlil 0 NA P~i'" ('J..Iny'hnu~
PLA~ FJiR1~ I FAdllTY PE~MIT. ~
YES'OV IlwtJ ES 0 NO 0
SIGNATU~E OF APr;J?ANT J ~DATE/
0'--.... C'7:.P /~_--' 7 'LJ 17 if
, Fj.,ElYB~ " ~ATE/
,.t:,. ,,,,, . 7. '/1!2$_
/7 "PERMIT # .. I /'
/35'6. -7'-1'
OTHER
PLUMBING
... PLAN REVIEW
SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST, BOX; GAL
DRAIN FIELD REQUIRED
.-
lIN:FT.
TRENCH WIDTH FT.
. OR SQUARE FEET
TYPE OF STRUCTURE . . ---, ~N'-'--'-OcCUPANCY
___________ ,_ __:_!J___'m_______~.
BlDG. SETBACKS - FT. FROM ClR. or. ROAD RIGHT OF WAY
ZONE
REAR 'Y!'-RD
PUBLIC UTll. EASEMENT
~R~NT y~ SIDE INT. ~
~~ ?/2Jht"
cs)rections to Find Property: '_____:_m__'__:...
SIDE EXT.
PLANNING .'
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- ---.., ---- ,Cl:?1--.., ,---- ---- --- --
,,-c:rJ'~~ USE CLASSIFICATION
REAR-r /. ///1
? - /~:?-''':'" M~! - A3- ty ....
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COpy 1 - OFFICE
COPY 2 - JOURNAL
COpy 3 - AUDIT
.____.~n__ ..~"___ .__~_.. ___~_..__.___ __._____ _._____.___._~______..._,_~____~
Form -= C~,. I?