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HomeMy WebLinkAboutPermit Building 1981-8-6 ~.. '. - ~ ~.- .' t.. . "v.. " ' CONST-~TjCTiON!P[A(j~MEN.r:,/:;"",; ,.', ,.. ;""":";."V.,}: ,'~i.'PEI{.~pI.::r '~;::fx~J\~,'~"~.-42:." /h'~'Y'~ ~i" ' ..,:, ~ ,: '....., ~ '~':":;'':;~'', ,,'~ :~;,~' ." ",~: ;'J , ;,~~:' ';~ ':~\~'l"~,,:I'~\)\:.uf"" ~;, ,'~ ", CONptE'rE';THis\~BLOCK. /PLEi.SE" USElBLACK INK::'A~[)~JnNT:: ','r,~' ~,-,?'-I}'SHIP '1'V-. ','J 'RAN~E~>,'/)Z 'I,SEPION/ /'7""~I', ~ -r'.bIou; ?~:.' ,,/'(J . . q ~2:;../,. //"'0 ~~ ~~/. ~ -., Z65U ji-<S<2f}y<T1'HJ' ~.. "P,PliCablel -4,/? / ~ L6y7\CEL I BLO~3:" '.'-, , ,. /./"~.r~~-"':J --~~ ,f~~ ' " '. "Lfi!!1Y,'.--"i')j,',""~,-D,)~,':,"'I:::"/.',',',~'.,~;,'S....,;TR-E~.., <', j :/.';"/;<.",," .__~ P" "" ,:,/5', 17,''''-:."z,:;;:~E;,''.' p'ROPOS~D_i~SE,,?F.,~~OPERT; ,.," c;:::?$//'~mr.N ~~~~'" ~~f..;;:?'/,7:/7- /~'eS'identl~aL ; DindGstri'aol .~~Z~~~:;~~;";i;i~,.) " OF ~~~I:'; OF 'S'T~~""I '* OF~.~~OY--'" ~'I.':["W~TER,s~~~::~:' ~);?',' , 7'-"O'~~o~os'id " '. 2' '/~~" J;ij; "'.'r.a-~A.!/""~ ," . ~~. ~ND;J)~S__" ' , "'i/~A', "b&!d;~~~',~~~?tJVi?~ (c~fcm-'0myz~~' - ~ f..,.c~~' ~. . .",~ / "/ /Y I TELEPHONE NUNBER V//~'~ 4~~~~0','j;( 1.\H\.' ,'.~ ,,::~,.)'~, "~"""':' ':. ".,,:.;.:,-, " "C,ONTRACTOR"SOSR "-;'I:,;''D~"IRE~ ,N~ T,9' 'a"'" ..~., , '~: ,:,,' ~' '..,' " ';;;p:.'-';:" /J>" ;'"./ --'-M' '~." ~", ~.' "lIfl6-::>':C.rv:,., .' ."" "i ,'''', '.' '"'''~''~&''''''' . ,c-'''-------'' '~J J:JlcAJ'" " ,." -- , . " fi '" ?/&7C': ,','dk' /1-6i' "/:::;df~_i/ ~~""'.:' ,),': ,."',', ,-',.": .', ~:";':: :';::,~ . . - I HAVE CA;iF0~:Y AMINED TIlE: COMPL~TE~APPL~~ATIO~;;~ .Pr;RMI~; .~~nd do hC~Q~Y ~(;~r';:i';i',~~h1l t'~l'L inf()nn~~ion !her~6n..'-i~;'\-t'rll~~,il'n'd' correct "ild ~l ,fu-!'thc:r certify that'~a.ny1odall Co:rk1perforine"d~~~h~dibe;'db~~ i~ acc~;da~ce wiih the 'Ordili'ances'.'ofL~;e'_\'-C~u~ty <i;ldlthe,;La.",s'of'.the. Sttll~C' of :61-~'l-:'l1l I;<irt.ailljnr~ to .th.e ":'or.k d~sc:{bed her~in: and .tha't NO'Oci:UPAt~CY "wilT. be i~ade' of any structure; wi thout. tn'~ permissiCl!-;.-O'C~thett Buildi'Jl':J. D'i ;"is.ion. i [urth;~r i::,~iti fy . that' registrati'onwi tn' t'I;7 "Builder' s Boa~d ~'is in,.ful~ .forc~ and effect as r~quJrlJ,<!hy. ORS 701. 055,~ ~ha't ~ir e:;;'e~pt the': hasi's.. f?i- 'ex'iiml)'ilc;f!. is noted.' ~ereon. and that On,lY,::~~bc?n~f~~~ofS a~d.emp/.c:~_e~~~~h~)~F~ ~r1:,~~'r.Pl.i;~C~,.w' .~ tORf 7q~.955...will~'r~..u~ed .()n; ~hi: p.ro~ect:t.; I HAV:;~~AD AtlO C11~Cr..ED. THIS :APPLICATIONTHOROUGHLY;-' . . " ,..,~ ...'~ ",:.-- . l" ;! '...., ~. '.' .J', .~. . ,._:' .,._ ..~ ' A'," .' .':.< ');!;g'l"" ",r, ~ (Jo "r' J, ,!l.~ ~,[r, '-," ...1'- ~ .,::1. ~j. ..il!"', ...'. l , .. ,'./'/7./) 7l'/V, ,: ~/ ;-'~ J 'lJ ''''''f '~"?~:.~,:;",' ~:~::act~r . /77//~, ,:L-L---e~.;" )l(,. 'tJU~-l/i& .. J,' 8..,10'-'(,\, , ~ ' , NAME" (p~eas'e prf~t) . "~.. . -,~'.<... ',' J '.SIG, " ':'.... ;'~::~, ".I~,~-O:' ,'D~TE. ~ UAg.0nt o PTI1\NNING1Z0N:i:~: '. ,~~~pa':~it{o,,:~'\~' ~ar~el #'~' ,:'::,:p~'~ce~"slZ!A.)X \SO . .i.., ".'~'.'J(j,-,',c~:!-,,:..,;J~~,-.,,';.,~,c ~.;. -!' ;....,,',',~,::,:,..:. .......--~, ~~/.:' "'.'~:."A1.,t=::..1 :;~~L. ..~.L~;.:~.~-4. :) ~r:~;: ' r<<~,' k,':~A, '.!~. tN,O( ~,""")V;:';.~';" ': ,e,a.r~",~, .. ~/,," ,.'., .' ~C:~;--:'.~ ~~~"'~t:~;;;l.-'D~~C\l~ (n p-j, .[1:1' , "'. i ,", "'-' :":'., ," ,\ "',>;7__ ~~;"'~~.L .,.' ,<,"'0 V"":\'C'" ~' " FLOODPLAIN :i1e In fJW1/~art;j.EZihJt~~''FUa:J~ate (? - - -~" ( . , RU~L~:A~o'RESS:~~',,~,I~;O~~:'r~I' H..:::" ::""~~;;",~~ ':' "~,',,,~~~:~,l ~:/7k'< l~,<': ,'., SP..NITATION: ,S. 1. # ., .... . B.n..:..,,#.ff?J1~V~"":7~~n~t~natlon Record ISSU8<1:?'~Yes DNO. ..' Iryst:alia:ti;nC ~. -.' ',.~alion'. ." .> t!;".;:; ~/i~.I~~~~'~.~J0~.'~?tD~::, !" ~\:'I' ....M'~ucimum .Depth.~_" Speci'fications: . ", " '-_Tank,. , '-;0.. ,. .::';C-~' ~f Drainfi~ld._ .," of <r:renches'- '.' : ~,O,~. .~c. ("".'.,~H}~~ ~fV j~, "~ ~~,,~1,". ~"~,' ~J1,:J ":'...,r1PA, ,,:: . J :C1n.-: i{-:~, '_ : : N..!}~.I\V pJ OtOMll2Ar:l:() II ~(~ 1\ ~~ -.~------'--W:. a.pn)PAt~(~th' ,'QjJJ :O/l)~~^ iJ ,If q'1sJ'cft?J1ail-2- ) , ii{);.iJp'P^lPd,[Jlr~f(j,~'alifffir .- ~89i,?:"'" ',', ,:'~<' . ,. <",~Q:~'6;'t~j"':'j9AQ)' '.' H ;I~ , 1\::i1 r: .:' ,>. .,rr- I"~ -~.'