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Home My WebLink AboutPermit Building 1974-7-25 " fl~i{/- '" ~ ',i' ':" '.'1 ..;. --.' .j,'-- _,i,:...-........~ ~'-, ,LOWEll R. ARNOLD SPRINGFIELD, OREGON rn H 30 t - 71. M-13Ql- 7)~ PHONE 746-,7887. .: PROPERTY Q'JNNER -,.;' LANE CC,- ':TY 'BUILDING BUilDING 0 . MH I'll MAILING ADDRESS , 1125 N.58TH (Sf> # 7) " ' PERMIT OR MOBILE HOME USE PERMIT PERMIT NO, CON,TRACTOR .' MAILING ADDRESS P~ONE ," PROPERTY LOCATION - INC~UDE :O~J~OFFICE 2091HAi1Q(lR 'QR(VE, PROPERTY lEGAL DESCRIPTION - METES, BOUNDS FilBERT GROVE 5TH ~DD.,' B-2, L-58 TWP RANGE 18 03 SECTION TAX LOT NO. ~ / -t.:t..:2. CODE 11-,G?% CENSUS TRACT APPL EXISTING STRUCTURES ON PROPERTY NOllE LEGAL ACCESS' TO- PROPERTY HARBOR DRIVE PROPERTY SIZE - FT. Q , WIDTH2 DEPTH ~ NAME & MAIliNG ADDRESS FOR MOBilE HOME PERMITS, ONLY No, of, Bedrooms !l 86 AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System D TYPE CONSTRUCTION SQ. FT. :!+ BDRMS New System ~ _VALUATION ~10B IlE" HOME ", ,., " , SEWAGE -DISPOSAL . fEES PLUMBING INSTALLED BY OWNER 0 . OTHER: NAME WATER SUPPLY ,. PUBLIC 0 BUILDING , WASTE DISPOS,AL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK 0 OTHERD "iO.OO' 4.00 PUBLIC ttJ o OTHER 10.00, TOTAL . , 54.00 COUNTY BUilDING & SANITATION 'SPECIFICATIONS ",?,>, MIN. SEPTIC TANK CAPACITY WITH DIST. B6'x:~'GAL. 900 DRAIN FIELD REQUIRED UN, 'FT 1~ TRENCH WIDTH 'F,T. 2 . OR SQ. 'FT, 300 No SERV ICE CONNECT IONS. T,O BE' MADE UNT Il WATER SYSTEM 'I S, A'PPROVEO'. SEE ATTACiiED SiiEET,. TYPE OF STRUCTURE OCCUPANCY ZONE RA4fti PUBLIC UTIL. EASEMENT M-l . BLDG. SETBACKS __ FT. FROM CTR, H5 RR6P_'~!9HT OF WAY. FRONT 45 SIDE INT, 5S0UTH SIDE EXT, AUTHORIZED SIGNATURE - DATE /5/ ,J.E. Boss BY CHARLES HARSAUGH ' USE CLASSIFICATION REAR ,7' J. SHOOK DATE '7-25-74 BP BLDG. PERMIT - WHITE OFFICE COPY"- WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN "SANITATION,- GOLDENROD Call 687-4065 to schedule all required inspections. All construe" tion shall comply with Uniform Building Code, D.E.Q, standards IMPORTANT: for subsurface sewage disposal and county regulations covering plumbing. All buildings require a certificate of occupancy before being occupied. :, . (See Details on Reverse Side) FORM =:-C55 -'13 (POST THIS PERMIT ON M~IN BLDG. AT SITE) .. 'LANE COUNTY, DEPT. 'OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 , , , ,fn~ ,i,;c? ' " '>" ' . r;t':..j~ aryctl1/ "" ,~ c' . - .,....., ~ -"' ".-' . ~ \l-. :'0( ".. . ,.'q,,~ ,'~ \-.rie H ",' " "',1(<<:', "~~""..",,, ;.- " " .' . ~ .' .<.,' '. "\ . ('" ',.\'. \~ ' " "'. ~ .\. ' , '-,j' \ . - - -'" ~', ~\-~~j ~-~ \... . " \: ._~.-- .. . ,,/' , .. ,I 1 . ',..\' . , . ~. :1: ," :1" I . " :--1"< ' , '" . '1 1 I' 1 .\ - . .~ '\\. ..I~~:c'~ ','I, . ql .'. , .1 I' .. ;1 I 1 .....,>. ", , " , -;:::. " .. r I I I, ,I , . I' " . ~.". I : ',1 , , .... .; . '..",' 'I . . '." . ""'~ I \~ . i .k' I ! \ ,'., \N :! . I' . ,\. \.j .-- ~\ "~'3d rid:., ,,' ~_ . d \DI . \~~~;1~~. ., ,:,,'~II~ I " \"" '1>;').<.- 01d ~', I .. .,.s.O~ ~iJ' \f" , . f . ' ' . :'\.~, I ., . ,.' .,.':..' : L.. ~'" '-If'" / . . ~ .- )\. "., , \ "., . . . . '\ .. . " ',- .' , ..t"... ..........-" '-.. .. \. ~ , -, ~" . ~~~. p , "';"'-.. ,~ ~ r w'i.' " T' . ~tr,t . -..~ " : " ., .,;. .,.- : -'...4 " '{ ~ :. .' :. ~ , ,[ '''''IIIl , . l I. :', I I ....-.. w, 'Jl\;''''>'''~' >.pl 4'-: '....4 . EVALUA,~Y--' r Permit Application No, ',\ J C~0f;V NlIso/-7V ( ) ( ) ( ) / T I1rR Os S Zg- TAX LOT CENSU,~I.' TRACT I=" I ber"'"" /"~. - 5-h APPLICANT:' ~lT~ /~ NAME L()I.A~ II ADDRESS .s-c.. L-sr BUILDING SITE Bu i I ding Site Inspection Pre-Permit Investigation PHONE DATE '7-/$'-7Y = I. Zoning Ordinance Compliance (Zone ) Subdivision Ordinanee Compl iance NOT appl icable () () () () () () () /()()~ ( ) C iY01") () () () NO YES NAME DATE LANE COUNTY PLANNING DEPARTMENT 2, 3, 4, Required Aceess Buitding Site (Area, Width, Frontage, Setback) Other (see comments) 5. ~ COMMENTS: -_.,- -- BUILDING INSPECTION SECTION NOT NO YES NAME DATE apD'1 icab I e - "'f/J 6, Plans Submitted . () () ( 7, Soil Stabil ity (foot i ngs) ( ) ( ) ( ) 8, Flood Plain ( ) ( ) ( ) 9, Other (see Convnents) ) ( ) ( ) Ij,?J~,i 7-)..:j''7'f L. COMMENTS: \ I TO APP LI CANT: ~ 1l'i Your IrA~~ ~l ( ) ( ) ( ) Building Permit / Site Inspection: Can be approved. Cannot be approved at this time as indicated on item NO, above, Questions and further information on items I through 5 contact the Lane- COUNTY PLANNING DEPARTMENT. Questions and further information on items 6 through 13 contact the Lane Countv Buildinq and Sanitation Division, Will be held in this office until you can resolve the problems indicated, Is being returned. Your building permit appl ication fee is being returned under separate cover, LANE COUNTY PLANNING DIVISION 135 Sixth Avenue East, Eugene, Oregon 97401 Phone (503) 687-4186 LANE COUNTY ENVIRONMENTAL MANAGEMENT 135 Sixth Avenue East, Eugene, Oregon 97401 Phone (503) 687-4065 C55-28 'c . ...... , .'