HomeMy WebLinkAboutPermit Building 1986-06-13RU RAL ADDRESSING
cHEe KED JUt{ I 0
La,ne County Authoriza,,tton- for,
S
o
{t
FOR OFFICE USE ONLY
Application,/
Permit #/56-r(
TAx tof f--'lour oF+30yo3sEaTroN /
e.a, /,2
app BLOCKZ
PROPOSED USE OF PROPERTY
[Rnesidential
[-l cc,mmercial
f rndustr:.a1
fle'luri.
?r ZIPCITY
o
STRUCTUFES CURRENTLY ON PROPERTY
-S€
L
DECI,ARED S VALUE
# OF EI,IPTOYEES= OF BEDROOMS * oF srcRrET I^JATER SUPPLY Proposed
Exis ti
NAME AND
L
TELEPHONE NUMBER
726 -FYr:lz-
",-L(.
AND osR #
e
TELEPHONE NIJI4BER
PIRI,IIT T'O BE MAILED TO (NAME AND ADDRESS)/I TELEPHONE NUMBER
I HAVE CAREFULLY EXAI,IINED THE COMPLETED APPLICATION r-OR PERMIT, arrd ,lo here!.r certify that all infomation hereon is true and correct, and that I
ave the following Legal interest in the property, Ior..t of recorci; ! contra,,! prrrchaseri !authorized agent.
I f:rther certify that any and all work perfomed shaI1 be done in accordance with the Ordrnance$ of Lane Comty and the Laws of the State of Oregon
rtaining to the work descrj-b€d herein, and that NO OCCUPdNCY will be made of anj' stxrrcture without the pemission of the Buj.Iding Division. I fu-ther certify that regislration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exenpt the basis for e
(a
/ 6are
o /
ase s
with ORS 701.055 will be used on thi.s project. I HAVE READ ANDis noted hereon, and that only subcontractors aal employees who are in
CHECKED THIS APPI,ICATION THOROUGHLY.
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION IIAS BEEN BASED ON THE FOLLOWING CONDITIONS!
Zone Partition # Parcel #
interior
ose-g
Date:
I sanrterrout
Installation
Soecifications: Tank
Date :
L AVI
COI'$1ENTS:
Date:
rearnL
ece
Gal10n
coIIIIENTS
ON
I
Parcel
L
s. r. *B. P. #
3-
Groun Use
rnstallation Record Issued? ! r"" ! ""
Minimm Setbacks:
co}!\lENTS
I pnnuruc,zzoNrNG:
Lineal Eeet
of Drainfield
l'raximun Depth
of Trenches
c", frora- c",
=ido
OFFIC Der ORs 4 805,DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INI'ORMATION
LANE COU
C1lL..?\ Rll4-
(J
I
n
/-tz- r
DATE
SETBiICKS AND OTIIER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED' VIOLATION CAN RESULT IN REVO-
C;TION OF TIIIS PERMlT, CITATIO:J UNDER PROVISIONS Oi LANE COU):IY':] INFRACTION ORDINANCE, ANO,/OR OTHER
RET1ED1ES ALLOWED BY LAW.
WI'IEN RE.qDY FOR IT-SPECTION, CALL 587-1065. A I{INII,1U}1 OF AT LiAST 24 IIOURS AD.iTAI{CE NOTICE FOR INSPEC-
@EN-.!ra'etIefoIIowrn9informat!onready:permitnumber,jobaddress,type
of inspecEion, when it atll be ready, you! nane and picie nunber, and any special Cirections to site.
BUILDING DIVISION:
REQUIRED INSPECTIONS:
I Foundation Inspection: To be made after trenches are excavated and forms erected and when all
--+-
nateraars !o! Ene rounoatj.on are delivered on the job. l'lhere concrete from a central nixing
plant (comonly termed "transit mixed") is to be used, nalerials need noL be on the job.
Concre te
servfce r
slab or Under-iloor'e.tuipmst;-rcnAilt, p
Inspection: To be made after all in-slab or under-floor building
Iping ressories, and other anciLLary equipnent itens are in
is poured or fLoor sheathing installed, including the subfloor.
