HomeMy WebLinkAboutPermit Building 1976-8-5
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LANE COUNTY PERMIT FOR:
PERMIT NO, 14H 353-76
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DOwner
.1hhn Harrell
NAME
MOBILE HOME t{ ) PLAN REVIEW [ ]
-1593 H~rberDriv~
ADDRESS
5i:Jf-d
CITY I
CHANGE OF OCCUPANCY [ ]
746-0349
ZIP CODE
PHONE
. CONSTRUCTION [ ]
o Contractor
~;lIn'"
NAME
"
ADDRESS
CITY
ZIP CODE
PHONE.
O.S. Reg. # NA
Twr
lA
Range ~
Section? ~.? Tax Lot
1300 Code
19-02 Census Tract
Subd ivision
Filburt Grovtot
8
Block 2
Acreago
Width
Existing Structures on Property'
Harbor Drive
, Garage and Trailer House
Depth
Access to Property (Road Namel:
Directions to Property. Address:
1'593 Harbor Drive
Springfield Oregon
97477
STRUCTURE (# BEDROOMS)
Permit to Park'Mob1le Home
SQ. FT.
#3 Bed:
VALUATION
SEWAGE DISPOSAL:
PUBLIC [] SEPTIC TANK [
BUILDING
PLUMBINC' A nn
3% SURCHARG F ,')
MOBILE HOME .,n nn
WASTE DISPOSAL
PLAN REVIEW
LAtif {CLI.~TY--SEWAl . Pk"i,:;ii AREA
360-67 PLUMBING INSTALLED BY:
] OTHER [ ] OWNER [] OTHER [] NAMF
WATER SUPPLY: PROPOSED [ ]
EXISTING []
[ ] PUBLIC
[ ] COMMUNITY. NAME:
[ ] PRIVATE WELL
[ ] OTHER. SPECIFY:
TOTAL
?A ,')
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY:
GALS. MIN.DRAINFIELD L1N, FT. MAX. TRENCH DEPTH INCHES
I(Clcn Mnhoflc. I-InmA In Teat Trnm ::!Ill n~Y"tc: nf the Dyic:.tinn C::At\l.=lnc rlfc:nnC:1I1 (;vc:t~m _
1'--;'r':_J/", ~ ~,,~ &--C /'{k;- '>.rt."L:'. 7~ A5/#~Ay ~+",/~_
:/-:. 0. tL-::- :'9"-'.:d ,/ r-'1"'j' _h'A'~:6P...i STM100'FFtOMALLWELLS
,YPE OF CONSTRUCTION~~ GROUP FIRE ZOr<J'E USE CLASSIF.
\
FROM CTR. OF r/W:
45 SIDE EXT.
FT. FROM PROP. LINE:
SIDE INT. 5 REAR 5
ZONF
RA f1H
by Fuller
ISSUANCE DATE:
G.I'I. GraY/sanitarians7sJ76 1 dllJ!
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 Slate Buidling Code, D.E.a. standards
lor subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy before being occupied.
(See Delailson Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX. 135 EAST 6th. EUGENE. OREGON 97401
~
BU I LD tNG SITE.
~;BuiLOING
EVA~UATION .' .~~ ~
PERMIT APPLICATION NO. /?1f1- ~$3-7b
() SITE INSPECTION
PLANNING DIVISION Not
ADPlicable
I. Zoni ng Ord i nance Cemp Ii ance": ZoneJtl--'/IIH( )
2. Subdivision Ordinance. Compl iance () .
3. Required Access' ( )
4. Building Site (Area, Width, Frontage) ()
5. ,Other (see comments) ( )
COMMENTS:
T IA _R 03
SUBDIVISION:
LOT:
S.7.-~-z.. TAX LOT i~
BLOCK:
APPL I CANT
DATE
No Yes
T) p 6.
() rr
( ) -H--
{ )-H-
( ) ( )
CK'D B)': -:,f~~9-;(,
Setbacks frbm cl! of road:
Front .f~
S,j de interi ar
Setbacks from interior lines:
Side -5
Rear ~~
BUILDING INSPECTION DIVISION
PLANNING DIVISION ACTION PENDING: YES{ } NO{ } APPLlCATIONH
7. Plans Submitted
8. Soil Stabil ity (footings)
9. Flood Plain
10. Other (see comments)
Not
Appl icable
~J-
{vr
{vY'
COMMENTS:
WATER POLUTION CONTROL
Not
ADOI icable
()
( )
11~ Meets Department of Environm.ntal
Quality Standards.
