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Home My WebLink AboutPermit Building 1978-08-30IRS, TL JOB LOCATIO Acreage or Lot Size Partitioning Contractor's O.S' # ) Completed Subdivision ' 'r ' Lot Block- LANE COUNTY PERMIT APPLLCANT'S NAME AND ADDRE Phone-Phone-Phone- OWNER'S NAME AND ADDRESS CON'TRACTO R'SNAME AND ADDRESS STR UCTUH ES NOW ON THE PROPERTY [/lail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call (owner, etc.) when ready. IHIS PERMIT IS FOR # B ED ROO IVIS-# P LUN/I B I NG CO NN ECT IONS I^/ATER SUPPLY ' SEWAGE DISPOSAL ' ,I s.l. # IA L-\\Y THIS PBOPERTY ISWITHIN ONE I\4ILE OF THE CITY OF J . PLUINBING BY -- 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; - reallor or agent. I further certify that (if not the owner) I am authorized to act {or the owner oI record, and that said owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relaring to this permit. Fee Paid $-{,€tffi rtSignature Date ( } NEW ADDRESS ( ' FACILITY PERMIT TO TRANSPORTATION DEPT.- SPECIAL PMT. AREA. IV]IN. ELEVATION SANITATION Minimum Septic Tank Capacity (Gallons) Drainfield Required - Lineal Feet Maximum Depth BUILDING' , Type of Construction se Classification Comments:-Group -Fir e zone ( Comments B Date: PLANNING REOUIREMENTS SATISFIED. B B Date .lR.-Date lssued SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROM P/L) LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEIVIENT, 125 EAST BTH AVE., EUGENE, OREGON 974O1 POST THIS PERVIIT ON MAIN BUILDING AT SITE BLDG,PERMIT-WHITE; BUILDING-GREEN; PLUMBTNG-CANARy; SANTTATION-GOLOENROD; OFFtCECOp\/_WHtTE Da ZONE ,C55-13 PH E: 687-4394 \I l\ LANE COUNTY DE}.HRTMENT OF ENVIRONMENTAL MANAGEMENT 125 EAST BTH AVENUE, EUGENE, OREGON 97401 Current Zoning lnending f]co^p ted AVERAGE PROCESSINGtl x M EIANNING DIVISION P.rtltlonlng I Parccl No._ Partltlonlng Requlred Other t fiATEN POLLUTION CONTROL N6v Sltr Inapoctlon(a) SDS Conatructlon [-1 Ney Nu!&er of Bedroonst. Conmcrclal,/Industr taI -I o! Employeee I o( Slter UIct, dF UI t ,U }d r. H c) }] Hoz EI.So"" \$ CONSTRUCTION PER'{ITS AND I}ISPECIION(See abovc lor I of bedrooms,/f of ernployeea ts t{obllc Horue' [l Permanent q Temporary t] ReneualStructuro Sq. Ft. Valuatlon FEE 'r*.,tO s s s Total Vrlu;rtion S -_ Plunblng fixtures at _ Severnater Conn. at al Statc Surchargc Plans Check Fee Change of Occupancy smm -;vp-- $--- each 9_ rach Subtota 1 s s s s s fr o!, TOTAL BUILDING PEMIT FEE }{lnltnun atructural aetbacks ! Frotr centerllno of ";;.;,";t.'. ,5? ' Froro lntcrlor lot linea: :::::H'* f] Corra'l plans 8heet to appllcant I CurU cut. to appllcant tr'FPUBLIC I.ANDS PUBLIC HOR!(S Address fl D facility pernit EIIVI RONYI:iITAL IIEALTII F, ninir.* Elevrtion H I ca!h- ch.* :AAO 6 Rcc,d *&//a,^-_TOTAT. s AFFIDAVIT: If this permit is for an agricultural building, I hereby declare that this bulldinguill be used for agricultural purposes as.rllowcd by zoning and/or the State Building Code, andfor no other purpose. I further cerLify tlrat the statements and other information submitted onthls appliqa,,ion are true and accurato. and that, I have Lhc. following legal interest in the Prol)erty: )(!cuner of record; conLracL purchaser; 1r'ssee; h()l.ler of an exclusive