~ ..o,'~ ",~; t., r~ ...-:. ".-:;.o."~ .':"'A",'j,~'.: ,; ,.L' ~). .: '..:' ~. ~ PLANS.,EXAMINATION:"~~Type . ."~ Group'_~ ...; U5e~f<,.....,~.<I , ...' ......... -_--:.... ....,::~~~~.~:[1~.~;~.<;;',..~':i:\:~~~<c....:;..:,'~J ','/:.~,'" ..,4'" '~l'.,,~_~.~,.~r "'~.~~'''''~~,~j:'''~-_',:;;,,, :',~::"...>,.i!:~;.,_~, ..~" ;:~..., . . y "'-:.SEEREVERSESIDEOFPERMITIlNDc" ,,' ,,{, "',," ,..,. .. 'CO,:'", '>,; ';' ",' . ~ ENCLOSURES FOR'INSl,..\!J~.lIC~!' . :-" "',' ' ,REQU,IREMENTS.' .:' ",', ::..- --, "',"i!Z:.I0'7.-./;.., f': , , . ,I. 'Date:-r~'I'= :)/.-.. -.' ). ----- , ;...:' ~~'f . '.~':;, - '.. _',-i :"J-l',", ,Y, ,', .., " ~ -,FQR '"OFFICE USE,",ONLY. t ,j,', Ti".fl~ :';'" 'l~";:~'t~' :,":: "";1;"; 1~~:;' j;t~~~I'~:~j~l.r~)1h'~~,5?i~" ' n ,'^' '" '.' . ".,. , , , u1;'wo ,C~pic? :.~f Plan~t .'~~.. ..'~: " .., .1,'", ~.." :'. .".,,, ".; :;:", ..,.' \ t' . ,) [J Two, ,Copies: of ,Plot,P:l.ans ", ." ,., , ,. L ...,~_'..- , - ". ,.~.. ,'[lMe~~.an~icaf 'checi.~i.st. ' , ~.' .",--" ,,'. ft',-"" ,.' . " ,.', ' '.,1,~ .. .' o Plumbinq Checklist 1." . .- , - "'':';', - 1 ,- i, ~, .......'1'..:-' "'n- '" ~Op.J,a:n CheS:_f:'.'_Info Sh'e.f7't"- .,j~-:,:. " , ,', "f D ',' '':'\, _ ), ","CONS-TRUC~'r'ON,AUTHoin ZED' .13'Y;~':HI S'.P~RM.IT~,. ~~ ':1:~~_:;/;":. ::;..'" . ~'., .. 1FixedFeej"".- ".., Floodp1'ain. 'Fee'":.9..I. '. Desci:"ip'tic)l:'...' . . Sq, ')?t:. ,. un'it Cost . -: -"'. ,,~ ;."-',.' "':~"..,;.; , . ~ .1\0...;. , ,subsur~a'ce Fe~s'- .',', ~ AU.:w i r 0.' Hr-'rrno ,',: .' "--:.' ',:, 'ICl~2 'VliNRhO~1FUi~ ,_?4 x',N"~J1bl.:Q~ ~~," '1 . ~...--.l~I'\. " . , . -- ,-'"" . ::'''' .A J\.L..:.t:JL..J . .. :, ' " . ~ }( '-Bu~ld.ing ~Fe-e~. .:., Sewe~/S,to,rm Draint,Wat~r ~ . ,~ . . , . - . .~. ' ../ PluIDbihg -Fixt"ures ~ :~Mechani"~'ai;e. .' ~ ~ ',- .0 .:, ,$;"1'0',0:0 ,"Y) cy::;, . 1 0?-,~. In. no '... ..... '. " -' ':..' -- .:' (~o~t 0~ fl(1 D,rt>., " '....".. "TOTAL VALUATION $.~ PERMIlS FOR Atl'ELECTRICIILWORK SHALL IlE'SECUREO FROM THE STATE ." OF OREGON. DEPARTMENT OF ' 'Cb~MERCE. EtECT~ICAlSECTlori:' . , . ,~' . ~ ~ ..... ".... ,,' ..... ~,' . o ..'.. "'" "l'. . , "'~~p " 1 ..- .> " ,t' , '. ..PERMIT APPROVED BY' BUILDING OFFICIAL/DESIGNEE . (per, ORS .456'.,805 (1),' , . ,~ . ' , ~ ,- '.. .. .'" , . - . LANE COUNTY 'DEPART~ENT 'OF ENVIRONMENTAL MANAGEMENT./ I2S,EApT , ~. '. " ...... . . I . .' . . C74-194 ': "'. " ,SEE :REVERSE:' DATE " ;.," :<. :~ " . C::: '..:.: ~- --;"".;; ,,,"' ~ (" ,', ',' , .j '. , .. i:t,i} ~"~;,J~fiio~t; ,;,i;, "",,'., :,,;;lli';;;;."~. ;.'.;,~; ;.;':;~,;;';:;;;;l1i;;I;( ;",,;c.:i;~~' ";' CITAHON'UNDER,'PROVISIONS OF "LANE'COUNTY-'S\INFRACT'ION"ORDINANCE,' AND/ORIOTHER,REMEDIES'ALLOWED BY"LAW, " """',,' " , -:' :: ......,:~.;'". .::\,...:.....,.~ ,~:.....;:..~,~. ,~,:". . .: ,"':.',,:-<,',. ::/."' \l.. ~,...... ;;; '.' ':... .." ~d..,,:...':T"'..' , 'WHEN READY. FOR INSPECTION CALL '6B7~4065, i 'A MINIMUM OF :AT, lEAST 24 HOUR ADVANCE NOTICE FOR 'INSPECTION'REQUEST MUST BE'-' -"," ,..' ~ "~-,. ~ --' '. ~ '. .. ,.... .. '. , ", -." . ,.' . j' GIV_E~:., Have> the lo~ lowiT}Q _ ~nf.9rniat;on.(r~ad~:~:l~_r~~~ n.~~~~'~ ~~o~ a,~~~e?s?. trp~;, ,qf' i..nsp_~~t~"2-~'~:Whe!l.. 'J!.~~il\A_~.e\r:e~ad'y,,:"':" _'~j.)}' . your ,name a[ld pho~e;number,.and,:any..spec',a:l..dll:-ectlOns.~t.o;,slte.'~.,._~".: ~~h'",~' -'",II;. -;j. .01,' ......, .,.....~~.:y,.....P'l<,___,~.." . .<f'''-,~' t 'SUILDI'NG D'i~ISiot':. "~~~: <';.:-'~,:'. .l, ,1:',',;,'.'.:" ~:~ '~1,~", ~:'..:, 't'~~- ..',....~" :~~;. ,....~~. ~,/~..t '.~'.. ';' :;.' .. jtx; ~" , , " ,.-., '_i,-'",' '" " . ...,. ~ "'" , " J. 1 -_l,'.' '" - ,.-. FM '1'-". . - '1,.. -..,. ~";-'~-.-...1---':;' ;~.,~REOUIRED'IrlSPEC-T'IONS' .,':, ....,,'1. ::':_':"_d;-,:~-.7 -',~..."..,,', -.-.~,~; ..,-:...:~~,":, ;~",. . r~ . ~ "', . "'. ., f" . t ~ ._~''''''-~:-'' '--.'...., . ,",p. ::,:~,~",_.,_~.,-.~",~\",.~,..,_""",:,.'''",>,', ,,\', ' .', , '"." ~ . ,',;" ".$. '..,.(,i.,.._" '(.'~; .... )"~..t,." . 'J~-).:~.:::...~.. ~":';; '.. __ '_"_' ,',' _ ... ~-.. ;',-.;1;) , 'FOUNDAT.ION~ INSPECTION; ~.~:..T.o .J?e ,made a(t_er. t_renches are)ex~v~t~d ~nq foms :~rect<ed_.a'nd_wh~r:!....a 1,. maten al 5 'for~ tne,~foundat10r' 1 " '" " are _ d~ l,-lvered, o~n .t~~,)ob.. ,.!