3. Framj.ng & rnsulation Inspeggions: To be made after the roof, all framing, fire blocking, and
[reAlng are-ln pfre nd all pipes, fj.repl"aces, chimneys, and vents are complete and aL1 rough
e.Leccrical and plunbing are approved. AlL wa.l.I insulation and vapor barrrer are in place.
4. Lath and,/or cypsum Boald Inspection: To be made after a]l- Lathi.ng and qypsum board, interior
5nE*ext6riorllE--i-n-pTrce-Elt--fetqe any plaster.ing is appLied and before gypsm board joints
and fasteners are taped and finished.
5. Fina1 Inspection: To be made after the building is conplete and before occupancy.
APPROVAL REQUIRED. 5'o uork shall be done on any part of the building or Structure beyond the point
indicated in each successive inspection without first obtalning the approval of the buil.ding offaciaL.
Such applovaI shall be given cnly after an inspection shall have been nade of each successive step
in the construct.ion as indicated by each of the inspections required.
Al1 building pernits requj-re inspections for the work authorized, such as but not limited to:
Block t"lall: To be maCe afler reinforcing is in place, but before any grout j.s poured. This
Ti-specEio-F is required for each bond beam pour. There will be no approvaL until Lhe plumbing
and electrical j.nspections have been made and approved.
t{ood Stove: To be nade after cohpl-etion of nasonry (if applicable) and Hhen installation is
ffipIeta. Installatj-on shall be in accordance uith an approved, nationaLly recognized testing
agency and the manufact.urerrs insCaLlation instructions.
place but before any concrete
I
!9I9, An inspection is required after the mobile home is connected to an approved
,a reptic systen for setback requirenents, bl-ocki-ng, footing conneclion, ti.edowns,
skirting, and plwbing connectsions.
1. Pootj.ngs and pj-ers to conply with SLate foundation requirements for mobile homes or as
recomended by the manufactuler.
2. MobiLe home mininum finj-sh fl-oor elevation shall be certified when requiled by a fl,ood-
p)-ain management letter.
3. Mobile home tiedowns, when required, and skirting shalL be instal,l,ed and ready for inspec-
tion within aL least 30 days after occupancy. Tiedouns and skirtj.ng shaLl be installed
per enclosure.
Swiming PooI: Below grade when steel j.s in place and before concrete is poured. Above grade
?hen pool is installed.
APPROVED PLANS MUST BE ON ?HE JOB SITE AT ALL TIMES DURTNG WORKING HOURS. THIS PERMTT WILL EXPIRE
IP WORK DOES NOT BEGIN I4ITHIN I8O DAYS, OR IF WORK ]S SUSPENDED OR ABANDONED POR I'IORE TIIAN I8O DAYS.
SUSPENSION OR REVOCATION I,IAY OCCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
ANYONE PROCEEDTNG PAST THE POINT OT REQUIRED TNSPECTIONS I,IILL DO SO AT THEIR OWN RISX.
SUBSURFACE AND ALTERNATIVB SEI{AGE DISPOSAL SYSTEHS:
I. Permits shall be effective for one year from the date of issuance.
2, Upon completing the construction fo! which a perniL has been issued, the permit holder shall
notify the Lane County Departsent of Planning and Comunity Development by subnittj,ng the
rnstallaLion record form. The Departnent sha11 inspect the constructi.on to detcrnine if it
complies uith the rufes contained in this di.vision. ff the construction does conply with such
rules, the Department shaLl issue a certificate of satisfactory completion to the permiti holder
If the construction does not comply with such !ules, the Departrent shall notify the permit
holder and sha).L require satisfactory compl,etion befo!e issui.ng the certificate. Failure to
meet the requirements for saLisfactory compl-etron wrthio a reasonable time constitutes a vio-
lation of oRS 454.605 to 454.145 and this rule.
Setbacks - Subsurface sewage Disposal
septic Tank Drainfield
I.ron: Interior property lincs I0' 10'
Edge oi road rrqht-of-way I0' 10'
Burldj.nq founCation 101
liells, other uatcr sources 50' I00'
}lobi l-e
sewer o
ACTI\/ITY INFORivIAT ION - SH EET ilI'.-COF4PLETE THIS SECTION. INCOMPLETE FORMS I,IILL BE REJECTED!