.' lj':(i;4)(~ i 6/ -.. ., ., LANE C( HY BUilDING 0 BUILDING PERMIT OR MOBILE HOME USE PERMIT MH ;~ PERMIT NO, MAILING ADDRESS 1125 N. 58TH (Sp () 1) SPRINGVIl!\,O, O:ll!GOIl MAILING ADDRESS " /'/, , PROPERTY OWNER lOiJiLL R. ARNOI.D P~301- 74 PHONE 746-1007 CONTRACTOR PHONE .. , ,.Ie', ~ .'> ."". ;. ~,.\,,-:,~,~ . PROPERTY LOCATION - INCLUDE ~OS_T OFFICE ~1 HARBOR DRIVE PROPERTY lEGAL DESCRIPTION - METES, BOUNDS F'IL6tRT GROVE 5TH ADD. B-2, L-58 TWP RANGE 18 03 SECTION 28 TAX LOT NO CODE CENSUS TRACT APPL. EXISTING STRUCTURES ON PROPERTY !-lONE LEGAL ACCESS TO PROPERTY HAIlBOR O;1lVll PROPERTY SIZE - fT. WIDTIi\2 DEPTH 86 AREA NAME & MAILING ADDRESS FOR MOBilE HOME PERMITS ONLY No, of Bedrooms a STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. :# BDRMS New System ~ VALUATION Mos 1I.1l HOMIt SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAilER , FEE~ PLUMBING INSTAllED BY OWNER D OTHER: NAME WATER SUPPLY SEPTIC TANK D OTHERD ~.oo 14.00 PUBLIC fu o OTHER ~.OO TOTAL , ~.oo COUNTY BUILDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY WITH DI$T. BOX: GAl. 900 DRAIN FIELD REQUIRED l~ UN. FT TRENCH WIDTH FT. 2 OR SQ. FT. 300 No s~nVICE CONNtCT'ON$ TO DE ~~O~ UNTIL WATER SYSTEM IS APPROVED. S&~ , ATTACHtD SlItET. TYPE OF STRUCTURE Mi OCCUPANCY I ZONE RA-Mi PUBLIC UTIl. EASEMENT BLDG. SETBACKS n FT. 45 /0/ FROM OR. ~P.5 R.C?e,D.,p-IGHT OF WAY SIDE INT. 5S0UTH SIDE EXT. REAR AUTHORIZED SIGNATURE - DATE J.E. B09S DY CHARLES HAROAUGK USE CLASSIFICATION FRONT 7' J. 5HOOII DATE 7-25- 74.-01"" -'. BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule 011 required inspections. All construc- tion shall comply with Uniform Building Code, D,E.Q. standards IMPORTANT: for subsurface sewage disposal and county regulations c(jvering ~ plumbing. All buildings require' q certificate of occupancy before being occupied. (See Detoils on Reverse Side) FORM == C55 -1) (POST THIS PERMIT ON MAIN BLDG, AT SITE) LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 SLAB FLOOR PLUMBING GROUNDWDRK ApPROVED (j DISAPPROVED .Cl DATE. REMARK S GAS PIPING GROUNDWORK ApPROVED /.. / DISAPPROVED / .; DATE REMARKS ROUGH PLUMB I_NG_ ApPROVED .C1 DISAPPROVED / / DATE REMARKS ROUGH GAS PIPING "+. ApPROVED .Cl DISAPPROVED. C1 DATE REMARKS FINAL PLUMBI,NG ApPROVED /~/ .Cl DATE o I'SAPPROVE 0 REMARKS ;FINAL GAS,PIPING ApPROVED .Cl DIS.APPROVED (j DATE REMARKS 'CERTIi'ICATE OF OCCUPANCY' ~ . READY "r;o' ISSUE.I _ /. . , 9-- 3-?.y ~ :. . NOT READY TO. I ssu'{ r ' / REMARKS ,."', " j DA T'E INSPECTOR INSPECTOR INSPECTOR INSPECTOR i' l~ .1,' ,'~ . . > .. .- ' INSPEC '(f INSPECT9R , -j :,', ,,' INSPECTOR -' , " " , " , ~ .. ., '''''Ie'. ~,. .~L, ..,. ~ .,.,': ~'l{, l." i' t ';;.'" "iotiit ',';' , y'- /ROPERTY/~WNER . I '" l~rLL R, ARNOLD r ; CONTRACTOR I r , ~ANE C~ITY BUilDING 0 BUILDING PERMIT OR MH .@ MAILING ADDRESS He, N, ~K (5,. , 7) ( ----- MOBILE HOME USE PERMIT PERMIT NO, 1+l})1"74 PHONE 1~ 7687 , I I ,~ S'fllN4rIELlt, OftItGOH OJ ~ MAILING ADDRESS PHONE . PROPERTY LOCATION -INCLUDE POST OFFICE , r 2091 HAIlHII 011 I VI . j PROPERTY LEGAL DESCRIPTION - METES, BOUNDS rll.""IIT GIlov~ 5TIt AOD. 1-2, L..,e t ~ ~1" t '..., 11 18 03 SECTION .ee TAX LOT NO. ~- CODE CENSUS TRACT ITWP . I RANGE ~- ...~. APPl. NAME EXISTING STRUCTURES ON PROPERTY ....1 & LEGAL ACCESS TO PROPERTY HA... Oft I VI J MAILING ADDRESS FOR MOBilE HOME PERMITS ONLY I No. of B~drooms I: PROPERTY SIZE - FT. W1DT~2 DEPTH ~ AREA I ',' I - NewSy~tg.rt) I!I d! : _VAL'U~_:r!.qN_.,;.tj : I',.'.., .iif ' .'~~ "r ','. '.. ~.i~~r\"hi, ,,' ".~...,.",:~, "t . ,:,,"~t~~~.:~\_:~'~':" 'J, ;, ,_: - ~''''''''M~~'~..!-' ,;;., :..,~4, .1fl~~:~d" t; ";1,1f~"';o~~'4~H'R-_ STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. ;= BDRMS ...' Ll HOMl r I I I !'" ; I ',I .- ,1_,J~EW ~GE, ~~S.POSAl i : PUBLIC D < :-"~'_ SEp,TIC. TANK 0' f" ~UrLDr~G.'~.;", .~. ',W.,A.',S,.,T1~6)s.p6~:,~'l.~ ... . ,:~~. r ,I :""q"'.',, "'r :L'~'i:UMB.I~G._'. "<, 'I' t. F>lA~ :'>;~~Y'iEW . - ,- .. . PARK TRAilER "!,'.1.,,. ',' "r '" ;..-~:-::, ~TOTAl' \F'N<.?~PTlC . T ::K ~:'AClTtf ,. j WITH - OiS:T:,,'B,O)(: GAL !i ...,"'.'.:'.,' I I ,,. . ,S\lII'<o<<I ; J . .. '-yo: ~.l\ll1l ~.W PLUMBING INST/~llED~~}: _,~" '\- ;',~:l~)il~~:?::.,' OWNER D ., "OrHER(1NAME'~i'" ;'r:,.;~~:~:..? ':".,', "N:.> ;,,~.t'~_~ " WATER SUPPLY "1 1:\ ,":~.; ./""J~ ,; ~~~. '~O'i. _~~'~. ~:"}."I: ;;.: ,'"' _ l' .A~'~",o,- .. '.... .}', j ~:'1:', ';;~'fi{1l~' . PUBLIC "'EJ -Q''''~)Ot. OTHERj"~' .- '.~ ,'P t> . . .