HomeMy WebLinkAboutPermit Building 1976-12-08*
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INFORMAT!ON SHEET
( ) Site Feasibility Study for Septic Tank. Number of sites-( ) Would like to meet on site. Call (owner, etc.)
Test holes will be read
Subdivisi
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Acreage or Lot Size ll\,tl
Partitioning #- ( )Completed( ) Pending
APPLICANT'S NAME AND ADDRESS
OWNER'S NAME AND ADDRESS,if different f ro
CONTRACTOR'S NAME AND ADDRESS, lail permit or results of site feasibility study to ( )
1 ) Prefer to pick up. Call
lot 5 atocu 4
Pho ne-rt
,S Phon
Phon\
Applicant ( ) Owner (X Contractor
( owner, etc. ) when ready.
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STRUCTURES NOW ON THE PROPER €_,A-
PROPOSED USE (this permit)
WATER SUPPLY
SEWAGE DISPOSA A
PLUMBING B
(
(existing or proposed well, etc. lf public, name of system)
(existing or proposed septic tank, etc.) S.l
Address
,
) PROPERTY IS WITHIN ONE MILE OF CITY S
* * * *n * * *rGL* **** * * * r( ** ** * *.r(* n * * ** r(*x **.r* *++ * O F F ICE USE O N Y BE LOW TH lS Ll|\f x** ********** ** ****+*+***t(* ********** ****t(r.
( ) New Address Necessary
zoNe(h'r\t H
( ) Facility Permit Necessary
SETBACKS: Front Side Facing Street
(FROM CENTERLINE OF ROAD)
( ) Special Permit Area. [Vlinimum Elevation
lnterior Side Yard
-
Rear
(FROM PROPERTY LINES)
To: Planning/Building lnspector/Sanitarian/Surveyor.
Thisapplicant appearsto have a problem with
Your assistance will be appreciated.
By Permit Processing Section
Response:
By
DEPA RTIVI ENT O F E NV I R ON ME NTA L TVIANAG EIVI E NT
Permit Processing Section
125 East 8th Avenue
687-4394c55-1 2
tvrston
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(
PERTVIIT #
TRS, T
Acreage or Lot Size
Contractor's O.S. #
JOB LOCATIO
Partitioning #
LANE COUNTY PERMIT
I
) Completed Subdivision
Lot .,- Bloc k
APPLICANT'S NAME AND ADDRE
STRUCTURES NOW ON THE PROPERTY
Phone
Phone
Phone
OWNER'S NAME AND ADDR
CONTRACTOR'S NAME AND ADDR
Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call : t. ,r. t"(owner, etc.) when ready
. HIS PERMIT lS FOR . .. ,:, , : : ,:..-.. # BEDROOMS-# PLUMBING CONNECTIONL
SEWAGE DISPOSAL ,1 d s.l. #\AJATER SUPPLY
THIS PROPERTY IS WITHIN ONE IVIILE OF THE CITY OF
Drainfield Required - Lineal Feet
Maximum Depth
-omments
Use Classification
Comments:
Bv
PLUIVIBING BY
I hereby certily that the above statements are true and accurate, and that I have the following legal interest in the property:
-owner
ol record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner ol
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 $Signatu re Date
NEWADDRESS () FACILITY PER I\4IT TO TRANSPO RTATION DEPT.- ( } SPECIAL PIV]T. AREA. MIN. ELEVATION
SANITATION B U ILDING
lVlinimum Septic Tank Capacity (Gallons)Type of Construction roup
-Fire
Zone
a ..l.t,
By Date Date
PLANN ING REOUIREIVIENTS SATISFIED. B Date lssued
ZONE: -,,,.,^, ....: tj. SETBACKS: FRONT -::',s SIDE FACING STREET , -, (rROMI C/L) lNT. SIDE YARD r'; . REAR "' (FROM P/L)
LAN E COUNTY DEPARTI\i]ENT OF ENViRONMENTA L MANAG El\4ENT, 125 EAST 8TH AVE., EUG ENE. OBEGON 97401 PHON E: 687-4394
POST THIS PERMIT ON MAIN BUILDING AT SITE
Date:
SITE INSPECTION
Appnov r o
R rManx s
D r sappnoveo Dare Ir.rspEcron
FOUNDATION I NSPTCTION
Ap pRov e o
Reuanxs
*Dr SAPPRovED oare p.1p. ful- lHspecton
FRAMING INSPECTION
A ppRov e o
Reuanx s
F DrsappnovEo Dar e /2 -tA./K I NsPEcroR
LATH OR SHEETROCK I NSPECT I ON
Dt sappRovEo D oo.,, /-/7-tt I xspecton
77furL
F I NAL I NSPECT ION
Appaov e o
Re t'taRx s
,R D t sappRoveo Dar e /-tZ-77 tNsprcroR
CERTIFICATE OF OCCUPANCY
ReaoY ro lssuE
RrmaRx s
D Nor Rrrov ro lssue D Dore_I rsprclon
n
Ae pnov r o
RexaRx s
,{,
bne county
AC T IVITY INFORMATION SHEET 6ll1
-
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJE D!