- Where con~r~te. t:rom-a centra 1, ,mjxing pl ant (commonJY,.te'rm_ed '''transi ~ 'm)xed~) . i s(t.G be used'. _' ~~ . - Jmat~r~.al~ re;r.~g,~~.Ij~~~,n~;Qe~j?_b:.~~' ,.': ,,~,~M'~ '~;~..,.r=i'"",.~.,~';_:,::.-,"",'<_';' ~~~~_.. _.:: ':... +.....,\..;...;'~J . .;-\~.. . 4":':.; 2) CONCRETE SLAB OR UNDER-FLOOR INSPECTION:' To be made. after a 11 incs1ab or.,under-fl oor:'buil ding: service equi pment, ,. > .' .. condu,i,t'.:p,ipi ng' accessori es_and other ~an~i 11 ar:y equ;"Rment items:-are '~;"n pl ace:'but :before any -'cone'rete:':i S' pour'ea... ~..'_ ';.L: ~ _ '4" or ~f1oor sheathing..installed . fnc1udirig~:the'):subf1oor;', . ...........,~ '-,-....'."..f... ;...._.:.L.. .~' :::::~~ .,:.;.' -!""... ."'f-?-. _ ~_ ~~__~_ ;o..~. ;> ~ M;) " FRAMING<':&' ;:NS:~~ATrON:.:iNS"PECT;6Ns"'0,TO.~b~~~a'd~~iit~r"t~i~ 'r~o~, .'a~:l1~~~f~amihg.: 'fire bl~ck'i'n.g ,and 'b..)~:{'~~~~~;~'~~n pl ac:":nd"L :'~. 'f . _J 't'~ ~ 1. p~ pes'._;f~reP1.aces-' and' 'ch;"!~e9s'and~'vent:s:,a'~e'~compl e-te~.~nd~~H,lo.ugh,el ectr:i ~ar.'_an=d..,piu~D,fng iaLre ;approved. ."-1\1.1": '?' ,'~-;' -~ : w~11~}~~~at1o.n and vap~H; b~tr1er_~re...1n p.1a~l?' ...'. , '''"7''';<L. '~'." '. " :o.~ ...~'. ..,., .... '.' : "4) . LATH' A~Dio~''\iYPS'uM'BOARD'INSRECTION(Tii be':'~a~~' 6~te':'ali',i a'th; ~t,a~;;'g;Ps~m bo~rd ,i n~e~&' ~~d-;~;~rior,' i Si~prace. . ~'1, : ,~ut.'pefo~e. any~pl a,st~!,:irm\ ic~.~~pp1Ted .or~ peforegypsum'. board .j6i nt{and fast.eners ~are. ~taped and:f~i1j shed. 'I 5) FINA~ 'INSPEC~I'~~';' 1."TO;:b:t'~~; ~~t~~' '~~e..'b:,i';~~n~~ ~'s .~:~~~~~~.,a~'d .~~~~~~-~cc~~a~h'~Y~? ~ .,-. ~~:i:~.;.-" 't'" ~~"~-. ::,:1~~:~ "~ ..' ." .-....:. '. ~~:'".t-._~ --_ "'..~" ~1."" ~'._...4,~'..~~;;;' i':_,,"':' .~'-'-"'-~"'~..'~"'--_'.' --',,~-"" ~",..,~_.....,,_ ...~,~:__~..:,),~~,~ "__,:~. .-' APPROVAL. REQU IRED, , No work, shall bedone~o,n':any part of, the" building-- or,structu~e beyond' the 'po'i~t ,indicated' in ;each' " " 'L, ' ~successi ve i nspection with9ti~"'.first .obtain ing:the' app'rova,-l '.01':. the b'ui,l'ai ng 'officia 1..,. Such'+ap'pr:ova1, shan/be ~gi ven' only I ._' after an i'nspecticin':s~'al1. have..been 'made of.;each'.' successi've;step,"in the' construct'ion- as 'indfcated- by'eachotof'_:the ';nspecfions~' 'f, ,'/ r~quired. .". ';. '.~ '''~''';;o ...-'-' ,...'. "....,. 1 ..-...'..... ~- ~ ":~. . t" . _'.. ::"~. ;., '..'. "", ~ ... ~;.. NOTE::~. Arl.bui.idi~g.pern;it~i reqUrre'ins.~eci-irins_.for,,;the"Wo~k"aGthor'1i~d, 'such~as."but~not"li~'ited to:::' .:....... :~- .,.. -. . -... ,.;-.....: ..~: ," : ~'. ". -; A. BLOCK, ~~L~: ,."fo~ b,e'"~ad~{~~.er;,,~~~hi~rCi~g, is .in: p_l"ace,' b:~rb~f8'te~~'Y. g~ou't \~. ;jJh~r'ed. ';".Thl ?{~JhSPE!C~i on 'ff.:. , ',~ ~", .requir~d~/or'e~~:Jibpncj~.beem.;p'qur~,.Th~re 'Y'n~'b,e'.Dg aRprqvaJ'until..the,~plumbi~g:fa,,!d el~c.tr;icaJ t1nsp~e~lti9_~S.," ,\;.h " :. I.' ."j .;h1.ly,~,.~e~nm~de~.a:nd,.~ppr.ove.d: 'L:..'.. . .;'.':);'~.d ,,'1,1. " " I, ._, :{"L,,! ~j . ;~,~, ~"'~"'" ,", , B.: WOOD ,STOVE; ~T(':'be"made'ait-er._ c6mpi'eti6n' '("f'masO~fY::{ if -app'ri cab-le}.~'ari~ when';:',inst~itat'ion_.iS':'-cOlno1'~te..' ~ 'Insta11ati'~n sha.11~be .in accord'ance _witha~', approved riatio,nal iy' recognfzed tes..t1D9' agency alid, ibe' .inanu~' 'factur.erls...installatfon' instructions. ~ ' ... . " ,,' . '" '.' ,\: '.. ,.., ","~ ..;~' /.. ~ ,;.' .\. ;:' ~"'.>...' ': " ~'., . 'I" .C.... r~qBJJ-E 'HQt1E-: A.IY.i~sPE!c..t~o~ 1s. r~~ui.re,d.~aft~.t' thg. ~9EjJ~}9l1!e:is c~nn_ec.ted. to,3U ~app}:oy~e~ sewe~ .q.r 2.!'!pti.c _ ., , ' .....s"y"stem, for~-,; setDack~ requ,irements; ,blocki ng ,', footi ng. connection. tl edown.s, skirting>;: and.,pl umb1 ng' ~ 'Ii '"1" :.. '~7'co'nnecti ons. ,,;'~,~, ( -','f-r ~ ~ ~~~. _ )_~'.~ " ,_ .' ,,,.....'.;... :,;i _ _~. ;,~~..:.~ .tt.::" ,,-~,,_,.:\ '~....:,.,...~..... ~..-:-'. ~-:-_:.' ";"" '1'~~ :.' ",. '';';-'':'V, ~~ ~...... j ,~ ,. ~'. ":; '",..~-{'n.', F06tiri~s'iand'..p'ier.s~' t~ 'co~p1Y w:ith State .foundation req:~i;.kent~ for;:"~obi1e;h~~~s o'r-,~-~s recommended. -", .~\.. ~"'~.' ~!>y.~tli'E!'mamifac.turer'.:_......' " . ,. . '~_>'-'""'" :"_~' ..\.,1.~.. ,\;. ",":~"I~"~.,. ...' +;J~_'...' ;_:: l' ., (2) Mobi'le'home miriimum~fin:ish ',floor elevation sha'll ~be,~'certified"wheriJ.rE~quired' by1a floodplain ',: .