12. Other (see comments)
COMMENTS:
No (~/
T)
( ) ( )
( ) ( )
( ) ( )
CKID~
C:t1tJ rt.-~-'7I.
DATE
No Yes
T).~
( ) ( )
CK'D B~:~.J~~ 7-..S'o.?,
. - {/ DATE
TO APPLI CANT:
Yo~ Building I Site Inspection:
(v, Can be approved.'
( ) Cannot be approved at this time as indicated on item NO. above.
Questions and further information on items I through 6 contact the LANE- '
COUNTY PLANNING' DIVISION. Qu~stions 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 being returned__under seoarate cover.
uEPARTMENT OF ENVIRONMENTAL MANAGEMENT
135 Sixth Avenue East Eugen~ Oregon. 97401
PHONE: 687-4065
LANE COUNTY PLANNING DIVISION PHONE: 687-4186
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\ C55-28
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.M'jl." .:;:' V"l"'~ ;> ~ ~! !."......~, --, ... ',<;.J-c... ...-... ~.., '1 ;::;:_:;;t.,'1''f> '.
,~ "'~ :.' ~.\:_~.~,...'~~r.~""! .",.:<:~~,;~t j; '/"'... '~r't'" .-,;,,'....,...,. "_~' :::.~'.",: .: ,., ..r.'
:'.~~f~~tNG"~ITE'~~VALUATIoN':" '<:~/.i>Z.y ..', ',: T . IA'-'~R CJ'3 . sl-3-Z- TAX LOT l~~
.- ~";.I':'"'' "", ,. ' /l..JU"'02.2le".l" ,~llY'\",,;<SUBDIVIS'ION:
j.";('kL'.:BUILOING :PERM'l'r APPLlCATlON~NO. /I!#'-"f'~"C7~'.'F. .,:: LOT: BLOCK:
f""'" . , to' ' J"f;i.;);';'I1J: .
.... ,..4 ,
SITE INSPECTION'
;. ( )
.'.-
,,'
~r:
(, PLANN I NG.' D I V I S ION "~,
.,
. 1.
2.
3.
4.
5.
Not
Apel icable
Zoning Ordinance Compliance: Zone~~'IH( )
Subd i vis i on 'Ord i nance Comp 1 i ance( )
Requ i red Access ( )
_Building Site (Area, Width, Frontage) ()
Other (see comments) ( )
COMMENTS:
APPLICANT
DATE
No Yes
T)P 6.
( ) '(-t
( ) ,(-)-
( ) .<-)~
( ) ( )'
.--.~.,..."
:f
?:PLANNING DIVISION ACTION PENDING: YESl ) NOl ) APPLICATION#.
v
~,BUILDING INSPECTION DIVISION",.(
.v
Plans Submi,t.ted
Soil StabiFfi1tY (footings)
Flood Plain ~
Othe~ (see comments)
'-
"\:,
Not
Appl icable
( )
(v)'
(v)
~"II//~P.l1W (v)
:' 7.
, 8.
: 9.
10.
s
If
. COMMENTS:
(..,;-i
f,,,j
'/
,.
"
<,.
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i,"
'~'-'" If t)~'
~"-,,,,- -. ....:- '~-. tl\.
~ CK I D BY :/..:,,/....1"'- ,f;;: ".::-,.,\''5
-" -= DATE \,', \lo'
; ~~.~~'^
;..._'""""_........-..-.a ..... h~._ .~. -----
~~
"
;-,
No ' yis
T')H
( ) ( )
( ) ( )
( ) ( )
~=-a.
. '..1,...-"
r.;-
If
jOf-t1
'I '
CK' D B,Y.:-J.~20/-it
Setbacks frOm cll of road:
Front -1~
S i.de-Exter-i:or.
Setbacks from interior lines:
Side ~
Rear . tJ't-l ~
Ii. ,/(,d'~
, ..,of(
/;u
~---
.-
.1....
..iV
k~~~
,.
..-;..1\'1:'
...JiJ"iJJlw
";"
J I. "'if
.,.,,"": ....~.
