HomeMy WebLinkAboutPermit Building 1976-10-13L_.1 uwner
LANE COUNTY PERMIT FOR
CONSTRUCTION [ ] I\,IOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
ZIP CODENAN/IE ADD R ESS CITY PHONE
D Contractor
NAIVIE ADD R ESS CITY ZIP CODE PHONE
O.S. Reg. +
T Range-- Sectio
Lot
Tax
B lockSubd ivision Acreage Width
DepthAccess to Property (Road Name):
Existing Structures on Property:
Directions to Property - Address
STRUCTUR E (# BEDROOIVIS)SO. FT VALUATION
SEWAGE DISPOSAL:
PUBLIC [ ] SEPTICTANK [ ] OTHER [ ]
PLUIVIBING INSTALLED BY:
OWNER[] OTHER[] NAIVI tr
BUILDING
PLU IVIB ING
3% SURCHARGE
IVIOBILE HOIVIE
WASTE DISPOSAL
PLAN REVIEW
TOTAL
WATEB SUPPLY: PROPOSED I ]
EXISTING t ]
PUB LIC
COIVIIVIUNITY . NAIVIE
PRIVATE WELL
OTHER-SPECIFY
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
IVIIN. SEPTIC TANK CAPACITY
GALS IVIIN. 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 rAN
FRONT SIDE EXT
FT. FROIVI PROP. LINE:
SIDE INT. REAR .- ZONE
AUTHORIZED SIGNATURES
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ISSUANCE DATE
BLDG, PEFIN4IT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GBEEN
SANITATION - GOLDENBOD
IMPORTANT
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 subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy before being occupied.
(See Details on Beverse Side)
POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY. DEPT, OF ENVIBONMENTAL N'ANAGEN,lENT
COUFTHOUSE ANNEX, 135 EAST 6th, EUGENE, OFEGON 97401
PERIV]IT NO.
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LANE COUNTY PERMIT FOR PERIVI lT NO. i r. r,,.
n Owner
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D{,1 rvroBrlE HorvrE [ ] PLAN REVTEW [ ]
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CHANGE OF OCCUPANCY [ ]
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CONSTRUCTION
, NAIV]E DDRA CITY
CITY
ZIP
Width
Depth
PHONE,
tr Contracto
O.S. Reg. +
Range :.. - o*
Subd ivision Lot
Access to Property (Road Name)
NA IVIE ADD R ESS EZ
.r ;I
P NEht'\% f'..;
Census TractSectax Lo
dd*
Codet
lock Acreage
,}
'tExisting Structures on Property:
Directions to Property - Address
'6i&]
" STR UCTURE (# BEDROOIVIS)SO. FT VALUATION
s(wace DtsPosAL
PUB LIC
BUILD ING
PLUI\,18ING
37" SURCHARGE
N4OBTLE HOTVTE
WASTE DISPOSAL
PLAN REVIEW
TOTAL
PTIC TANK I OTHEB [ ]
PLUIVIBING INSTALLED BY:
OWNER[] OTHER[] NAM
PR IVATE WELL
F
OTHER-SPECIFY
t' i#I
,{ ,.,1r.:"tr
*
', CONSTRUCTION PERMITS & INSPE NS AND WATEB POLLUTION CONTRO SPECI TIONS
IVIIN- SEPTIC TANK CAPACITY:
GALS.--- VIIN. DRAINFIELD--LIN. FT IVIAX. TR ENCH D EPTH- INCHES
STAY 1OO' FROIVI ALL WELLS
TYPE OF CONSTRUCTION ."fl"4i cBoup "Y FIRE zoNE _$USE CLASSIF di#{r# S*ffi qr'
SIDE EXT
FT. FROIVI PROP. LINE:
stDE tNT. 'n'.ll:"," nEnn ,.,, ,, zorur
ISSUANCE DATEAUTHORIZED SIGNATURES
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUN4BING - CANABY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT
Call 687-4065 to schedule all req uired construclion inspecti ons. Call 687-4061 to schedule all required
septic system i nspecti ons. All construction shall comply with the State Buidling Code, D.E .Q. standards
certificate offor subsurface sewaoe
occupancy belore being
disposal and
occu p ied
(POST THIS PERMIT ON MAIN BLDG. AT SITE}
LANE COUNTY. DEPT, OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX. 135 EAST 6th, EUGENE, OBEGON 97401
the State Plumbing Code. All buildings require a
(See Details on Reverse Side)
c55 -1 3
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WATER SUPPLY: PROPOSED i ]
EXISTING t ]
n PUB LIC
COVIIVIUNITY - NAIVIE:
SETBACKS - FT. FROIVI CTR. OF r/W:
SITE INSPECTION
Ap pnov r o
Rruanxs
&I ruspecronDr sappRoveo Darr / /*"1--1.(
FOUNDATION I NSPECTION
AppRoveo
Rruanxs
*Dr sappRovro oare //- z'7L I ruspecron
FRAM I NG
A ppnov e
Rr ulnr s
I NSPECT I ON
Drslppnove, D oart / /- /L- 7 L I NseecroR
LATH OR SHEETROCK INSPECTION
Ap pnov r o
Rrxa Rx s
D Drsrppnoveo /-'-7
,h-r*'r- o s-
Dar r I HseectoR
FINAL INSPECTION
JAppRovro W Drsappnoveo
Reua Rx s
oort //-/( - /L I Nspecron
CERTIFICATE OF OCCUPANCY
Reaov to I ssue
ReueRx s
D Nor Re aoy ro lssuE D Dore_lxsercroR_
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