HomeMy WebLinkAboutPermit Building 1980-01-25This permit for the relerenced property is hereby epplov€i. Setbacks and other conditions of approval must be gtrictly observed. Violation can
result in revocation of this permit, citation under provisions of Lane County's lnlraction Ordinance, and/or other remedies allowed by law.
POST THIS PERMIT ON MAIN BUILDING AT SITE
JOB ADDRESS: 573 Pheasant Blvd., Eugene, Oregon CONSTRUCTION pERMIT +r
TRS, TL: L7-O3-22.1.3 # 1800 Subdivision' Ganebird Vl1lage, Iot 5, Block 1
Applicant/AddressMlke Thonpson, 573 Pheasant Blvd., Eugene, Oregon 97401***
Owner/Address: aa@
Contractor/Addresu
Contractor's OS +* na Total Construction Value: na
Construction approved by this permit: Repair SDS
Structures lrorr on propertys houee and shed.
LC-195-80
Telephone: 726-0779
Telephone: same
Telephone: na
Water Supply: Ralnbow + Bedrooms: 3 + Plumbing Fixtures: na + Employees: as
PLANNING DIVISION Zoning: na Partitioning + Da Parcel +r
Minimum required structural setbacks, from: centerline of road, front:
side exterior: Da ; interior property lines: na ;rear property line:
Special lnstructions: none
Da Parcel Size: 60 x 120
Ea; centerline of road,
aa
AnY alteration ot thc
natural conCiticns in
For information call 687-4394, Susan thearea oved lorthe d;ain'
or aceme
Special lnstructions: IostalL new dralolfures in the backyard as showrr on the attachedplot plan stanped approved and dated March 24, L98O. Squeeze
l-ines to 8t on center if necesaary. Maintaln a LOr setback fron all
property llnes. Keep all llnes at the same elevatlon if posslble
and loop across or the eoda as shorn.
For information call =687-le60een 8:00 - 9:00 a.m., Kathl M. I{lederhold
WATER POLLUTION
CONTROL DIVISION
Site lnspection + na lnstallation specifications: gtrlsjlng gal. min. septic miltAig'tttf,;
see lineal feet of drainfield required; max. depth of trenches: 35 iacehs.
below
Setbacks
I nteiior property lines
rc of road right-of-way
r-.rrlding foundation
Wells, other water sources
Septic Tank
10'
10'
5',
50'
Drainfield--ln?-
10'
10'
100'
CONSTRUCTION
PE RM ITS/INSPECTION
DIVISION
Type of Construction:
lnstructions: tron€
Group: na Fire Zone na Use Classification nana
For plans information call aa between B:00 a.m. and 9:00 a.m.,na
For inspections (see back of this permit) call 687-4065 between 8:00 a.m. and 5:00 p.m.
hne countyDirections 1e gllg;Down Earlow, left on Pheasant,
Date lssued: 03-26-80
go to stop slgn, go stralght, 5th house on right, green
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE / PUBLIC SERVICE BUILDING
125 EAST 8TH AVENUE, EUGENE, OBEGON 97401a55-1 3
By: Ibtht M. Wlederhold/Iky tr
I
2
3
I
5
6
IO
t2
l4
1
t6
18.
jr! LANE C0UNTY DEFT ENV l.tGT RECEIFT + 19580 DATE oltsBo
AF.FLICANT THOI'IF'SON, I{IKE ADDH 5?3 PHEASANT BLVD, EUGENE' OHE
37 TL+ t?032?t3OT8OO SUBDIV GA}{EBIRD VILLAGE - LOT 5 BLK {
NEU' BLDG TYF'E USE R NO BDRHS OO NO UNITS OO1 NO STORIES NO ELDGS OOI
34 CODE AFFL NO ACTION DESCRIFTION SQ FT TJNIT COST VALUATION FEE DAYS
3P
]q BF
BP
38 3P
BF
40 BP
0
o
o
0
0
o
0
5
-12 PL
: HIif,H
44 :UR
-'PCX
ro SDS
NO. FIXTURES
L.C r 9580 SDSR
CONNECTORS:
HECHANICAL FEE:
S'TATE SUR{:I"IAR6E
F,LAN CHECK FHE
ELEV ADDR FF
CIIHF.LETED EY
5.O0 EACH =
4%
o/"
TiNVH
TI}TAL F.EEX,(
NS.