- t : ~ ,;.' .,' ~r' '{;, ';>';;''''';:~'''/~;~~~~;' '" Ii' 0' ~'~1f m:':;J}:..~~JIt,;'t~. :t' . 2; -;.~ ,;~' '-~~~':' "~I' I" : f"~ ,~, ~I,:f~f~ "'~' I .~ . .~ ~: .;"......,.... .~ .~;J< :' 1. ' ~ ~ '. ...".. . \ ".J .-,. ..' .;i,:;~.,~ >i1~ ".'!,.~~,\.!'I . ,"" ','Nt..'...."',..'''-"''' """".' , .'1: nj::--,~.;'_.Ii.-."iM":,~~ojHII-.&h,.}:,".:_:,_::.,,_,.'.',' DRAIN FlElD'REQU',RED,'/ ,.' '.. '.' ..., "...~J...'\"'..., -: ~1'i'~;f:,~" .' 'I'''' " III ",' ":>"~_~7.'.......,.' ,',. UN. FT ,-- TRENCH WIDTH FT., "," : ",.?R.~SQ:{:~:T.~~.:;;,~~~~~::~ .'_ _ .~~_4 ,t T~1il\. tI4"~'I~ 'VAtlll llY"~ 1,\4"'\\.~o...<:: ....i:.'.<i~l.~}~flft"~,, J~~\~'" '. ,\ ~ ,'", \. ~~~'. ~,.:;~';W~: S~i~i':ri":%~<~il!.,'~,' , '~ ~_'\,-I..! " --:""_:'l<:'-::.'. . ~~'-\J:":~'~.',,<_;.-t:;w'<.., J?~"''':':- ':!: .:...~~~4-.' - ., >_ '~'. __ ~, ,,,,,,,",,,I.,. J:'IIIIii. ,0,..,;<P.> _,_J-'~ij .;' '; .,.: :;~. :':_-'::":;~;;;,'>~,":~~~~:. r.-:_~,:')~~!?~~: . '.', --,;;.,-?"ifj'"j1!'W""l' ;",.<r~L..l ZO..N .E.. . ,.... " ~l!~B~ICi, UI!~iEASE~$~r~:~.-.",!;f,., '~i~l-"t:'. ~ .'_ - . t, ~. "i ..."1.,:"..4H- "'~ ';~' ," ;"i,~J, ..'~I~"'~.". ;:~1" , r "',\,1</..."., ':: '. .' I , ~'h~:,.:.. '<.:~ .~_"'~:: .' " '.' . .'. '. -', DATE ~".... ... FEES I:'OTHERO '.-.' ,,... "I~.W _. ; t $ ~.W .'~ COUNTY BUll[jINGj'&,St>:NIJjATION SPECIFICATlOIiis. . ti_'~"'It!N* . I .~l1-i~,ill'l.&t"I'.. , I .it [' j . TYPE 'OF S,TRl,J~'~~~F I" ..t , . OCCUPANCY 'h ~,BLDG. SETBACKSt_,-FT. fROM CTR:cf0_F R0~[j'RfGHT OF WAY ii" .!( , . It............ . ~ 'SH)~ ~INT:'.,~~,,,,, SIDE EXT. ~AUTHORIZED SIGNATURE - DATE I~ J.t, 1&. liT ~In.n "'''.A~ 'fRONT REAR l' USE CLASSIFICATION ..' I , I ~~~ ~~~,i4~~~:'~~~t~d~~if~~~e~~;id~~n~~t;:o6~~:t.)!i~;~~;~~1 IMPORTANT:' for subsurface sewage djs'pos~1 and '.cqoniy ,regulations c9verjnQ~ i plumbing. All buildings require a certificate of .occupa~hcy; 'Refor~1 '; being, occupied., :, "', '_ _ ," ~:.,,){.'~ " -...... \- :,;';' (S~e~Defail~"~8h', ReJ;rse "Siae) .~\ ",,,;'",\ ,;,'" , '! J. $/tM<< ,-'.,. I , . ;'BLDG. PERMIT::':' WHITE IOFFICE COPY - WHITE 'COUNTY TAX - PINK ' tpLUMBING - CANARY IBUILDING- GREEN '-SANITATION'- GOLDENROD I ; '~" ;:. . ~"11:}';' " , rORM = C55-)) -. - . . ~', ~;-', ~ - i (POST THIS I'.ERMll ON MAIN BLDG, AT SITE) ." LANE,'CO(n~rY:;D"EP_T~;Of;.rE.NVIR0NMENTAL 'MANAGEMENT . :.'