-... '. '.'m-a:nag~riient letter:":~.~, " ,'+ .;~:'. ,..- .:'~" :r:.....:.~ -:' ",,''''' :. :~.:" ".I'}. . (3), J10bile ho~e ti ~dO\-in.s" when'requir,ed, ~n~,sk'i!'ting' sha,l1',b~~i ns~aJ.led and ,~e_ad~, fqr; i~,specti o,n , , ,- .w1thln~,at.least 30",days'"after 'occupancy'.~ .Tledow_ns :and.._sk1r:.t1ng shal1"'be' lnsta'11ed; per enclosure. '.:.~"::~ .:~;t,;}~ -.<~,:'~::,,-~ ':.:'. ~.<~ :-:...=.~..... ;~~,~, L ~~, ..~-~.~::.~~:::~.j~_".':"'..Jl ._..- . ;..~./ r~...,.:: ," _---~...._ _,: " D', SWIMMING fOOL : ';'Be1 ow' grade :when 'steel is .in place.arid'before concretei s poured" - A,b'oveg~age 'when,pool "">F ' ,c' ~~~,} \ i-s--_ins'tai{ed..~.. ~~-~ ,'" -\ (,: ";\;;~\~"'~"~' 'G-:~~', "~"':c.~.'.':",,'::~-j... ,~}.,~:"t\( i':..:~(0: (-': ~:'I l~{'~~\ ~~::\~-r.:'~- .~.:~.' ,I "~ :--iJ .j" \APP.ROV{DP.lANS,;~UST~Bt dN;JHE:i6B'~i~E--'A;: ALL '\TI~E5 OUR irfG-WORKiiiGoJoJ~s ,i~~~is"?ERMI'i-' wIL(ixp,'iRE; I (,HORK':DOES.N.o1:iB~~,Ii . ';'WIrH'IN -'SO"DAVS. OR 'IF\WORK- IS.SUSPENDED~'OR ABANDONED, FOR-MORE: THAN,'lBODAYS,-. 'SUSPENSION OR"REVOCATION'MAY OCCUR:!F'THIS ,PER~II-T'WAS 'ISSUEDON'.THE-;BASIS OF\INCOt1PLETE,OR ERRONEDUS 'INFORMAT,ION','-:"" "'" . /'" " ., ",. ';'" I" If''< .:."__ ,L" ' j>-"'., -.'---' ".., :'.", ;. -"..,,:=-.-~ ~~ ~ ?_;. "_, -:;~.'.--".'~-'. " ..... __ -'0.' ... '. . . ., IJ" t ,~ " ...~ , .ANYONE"PROCEEDING PAST THE POINT OF'RE'QUiRED INSPECTIONS WILL DO'SO'AT'HIS OWN RISK" "" '. 1, "'~'"':- .~ ';,,::, ,', 'I, "~", .~," _:.-.:..,. o' ..:....?: .,..'., ',-,: ,~,.\,.,;~<..':;:, "C'.,' SU8SURFACEAND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS "'" ' w. '0' :.. ':'1. :~~':.' ;...'.. ,'----..,.,:. ~......~...-..' ..iT~.'."""_"':.."."'~';...,::-...':'~.~' ''', . {l),i',tPermi_ts .s~~"ll. ,.?e "~f~ecti;Ye fQ:" one, ,~eaT f'rom- the date .c'f iss.u-~nc~':" '., , . .,,;~~. , ...., '" .!.' ,_' . <-___)-,':'" '.-'-_......~ ~l,,-~.~' ._~.: ...._:',~.. .....,,_...~ ", 7~._.. .,-.. .,~':" ..' ...., ", ,'! ~~ .._,- ;. , ,.1' ..(2) Upon cqmp.1et-ing,~the. _~oiist'ruction' for, whi ch .a permi t has been i ssue.C1 Jh~ perTI"i~.ho'lder' '~hal 1'-'notify. the, . M Depar:.tme.nt~,by~sub.mi tti ng,-:~h~'_ i nsta llat i?n . r.esord fqrm. :Jhe. D~p~ rtmentl'ls ha l~~,..1 n~ pect'~he ,c9ns,truct19p, .,~o ;,.' __ . ~. o ~ d~termi;i.e if i,t compl i es. I>i~!h,~th,e -rul es ~co~ntained:'ll n thJ S' d1 Yl Sl on "....:r~~f- "the ~o~?~ruc~'9D.,_ ~?,~? ..~omplY!~l1th -~ i!,or ~ ' ~ures, the Departinent.sfial1.issue"'a certificate of 'satisfactory,.completlon' to::the' perml,t no1der:.~ :If thel_~ :. construction does~not' comp1y'with such rules, the Department shall. notify tne permit holder and shall require o ~sat.i sfac'tory" conipl etion ~efor.e i ssui ~g~ the;,cert; fi cate.!._.Fa il ure to "meet_the requi rements_fo~ sati s fa~tory ~ompletion within a J.:~asoriab1e ti~e.. con?titutes ~a vio1atJon~of '40RSCA:~:m0'5l~"i4ElOi'2J.SOOu:11~f.rilS'l~ule. " .' "'.-- "",.' "'"'' ' ,- - ",;,', ',"'\-' MOITAJJATeI1I1l0'l,a311UZOJ0I13' Setbacks..r\..,.Subs\~'r,face':Sewaae .Di S005a1 .', ,/'. ':'... : ' ~~M~1U.U03i' ",_,.'0 .; "',...."'.."..~;.~.cf":': '-... 'SeDticTank ~Drairifield" ~. .' ,~~:;. Fr~fn:~-I~~er.~9; ~;~oi~~t~ 1.;rI~s~'~,;~::~J."'. JO.:,:",~, :'.-.:.10'.1 "I ,~~~. :i"':"' - :,M....... , ,;,Edge "of road-nght-of-way -- ,':;'" 10 ',' '. 10' ," ',.', ' " ',' ~".Bui1ding foundatio~~... ...': ..' , .,51 . . : 101 '., . -" ~el'ls; ot~e::....:,~?:.tr.'~sour~J.~~~ .:.:~~~~ .~.', ,~Ol ....~. ;.~ ~'::'.:.iJ~~~, ,~ ~", (~~~. -.;J;: _"." , " ': \.'fj.j', ::;1"';"-::: "~,, " , '- Ol',.. .' ',- .... .. , -'';\0..- .' " +\..... ...... ,.~z., .~ +,,~ 'J" .. . to' '. "h . ~, ~". "",";" ,",:,' :,,-., "*lIilAJCl'~* e,":':' ~c;j;',>".-":,:~"~~,,,,c, ~ ~.~ "::":~~:~,j~~~" :._. ~,~/ot._." .. i'''' , , , ~r-- ~.:'~ ,~~ ~~~~~, :;.. ..: >41, ,~ ", ~"'..- , J-.'; .........' ", ' '., ,_ .';~. . ,.:,'1: , ....... ~ :~ ;,:,r~',~~ " .-..- ~,-'" ':"""-':- .,-f.~ ~'~ , ',,1: '., j..IJ.~~~ ...--, ..~ II :.....,..1 ~. " ,-..ll,..-'-~ ~_ , , '" :.. : '. .....~ 'r., "\,~ e.>.~r :,' ';". " ' -' ;~ ~~ "~. . . . --. , , . , ..' ..".0 " , .... -:' ., . :,:.1 , 1 . ~ "l .:. .....,....:..,.. , , , ' ~. . ..~ .....h ,'( . :;,~<.. , t. 1,,:' t' ~.. o.'";__-:"~;'"!