?5.00
?5.00 cK
T
il8
s2 sIF0 cFI- ,.AKEN TJY SK
UFC FLAN
50
5l
56
5t
I
I_)
60
67
t2
ll
l0
1
EL
e
64
,(Job Address
Appi ication for
Structures now on the perty
/-/
Affjdavit: i,
If this appl ic ation for an a cu tura
,1firi*,f;i
r,lid$1ll ,' m$o.lti
/_//_-/:iifi*#3 it r-r i{$ftit.}ifilt
hereby certify that this information is true and accurate
di ng it wiIl be used for purposes allowed by the State Bui.lding Code and
DEPARTI]ENT OF ENV I RONMENTAL I,IANAGEMENT
PSB, I25 EAST BTH AVENUE
EUGENE, OREGON 9740I
' purpose.
les
EnowledGab
:.ffiU*::llr+*U,t$niifllcl' ;At,eiffidiiiffiffi$'ffii:
:x:fr;
).si snature/Addres
Code Chapter 10 (zoning) and for no otherr of record;contract purchaser;
authorized to actTor the owner, who is s appl i ti on
1 ephone 0r Da te
/r Applicant /-/ Orner /]/ Contractor pa: fi nail /-J phone
z1 Phohe
Phonez1
Plumbing by
s
Te
noti fy:
I have the following legal interest in the property:
see; holder of an exclusive option to purchase;
z1
t,lhen permit i
Ourner
Contrac tor
Contractor's 0SR#
If Commercial
Residential:
# of employees _i#iiftiiltir,fr,{tjiir
!$$-Sliii' /-/ Existins, BP #
I Proposed, SI #SI test holes ready
:r;EHe,11
a
.gg:rii.1fit;,:.:.iilr.t i t
.#rrt!f,.::::S}t{g. iffi$.t,Va l uati on Fee
$
$
Total Va.l uati on : $ $
4% State surcharge
Plans check fee
Change of Occupancy
$- each
$- each
Subtota l
TOTAL
$
$
$--
$
$
$
;,r,l.ffi iio$iiiiif
.l.*ifi
ytrs$.i
fi illlrAttErriiiisgtt!*la,:,
at
at
t_/
Rece i ved
Water Supply
Proposed _
Year Instal led
Existing
PERMIT PR0CESSING Zone /?/ +Part. #
Minimum setbacks:t, f.on
Comments
Parcel #Parcel Si ze
, s ide ; int rea r
To be typed on permit
By Date
CP& I Type- Group-Fire Zone Use Classification
By Date
PhoneFor plans information call (area inspector)
Di rec s to si
/_/FO
Date
Requ i red
Hold Sl ip
to PCC
r-/ CP&lL,N l,JPc
/7 Planning
l/ puolic Works
f7 Elevation /-/ nla
/7 Address
/-/ Facil ity Permit
l7 Environmental Heal th
FOR INFORIIIATI0N about progress of your application call
c74-L7L
Da te
Compl eted
Pl ans te to
PCC
perm.it Control Center 687-HELP (687-4357)
R{?
To be typed on permit
(
CP&l set(s)
l^lPC
-
setls )
DEPARTIJENT OF ENVIRONI.IENTAL I1ANAGEMENT
PSB, I25 EAST BTH AVENUE
EUGENE, OREGON 9740I App) ication #
Job Address 73 Ci ty Assigned Numbers-"fr2.
Lot Jf gtock
17 Commercial 17 Industrial /_/ Publ ic
hereby certify that this information is true and accurate
holder of an exclusive option
property:
to purchase;
the owner, who is tn-owt eogeaul s appl i tion.
Qr.