- .COURTHOUS~ ANNEX, 135' EA~T 6th, EUGENE, OREGON 97401 ,. ,;_,'--',1-;::" S!TE INSPECTION ApPROVED Cl DISAPPROVED Cl DATE REMARKS FOUNDATION INSPECTION ApPROVED;----Y DISAPPROVED / / DA TE REMARK 5 FRAMING INSPECTION ApPROVED / / OISAPPROVEO /7 DATE REMARKS LATH OR SHEETROCK INSPECTION ApPROVED / / DISAPPROVED ~ DATE REMARKS FINAL INSPECTION ApPROVED ~;:;;;t) f7 2. D'iE~ Af ( '- REMARKS CERTIFICATE OF OCCUPANCY INSPECTOR INSPECTOR INSPECTOR INSPECTOR ~'I NSPECTOR READY TO ISSUE Cl NOT READY TO ISSUE Cl DATE REMARKS '/VI N 301" 71( ~ INSPECTOR ~091-7(~f)?We ; , o ", , ~ : ..'; =. ."' ., 1s p~~~~~ O~,iCa:tl,~~':~,7'~ ~li3':'~ '.INSTAlLER: ' ,Camprete . top PROPOSL~SEWAGE DISPOSAL SYSTEM RECORD p~rt of; form "to si gnat,ure ,and sub';i t: bpth .co, . No"'" I OW~Ll""A'RNOlD " . ." ' , , Feet froni . " ,'. HAILlN~"' ,'ll'?~,~I""B.T~'i~o'J17\ ,WE1." ~ Foundat,ion'>:S ," ADDRESS - ., " " Lot Li ne. ,r', ,,_, ," 7' , ~pDI'Mr.:il~l-n 'Qot'-'r.:nl\I"." ~ Front --' /0. Side.. /0 . ~~1Rear'-,-,~' ,'. ,~~ng~~, tfji 4~~-~~'- 6. nj~i~~1.~~~a~(ls~, ':1 ~'~~e:et7d li~.~~ix "I~~~~:r T~i~t~ i n~;: ~e~ Br~~ ' '.Jot Pl"an I see'. instructions!::' -, , ','~S.', '. . ".' J"':':~~ ...... . _....-... :-. '0 <t!"""' ; s~ ;0.-', -' ~. '-' , .......... ~ ...... t/, ; ."'J..o . .-.-("-' ....:::, '}.<l-77 -:... ~ ....-. / "\ '" .!;o' ~ ",,' ~, , ~ ~. .... ". " ,. ',' , < .... . - . ~, .' --t-" 'fl'~ ~, .'') ~b,' I,". -". , ,',-RE'Cfr~VE~' ,By' ,',," .L, ":, /96" ,,~r\' '- c --C---'---=-- . ;-'; , Z..',I ;- ,'. .:',~ .~ "\ . , . , .- ~ ..:;..~-~-~~. . '- ,'- , -'- ,AUG05197Lt: '. " ., ..... -. '.- . . . ".:~.. , t:: LANE COliN'TV' , .. ~,~YIR6NMENTAL .MGMT;';, f;' ,-' : ,~ .." :-..,' l ,~ , o".~ \'t. -, 9 '. ,.~'" If:"" OF' ::;:~~:J"~TI~"~~ r;hr)' .. Fo/'San i tad an ilia o.n ly: ", , ' ,Date g"; '''7f f In accordanee',wi:th"1973 Oregon .Laws Chapter 835;' 'Section 21,4'this ce'rtificate' i: i~su " ~'t';,:. :as~,eviderice ot"sat-i,sfactory,camRletion of a subsurface.sewage,d'isposal syst~m at the above , ".,~~~'~~:XTAPpr()~ea.: ':;Y~,tem~1 ~s:ta. \: l;~ io~' conf~rm~ ,to current 'standards ~ ' ", " ,; Disapproved: . Does. not conform' ,to current standardS' <"" 'R'emarks:: " ',.' :" , , " . -~., ~'. , .:- , ~~ ,(O;4m .!bATI1Pfj '," , ~tFf.arrfml.s ~;€-C1r~ . -:- > ~ LANE COUNTY , ENVIRONMENTAL 'QUA~ITY . .. "..', .-. :,' C55-11 :" .." . " ~.. , ' ". . ',' ,.-j' - .. . , 'STATE OF. OREGON ',OEPARTMENT OF. '. . , ~ I' ;-~-,....