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/ Acreage or Lot Size
Partitioning #
Job Location
INFORMATION SHEET
( ) Site Feasibility Study for Septic Tank. Nu of sites __--
T,read v( ) Completed( ) Pendi
Subdivi
ifferent m applicant's
APPLICANT'S NAME AND ADDRESS
OWNER'S NAME AND ADDRESS, if d
^ONTRACTOR'S NAME AND ADDRESS
ril permit or results of site( ) Prefer to pick up. Call
STRUCTURES NOW ON THE PROPERT
PROPOSED USE (this permit)
feasibility study to
or,)I"/EIQ
)Applicant ( )Owner ( )Contractor
( owner, etc. ) when ready
Pho
Phone
Phone
Contractors O. S. #
(existing or proposed well, etc. lf public, name of systeml
(existing or proposed septic tank, etc.) S.l
t/
WATER SUPPLY CffI
SEWAGE DISPOSAL
PLUMBING BY Address
t r,/t pnopeRTy ts wtrHrN oNE MtLE oF ory
******++****r****r**+t***********rr*+******FICE USE ONLY BELOW THIS LINEOF
1)ece ssa ry
ZUNE
To: Planning/Building lnspector/Sanitarian/Surveyor,
( ) FacilitV P,ermit Necessary
S: rront6! Side Faci ng Street
(FROM CENTERLIN E OF ROAD)
( ) Special Permit Area. Minimum Elevation
lnterior Side Yard .S,Rea r s/
(FROT!1 PROPERTY LI NES)
This applicant appears to have a problem with
Your assistance wi ll be appreciated.
By
By
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Permit processing Section
125 East gth Avenue
687.4394
Permit Processing Section
Response
c55-12
D ivision
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Plcrt PIan
Subdivision
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Job Location (Add
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JOB LOCATION
LANE COUNTY PERMIT
Partitioning #- ---( ) Completed Subdivision-
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Acreage or Lot Size
Contractor's O.S. *
APPLICANT'S NAIVIE AND ADDRE
Lot- Bloc
OWNER'S NAME AND ADDRESS
Phon
Phone--
Phone--CONTRACTOR'S NAME AND ADDRE SS
Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when ready
STRUCTURES NOW ON THE PROPERTY
, HIS PERIVIIT IS FOR-
-
= SEDROOt\,ls__* PLUtulBtNG CONNECTtOI.jS__ _
WATER SIJPPLY SEWAGE DISPOSAL-s.i. #
THlsPRoPERTYlsWlTHlNoNEMlLEoFTHEclTYoF-.PLUlv]BtNGBY-
I hereby certify that the above statements are true and accurate, and that I have the fotlowing legal interest in the property:
-owner
of record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. I lurther certify that (if not the owner) I am authorized to act for the owner oirecord, and that said owner is aware and approves of this action. I hereby agree to clmply with all applicable Codes relating to this permit.
Fee Paid $-Signature Date _----( }NEWADORESS () FACILITY PERM IT TO T RANSPORTATION DEPT.
-()SPECIALPMT.AREA.
IMIN, ELEVATION:--
SANITATION BUILDING
Minimum Septic Tank Capacity (Gallons)Type of construction
--Group
---=Fire zone
Drainfield Required - Lineal Feet Use Classific;ation
l,{aximum Depth CommentsyIflffleOtS
B
PLANNING REO
ZONE
Date
EMENTS SATISFIED. By
SETBACKS: FRONT SIDE FACING STREET
B Date
Date lssuedUIRDate
(F ROIVI Ci L)INT. SIDE YARD REAR (FROM P/L)
LANE COUNTY DEPAHTMENT OF ENVIRONMENTAL I/IANAGEt\iIENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. PERMIT - WHITE; BUILOING - GREEN: PLUMBING - CANARY; SANTTATTON -- GOLDENROD; OFFTCE COp\/,,__ VvritTE
c55-13
PHONE: 687-4394
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CORRECTION NOTICE
IANE COUNTY DEPT. OF ENVIRONMENTAT MANAGEMENT
Conslruclion Permits & lnspections Division
EUGENE, OREGON
This building or structure does not conform to Lone County building regulotions, ordinonces or codes
os noted below, ,
I nspector
V
c55-73 RE-l NSpEGTJCTN rs,adnt@ D
Building Permit #
,ur" A- / 9-7 7
SITt INSPECTION
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FRAMING INSPECTION
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FINAL INSPECTION
Appnov r o
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D o^r, /2-/f-82DrsappRoveo I HsPe cron
CERTIFICATE OF OCCUPANCY
Rraov ro lssuE
Rru anx s
Not Rraov ro lssur Darr I NSPEcToR
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TRS, T
Acreage or Lot Si
Contractor's O.S. #
APPLICANT'S NATVIE AND ADDRE
OWNER'S NAME AND ADDRE
CONTRACTOR'S NAME AND ADDRESS
Mail permitto (,)Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Calt
STRUCTURES NOW ON THE PROPERTY--
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Fee Paid $Signature
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a?+-7 -7 74FooPERMIT #,1,3 JOB LOCATION
LANE COUNTY PERMIT
L- 3e,2- t2-9,
Lot =.- B loc
SS,Phone
Phone-.-
Phone--
(owner, etc.) wherr ready
WATER SUPPLY : i SEWAGE DISP9SAL
+ 3EDBOOI\"4S--_ -# PLUfu1BING CCNNECTIOI"JS-
). t. +i
THrs pFopERTy lswtrHrN oNE rutre orr(EcrryoF . _.pLUMB,NGBy_
I hereby certify that the above statements are true and.accurati and that I have the lollowing legal interest ,n ,n" oa]"*,
-o**,
o*""*+
-contract
purchaser;
-
potential buyer;
-
realtor or aglnt. I further certily that lit iotihe o**rt i ". "iir,oria"d to act for the owner ofrecord and thal said owner isaware and approves otthis action. Iherebyagreeto compiy *itt att"ppti""uie coj". [i"ii-ng ro rni, p"rmit.
Date __.--__-( } NEW ADDRESS (} FACILITY PERMIT TO TRANSPOR]ATION DEPT.--_-- () SPECIAL PMT. AREA. N4IN. ELEVATION
SANITATION
Minimum Septic Tank Capacity (Gallons)
Drainf ield Required - Lineal Feet
l\,4aximum Depth
BUILDING
Type of Constructioh
-
Use Classif ication
Comments:
roup F ire Zone
A*.nr,
B Date:B n^-^TJd LUPLANNING REOUIREIVIE NrI9ATISFtED. By
ZONE Date lssuedSETBACKS: FRONT SIDE FACING STREET
Date
(F ROIVI C/L)INT. SIDE YARD REAR (FROM P/L)
LANE COUNTY DEPARTMENT OF ENVIRONM ENTAL IVIANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT SITEBLDG. PERMIT - UJHITE; BUtLDtNG - GREENT pLUMBtNG _ CANARy; SANTTATION _ GOLDENROD; OFFTCE COp,r' - yys;16
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PHONE:687-4394