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r
5. 1'1" n
,
; WATER POLUTION CONTROL Not ,
'11. ,. -y _:;:-'~"'C.. . ,,'" ,At'pl i c(ab) l.e /~)"_(~) . -"",,; "hAl'/",,~ .C,c? ,'7' '
Meets Depar:tmen.t€C?f~: Env'lt~onmen'ta'l'"' ..;: ~?:.,;f.. $ ..:-,t/ .\ 1>. .... ~ r. .... ~. ",.~, ~ ~ . ~
Qua.1:i;fy..S.tindar.d s1'"ttE _J'r'.o'l-t:. 6:->-7' ,';.' 'I., r(. '::~'i'i:<, :"p: e r ....7,?'cr /C:.;';:;;: T):?':;rc~.u~-# '
12. Other (see comments) ( )". ,( ) (').~ CK'D BY:N:0!~ 7:?o.?t
C~'~~S: II f!!f r' ,'> ., ,~-- .. {/ DATE
f}...~ Uc-J..I
- ,- -. ""'
1/_,,'---.-
!..L;....~ n- ~;-.....;;;..
. - /7""'--'"
__. _ . . ~/? ~ _ ~ _". ""7/ d'Z'Jf:"" .t.....
"'''';'';' '-_A;='i .r /",,_",,:/ ~~--:;..~~:z-- '-/
"-,,,~ r'/
TO APPLICANT:
~ YOUy Building I Site Inspection:
(v) Can be approved.
( ) Cannot be approved at this time as inaicated on item NO. . ab?ve.
Questions and further information on items I 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 al?plication fee is bein.q .~eturn.~d und~r seoarate cover.'
~EPARTMENT OF ENVIRONMENTAL MANAGEM~NI
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANNING DIVISION PHONE: 687~4186
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U.NE COUNTY ENVIRONMENTAL MANAGEMENT
PLOT PLAN
.'.
Name and Address of Owner C~
/S13 '~~~"",-tf
'1'h'
~
Telephone:
-'}'-f~, . c; '!3.vy
,
The building being, constructed under this permit will be used for
), LALki A~1-UA
,9 '
,Date this property was purchased
,--1~a q: IC/(" 7
Do you now, or did you ever own property adjacent to this tax lot?~~f so, please
list those tax lot numbers or draw those properties on the plot plan below.
Indicate on your drawing the location of all homes.(including mobile homes) now on
:::".7'~~"~" W;~:~ t~m~~l~\ F ~E",ld" ,. ....: :=:=====~ =~==
~~~~ ~.~~~~~~~~~~~~ ~~~~~~~~~~~~~~;~~~~~~~~~~~~~~~~~~~~~~~;.
. - -- ,_.. ... - -'.- -. ,-,.- _. -_ -_' -_. ,_ "_ ~ _. __... . .._ - n. ._ _ _ ._, _ _" __ _ ._ __, __ .. _ _. _ _ ~..'__
~ = = ~:~ ~ ~~; ~ ~ ~.:' ....: .: ~ . '\1) i ~ ~ .. = ~ ~ ~ ~ ~ ~ ~~; ~ -- =~.~. J ~ ~] ~~ ~. =~:.=~.
=:==::::=::'~~~=~:::_~:~~~~'~=J'~[~~~~~~:f~:~~~~~-::'==~~~~~~~~~~
:::::::: ::.:::::: .. ..-. - ::: ~ :: :::= :~:: ::::::. ~ I:' t."::.:- _ :: <i. .: _'h' _..... ..
n...... "'::':'=~::::':i"-'" :~. l:. (I,:::. ~~. ... ., ..n.
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- - -- - - -- - - 7} '''C:".or-'!..
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Name of Applicant (if different from owner):
Address
Telephone
Applicant's Interest: Buyer 0 Seller 0 Agent 0
C74-99
~p
Tax Lot J.~ [)O
Permit II
.
lane county
September 29, 1976 ,
Mr. John Harrell
',1593 Harbor Drive
Springfield, Oregon,
Dear Mr. Harrell:
Reference is made, to Lane ,County'Permit MIl 353-76 issued to you on
August 5, 1976 covering'the parking of a new mobile home trailer on tax
lot 1300, township 18, range 3, section 2.3.2 (Filbert 'Grove subdivision
lot 8, block 2). .