,,f)no*l a A os/Elu.no,*{ ,Al 0*o
PROPERTY Ot,lNER
.s/e
fric,pnp- - D ?Ay'otfTfrY---/-
4(*aqts
m
6&-o?62 --
HOME TELEPHONT #
/a6-p,.afz
BUSINESS TELEPHONE #
PROPERTY ADDRESS
BUSINESS TELEPHONE # HOME TELEPHONE #
2
(IF DIFFERENT Tno@
3 ruee g PAHeEL NUMBEFT
( REQUIRED INFORMATION)
(from tax maps in Department of Assessment and Taxation
or from tax statement)/'* a_3
TOI^JI{SH IP RANGE ##3 o*oo re/
TAX L0T(S) 0R PARCEL # Z0NTNG
MIISFTP EANGE SEETI-ON W ZON I NG
MNGE SEETMN
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
W ZON I NG
ACRES
4 SUBDIVISION ( if appl icable Lor g BLocK
5 REQUEST (s;tate exactly what you plan to do)nCe/./_ bealtere*-u-r
6 DIRECTIONS TO SITE:
** FoR STAFF USE oNLY **
ZONE/LAND USE:
L4-33
LAND MANAGEMENT DIVISION / 125 E. Bth AVE., EUGENE, OR 9740I / 687-406I
).,d*o'n'E;";yt#-
?l'uawn^;
+D 3 / 'rt'"
/o ^.
L€t'-
3 /80
Lrc
tL44-
sqhe
/a /'iG./t%)
So**lct
oF o t
eo
thr.lft
r
I
\
\
/
LANE COUN"
BUTLDTNG E
,}UII.DING PERMIT OR MOBITE HO...I USE PERMII
PERMIT NO.MH
MAITING ADDRESSpnoprnr: -w NSo PHONE
CONTRACTCR
:
MAII.ING ADDRESS
I lr
PHONE
PROPERTY LOCATION _ INCLUDE POST OTFICE
PROPERTY TEGAT DESCRIPTION _ METES, BOUNDS
RANG E SECTION TAX LOT NO CODE CENSUS TRACT
,1, 4 *4300
lla f fo rd
EXISTING STRUCTURES ON PROPERTY
Drrre I I ln
APP[.
NAME
&
MAITING
ADDRESS
LEGAT ACCESS TO PROPERTY
PROPERTY SIZE - TT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
Connecl to Existi Sewo e tr New
BDRMS VALUATIONse. FTTYPE CONSTRUCTION
6 @ t2 7
PLUMBING INSTALTED BYSEWAGE DISPOSAT
PUBI.IC
BUITDING
WASTE DISPOSAL
PTUMBING
PIAN REVIEW
PARK TRAITER
SEPTIC TANK OTH OWNER OTHER: NAlr{E
WATER SUPPIYF EES(
PUBr.rc tr tr OTHER
TOTAT
COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX, GA[.
DRAIN FIEID REQUIRED
tIN. FT TRENCH WIDTH FT.OR SQ. FT.
)art €f{ cotstruct ioI Er any par
xistlng .Gwage dirposal sy3t€m.
OCCUPANCY ZONE PUBI,IC UTIT. EASEMENTTYPE OF STRUCTURE
BLDG. SETBACKS,- FT. FROM CTR
TRONT SIDE INT.
OF ROAD RIGHT OF WAY
SIDE EXI.
USE CTASSIFICATION
REAR
DATE
/s/ J.E. Boss
AUTHORIZED SIGNATURE _ DATE
lol:n Cru i cksh
BI.DG. PERMIT _ WH ITE
OFFICE COPY _ WHITE
COUNTY TAX _ PINK
PTUMBING _ CANARY
BUITDING - GREEN
SANITATION _ GOTDENROD
coll 687-4065 to schedule oll required inspections. All conslruc'
tion .fr"ff comply with Uniform tiuilding Code, D.E.Q. stondqrds
IMpORIANT: for subsurfoce'slwoge disposol ond county regulolions covering- pir-bing. All buildiigs require o certificote of occuponcy before
being occupied'
(See Detoils on Reverse Side)
(posT rHls PERMIT ON MAIN BIDG. AT SITE).