~'.l:: ~;''-2',.~ " ' . , ; "'-". ;,,~;;.! . ....., ;,< , -.' ~.,'" . ..... ".t' ~ .,.. ';7,;;""~,., : , .... ,"~ ,::-.~'.. .~~" '0' ... . ; , -0-____ '.._ _'_ ",..1.'. ....: ...., ,I " :'!., ~'. ~M'. ,,, '. :.. , '.. :,>~ ',~~:~~i\.';;t-,';":' L:?f:,:,,~L~!~: ." "',,'.' . . . . '.~, :"t,.; '~';- . " ~ .. .t,..., .~i>:, + ; - .,~' '!~~: ", ;'!"?,?.").; '.. . ...:to.. ", , . -, .t ~~'~" ~' . :;l.. , .. . ~; ~>~.. '. ~ ',' J/:;~, . ~,~~t,>. ~, .;. ':~.' -./', yt;' ::,. -i;~, " ';., ~ r .:~~ '.' " (.', , " ....' '.~' . .;;. '!"..::. " , ~' '!h . " " ~- JO-8! FLOODPLAI N ~lArJAGEMErH Management/l25 East 8th Ave., Eugene, Oregon 687-4357 By 1J{.6. Department of Environmental ~~Rermit Processing o Planning o Publ ic Works Applicant Name Address of site Permi t No. 170c.-8;' Date To: o 18 ~. o o Partition No. Subdivision No. SFD fi?N.lPf" /-It..t:l9/ .a:::> 3B i-/r/Ktl.icx iAC- AG <f:1:P ADD. COMM. ~ Approximate flood hazard study area, extra precautions may be appropriate to assure that the building site will be reasonably safe from flooding, Detail flood hazard study area. Mobile home tie downs reqUired.;.{'-/)r?:5r&>iJr?Y1 S b't 'l' P/<?rerl 011 IG u s antla lmprovement. , Site in regulatory floodway channel, building prohibited unless it is demonstrated that the cumulative effect of proposed development wili not increase the base flood at any point. ' \ BASE FLOOD ELEVATION + l' = ~~t),C) this elevation required as checked below, e/ev. -/-Jud r)-1d,;i, ht:',w,' i~ ,t,,,,,lot<..J -;he: k~'-" --f1->o/ "",k,y. , (r1SL). Certification at or above o OTHER :****************************************************************************************************J ~ ~ CERTIFICATION OF ELEVATION . , , a Registered ProfessiDnal in the State of Oregon, do hereby' certify to Lane County, that the following elevation represents a survey' made by me or under my supervision. o The foundation elevation (including basement slab) = ~,~~ The ground elevation that structure will be placed on ... l~~ The first floor elevation = _" ' (MSL), o The elevation of the top of floodproofing: = o Other I, 3: '" -0 ....... ~ , (r.jSL) , I ~/: ;! : / (~1SL )'! ~ , (MSL). .'\. I ~ , Reference Bench Mark No, Location ('0 N I.> -l Signature Date SEAL r Original to be certified and returned to Lane County Floodplain Management 1st copy with application/inspection 2nd copy to applicant 3rd copy to Floodplain Management \N ~ ~' --'~---- '-.. - -..- -- -- - - - -, 0,,,<';:: ~ ~: '~" ;(J:ir!, /' / };',~i~' ,'"",~.3 'fJf::I'/Af--f,) -tsvft./HU ,,5(.. ~ COUNTY' "'IffsPECTION RECORD " ,,~-..OWNER S N~1:!-E/J _ /J _ A. . '/J ,_ ~'JCJ~ :' CON~ ~~..5dp1~ t~k~~6~/JQ~I5(~~~t~lDE INTERIOR S-/ REAR S- / /lPLUMBING FIXTURES \,ORK AUTHORI,'ilED BY PkflMlll A;I /J () ;, ()111'~~, tq' ~ ' . DIRECTIONS TO SITE ,1 'If!... D' I,,, _ () I. I j A, \ p" ~J. ~ /-r -cg ~ ~ 7:7)~ P-x /1..-f O"IA /-.a;ki ~()~l( ~~ f1'~A./~/nt7LJ, ()L SITE ADDRESS -/-- tfl . / . FOOTING / FOUj:J.OATlON INSPECTION OR (MOBTLEHOM?JSET UP INSPECTION /Approved ~ t,correction Disapproved ~_I- 1'2~Inspector / U-JU4- ^U .....w~ -A~, 9 - ~,f') R'1.L , - ~-.""- ---. ---.-- <n, 't~~' PHONE NUMBER 7---2k - /.:).1;-/ PHONE NUMBER ,- () / '7ofl:-.- rr/ PERMIT NUM8ER ftJ;L CONCRETE SLAB / UNDER-FLOOR INSPECTION Approved Correction Disapproved Date Inspector ,- UNDER SLAB / PLUMBING GROUNDWORK INSPECTION Approved Correction Disapproved Date Inspector ROUGH PLU~1B I NG I NSPECTI ON Approved Correction Disapproved Date Inspector .... FRAMING INSPECTION Approved Correction Disapproved Date Inspector INSULATION / VAPOR BARRIER INSPECTION Approved Correction Disapproved Date Inspector LATH / GYPSUM BOARD INSPECTION Approved Correction Disapproved Date Inspector FINAL PLUMBING INSPECTION Approved y---- Correc t ion Disapproved Date j- 15:=-s:'a:1nspector fYl.i- FINAL WAS1E DISPOSAL SYSTEM INSPECTION Approved Correction Disapproved Date Inspector - ---- \--~ - FINAL INSPECTJON BUILDING ( MOBILE HOME) t"'- /1/1 _ Approved y Co~tion DiSClppre,cd - Date~/- f'.2Inspector ~ ~~~ /-~gJ:~~.~~,v~ ~O-02.'<~PJ.f'L CERTIFICATE OF OCCUPANCY U TEMPORARY CERTIFICATE OF OCCUPANCY Approved Correction Disapproved Date Inspector ~ Form C74-197 .