The permit requires that the mobile ,home be kept 10 feet from all parts
of the ,existing sewage disposal system. art Augtist 16, 1976 Mr. Wagner of
Harrison Homes advised us that it was, not possible 'to' comply with that
requirement in all respects due to the.small size of the lot which finding
we confirm. On the same day, Mr. Stan Petrasek, supervisor'of'septic tank
installations, and I inspected your trailer installation and found'that it
does not in any way interfere with the proper functioning of the sewage
disposal system, even though the trailer location is less than 10 feet from
some parts of the system.
In view of the above, a variance to. the clearance requirements of the
permit is hereby granted.
Sini,erely,
g.
George Svoboda
Director
cc: Harrison,Hornes
1441 Highway 99 North
Eugene, Oregon
Attn: Dick Wagner
Permit F.ile /'
"
~ lHE DIRECTOR
I DEPARTMENT OF ENVIRONMENTAL MANAGEMENT / 135 EAS'I 61H AVE / EUGENE, OR 97~01 115031687,4065
.;
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LANE COUNTY PERMIT FOR:
PERMIT NO. t!iI 35$-76
.,
CONSTRUCTION [] MOBILE HOME t;
PLAN REVIEW [ J' CHANGE OF OCCUPANCY [ ]
DOwner
. JIlIm Hlll'rall
NAME
1593 HG~er Drive
ADDRESS CITY
746-0349
ZIP CODE
PHONE
o Contractor
$003
NAME
ADDRESS
CITY
ZIP CODE
PHONE ..
a.s. Reg, # NA
.T wp 18
Range 3
Section 2.3.2
Tax Lot
1300 Codp
19-02 Census Tract
Subdivision
Fn burt Grov~ot
e
2
Block
Acreago
Width
Access to Property (Road Name)',
Hlilrbor Drive
.r~ragQ and Trot1er House
Depth
'Existing Structures on Property:
Directions to Property' Address:
1593 Harbor Drfve
Springffeld Oregon
97477
ST"RUCT1URE I~~BEDROOMS) u..
rom t to "OV'K \;illDlIG n,,:ta
SO. FT.
03 Bed:
VALUATION
SEWAGE DISPOSAL'
PUBLIC [] SEPTIC TANK [
BUILDINr.
PLUMBING ll.nn
3% SURCHARG" .1~
MO'BILE HOMF ::lO~M
WASTE DISPOSAL
PLAN REVIEW
360-67 ,
] OTHER [ ]
PLUMBING INSTALLED BY:
OWNER [] OTHER [J NAM"
WATER SUPPLY: PROPOSED [ ]
EXISTING [J
[ ] PUBLIC
[ ] COMMUNITY, NAME:
[ ] PRIVATE WELL
[ ] OTHER r SPECIFY:
TOTAL
:i4.12
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY: --...
GALS. MIN.DRAINFIELD lIN. FT, MAX. TRENCH DEPTH INCHES
KeOl) /!:obl1a Hlhi:3 10 feat from all oort!; of tho mdstfnq Se;l&lW dfsOOliOl llYSItEtJ
TYPE OF CONSTR UCTION
GROUP
FIRE ZONE
STAY 100' FROM ALL WELLS
USE CLASSIF.
SETBACKS, FT. '4ROM CTR. OF r!W:
FRONT ~ SIDE EXT.
FT, FROM PROP. LINE: 5
SIDE INT. I:l REAR
ZON"
RA KM
AUTHORIZED SIGNATURES:
/s/ J. E. BOliS by Fullor
!
ISSUANCE DATE:
G.M. Gray/sanitarian 8/5/76
dlm
, '.f'.".
.,.\' ',...."
"1::;1
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 inspec1!ons. All construction shall comply wilh the Stale 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'Reverse8ide)
C55.t3
LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
\
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
,/
, '~
S LAB FLOOR
PLUMBING GROUNDWORK
ApPROVEO
17
~
,
DATE
DISAPPROVED
\, REMARKS "
GAS PIPING GROUNDWORK
ApPROVED / / DISAPPROVED ;---? DATE
REMARKS
ROUGH PLUMBING
ApPROVED ~ DISAPPROVED ~ ,DATE
REMARKS
ROUGH GAS PIPING
ApPROVED ~ DISAPPROVED ~ OATE
REMARK S .
