HomeMy WebLinkAboutPermit Mechanical 1977-03-25PERIVIIT #
TRS, TL
Acreage or Lot Size
Contractor's O.S. #
APPLICANT'S NAME AND ADDRE
JOB LOCATIO
Partitioning #
LANE COUNTY PERMIT
Lot_ Block_
Phone---q
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N
(
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N
OWNER'S NAME AND ADDRESS
CONTRACTOR'S NAIVIE AND ADDRES s Phon
Phone---Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Preferto pick up. Call-(owner, etc.) when ready
STRUCTURES NOW ON THE PROPERTY
' Hls PERMIT ls FoR j ' # BEDRoorvrL# PLUMB|NG coNNEcrtoNL
WATER SUPPLY '
SEWAGE DISPOSAL s.l. #
THlSPRoPERTYlSWlTHlNoNEtVllLEoFTHEClTYoF.PLUtVlBlNGBY
I herebY certily 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 (if not the owner) I am authorized to act Ior the owner oirecord. 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
ORTATION DEPT( ) NEW ADDRESS il FAcILITY PERMIT To TRANSP ( ) SPECIAL PlVlT. AREA. tvttN. ELEVATTON:---
Date
-
SANITATION
lVlinimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
BUILDING
c",.nr""tr=
Use..classif ication
Type of Construction
-.-Group
ire Zone
-Jmments
B Date:
PLANNING REO Ul REIVIENTS SATISFI ED. By
B Date
Date
ZONE SETBACKS: FRONT
Date lssued
SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (F ROIVI P/L)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG.PERMIT-WHITE; BUILDING-GREEN; PLUMBTNG CANARy; SANTTATTON-GOLDENROD; OFF|CECoptr_WHtTEc55-13
PHONE:687-4394
)
6 r>- 27
TRS, T
}(erito'ng permit
Acreage or Lot Size b xleo
Partitioning#---_- ( ) Completed( ) Pending
INFORMAT!ON SHEET
( ) Site Feasibility Study for Septic Tank Number of sites_
(owner, etc.)
Job Loc-ation ,{l ufy<,
( ) Would like to meet on site. Call
Test holes will be ready_
Subdivision Lot _ Bloc
APPLICANT'S NATVIE AND ADDRESS x/a h,rs I K t.t t)-,6 loE /rt/s S/-Phone
Phone-
OWNER 'S NAME AND ADDRESS, if different from applicant,s phone_
'{a il
)
CONTR ACTOR'S NAtVlE AND ADDRESS
permit or results of site feasibility study tg Applicant ( )Owner ( )Contractor
Prefer to pick up. Call ( owner, etc. ) when ready
STRUCTURES NOW ON THE PROPE
6PROPOSED USE (this permit)
WATER SU.PPLY fu ,c
existing or proposed well, etc. lf public, name of system)
SEWAGE DISPOSA {(existing or proposed septic tank, etc.) S.l
* * * * * * * * * t( * * tt * ra * i( * Ja * * * J( * * J+ Jf + + * r( * * * * * * * J( J+ * tt *
PLUMBING B Address
() PROPERTY IS WITHIN ONE MILE OF CITY
* * l( J6 * * * t+ J( * * * l( tt J+ + * * * * + * * lt * .t( + .t+ J+ Jt t(.tt * * * * * * * * * * *
( ) New Address Necessary
lN tr
To: Planning/Building lnspector/Sanitarian/S
This applicant appears to have a problem
Your assistance will be appreciated.
OFFICE USE ONLY BELOW THIS LINE
( ) Facility Permit Necessary
SETBACKS: Front Side Facing Street
(FROM CENTERLINE OF ROAD)
( ) Special Permit Area. lVlinimum Elevation
lnterior Side Yard Rear
(FROM PROPERTY LINES)
u rveyor
with
By Permit Processing Section
Response
By
D E PA R TIVI E N T O F E NV I R ON IVI E NTA L N4ANAG E IVI E NT
Permit Processing Section
125 East 8th Avenue
687-4394cs5-1 2
ivision
7y'2-zuur
+
SITE INSPECTION
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D I SAPPRovED Dare I NsPEcroR
FOUNDATION INSPECTION
Appnov r o
Reua nx s
Darr I ruspecton
FRAMING INSPECTION
App nov r o D DrsAPPRovEo D Drr r I NSPEcToR
Rguanx s
LATH OR SHEETROCK I NSPECT I ON
DrsAPPRovEo Dar e I rspecronAP PRov E o
RrunRx s
FINAL INSPECTI
AP PRov E o
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Dr sAPPRovEo Dare I NSPEcToR
CERTIFICATE OF OCCUPANCY
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