*FLOOD PLAIN* .lverify elevation ",', ",:~a;l~' '~l ~_..:' 'iJj , , fC-V'CVV (,0.73 -" " ,., , .. : ~ o , , -J I'l ! " *flO.GDilPLAIN* "verify,elevation ~'- o -, <fJ N .lA' @)~ 5' ~ , ~ Ib ~ ... co 2./' '" . 1: ll!"'\~""" ~ r- ~ . ~ ~ .a , ~ ,;..ILA6& ,. .. III ::l S' '" I!I - 0 , f 4' %.1' -rr- I I I I r. " : Coi2.=-<- I iE}-.--- - - ~J I J I L_.._ ..s ~.....,... '11-,_1> ' , .2.... 'r ~ ~ ill ,. rt a -, I I _ _J u z i: '" "- \II ~ ~ i : y, .' <;.a' o R.\ \,IE; H AI'BoP. . .~ " I'- .v ~,- NORrH 1;1'llr'~I~Qi"!I'I' lINi1""I: 0 ~,,'!l ~..( ~t>;!:~1 Zo3R HM.BM? M. 5PF"LD, L.lt-NE I O(1.t 974-17 ' 16 -.3- It -2.-'Z. -r: L.. 3'100 5 T<lA-I>[)Il1llt11 FI Lf564tr G-fJ.6VIE: OYI.H. Su.el>tllf510rJ ur 4'2.. B/..oC./<' z. AE. PuA-'-E1M eN i F6 i<. IM~. 4-g~-1" \) ~" ;--'\ n APPROU LiR"'" ' ~'lf~i0: '6' ..11:"".. DATE Ie; Ar.lJ Y BY ~ fA/~) It Q of ~ ~ :t --./ /8.~ '-.-L 5PFLD 'A. ~r. SO""H .. il N :!: l( , ~0311' /1AR80fl. bR. ~1;~tl .r~"'-i" . ~ _!., i.. 1. ,_I ,.. 4")~':' . ~ r:.: .~ : , o;c. HU'::>- 11- '1 - C!!> I .-/l€'~Po~~ !-Jo-r(2gQ. Department .of f:. ,iranmental FLOODPLAIN MAFJAGEMEI/" Management/125 East 8th 687-4357 By , J..A u.. -1.J! - /7c:J-? - 8/ Ave.. Eugene, Oregan Date Ta: f-h-&( ~ Pe~it Processing o Planning o Pub 1 ic Warks App 1 ican t Name Address .of site Pennit Na. Partition 'No. Subdivision Na. SFD ~J. YDY &cce..:J 2036 .g A'C 'l3D~~R... AG ~ ADD. COMM. ++r.~ ~~ ~e:.. [] Appraximate fhlaad halz~rd study' arlela, extra prec,autiansfmay be adP~rapriate ta assure that t e bU1 dlng site wi be reasonab y safe rom flaa lng. ~etail flood hazard study area. ,( . { , ~ :o1abile home tie downs require~~+le"b~N:!ldeYI-t{Q..l MO(,)-?f ko#..J.~ I' o Substantial impravement. "V'a Df\ L$ lae o"--O>-nI.e l:xSe -'c-(<=<:t'\ ekt/. o Site in regulatary floadway channel. building pra~ibited unless it is demonstrated that the cumulative effect .of propased develapment will not increase the base flood at'any point. 450'0 I ~ BASE FLOOD ELEVATION + l' = 11~~. '-':" this elevation required as checked below. o OTHER , (r1SL). Certificatian at .or above *************************************************************************************************~ ~ CERTIFICATION OF ELEVATION I, /~,-rA'//?c /_, (, ,L:t~AA/C 1/ , a Registered Professianal .<:L/~L/~-~C/"~ in the State of Oregan, da hereby certify ta Lane Caunty, that the following elevatian represents a survey made by me .or under my supervision. o The foundation elevation (including basement slab) = The ground elevation that structure will be placed on = -;14'7. / , The first f1QJ;!r elevatian = 45/. I '(MSL). ----'----.---___._ o The ele~~~ti~~~~!. th.e._ to;?, ,~f f~?ad~~~o!2ng;= / ' (MS:~ .,_~~ O Other; ,-'.....- -: (/-; /,- '......' n.........~ .........0v ~../~C ;~.. ~"/'_"";;J"""""-"~ /L:-g.."-~ :-~c-'y: Reference Bench Mark Na~ ,Locati.on /}-Z ~ ,~-:4 'F(/;:Y5' /'/1/,--7 4- <""" "J /--~') _~~ //L.'/,i....;C'.-.? . I "---,,E, (G>k/V-"-,<', 0. /7/7/'..,-- .,-, //. ,/.;"';'/,:,")' ;;:- Signature~;:,~'.2.~:.:-/~ ~.(..;..? <;,..--( Da te C) 6 /~ / ~ /,;(f"/ /, Original to be certified and returned to Lane Floodplain Management .lst copy with application/inspection '2nd copy to applicant 3rd copy to Floodplain Management 3: '" -0 GJ. , (r1SL). I , (~lSL1, \) , , \N ~ _~.,.c., N ('!'l' /A/ TV// Or e v/.::Lf /;:k,/ 1/:: >-~ ,C'~~-/J-;:?-;,,{/r /'1'-: -j SEAL ,REGISTERED .... PROFESSIONAL Caunty ~.LAN~c SU=)VEY. OR)/ c;i /',/ G/o; /,.- -' J) / b...<<<;,...... ...,.. (~/ ,. _.' " ( n,/ '''"",..- --I./ /~C'/'';' , () () r O'REGON SEPTEM8Ef123. ;917 - DONALD L. BRANCH " 1137 '" ,",~~I- ", ~ ' . '. " , , '..;-pl' ,.', , '. FLOODPLAIN ~1AtJAGEMErH . Department of Env, ronmen~al Management/125.'East\Bth'Ave..- Eugene, , 687-4357' " Date' P,;';O-8/' " . By": ',IJ.c& :' To: Oregon " , ,Y. !:29-P-ermjt 'Processing o Plann,ing " D Pllb ~ic. Works' , . '.' ., I . Permit No:,170c:.-8/" Partition No,. ' ' Subd'iv'fs i on No. SFD " 1?MIPY' ~ ;;0 3B . ;.//1~ac, ~ AG <:r0P'. ADD. -COMM. App lican t Name Address of site '" ",,0' App'roximate flood"hazard'studyarea, extl'a'precaLitlons may be'appropriate to ,0.