optionto purchasff duly authorizcd-to act for ! person whb-h.rs the to.flowrng leqal iniercst: he omer of record is knowlcJ.leable of lane coLrnty cat oo,.1m not r or that t ii;-5;ner-. -l' f urther .9 o comply wrth all !rl.rl,c thi s s relat lng) thi Applicantt a Si,lnature TttISISYoURRECEIPT,ANDDoESNoTGIVEYoUPERMISSIoNToBUILD. rO&{ATION ASOUT ?HE PROCRESS OT'YOIIR APPLICATIO:I, CAL!, PtiRMIt CONTROL, 687-']57 (687-HELP) Address s 5 Minlmum Elevation s s s I I I ! '.c s I I II I Job Locatlon (Addre cp)TRS, .TL ForPernlt # Pernl,t Pemlt f /4c& i) ForPenmLt #PIot frlan Permlt # Permlt I I p NoNtaSl Jtrn irt ,$_l b, For For For For =1 y'//,, ;oo Subdivision Lot 3 / Ex u ?. ,// c * Ns NL, i! rq L FIi i * r) t$ uNr rr: Block 1 ) \ ) : iJll I t,tqlc NEw Wrl-t- ? o/.DwFl er- P*pee ).ffi --\ r,/ l,*, ti qotUotaJ i__g{ : $u t4 lt te $bV I or.-,7 v \Iq r \. q \7Nr?Air &"I' t;l!ir o o o firl itt I n \ s t (_ F G r. lbt h.\II P L t/' $ l.-t J \o -+i v Sle o r + \l \ v QIi flw' TR€ to- ".-4 71 Zaecs I-t Izo--t r Lo<N Y d[> -<No prF <<<t. r;7'l/f (t\, ,S'P1t"';1 ftl ,l l'rlO Jri,.r,. //.^'DvlrMaPv1 lfr -2 -4 j Nr A( I I I Please Prlnt - Rerum Appllcation to Reeeptioni st t{hen Conpleted Appolntknt Dat. APPLICATIO I\I Office Use Only APPL OI.INER (IF DIFFERENT) ADDRESS ty ZIP IS OR.E. STATE LICENSE MAIL COMPLETED PERMIT TO AP (crRcLE oNE)fl PREFER ?O PICK I'P. CALLl. PRESEI{T USE OF pROpERTy (resldent ; type of faming; corerclal or indstrial ; vacant; etc.) a{ 'q 7472 r{{zq Hjt z C, "E @E : Ft Fl- EF IdH z U oz ADDRESS \ 2. DESCRIBE STRUCTURES NOW ON THE PROPERTY.NOII'E AN\ S'I'RIICTURES TO BD DE}IOLlSIIEI)IS t- IATE PL\NS }'OR TH PROPERTY (THIS APPLICATION) ARE 3 4. FUTURE PLANS: E oE I .';'ol I I i 5. PLOT PLAN. Sketch (a) a1l roads (b) bomdarles of properry (c) proposed seuage dlsposal areas (e) ex|sttng/propos ed(e)easemenEs (h) dralnageways, streaEs, cre eks, anyor 1ndstr1al, show freestandl ng slgns, parklng areas exlstLng/proposed buildings wells (f) extstlng/proposed other pertlnent features. If I.I,IDI CATE D IMENS IONS. (d) exlstlng/ driveways colmrcial r H Eroo o €FH|l FIEz t, H7ro}l Hoz @ }lo H}., tr, E Fo }J Hoz + 6. 9. ll. 12. 13. 14. TOTAL LOT SIZE OR ACREACE HETHOD OF SITIAGE DISPOSAL ION TEST HOLES READY (DATE) {\) N Nt\\ p PROPOSED WATER SUPPLY ELECTRICITY FUPU\ISIIED BY WELLX spRrNc__ STREAL LAKE? O* f PUBLlC: NATURAL CAS FIRE DISTRICT SC}IOOL DISTRICT PLUMBl:{G BY ********it***********l***t****** DO NOT I,/RITE BELOW TIIIS LINE *r*r*****r*t*****t*r*********** BEPORE YOUR APPLIC\TION C N BE PROCESSED YOU MUST FURNISH: _8!xll PLOT PLANS LEcAL DESCRIrTION (DIMENSIONED) bre county I x ^l n,'re---I-l6:_7f, LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 6lv-- BY \ I t -2 *y+r. . ..it .rl, ,)t^); ::;: itR :r-i,t.,4 I I I I i ,I i i /E^z-4'T.L. ZaOo IO: PLAti:r il,rG PIRI.lIT PROCESSIIJG OTHER FROM: FLOOO PLAIII I,IAIIAGEMEIIT DEPARTT.IENT OF PUBLIC iJORKS PHoilE - 687 -4195 SUBJECT: BUILD ING pERNTT NUuBEp. Zz ?t -"8 pARTrTrotl NUIIBER SUBDIVISION OTHER SITE IN FLOOD HAZARD AREA. YES NO I DETAILED STUDY APPROX I I,IATE STUDY NOT A SUBSTAI{TIAL II,IPROVEI.{EIlT HiNIlluM FL00R ELEVATI0N REQUIRED SITE IN OESIGI.IATED FLOOD HAZARD AREA EXTRA PRECAI'TIONS MAY BE APPROPRIATE. RECOI'II'IENDAT I ONS : DATE &BY .7 ?