~~.; <.''- . ;,"',,' , .. LANE"' COUN BUILDING PERMIT OR MOBILE Ht....t USE '1~~ICATlON' , ",' PROP':TY OW~~:MIT TYPE -, BUI;G 0 MAI~'N~~:~;:S~HOME ~ ~SC R~G: ,'. ..,,~1)~~1T M/J 301-p2N! i owe U~ - [IdS IVSf?',- (~f 'ZJ 1~'nrFE/j .the ~ CONTRACTOR MAIlIN9 ADDRESS . '.... '':'" -' . ~: ,-., .' PHONE ", PROPERTY LOCATION - INcLUDE POST ,OFFICE ::fo 9'/ i-HA!e f{nf <1J ,: I ,; ("_ :- -d-r-' " ., S - Jdcl ,5,'0'" 'l3th~f'd:.. j~T<J8" TAX L.OT ~# CODE . ,'. CENSUS TRACT METES & 'BOUNDS 0 YES ATTACHED 0 NO PROPERTY LEGAL DESCRIPTION r; J .'" 'T' C' LOT - BLOCK-- SUBDIV, . il . hl!f yo. c.-v e.. TWP RANGE " 'SEC. .:1:8',' Jg 3 SA fh f_ PUBLIC. 0 BLDG; 'WASTE DIS. .PLUMBING .' PLAN REVIEW PARK TRLR. . SEPTIC TANK ~ 'OTHER 0 FEES WATER SUPPL..Y P'UBlIC,~, PLUMBING F ES . DESCRIBE EXISTING S~R-y'CTURES ON P,ROPERTY IF ANY. " fV f) IV "C-- LEGAL ACCESS TO PROPERTY - ROAD, NAME OR # . . ' / ' : ,.."'" f/.{I ~ hrQf<- J:Jt I ve..' , PROPERTY ,SIZE-WIDTH ,/ DE~JH , ?t.j/':' 'f! (,Ii ',', (oimed" to E~.istjng se:~"9gej(;~terY.:l 0 TYPE CONSTRUCTION '. I ',SQ. FT- /." I. I PLtfMBING INSTAllED. BY . " "'/', WNER'~ OTHER D~~AM~ ", ','~ .. PLANS FU.RNISHED ~, " :. ,~ OTHER : " -YES '0 NO, 0 . YES 0 h~. ',' SIGNATURE OF APP!-fC4~T 11 )-POu,~/c~j'~ l FEE RECEIVED BY -z-.--I ' .:p " . ~~B~~E~t6~R FEE -7-f- PERMfJ! II 3 ol-f7'f ' COUNTY BUilDING, & SfNrrATIO,N SPECIFICATIONS ~:~_I:-T.FI;L~R:~E~C~ \Vr~TH .FT. :~ 'OR SQUARE FEET AREA APPLICANT NAME AND " MAILING ADDRESS FOR MOBilE HOME PERMIT ONLY Number of Bedrooms ..::L ' STRUCTU.RES TO 'BE BUILT THIS PERMIT or. Ne-w System Req, KJ # GEDROOMS VALUATION - , . .' :"< . SEWAGE DISPOSAL ~ FACILITY PERMIT _ ') t€> q ,~o ~,FIXTUR s' '", . CASH'~~EWER' . "CHECKf.'l CONNECTION F E NO~ DATE 7:"/5-71 DATE (J-/S''j y TOTAL' fS1 ~ ~IN. SEPTIC-TANK CAPACITY WITH DIST. BOX: GAL ClOo 300 NI'.S-e1'\\;;('(".~ C6hn~p;llD:~!:. C'GIs:1('~ Ir~a~O;-OiJer.r S~e. 'u IF -/^ hp':'Jn"-"'cI €- atf a r 1 pr! s,hei.t- u~k..\ IA)rA+~1' TYPE OF STRUCTURE . '.... " -li nH 'OCCUPANCY J ZONE REAR YARD PUBLIC UTll. EASEMENT . A~'--MTI BLDG. SETBACKS - FT. FROM CTR. ~~ ~~T OF WAY . . __ iRONT l/ c- SIDE INT. -5-' _S~SIDE EXT, --'- REAR ;? /, ' ,A \\~1L71bJ;q ptA~ 7-/~~;7 BLOG '~~eIt'1-:l1-7~/~te ~ons to Find Property:' V I USE 'CLASSIFICATION COpy 1 - OFFICE COpy 2 - JOURNAL "COpy 3 - AUDiT " Form # 05-1~