- '. ,assure that. the building sit~. will be'reasoJ)ably safe from flooding. < , ",'8' Deta'n flood'hazard study area. , ,',', '. ',/':', . '18 . Mobile home ti~ d~wnS"reqUired;p-Ilef5('~rJni!e!ej/, M.."JJob~/19 lOPfe Is ;" , ' O. Substantj al, 'improvement. Plt2ced .(9-'7 160 ..6,p~kJ Yft~ ~~e +/lbOd' &'/<!!!t/-;, . . j , . o Site in re'gulatory f'loodway channel, l{uilding' prohibited unless it is, ,demonstrated " , ~hat the cumul"ati ve' effect of proposed:' devel bpment. will not' i ncreas~ the .base ,. flood at any point.,' ' ,"< ' , , / BASE. HOOD ELEVATION + l' = 4-=So ,0 " (t1SL). this ,el evati on" requi red as 'checked below. , ' OTH ER , , " ;13 . , ,0 Certification at or ab'ove , '***,**.*****:****.******************,****************-**-**************************************************.; ~ , . CERTIFICATION,OF ELEVATION , , I, , , a Registered Professional ,in" the State of Oregon, do, hereby' certify to Lane County, "that the followj'n~ ele~ation represents .a survey , .'.' ~,' made by me or undermysupervi sion.' 0, The foundation elevation (includfng basement slab) = ~ The g~ound elevation that struc~ure will be placed on - !i5l Th~ first floor ele~at;on =' ',(MSL),' o The elevation.of the. top of'flood'proofi.ng = o Other , (MSL): ".., ~ .' ,(f~SL). . ~. , (~'SL). \N ' , \ ~ , 3: OJ ,., -0 ::" , ,-" , " '. , ~" . Reference Location Bench Mar;kNo. .\'" N ... ,. ."-,,, il," . .~. " S i ,gna ture Date , . SEAL '. , , -I " " . ' , ' :I .' .' , , Original to :,be certified, and rE:!turned to Lane County' 'Floodplain Management . 1st copy,with'applic~tion/.inspection ~ 2nd copy ,to applicant '3rd copy to Fl oodp 1 ai n Management , ',,. " ~, ~ \) " \ lLLU~ f!JJJeN ,()~7 3 --- - --9 ... ~ o '. ... I'll *flOQP)1fMIN* .' \..verlf1.elevation .' .l4' s' "" ~ '" "" - ~ \~ ~ o l: . 2,1' E!"'S~"" ~ ,....~~ - .. 111 '!I 19 o f 4' I I I .2....' r : ,," I ,,2...... . , I {E}-.--- - ....;. ~J I J ' I '-'- - " - "..$ . ('-i. -...-i,...., '8' -, -, J I _ _J . 1O! y c,o',' o P"\\lE: , H AP-SOP- a.I' u ~ j: ~ >( III . o ., <P N .... ., ~ 'it s' ~ "'J; r ~ 1/1 '> U o . -~ ~ ," ~- - Nop.nl 'I{~ Z03i HIt/l./3(JfZ. DR. 5PFLD, L..A-N€ / oile Cf7q.17 ' /& -1- II -2.-'Z. ' J. 1... 3'lOD 5t1f AbOlTllltll FI4S~ G-IJ-o\JE WI.':'. SU.liDllf'SIDW ur 4'2.. 8L.OC./C. 2- p.EpI./l1-CEIN\e.JT RJ{2. ~ ~. 4-8'1-7t.. I) ~" ;--"\. n ~.;; APPRO'V~[Q. DATE ~)[J BY ' ' nli(} ~, 5PFLf> SO".H - . A sT. ~I N :!: J( <t ~ ~ 1: J8Y' 2,038' f4AR80~ t)I:I. 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" ""...,.. , j l , \!'j ,::' ,,,\, ~\ " .,: ! ~\ :i:l - '~..< ,.~.! '-, '1--... I \ ~L",,_. j ~~~'. . r .j ",-~"...1 i'"....-,....~...._ ' ! .', -,_ l!-'\",f,.',,\' , --.::...;"::;,~...., '~ ----. , . <l I. f", .~. l vI , I ,~ , . i I ; I i I . , , , \, , . '," r('t ~ jt' :+r 'FiJ( ~__ :J /1"0) ~"'j (~~~5 r' --------..........,- .,. *VlIAJQJKlOJ1* . , noifsvels;llhs'l,' ':""':" h." . -. ~ I ~ I ,"i (to;' \ \,-" ~ ........~...Jl i )1 1-.--.-'7is..,---j o , :-;~," f":;-~~1-; I T! f j.~ ,~,P..I"Q.;ti~t;~ ." I.." ft"t 1/$, f" ,:,. Ci) .1 . . . I" , ~ t i':;" ~..t.'~ ,--......''::'-.....;......,..,,< < l, . ' il ; , ::;~-T~(yJA \\ :d';_ :JTAQ ~~~'':,L ~, va " b'" ~, ''':!'.:..I:J .~\, Sil1 :.:],~s~ ~ i-;. " , !, I , I I Il ' '.-I i" ~I .' ~ .t.' I " ! ..#: , , , , I i . I '! Ii , " t'j I ' , i I I . "; I' j'I , , q! ,--..,--~-.~-LtJ ,~ ~ ~ '" I I I I 1."'- i ~: . ), r, ':' " ,,' I I, I .- I i , I J ,I.. :] ~...' '- )< e: ~, ! ,:1., '''-'J' ~'(l '..;-,:;. -",,~ -.', . I,' , 'I} I;., f '\1 r , i I ,t I ....,.......~. .' ," ".~~., ! -( II ' .3 ,-t~it:," ' ".'. ; II' l!! ~, .' i. ,'. " : ",i;,~) I' , ..,.J .,..... 0_,"" ~..~.... ...' ,,',!rt'.~~ q I f t:I.;::.,., '; I' . ~ ; I I It . ~~' :!l! i1' II q. ~ I J I; I I I ,,' I ? I i j- t~.;(;. i.- l ~'(# ~l r j 1 , I I I ;' I , I " L. '"~io -7--'-'-- ~ ", ~- I ! , ,,~ I , I I I - It,? f: - ~ l:;~.l I I I i 1 t t;i, ~ <' ~ I i , , !,- , - ".. t \..., I I J I 4 I . f 'I ! 1 " :'1 ' ~-"" ' i.J ~ . " " ~ ',' ,j ", (, '!-' ' ~-' -- j _.:,:..,__ . __ lJ " t),;;) - ..-..--";t.l:......'...... ;~. ''::<:;'/1 /\" ,.~~ Idne county .,t ~~ PROPERTY OWNER/CONTRACT PURCHASER' ~~. MAILING ADDRESS CI~ .. Envi ronmental Manager 'nt .'AC~IVI=rY., I:NFORMATJGl~ SHEET. COMPLETE THIS 'SECTION. INCOMPLETE .FORMS WILL BE,REJECTED~ ill c;{.LG~ULIC~/RE~ M ;2..0 3~ ~..... ,~'""LING ADDRES~E 2J)3f 1f7 <rr1 ZIP COOl? ----- 1Z.4-(,,^1 . H?ME TELE,PIlONE: NUMBER 8 A~PLICANT/~"'~Vl\l'fll':f"J"Inm BUSINESS TELEPHONE NUMBER o PROPERTY 0\-INERjCON1'RACT PURCHASER H011E TELEPHONE' NUMBER BUSINESS- TELEPHONE NUMB~R @MAIL INFORMATION TO: &.t 97 V77 STATE ZIP CODE Tax Map Number: It - 3...1l-2.-"L 'G) TAX MAP/PROPERTY DESCRIPTION Nut-mER (from tax maps' in Department of Assessment'& Taxation or fwm tax statement): 3,6D Tax Lot (5) :. o Out ~fTL # Tax map number of a'dj?ir1ing property' in same ownership:" "IJ No'ne ,Tax Map Number: -Tax Lot (-s) : @ REQUEST t~~ . S'tl.. 'aU . ' ~, '.,-- information needed~ .' . A~ r (~ ' , .; . ~; I . '@,SUBDIVISION (ifap91icable);: (briefly describe 1Wlt-l '-f'Y-l , , COMPLETE THIS SECTION FOR LAND USE, CONSTRUCTION APPLICATIONS. OR PROPOSALS . SEE "NOTE BELOW. ~ TOTAL CONTIGUOUS PROPERTX IN SAME.OI~ERSHIPl acres @ PROPERTY ADDRESS: ~l~ .~ I14k~ ~ - Vk.* ~ ';:2. () ;~ Gl PRESENT DSEOF' PROPERTY; .--5.F. @ NU~BER,OF STRUCTURES ON PROPERTY: Standard' home Mobile home ." Modular home RV in use as residence______ Storage Garage~ , " " Shop~ Barn Other (specify) @ ACCESS TO PROPERTY: .~ ~ Pu~lic Road Name prl~ate Road Name Road Easement I...' ~ of Users - Width @ OTHER. EASEHENTS OVER PROPERTY: (j) \.,'^TEl~ .nIS'!'RICT: ~.~ @ FIRE DISTRICT: , ..,....-- C0 FXlS'l'lNG PER!>\ITS ON PROPERTY: ~ 1+ ~f"'(-1f, 7/81 (OVER) By partition ~ o Unknown' BLOCK: 3 LOT: ~ 4z. """- .*FORSTAFF USE ONLY.. 9/ >-3 q; - ~ -<if ~ -,... >-3 TIME INITIATED, I D .') -:r' t" CHE~KED BY: ~ NUMBER: . DATE: ATTACHED EXHIBITS: o Plot plans (2) Oconstr. Plans (2) o Site Plan o Copy of Tax Map o Other SCREENING VERIFICATION: By: Date: Time In: Out: o Accept 0 Rcject Routed to: *NO'l"E: ATTACH A COPY OF TAX NAP; SHOWN EXISTING STRUCTURES AND TAX LOTS IN YOUR OWN- ERSHIP. OBTAIN TAX ~ffiP IN S~LF HELP AREA. " . j .: .~'. (!f COMPLETE THIS SECTIONiFOR, IJ\ND: US",-,OR;CONSTRUCT.,ION; APpLICATIONS.", " 1@ PROPOSED USE OF PROPERTY IN DETAIL: ,~ '.,,;\',,' ,t ~ : ([Y BUILDING REQUESTS: or: D~q~3~tJ .~A.~ ~~:io ~2... '2.0~~' Contractor's # (for mobile home setup also) ,Directions to Site: 't'b ~ I Check the type of permit rcguc~ted:. 0: Owe 11 ing : D:' New 0 Replacemen t, 0' Addi tion,~l ; o Addition ClAlt~ration; Dr-~odular !-lome fl.MObil.~:. Home -. Model Xear ,~ ~ o RV Dsta'!dard Construction,: D P lciri Cl1eck Onry '.D.con:rnerci.al.: Use Floor Area ." ~,,'.~D;Agric~i-t1,1r.a.l: "U5'e' O',()thcrs:. Use o Change o'f Use -, 1~IOW?! 'i Floor Arl;:a .,.. ~ SANITATION 'REQUESTS: [J,Site evaluation for SOS feasibility o ~ew system installation o Bepai~/replace;n~nt, o Alter'ation/~elocat.io~ D.Hook to e:xistin,9 /1J~ ADDITIONAL INFO~~TION: " ., *.,*FOR .STAFF USE, ONLY*'" - ~'.---'-- .',;.'. ::;E/L~ ~ Dat~-:~.l.:--C. A'7... (~. . . . 'VII )' c-"'C/ Time In :le)',(7 Out: ( '0;..) o Accept, o Reject [] Plann~ng Application o Construction Permit ~pp< , O'InformatiO~' 0 y ~ , zo~ing; Rik V1fL (<:1-: . ".~omp. Pl~n De ignation: ~ co~ts : " '~-..('\,l^. ci1. ' - .J..~r ,~ ' .,., , ' ~ l*-- Yf . ; ,SANITATION: :, By;:'.' !<t,,,- &qA:....l' " . Date: ~ ( ....._ Go ( ~( Time In :-/ {<.JU Out: ~'A~cePt 0 Reje~t [] Constr. Permit Issue . 0 S.{ te Evaluation Issue PERMIT ISSUED (SAMr, DAY ONLYl : Permi t :If. By:' Date: Time In; Out: \ ) ') 'i I( , Ii ,0 , , i II' " " ~ , ~ , " , , :1 ri .. , . , ~ ~ ~ 0 . , .:( I'I~ l :.:X t C f. '-' C~ \ t".:,,< I 'If! '" , _ ~ _. _ ----.3!~ .___ __,_ " t LANE COUNTY DEPT ENV MGT RECEIPT I 170281 DATE 080681 APPLICANT ALLEN, I:!ANDY' ADD!', 2038 HAF:Elml: Dk. ; SPRINGFIELD , ORE:.GON !F~t lU0341~203900 SUBDIV FILBERT GROVE 5THADDITION LOr 42 BLK 3 , ~EW BLDG,TYPE MH USE,R NO BDRMS 02 N~UNITS 001 NO STORIE:.S NO BLDGS 001 CODE:. APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DAYS, BI',' t:<p ,,,,p BP t:<p ..,I'" . 11H' 'LC 'i 702Bl MH MHPL NO. FIXTURES: "ECH I' tllr~ I::'CI( , ",DS 1"'1'" " I , NO. CClNNEC'fORS: t,E:Cf'Io^.JN I C,;I., n:E' t STr'-,TE SUI'~CH("RGE PL(.~N CHECI< FEE j 5 . 0(,) EM:H '" 62,. ~:;(.) i0.00 I 4% o;{. 2,,?O SDSC ~}o~oo ',0.00 'r~fYfG : ",EQU: Tr'-,KEN (iPP o BY I'!LH 1'1:,; 1 FF' SDS SI F'CK -4 D(iTE ,OB2581 OTH IS'\' . I Ill; 2 ~.:) EST. COr1PLETION ~> 'i 3 i 3~';. 40 CK TClT(.~I.. FEE""" , " ~ I I