-/ ENVIRONMENTAL MANAGEMENT CHECKLIST Date: Date Date In i ti al ed/ D i spSent Req. Date Comp'l . Code Da te Rec. El ap. T ime P'lanning Action: Rezon i ng Conditional Use Permit Varjance: Type_ Temporary Perm'it Unzoned Area Dev. Perm'it Subdivision Prel im Maj/mi n/Part Final Maj/Nin Part t\- b F I)E (1 0, C+ 5o, =(D Referra I 0ther: Time in divisionWater Pol I ution Control : Site Inspect'ion I nsta'l I S Referral Disp. Sys. 0t.her:a-w Time in divisionConstruction Permit and Inspection: Plans Review Mobil e Home Refe rra I T- 0t her: P:rbl 'ic Lands : ffi n:nll?ln( Fr oodPl a i n )-, 2 7B/4/j- JBJ- Ti* inli'ivi Time in divison sionPubl'ic Works: Facility Permits Referral E'o oq, r+ o = E (7 (D-t }o }}\o Fe t\Nl\ Time in divisionEnvironmental Health: H Water Supp'ly 0ther: 0ther Agencies:Time in division D s. t.F.o. tJP 6520-R-4 7 Time in process ( E H TRS, TL 00 Job Location (Street, mile post)30m V<rurron, U Plot PIan Subdivision Lot- Block'- t?.c FOR SANITARIAN'S USE ONLY COMMENTS: FOR INSTALLER'S USE: Trench Depth m Approved fl System Disapproved fl Needs Correction Si ure Fit Below //5t i)', ic e'/r'S,,*t^ o t,^*ff rtr *c Tank Capacity [Vleasured dista F{"{t+ Stp {:^; (€r'. ' n ufacturer tank t rt from drainfield I 6 €d f ,L ue J A5 ?eA ,/h* +Yafr * )+ .\rl "-g,!h it }(xx I rt L9t- ,6A)fr \ Wa uJF Nf-t F,.- l3L l-- T \d Ll' + CL6 oh o) !E o) E '(rJ o) E z o P.c(o .oao. 40l 1 UJ GlF z (9 6 +Ro;\ *Jtt*'r d""L &*f tQJ Sca le m L o, C'P6c INSTALLATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat- isfactory completion of a subsurface sewage disposal system at the above location. Return this form to: Permit Processing Section, Department of Environmental lVlanagement, Public Service Building, 125 East 8th Avenue, Eugene 974O1 l DT c55-1 1 r t+l h I lAp TRS, T JOB LOCATIO Partition ing LANE COUNTY PERMIT Acreage or Lot Size Contractor's O.S. # OWNER'S NAfuIE AND ADDR APPLICANT'S NAME AND ADDRESq Phone- ) Completed Subdivision Lot- Blo nk Phon CCNTFACTOR'S NAME AND ADDRESS Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when ready Phone- STRUCTURES NOW ON THE PROPEBTY THIS PERI\4IT IS FOR # BEDBOOI\4S # PLUI\4BING CONNECTIONS- IIJATER SUPPLY-- SEWAGE DISPOSAL- S.I. # THlSPRoPERTYlSWlTHlNoNErVlLEoFTHEClTYoF'PLUlVlBlNGBY I hereby certify that the above statements are true and accurate, and that I have the lollowing legal interest in the property: - -Lowner oI record; -contract purchaser; - potential buyer; - realtor or agent. I lurther certily that (if not 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 $Signature Date ( } NEW ADDRESS () FACILITY PERIVIIT TO TRAI\SPORTATION DEPT,il SPECIAL PIVIT. AREA. IVIIN, ELEVATION:- SANITATION BU ILD ING lVlinimum Septic Tank Capacity (Gallons)Type of Construction roup ire Zone Drainfield Required - Lineal Feet Use Classification Maximum Depth Comments Comments By:Date By:Date: PLANNING REOUI RETVIENTS SATISFIED. By Date Date lssued ZONE SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROIVI P/L) LANE COUNTY DEPARTMENT OF ENVIRONMENTAL NNANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 974O1 POST THIS PERMIT ON MAIN BUILDING AT SITE C55-13 