LANE COUNTY, DEPT. OF ENVIRONMENTAT AIANAGEMENT
COURIHOUSE ANNEX, I35 EAST 6th, EUGENE, OREGON 9740I
ronu #C55-13
tn
BU I LD ING S ITE EVALUAT ION ;ffi-#s ?Q/'fo',or--
G , .e-Bi
L I CANT:
e.- L-t R-z
TS .H
U
( ). Buil'uing Permit Application No.,?o
( ) Site lnspection
( ) Pre-Permit lnvest igat ion
APP
NA.}I
ADD
E
R
PHONE
DATE
L/.,NI COUNTY PLANNING DEPART},IENT NOT
Zoning 0rdinance Compl iance(zone.4er )
Subd iv is ion Ord inance Comp I iance (
Requ i red Access (
Building Site (Rrea, t/idth,
Frontage, Setback)
0ther (see comments)
(
()
r?3- ^->;7
NO YES NAI-1E DATE
I icable
() ()
2
')
4
5
(
)(
() ()
)
())
COHII1ENTS:
EUILDING INSPECTION SECTION
6. Plans Submitted
7. Soil Stability (footings)
B. Flood Pl a in
9. 0ther (see Comments)
NOT NO
ffit i cab le
YES
(fr'
/
()
()
NA}4E DATE
()()
()
()
()()3_1,/''? 6
COH},IENTS:
SAN ITAT ION SECTION
10. Sewage Disposal
ll. Usable Area
I 2. Water Supp I y
I 3. 0ther (see Comments)
NOT
epgl ,!eq&
NO YES NA},1E DATEr
A
(*
(
() ()?
(
(') () ()
COI"lIl ENTS :
TO APPL I CANT:
Your Building Permit / Site tnspection:
( ) Can be approved.( ) Cannot be approved at this time as indicated on itenr N0
Quest ions and further infornrat ion on itenrs I through !
above
contact the Lane-
COUNTY PLANNING DEPARTMENT"Q-uestions .)nd further information on iffi 5
)
)
)
throuqh l3 contact the Lane cou^ry_gyj ta iu_",,d lgli!3I-gl-!_gls ion.will be held in this otTlZ"TitiT-y"r ca";A;Tre rt,; pro6l"-s-fndicatr:d.ls being returned.
Your buildinq pernr it appliq.at ion fee is being returned under separate ct:r'€r.
LANF COIIN'IY t'[ /\NN ING DEPARTHENT
115 5i,r<tlr 4verr0e fast, Eugene, 0regon gl4}l
t'noNE 3lr2..l-llt EXt. t3t
IANI C0UNIY t]tJlLl)lNG 6 S/rNlTATt0N DlVtSt0N
135 Sixt,h Avgrruc East, Errqerrr', 0rcqon 9740lr
PfioNl 142-|Itt txr. 4rI
/
\
()
M55:rt
IANE COUNi
BUTLDTNG E
SUtlDlNG PERMIT OR MOBIIE HC.
MHE
USE PERMIT
PERMIT NO.
PROPERTY OV,/NER MAITING ADDRESS PHONE
CONTRACTOR MAILING ADDRESS PHONE
PROPERTY TOCATION _ INCI"UDE POST OFFICE
PROPERTY LEGAL DESCRIPTION _ METES, BOUNDS
RANG E SECTION TAX LOT NO CODE CENSUS TRACT
EXISTING STRUCTURES ON PROPERTYAPPT,
NAME
&
MAITING
ADDRESS
LEGAT ACCESS TO PROPERTY
PROPERTY SIZE - FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connect to Existing Sewoge Sysrem !New System
STRUCTURES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION SQ. FT. # BDRMS VALUATIoN
SEWAGE DISPOSAT
PUBUC tr SEPTTC TANK !oTHERn
PTUMBING INSTATTED BY
OWNER E OTHER: NAME
BUII.DING
WASTE DISPOSAT
PTUMBING
PtAN REVIEW
PARK TRAITER
FEES WATER SUPPTY
PUBTTC !tr OTHER
TOTAI.
COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN, SEPTIC TANK CAPACITY
WITH DIST. BOX: GAT.
DRAIN FIETD REQUIRED
TIN. FT TRENCH WIDTH FT OR SQ. FT
TYPE OF STRUCTURE OCCUPANCY ZONE PUBTIC UTIt. EASEMENT
BI.DG. SETBACKS
FRONT
FT. FROM CTR. OF ROAD RIGHT OF WAY
SIDE INT, SIDE EXT.
