HomeMy WebLinkAboutPermit Building 1978-9-26
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LANE COUNTY PERMIT "..... FT .
Acreage or Lot Si7~ .-;- .4-c, Partitioning #)1 312:.2l.~Completed
Contractor's O,S. # AI I<- f/#.,C.e.i.. ;l-
APPLICANT'S NAME AND ADORES" IJ/t/ll 01 110 rf ~ f'-S - //..2J- .)1'1/), Ue ~"'r..l'-IJ,t:
OWNER'S NAME AND ADDRESS L -,e" '1' tt!t.YLo~ - ~~d~__ Ru,,-,~ sf' FL_fI'
CONTRACTOR'S NAME AND ADORES"
Mail permit to ( ) Applicant ( ) Owner ( ) Contractor, J>\') Prefer to pick up, Call t:F9- -::21/.2.
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Subdivision
Lot
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Block
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Phone
(owner, elc,) when ready.
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STRUCTURES NOW ON THE PROPERTY. _____._,__,__
_HIS PERMIT IS FORl2u-"<.bj..~~..e. . Jif x..'O-).{ ohJff_jA~!!,:/, Z"vff,oJL( ~~ = SEDROOMS---3'.3 PLUMBING CONf'!ECTIO;";S~_
WATERSUPPLY f,Je-u'., ,SEWAGEDISPOSAI S~.Pf'tL ~<;y5J'-",,bt $,1.# 7i-5-~.:L.
AJr'T
THIS PROPERTY IS WITHIN ONE MILE OF THE CITY OF
,PLUMBING BY Llf\K r\"'J,,~,10
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I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: ~owner of record;
contract purchaser; - potential buyer; - realtor or agent. I further certify that lif nO! the owner) I am authorized to act for the owner of
record, and that said owner is aware and approves of this action, I hereby agree to comply with all applicable Codes relating to this permit.
Fee Paid S '7[;, 90 Signaturp/,/ 1I//f1olC, y' !Ior/(; E5 Date ~//"7,Y'
(Xl NEW ADDRESS M-FACILITY PERMIT TO TRANSPORTATION DEPT~L (~EC~AL PMT, AREA, MIN, ElEVATION:A/....Lf-_
SANITATION ~5 b~(.fco(),~ BUILDING
/oC':~? Minimum Septic Tank Capacity IGallons) ~H_ .:!i'pe of Construction M~Grol!P ~_.Fire Zone
'75 (:) Drainfield Required, Lineal Feet SEJ> Use Classification
. zv ~,1aximum Depth -te k ~.ti. --' ....:C c.o- . ~
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By:/ 6, ,.J~ /l.....J Date: 9/'U/7? BV~..J.>." Date 1-':2-&-/,'
'""'~ PLANNING REQl/fREMENTSSATISFIED, By: ~N/JJIf-Lc.E-) <!1C-5 Date: 7'; // 7'.Y'" Date Issued:-:::-zK
~NE: I1C 1; ~- 2ETBACK.?,: FRO~T 60; SID_E FACING STREET NI't-(FRO..M CILl INT. SIDE _YARD~ REAR ~ {FROM Pill
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT. 125 EAST 8TH AVE., EUGENE, OREGON 97401 PHONE: 687-4394
C55.t3
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. DEP:MIT - WHITE; BUlLDING - GREEN: PLUMSING - CA~ARY: SANITATION __ GOLDENROD: OFFICE CO.,.( _. WHITE,
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Job Location (Street, mile post) ,::57 ()~ Jjo crI p.n ffi..J.C?" n (. Jc:.....
Subdivision
Lot
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FOR SANITARIAN'S USE ONLY: ~~~n~~_:_sYs,tem Disapproved
COMMENTS: 1i11bir_ ~
,_'.',__ Signature: ,.,(/ P1.<l;:.r
FOR INSTALLER'S USE: Trench Depth 1.i Filler Depth Below'tJ~ _ t1
Tank Capacity Ie c' C Manufacturer,L,c, (_, r <;"., J
Measured distance to well from tank /C (i fro~ drainf-ield..il S
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INSTALLATION RECORD AND CERTIFICA E OF SATISFACTORY COMPLETION
When signed by the County Sanitarian, this certific e is evidence as per qFt 454,665 of sat,
isfactory completion of a subsurface sewage dIsposal sstem at the above \oqallon,
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Retern this form to: Permit Processing Section, Departme t of E.t'."i- . . '.
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