BLoG. pERMtr - WHrrE; BUtLDtNG - GREEN; pLUMBtNG - cANARy; sANtrATtoN - coLDENRoo; oFFtcE coPY - wHlrE PHONE:687-4394 trcq SLAB FLOOR PLUMBING GROUNO/ORK APPRov E o ReManxs D Drsappnovro D Drr e I Nsprctoc GAS P lP I NG GROUNU^/ORK Ap pnov r o Rruanx s D DrsappRoveo D Dare I nsprcroR ROUGH PLUMBING Appnoveo D DrsAppRovED D Rtxrnxs Dar e I nspecron ROUGH GAS PIPING AeeRoveo D Drsappnovro D Reuanr s DrrE I xs pe cron FINAL PLUMBING Appnoveo E Re uanx s Dr sappnove o .U oarc 3- A-'7?I NspectoR RI FINAL GAS PIPING Appnoveo D DrsappRoveo D Rexanx s Dare I ruspectoR CERTIFICATE OF OCCUPANCY Reaov ro lssue Reuanxs D Nor Reaov ro tssuE D Dare I xsprcroR TRS, T Acreage or Lot Size Contractor's O.S. # JOB LOCATIO Partitioning LANE COUNTY PERMIT Lot- Block- APPLICANT'S NAME AND ADDRE qq OWNER'S NAIVIE AND ADDRESS CONTRACTOR'S NAME AND ADDRESS Phone Phone Phone s.t. # Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when ready. THIS PERMIT IS FO # B ED ROOIVIS-# PLUIVI B I NG CO NN ECT IONS STRUCTURES NOW ON THE PROPEBTY \A/ATER SUPPLY SEWAGE DISPOSA THlSPRoPERTYlSWlTHlNoNElVllLEoFTHEClTYoF.PLUtVlBlNGBY I hereby certify that the above stalements 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 (it not the owner) I am authorized to act for the owner of record, and that said owner is aware and approves of thir action. I hereby agree to comply with all applicable Codes relating to this permit. Fee Paid S-Signatu re Date () NEW ADDRESS () FACILITY PERIVIIT TO TRANSPORTATION DEPT ( ) SPECIAL PlVlT. AREA. tvllN. ELEVATION:- SAN ITATION BU ILD ING lVlinimum Septic Tank Capacity (Gallons)Type of Construction roup -Fire Zone Drainfield Required - Lineal Feet c"-r."t, Use classification Maximum Depth Comments By Date:By:Date: PLANNING REOUIREIVIENTS SATISFIED. Bv:Date Date lssued ZONE SETBACKS: FRONT SIDE FACING STREET (FRONN C/L) INT. SIDE YARD REAR (FROIVI P/L) LANE COUNTY DEPARTMENT OF ENVIRONMENTAL IVIANAGETVIENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401 POST THIS PERVIIT ON MAIN BUILDING AT SITE c55-1 3 BLDG. pERMrr-wHrrE; BUTLDTNG-GREEN; pLUMBTNG-GANARy; sANrrATroN-coLDENRoD; oFFrcEcoprz-wHtrE PHONE:687-4394 S ITE INSPECTION Appnov r o Reuenx s Dr sappnovED Dare I Nspecron FOUNDATION INSPECTION AppRoveo Reuanx s DrsAPPRovEo D DrrE I rspecton FRAMI NG I NSPECT ION A ppRov E o Reuanx s Dr slppnovEo DarE I xsprcloR LATH OR SHEETROCK AP PRov E o Reurnxs I NSPECT I ON Dr sAPPRovEo Dat E I xspecton FINAL INSPECTION Appnov e o Rruanxs m Drsrppnoveo D oor- //-/A,LI Nsprcton ts d CERTIFICATE OF OCCUPANCY Rerov ro lssuE Rruanx s Nor Rraov ro lssue Drr e I NSPEcToR TRS, TL B-2-4 Job Location Pentrit ,i Permit Permit Block woNta1l -t,ttn fr /*7 "7-4*)/4'* Pernlt /l Permlt PermLt /ao& t) &@?/.-^i;^_ AIE W Wet-t- ? For For ForIrlcrt Plan For, For For Subdivision Lot { l/f, ', ) offi --t i/fr q 0 0tDWEIL { $ rq L E D o vlb TI &a rll ) t{- l'- ttE. p <. r)L/ a \* {-t\l$lr \Lr L,>\1ir- ..il\ t J \o Nrt4 €rpnefiN *R€ /g- rr:4 7t 2oo-o_ fi-gYrixy Pr.pce + l( \ v QI \ nQ\ r\h tr #') il \ SEr,fTE(/\t PFu r{ re''fn' t tfo to \/'t J rsPu* 4o rtb '' 04Ic7 Vlc ty Map N 1f !- t /4 P/N vtzc#- .# U ra t \ \.1q r \ No orH r --f t Rr.tstr tr N Fr h HHiP v {a q 'l ffi I o l,'-lr>h .<\-rtS<(