USE CTASSIFICATION
REAR
AUTHORIZED SIGNATURE _ DATE DATE
BI.DG. PERMIT _ WH ITE
OFFICE COPY _ WHITE
COUNTY TAX _ PINK
PLUMBING _ CANARY
BUITDING _ GREEN
SANITATION _ GOTDENROD
Coll 687-4065 to schedule oll required inspections. All construc-
tion sholl comply with Uniform Building Code, D.E.Q. stondords
IMPORTANT: for subsurfoce sewoge disposol qnd county regulotions covering
plumbing. All buildings require o certificote of occuponcy before
being occupied.
(See Detqils on Reverse Side)
(POST THIS PERMTT ON MAIN BIDG. AT S|TE)
LANE COUNTY, DEPT. OF ENVIRON'{ENTAI MANAGEMENT
COURTHOUSE ANNEX, I35 EAST 6Ih, EUGENE, OREGON 97401ronu#655-13
SLAB FLOOR
PLUMB ING GROUNMORK
Appnov E o
ReManx s
D r slppRovro Dar E I Nsercron
GAS PIPING GROUND,VORK
D DrsrppRovro D Dare I HsprcronAPPRov E o
REuenxs
ROUGH PLUMBING
Appnovro N DtsrppRoveo D oorrS'12-A.
Reuanxs
I uspec
ROUGH GAS PIPING
APPRovED D DrsappRovEo D
ReManr s
Dar r lr.tsprcron
FINAL PLUMBING
AppRov e D
Re uaRx s
DrsrppnovEoH D o^,#ZJ_L lNspe c
FINAL GAS PIPING
Ap pnov e o
Reul nx s
D DrsAPPRovEo D o#
CERTIFICATE OF OCCUPANCY
Rraov ro lssue
RruaRxs
Not REnov ro lssuE Dare I NSPEcToR
IANE COUNI
BUTLDTNG E
dU!LDING PERMIT
MHE
OR MOBITE HOn,c USE PERMIT
PERMIT NO.
PROPERTY OWNER MAITING ADDRESS PHONE
CONTRACTOR MAITING ADDRESS PHONE
I E
PROPERTY LOCATION - INCTUDE POST OFFICE Yub-s,t{0
PROPERTY TEGAI. DESCRIPTION _ METES, BOUNDS
I
RANG E SECTION TAX LOT NO CODE CENSUS TRACT
EXISTING STRUCTURES ON PROPERTY
APPT.
NAME
&
MAITING
ADDRESS
TEGAT ACCESS TO PROPERTY
t \ns.-\\)\\FS$, N\DEPTH AREA
FOR MOBILE HOME
No. of Bedrooms
J
mnto Exi ng New m
DRMS VALUATIONSTRUCTURES TO BE BUILT THIS PERMIT
.F s\
\J $- \s\\s+\ r\
SEWAGE DISPOSAT
PUBttC N SEPTIC TANK tr OTHERE
PTUMBING INSTATTED BY
OWNER ! OTHER: NAME
BUITDING
WASTE DISPOSAT
PIUMBING
PtAN REVIEW
PARK TRAII.ER
(FEES WATER SUPPTY
PUBUC tr tr OTHER
TOT,AT
COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GA[.
DRAIN FIEID REQUIRED
TIN. FT TRENCH WIDTH FT OR SO. FT
I
TYPE OF STRUCTURE OCCUPANCY ZONE PUBTIC UTIL. EASEMENT
BLDG. SETBACKS
FRONT
FT. FROM CTR. OF ROAD RIGHT OF WAY
SIDE INT. SIDE EXT.
USE CTASSIFICATION
REAR
AUTHORIZED SIGNATURE - DATE DATE
BLDG. PERMIT _ WH ITE
OFFICE COPY - WHITE
COUNTY TAX _ PINK
PTUMBING _ CANARY
BUILDING - GREEN
SANITATION _ GOTDENROD
Coll 687-4065 to schedule oll required inspections. ,All construc-
tion sholl comply with Uniform Building Code, D.E.Q. stondords
IMPORTANT: for subsurfoce sewoge disposol ond county regulotions covering
plumbing. AII buildings require o cerlificole of occuponcy before
being occupied.