PROPERTY OWNER
MAILING ADDRESS MAILING ADDRESS
CITY STATE ZIP CODE C ITY STATE ZIP CODE
ffi HOME TELEPHONE #BUSINESS TELEPHONE #m
2 PROPERTY ADDRESS
( TF DIFFERENT TnO
3 rvlae g PAFIGEL NUMEIEFI (from tax maps in Department of Assessment and Taxation
(RE UIRED INFORMATION)1g \"'^I.'5"5" /?re
MilNSHTP R_'ATCE SMTMN ffi ZON I NG
MINSHTP MNGE SETTMN
TOENSETP RANGE SET-T I oru
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
W ZON I NG
W ZON ING
4 SUBDIVISION ( if appl icable)LOT BLOCK
5 REQUEST (state exactly what you plan to do)=ps E;
6 DIRECTIONS TO SITE:
** FOR STAFF USE ONLY **
ZONE/LAND USE:
BY'_ DATE:_ TIME IN:_ OUT:_
NUMBER
DATE
{Farl
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LAND MANAGEMENT DIVISION / 125 E. Bth AVE., LUGENE, OR 97401 / 687-4061
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ACRES
/F- 03-02,3,3 '*7?fr
TRS, T OB LOCATIO
ERIVIIT #
LANE COUNTY PERMIT
Acreage or Lot Size
Contractor's O'S. #
Partitioning #) Completed Subdivision
Lot--- Blo
APP LICANT'S NAME AND ADDRE
OWN ER'S NAME AND ADDRESS
CONT BACTOR'S NAIVIE AND ADDRESS
lVlail perm itto ( )Applicant ( )Owner ( ) Contractor. ( ) Prefer to pick up' Call
HIS PERMIT IS FO
Phon
Phon
Phon e_
STRUCTURES NOW ON THE PROPERTY
\AJATER SUPPLY
(owner, etc.) when ready
# B ED ROOIVIS--# PLUIVIB I NG CO N NECT IONS
SEWAGE DISPOSAL S.I, #
Date
THISPRoPERTYISWITHINoNE[/IILEoFTHECITYoF
PLUIVIBING 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
P urchaser;
-
Potential buYer ;
-
realtor or agent I further
y agree to
Signatu re
certif Y that (if not the owner) I am authorized to act for the owner of
record, and that sa id owner is aware and aPProves of this action. I hereb comply with all applicable Codes relating to this permit
Fee Paid $
YPERIVIITToTRANSPoRTATIoNDEPT.-()SPECIAL PlVlT. AREA. IVllN. ELEVATION:--I r ) NEw ADDRESS ()FACILIT
SAN ITATION
lVlinimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum DePth
BUILDING
Type of Construction
se Classification
Comments
roup
-Fire
Zone
Date
-bmments:
Date BBy
Date Date lssued
PLANNING REOU I REIVIENTS SATISFIED. B
SIDE FACING STREET (FROr\4 C/L)INT. SIDE YARD REAR (F ROrvr P/L)
ZONE SETBACKS: FRONT
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL IVIANAGEMENT' 125 EAST BTH AVE" EUGENE' ORE GON 97401 PHONE: 687 4394
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. PERMIT - WHITE; BUILD|NG - GREEN; PLUMBING - CANARY; SANITATIoN - GoLDENRoD; oFFICE coPY - wHITE
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CORRECTION NOTICE
LANE COUNTY DEPT. OF ENVIRONMENTAT MANAGEMENT
Conslruclion permits & lnspections Division
EUGENE, OREGON
]l:"i:ltgoor structure does not conform to Lone counry buildins regulorions, ordinonces or codes
RE.INSPECTION REQUIRED
FOR APPROVAL
lnspector Date-
c55-73
Building Permit #