FINAL p'LUMB lNG,
ApPfWVED J52t"~ DISAPPROVED ~ DATE/~_//_"7/
REMARKS
FINAL GAS PIPING
ApPROVED ~ DISAPPROVED ;---? DATE
REMARKS
CERTIFICATE OF OCCUPANCY
READY" TO ISSUE 17 NOT READY 'TO 1 SSUE 17 D~TE
REMARKS
''- ,
"
'.
INSPECTOR
INSPECTOR
INSPECTOR
i
INSPECTOR
I.NSPEC'T~~~ _~"~~
"
INSPECTOR
INSPECTOR
'-11'1J.J-e..
.
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LANE COUNTY PERMIT FOR:
c
PERMIT NO, r)i!
-,I,.
;,
.,.;!"
CONSTRUCTION [] MOBILE HOME F] PLAN REVIEW [
DOwner ":0:':1
liGri'ol1
NAME,
~r,j~
,\:,V...~,
N.l\ME
.tl'l
'~.s~i3 ~:;:~fy::r
ADDRESS
tt~'i/'-:
CHANGE OF OCCUPANCY [ ]
14~'-"O~~t 9
CITY
ZIP CODE
PHONE
o Contractor
ADDRESS
CITY
ZIP CODE
PHONE
O.S. Reg. #
Twp
1"
.-
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Range "
FllbUl't Grov"l'
ot
Section 2.3,2
Tax Lot
1 r~"n
.....v Code
hI<<~':~ Census Tract
Subdivision
B
~
.:
Acreago
Width
.Access to Property (Road Name)'
Block
Harbor !!l'hc
Depth
~xisting Structures on Property:
nar~0C ond TrAiler Kousc
Directions to Property, Address:
~G9:3 ~:..T'bol' 91"iva
Spl"hlgf'Jeld Orer;on
97477
ST~~~:WNJ#~~~P:R8oq)~1b tlu,.:':!
SQ. FT.
1'3 Dc;J:
VALUATION
I q~". ~f':"
.l1nc WlJr~I\i WH liB D~Il)AUr
. M. ,.;"11 AReA
SEWAGE DISPOSAL: SGfr-1i7
PUBLIC [] SEPTIC TANK [J OTHER [
BUILDING
PLUMBING ..,'.::1
3%SURCHARGIO .l":
MOBILE HOMF :0.']"
WASTE DISPOSAL
PLAN REVIEW
PLUMBING INSTALLED BY:
OWNER [I OTHER [] NAM~
WATER SUPPL Y: PROPOSED [ ]
EXISTING [J
[ ] PUBLIC
[ ] COMMUNITY, NAME:
[ ] PRIVATE WELL
[ ] OTHER, SPECIFY:
TOTAL
...~ ,~
.~..t.
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MtN, SEPTIC TANK CAPACITY:
G~~.S<';il ..(le'IO i ~;NJ.!Ni.~R.A-'~iI1fR; !iI' P".rl;J.I~ll;le cld::n;ft){~E:~i,I;l~Df~1~'J:::5! O,YiJr.c)NCHES
_r ", ,...
'. . -.....'\-.-
. ,
..
. , ' STAY 100' FROM ALL WELLS
USE CLASSIF.
TYPE OF CONSTRUCTION
GROUP
FIRE ZONE
SETBACKS, FT. F.flOM CTR. OF rNV:
FRONT - SIDE EXT.
FT. FROM PR0P. LINE: "
H II
SIDE INT. REAR
ZON~
11;\ :i"
AUTHORIZED SIGNAJTUI1ES:"'n..., ...') ?lli~' "'
/s/ . C" VV;o).., i.J .
'.. " ISSUANCE DAT.E:
1i,..I. \.,r.'y/slIfl1tartnn JI\III.:
uti;
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 Slate Buidling Code, D.E.Q. standards
tor subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate oj'
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
,
, '.,
SITE INSPECTION
ApPROVED ~
DISAPPROVED ~ DATE
REMARKS
FOUNDATION INSPECTION
ApPROVED ~I DISAPPROVED ~/ DATE
REMARKS
FRAMING INSPECTION
ApPROVED / / Dl SAPPROVEO ~ DATE
REMARKS
LATH OR SHEETROCK INSPECTION
ApPROVED /
1 DI SAPPROVED ~I DATE
REMARKS
FINAL INSPECTION
ApPROVED
~
/1~
/
/ / DATE
DISAPPROVED
~ /
".
/r-f7-7C
REMARKS
~ ~
CERTIFICATE OF OCCUPANCY
INSPECTOR
INSPECTOR
INSPECTOR
INSPECTOR
INSPECTOR
Qd_ j~
(/ )
READY TO ISSUE / / NOT READY TO ISSUE ~ DATE
REMARKS
INSPECTOR
'/0
~/rL c/~-7?
/'
.~ ~
~~~~
,PERMIT IF ~ <.J;.-, ,.~
BEEN APPROVED
NOTE:
NO PERMIT WILL BE ISSUED UNTIL THIS APPLICATI0.. dAS
APPLICATION FOR:
~
PLAN REVIEW c:=J CHANGE OF OCCUPANCY C:=J
/1
Q II
,1-
~City , .' Zip
Section 2..3.).. Tax Lot 1300lle 1'1-0,2, Census Tract
ubaiv S10 _ ~ .. 'J Dr." L tp.~ . Lot ~ B~OCk:J/./ PJ;operty Acreage
ACCESS TO PROPERTY (ROad' Name) ~~ ~ ,'1/' . '
Existing Structures on Property: ctla: /1.1'1 L'l V -- ...2AA:u...J~
. 0 I' /'1 .,/ 7 . Q
Property' Location - Address/Di:rec~ions:' / S-q,~ iLl!..', t. J.~)1 rll).~"-AJ....PJ';- ...K.L/.IJ /-..i ~.p.A~.-7f~ ~.~
'fk.J.cA~,Q(..:I(J,:a..,.Atc-, '12<~Id' );Jb
!:? / '
CONSTRUCTION c:=J
MOBILE "HOME
[~
OWNER \\..A.~ '1)1, i1.",>v .PO
(J " Name
I .71 a 'i/....-J.....v,k.
Address
97471
l:ip
74/, .03"z'1
Phone
c:J
CONTRACTOR
Name
Address
Phone
O,S. REG. II
Range
3
Width~Depth
I_~^--~ '
'1747')
- Below for Office Use - OnlyXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXxxxX
/:J' I. Cn~ i'/ .11' . AS/I' Ft. IIBedrooms
L?'lA L/ / /ttJ-tlt.AJ 0 ~ 1~ ,3-.
, . '.
N
D
COUi;,JTY SPECIAL PERMIT? AREA 260,;.. ~ 7
IV . .
~xist~ri.g Sewage /9isposal System ~". or New System Required c:=J
\ 'p'ublic, ~.
H ~'
Other. Community ~ Name of Community or Public System
\. g. L-J .
PLUMBINGa'. IJ
Installeo by Owner c:=J
\, l't
PLUMBING FEES:l'
\ It of Fixtures
:'i1 d
"
o CAS\/
. ~~ECi!l
~I
Valuation
LAI'<!E
SEWAGE DISPOSAL: '
Site ,Inspection #
WATER SUPPLY:
Well
Spring
FEES:
Other
c:=J
Name
Bldg,
f',1f-O
I /;L.
SeV?age
Connection
~
Wate.r
Connection
~
Plumbing
3 % Surcharge
Waste Disp.
Mobile Home
3.t2. CrO
,'3 C;, 1;2
~FflISHED "
t ! .
YES c:=J ' NO
FACILITY PERMIT
Plan Review
TOTAL
.. -
Signat.ure. of A;plicant! 1J1t;,
Fee Received BY::~': ,....."..1' . ~
c:::J YES ~O
~N.) -nt. x!..,;hYPOL.
~ Date: /'~::?9-70
Type of Construction
Dralhfield Required - Lineal Feet .
.~~~~/~'~. ~(/~
1m
~
~
Group
Fire Zone
Max"imum Depth ~ j.
. 'F. p~ ~ ..fLLr
> 1
1.../
I, I J .
I
Min, ;(;;~n)1j~ /
'{
Bldg Setbacks - fro~ Center of Road Right of Way:
Front" 4:s:' Side Int. 5"" Sj.Ac li'V'+-~...~:-...
Rear s'
Zone K A--/JJ 1'1
~PIANNIN : DATE:
~ 7-7_t:1-7b
, .-
C55-12 LANE
SA~.IIJ A:~ ' DATE: ~~ DATE:
.r~! ~~J /-:. ~ - /' - ;) ~g-?'F
COUNTY DEPARTMENT t;I ENVIRONMENTAL MANAGEMENT