(See Detoils on Reverse Side)
ronu Jt C5s- t3
(posT THIS PERMIT ON MAIN BIDG. AT SlrE)
IANE COIINTY, DEPT. OF ENVIRONMENTAT MANAGEMENT
COURTHOUSE ANNEX, I35 EAST 6th, EUGENE, OREGON 9740I
\
TYP.P SQ: FT
SITT INSPECTION
App Rov r o
Reuanx s
DtsappRoveo Darr I Nspecron
FOUNDATION INSPECTION
Ap pnov r o
Reur Rx s
FRAM I NG
AppRov e o
Rr
INS
Drsap ROVED
DrsappnovEo
4
Dar E +) ''
q - 3'-l {
Drr E
I rspecroR
I Ns pr croR
K
LATH OR SHEETROCK INSPECTION
AprRovEo D Dr srppRoveo
Rruanx s
Dar e I HsrEcron
- L>-
FINAL INSPECTION
Ap pnov e o
RrueRx s
I SAPPROVEO Dar e I Nspecro t,
/
CTRTI FICATE OF OCCUPANCY
Reaov ro lssur
REuanx s
Nor Reaov to lssuE DarE
6 o'o€D6 -7/
,
llrsprcton
D
t0N-
f/mse cr// dien rea/v */,J,//p,bfr of
-?N'LANE COUNT' JITDING PERMIT OR MOBITE HOIVT- USE APPTICATION
PERMIT TYPE - BUILDING MOBILE HOME OSC REG. #PERMIT
RTY OWNER MAITING ADDRESS
7
, lc-
CONTRACTOR
PROPERTY TION _ INCTUDE POST OFFICE
0 €a
G S(I €d.f il nT
PROPERTY LEGAT DESCRIPTION
LOT-BLOCK-SUBDIV.
TWP RANGE
&a r.L
2_a
MAITING ADDRESS
2
"J
T CENSUS TRACT
PHONE
METES & BOUNDS
ATTACHED
,?J
YES
NO'a-L-Y 8. Z
CODEl-r 3
APPLICANT
NAME
AND
MAII.ING
ADDRESS
DESCRIBE EXISTING STRUCTURE PROPERTY IF ANY
/l
TEGAL ACCESS
PROPERTY SIZE_WIDTH
OR
J ,r,l
AREAEuqe he Or"q 6o lt 0,ron MoerLE not*fpenMrr oNLY
Number of Bedrooms Connect to Existing Sewoge System I or New System Req.
SQ. FT.BEDROOMS VATUATIONSTRUCIURES TO BE BUITT THIS PERMIT
A dd^"k o,^
TYPE qP\.rSTRUcTroN
JTrrnne Llx t3 t,54w
SEWAGE DISPOSAT PTUMBING INSTATI.ED BY
PUBLIC N SEPTI TANK OTHER OWNER OTHER NAME
WATER SUPPTY
PUBUC n
PTANS FURNISHED FACITITY PERMIT
FEES
OTHER YES E NO I-I YES fl NoIBtDG.
WASTE DIS.
PTUMBING
PTAN REVIEW
PARK TRLR.
6.-PTUMBING FEES
{ ,,rrr*,,
NATU DATE
TECASH n sEwER
cHECK n CONNECTION FEE
PERMIT
PUBTIC WATER
CONNECTION FEE
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FIETD REQUIRED
LI FT H WIDTH FT
95-TOTAL
MIN. SEPTIC TANK CAPACITY
D IST,E FEET
C
TYPE OF STRUCTURE
BLDG, SETBACKS _ FT. FROM CTR. OF ROAD RIGHT OF W,
OCCUPANCY ZONE REAR YARD PUBTIC UTIT. EASEMENT
USE CLASSIFICATION
Form # css-t2
REAR
3-/l-?
FRONT SIDE INT. SIDE EXT
Dqte BLDG. INSP.Dote PLANNING
COPY I _ OFFICE
COPY 2 _ JOURNAT
COPY 3 _ AUDIT
Lar v ,t P,a,.. l//6 ^,f a v 1r,, ,.sb 742 - ?3.f,/
I I
Direclions lo Find Property: