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Home My WebLink AboutPermit Building 1976-05-14f t+- /ck NOTE:NO PERMIT WI BE ISSUED I]NTIL THIS APPLIC.ATI. APPLICATION FOR: CONSTRUCTION MOBILE HOME PI.AN REVIEW PERMIT /I HAS BEEN APPROVED CHAI'{GE OF OCCUPA}ICY >( X O!,INER CONTRACTOR Name Name Address lty Phone .ty l.3r^* rc,5(7D ",u" q -oS zLpess o.s. REG. /l *r- 17 Subdivision Section Census Tract f rcctss ro PRoPERTY (Road Name). Structures on Property: Location - Address/Dlrectlons : Block Exlsting S Disposal Systen Publlc Comunity ,TJMBING 1ed Owner Other es ield Required - Lineal Feet erty Acreage Width-DePth- or New System Required Name of Community or PublLc Systen Name Sewage Connection PLANS FURNISHED FACILITY PERMIT YES Signature of Applicant: Fee Recelved By Date Maximum Dep rh Existing fr'or".., $ Below r Off DISPOSAL: Site Inspec tion il WATER SUPPLY: Well FEES: Bldg. Plumbing 3% Surcharge llaste DisP. Plan Review Moblle Home TOTAL Min. Septlc Tank Capacl On1 Spring _0ther 1on terWa Connection fv ,+ tq Fr. ( I Iype of Construc FLre Zone Use Classifica!ion Bldg Setbacks - frm Center of Road Right of Way Fronr side Int._i Side Exterior Rear Zone PIANNING:DATE:SANITATION:DATE cs5- r2 LAI{E COI]NTY DEPART},IENT OF ENVIRONMENTAL ING:-/u \ ,<4. t- pb (-r J CONSTRUCTION [ ] IVIOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY t ] NATVIE ADDRESS CITY ZIP CODE LANE COUNTY PERMIT FOR: n Owner PHONE n Contractor NAME ADD R ESS O.S. Reg. + Twp- Range-- Section-Tax Lo CITY ZIP CODE Census Tract PHONE t Code Subdivision- Lot Access to Property (Road Name) B lock Acreage Width Depth Existing Structures on Property: Directions to Property - Address STRUCTURE (# BEDROOIVIS)VALUATION SEWAGE DISPOSAL: PUBLIC[] SEPTICTANK[] PLUMBING INSTALLED BY: OTHER[] OWNER[] OTHER[] NAME- BUILDING WATER SUPPLY: PROPOSED t EXISTING tPLUIVIB ING 3% SURCHARGE IVIOBILE HOIVIE WASTE DISPOSAL PLAN REVIEW TOTAL PUB LIC COIVIIVIUNITY . NATVIE PRIVATE WELL OTHER-SPECIFY CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS IVIIN. SEPTIC TANK CAPACITY GALS.IVIIN. DRAINFIELD LIN. FT IVIAX. TR ENCH D EPTH I NCH ES STAY 1OO' FROIVI ALL WELLS TYPE OF CONSTRUCTION GROUP F IR E ZONE USE CLASSIF SETBACKS- FT. FROM CTR. OF rAff FRONT SIDE EXT FT. FROIVI PROP. LINE: SIDE INT. REAR - ZONE AUTHORIZED SIGNATURES lsl ISSUANCE DATE BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUIVIBING - CANAHY BUILDING - GREEN SANITATION _ GOLDENROD IMPORTANT POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIBONMENTAL N4ANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OBEGON 97401 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 State Buidling Code, D.E.Q. standards for subsurlace sewage disposal and the State Plumbing Code. All buildings require a certificate ol occupancy before being occupied. (See Details on Reverse Side) c55 -1 3 PERIVIIT NO. SO. FT. n Owner LANE COUNTY PERMIT FOR PERIVIIT NO CONSTRUCTION [ ] IVIOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ] NAIV]E ADD R ESS CITY ZIP CODE PHONE n Contractor NAME ADD R ESS CITY ZIP CODE Census Tract PHONE O.S. Reg. +t Tw Range- Section LotSubd ivision Tax Lot- Code B lock Acreage Access to Property (Road Name) Width Depth Existing Structures on Property: Directions to Property - Address STRUCTURE (# BEDROOIVIS)SO. FT VALUATION SEWAGE DISPOSAL: PUBLIC[] SEPTICTANK[] PLUIVIBING INSTALLED BY: OWNERT] OTHER[] NAIVIorHER [ ]E BUILD ING PLUI\4B ING WATER SUPPLY: PROPOSED I ] EXISTING t] PUB LIC COVITVIUN ITY - NAIVIE 3% SURCHARGE IVIOBILE HOIVIE WASTE DISPOSAL PLAN REVIEW TOTAL PRIVATE WELL OTHER . SPECIFY CONSTRUCTION PERMITS & INSPECTIONS AND WATEH POLLUTION CONTROL SPECIFICATIONS IVIIN. SEPTIC TANK CAPACITY: GALS.- N/I IN. DRAINF I E LD LIN. FT IVIAX. TRENCH DEPTH- INCHES STAY 1OO' FROIVI ALL WELLS TYPE OF CONSTRUCTION GROUP FIRE ZONE USE CLASSIF SETBACKS- FT. FROIVI CTR. OF rAtV FRONT SIDE EXT FT. FROIVI PBOP. LINE SIDE INT REAR -- ZONE- AUTHOBIZED SIGNATURES ISSUANCE DATE BLDG. PEHMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANABY BUILDING - GBEEN SANITATION - GOLDENROD IMPORTANT POST THIS PERMIT ON MAIN BLDG. AT SITE LANE COUNTY. DEPT. OF ENVIHONMENTAL T/ANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 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 State Buidling Code, D.E.Q. standards foi subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of occupancy before being occupied. (See Oetails on Fleverse Side) c55-l3 F S ITE I NSPECTION AppnovEo RruaRxs Drsappnoveo D Darr Ir.rsprcton FOUNDATION I NSPECTION APPRovED Rruanxs Drsappnoveo Dare I ruspecron FRAMING INSPECTION Appnovro Re RKS tf,Dr sapenoveo Dar r oart f I xspecr I ruseecton LATH OR SHEITROCK INSPECTION AppRovro N Drsappnoveo Rett rRx s FINAL INSPECTION Ap pRov e o RrMaRx s &D r s APPRovEo I NSPEcToR CERTIFICATE OF OCCUPANCY Rraov ro lssuE Rru lRx s D Nor Reaov ro lssuE D Dorr_I HspecroR Ii'Yb I ? fl,"{