O.
n
Township, Range, Section, Tax Lot
Subdivision
Appl i ca ti on
Structures
for
Proposed use of property: /l Residential
ffidavit: I,
eas
now on the
aulhori zed
c0
to act for
If this application is for an agr cul tural bu lding it will be used for purposes allowed by the State Building Code and
Code Chapter l0 (zoning) and for no other purpose. I have the following legal interest in ther of record;ntract purchaser;lessee
p
i
Lane County' owne-----du I y
Si gnature/Address
Te l ephone
When perm it is rea dy notify /_/
Owner
Contrac tor
Contractor's 0SR#
If Cormercial: # of stories
Residentia'l:. # of bedrooms
# of employees _# of units
SDS: , Existing, BP #
l/ Proposed, SI #
z
r Da te
Appl icant /-/ Owner 17 Contractor !y: $nail /-/ phone
(zip) Phone
Phone
Plumbing by
SI test holes ready
Fee
Code
Sq. Ft. or
# of Sites
Unit
Cos tDescri pti on Val uation Fee
$
$
Total Val uation:
Pl umb i ng fixtures at
Sewer/water conn, at
b
/-/ Cash
/-/ Check #
Received by
q
$_each $
each $
$
t
Subtota l
TOTAL
t
$4irl State surcharge
Plans check fee
Change of 0ccupancy
Water Supply
Proposed
Year Instal led
Existing _
PER[4IT PROCESSING
Min'imum setbacks:
7o .,4,Part. #Parcel #Parcel Size {)
at, front t, side int rea r
Comments
To be typed on permit
By c.te O
Instal lation l. tank ft of drainfield; max. depth of trenches:s pec
l^
ifications:
. Tobe 0n it
Te1 ephone
Di recti ons to site rt.)
r€4 ?z-<r1.
ans to: CP&l
I,JPC
--
set
Da te
Requ i red
Hold Slip
to PCC
Da te
Compl eted
set s
s
t7/_/ sr te to
PCC
r_/ CP&l
/7 Planning
/_-/ Public l.lorks
, Elevation /_-/ n/a
/7 Address
1-/ Faci 1 i ty Permi t
/ / lnu\ronmental Health
FOR INF0RiIAII0N about progress of your application call
A-"r'r 4--a-
teBy
'l-.o r'?,
e-vI?.--?
Permit Control Center 687-HELP rc87-4357)
(zip)
$
s
$
WATER POLLUTION CONTROL
lane county
Water Pollution Control Division
Env'i ronmental Manaqement Department.I25 East Bth Avenue
Eugene, 0reqon 97401
LOCAT I ON
stem
the gro
a oth
rupZ- aunq"e3-Secti o&,{Jax Lot
subdi vi s i on {,,i:#.w{ T":Pt'61,,*. *
I have no information that the existing subsurface sewage disposallocated on this property has ever faiteo oy discharqing-sewage uponund surface or into public waters, by clogging or backing unl or iner manner.
PROPERTY OWNER: XTYDATE: ./.- 2 SjfA CS
I have information that the existin g subsurface sewage disposal sys-
em ocated on this property has failed in the past by discharging sewage
upon the ground surface or into publ ic wate rs, by clogging or backing up, orin some other manner, and that:
The system has not been repaired.
The system has been repaired and has operated continuously
since the repa'ir wi thout other fai I ures.
Date(s) repaired- ,
I have had personal knowledge of the performance of the existing
subsurface sewage disposal system located on this property for-years and_ months.
The existing sewage disposal system consists of:
Septic tank has a- ga11on capacity.
Number of drainlines
Length of drainlines
Distribution box? Yes_ No _
The existing septic system was install (Date),
under Lane County Building Permit #_
Th'is system last served a dwellin g having- bedrooms (include all
rooms which could be used as a bedroom though actually used for otherpurposes such-Es for a den or a sewjn g room) 0RJf-For commercial use, this
system last served an establishment h aving-- employees, and- ga1 lons/
day sewage flow. This system was las t used (Date).
In case of an addition, the new portion will be_feet away from theexisting drainfield.
APPL I CANT
a
b
c
d
(
WATER POLLUTION CONTROL DIVISION I
125 EAST 8TH AVENUE / PUBLIC SERVICE BUILDING
c74-156
ENVI RONM ENTAL MANAGEMENT DEPARTMENT
EUGENE, OREGON 9740'l / (503) 687-4061
No
)
)
)
)
/z-<- z z-/-Job Locatlon (Addre s s )TRS, TL
Lot
Permlt /I
Pernlt
For Permlt /l
Pernit /I
Pernit
For
Irl C't Pla For For
Permi rll For For
Subdivision
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6,o,tnnebrrad- tlulo,Ep.
htos br.ol lane ccunty
December 2, l9B0
Mona Thompson
573 Pheasant Blvd.
Eugene, Oregon 9740.I
Dear Mona Thompson:
Here is the information regarding septic repair loan grant programs
which may be helpful to you.
l) Lane County Housing Authority & Community Agency. Contact Crawford
Lyle at 687-3900. He should have called you by now, but in case
he has been unable to reach you I have'included his number.
2) Farmer's Home Adm'inistration. Contact Ken Murphy at 687-6443.
If I can be of further assjstance to you in this matter, please do not
hesitate to contact me. Unless I hear from you other'wise, we will
expect your sept'ic repair to be completed durjng Christmas break,
as you indicated during our telephone conversation of this date.
Sincerely,
STANLEY PETRASEK, SUPERVISOR
BUILDING AND SANITATION
-{bl4,t' w. Nddorl'oU
KATHI M. hlITDERHOLD
SANITARiAN
cc Janet Chase
Crawford Lyle
KlrJ/ bs
INVII]ONMI.N IAL MNNAGTl\I ENI DEPARTM[NT
125 EAST BTH AVENUE / EUGENE. OREGON 97401TECHNICAL 8 PUBLIC SERVICES // (503) ffi7-4071 0R l-800-452-6379
0 VrcIT{ITY MAP
@
form c55-11
Permit No
UST BE IN B
Range
INK
Section 72. 1,3 Tax Lot lW
Standard System P Alternative pecify T
Job Location (Street Address)Parcel-Subdivision / Partition #
DETAIL SYSIEM PLAN AS
slo"k- 3J-
CONSTBU TED
5Cale
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T^tephone
-rnse No
Bonding Company
.-.Date--
(Signature of Lic6ns)
lnstalled By
* J'/8/
IO lz
I
USE BLACK tNK ONLY
FOR IN U Trench D
Tank Capacity Manufacturer
Measured Distance from I to Tan From Drainfi
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS I NSTALLATION:
I (installer's certify that a (
and Mercury Float Switch (Mfg. and No')
Signatu
FOR SANITARIAN'USE QNLY:System
COMMENTS
tr
System CapacitY l.l day Signatu
INSTALLATION RECORO & CERTIFICATE OF SATISFACTORY COMPLETION When
evidence as per ORS 454.665 of satisfactory completion of a subsurface sewage disposal system
:.
u
Gravel DePth Below Ti
er-
Total Length of Li
(Model No.)
have been installed with this sewage insta
ump
llation
D Needs Correctiontrrsa
at the above location.
Date ,
oatel?tQhYl
signed by the County Sanitarian' this certificate is
Return this form to: Water Pol lution Control Div., Dept. of Enivronme
Appl icant's Name I Address
Public Service Building, '125 E 8th Avenue, Eugene 97401
ntal Management, located in the basement of the
TwnshP.
4 ibr
\i1 ;
tnstatter S%*_2-5,=?QR / t(o nf
.-.
POST THIS PERMIT ON MAIN BUILDING AT SITE
JOB ADDRESS: CONSTRUCTTON pERMtT #
TRS. TL: Subdivision:
This permit for the re,ferenced property is hereby setbacks and other conditions ol approval must be strictly observed
result in revocation of this permit, citation under provisions of Lane County's lnfraction Ordinance, and/oi other remeaies attol/v-ea uy taw.
Applicant/Add ress:
Owner/Address:
Contractor/Address
Contractor's OS +t Total Construction Value
Construction approved by this permit
Violation can
Telephone
Telephone
Telephone
Water v
PLANNING DIVISION
+ Bedrooms + Plumbi F ixtu res + Employees:
Any alteraticn oi rir:
natural conCiticris in
Zoning: Partitioning +
lVlinimum required structural setbacks, from:
side exterior: ; interior property lines:
Special lnstructions:
Parcel +
centerline of road, front:
;rear property line:
Parcel Size
; centerline of road,
For information call 687-4394,
eareaap
WATER POLLUTION
CONTROL DIVISION
Site lnspection +* lnsta llation specif ications:
lineal feet of drainfield required; max. depth of trenches
Special lnstructions:
gat. min, septic tank {8ffiff1tffi,ffi.rffr,
area vrilr
Setbacks
I nteil-o r p ro perty I i n es
i l" of road right-of-waY
uuilding foundation
Wells, other water sources
Septic Tank Drainfield
10'
10'
5',
50'
--lo--
10'
10'
1 00'For information call between 8:00 - 9:00 a.m.
CONSTRUCTION
PE RM ITS/INSPECTION
DIVlSION
Type of Construction:
I nstructions:
Fire Zone:
between 8:00 a.m. and g:00 a.m.,
Use ClassificationGroup
it) call 687-4065 between 8:00 a.m. and b:00
hne countyDirections to Site
Date lssued:
c55-1 3
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE / PUBLIC SERVICE BUILDING
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
6t!'
-
By:
p.m
For plans information call
For inspections (see back of this
ht
Itr
U
Pt{ite
*z/-/-d Job Location (Addre ss)
Lor {-
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Permlt #
Pernit
Permlt
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Permlt #
Perrnlt
Permlt
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ForlotPlanFor For
For For
ubdivision
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c74-150
Vlclalty Map
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30 &
For
(
il;rtrF.il
IANE COUi\ BUILDING
BUILDING
P-RMriI-
MH
MAILING ADDRESS
OR MOBITE HOME USE PERMIT
PERMIT NO,
PROPERTY R PHONE
CONTRACTOR MAITING ADDRESS PHONE
PROPERTY LOCATION - INCLUDE POST OFFICE
PROPERTY TEGAI DESCRIPTION _ METES, BOUNDS
RANGE TAX LOTTNOfl CENSUS TRACTSECTIOND
EXISTING STRUCTURES ON PROPERTY
:
APPL.
NAME
&
MAITING
ADDRESS
LEGAL ACCESS TO PROPERTY
PROPERTY SIZE _ FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connect to Exisling Sewoge System [] New System !
STRUCTURES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION sQ. FT. # BDRMS VALUATION
SEWAGE DISPOSAT PI.UMBING INSTALTED BY
PUBTIC
BUITDING
WASTE DISPOSAT
PTUMBING
PTAN REVIEW
PARK TRAII.ER
SEPTIC TANK OTHE OWNER
WATER SUPPIY
PUBTIC D N OTHER
OTHER: NAME
F EES
TOTAT
COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAT.
DRAIN FIELD REQUIRED
IIN. FT TRENCH WIDTH FT.OR SQ. FT
TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTII. EASEMENT
BIDG. SETBACKS
FRONT
FT. FROM CTR. OF ROAD RIGHT OF WAY
SIDE INT. SIDE EXT. -
USE CI.ASSIFICATION
REAR
AUTHORIZED SIGNATURE - DATE DATE
BLDG. PERMIT _ WHITE
OFFICE COPY _ WHITE
COUNTY TAX _ PINK
PTUMBING _ CANARY
BUILDING _ GREEN
SANITATION _ GOLDENROD
Construction to comply with uniform building code ond county regulotions
covering plumbing ond sewoge disposol. All buildings require o certificote
of occuponcy before being occupied.
(See Stotement on Reverse Side)
(posT THIS PERMIT ON MAIN BIDG. AT SlrE)
IANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 9740I
---"*" lt c 5s - 6
TI
$
( ) Site lnspection
( ) Pre-Permit tnvest igat ion
6"pK
Euildin-c. Permit Appl ication No./1, z
s "3:./.,TAX
'6-/ X=fAPPL I CAN
NAhE
ADDRES
PHONE
DATE
L/iNE COUNTY PLANN ING DEPARTHENT NOT NO YES NA.I.'1E DATE
eppl icable
Zon i ng Ord i nance Comp I i ance
(Zone R4Subdivision 0rdinance Comil iance
Requ i red Access
Building Site (Area, Width,
Frontage, Setback)
0ther (see comments)
)
( ) -(
({(
() (
)(4
(+'
2
')
4
5
)
()d
)(
)
()
()
CO},IHENTS:
BU!LDING INSPECTION SECTION
6. Plans Submitted
7. Soil Stability (footings)
8. Flood Pl a in
9. 0ther (see Comments)
NOT NO
EE?_! icable
*YES
('
()
NAHE DATE---r]-( )
(
()((
)(
)
f AA x"//'U
CO}lI.1ENTS:
SANITATION SECTION
10. Sewage Disposal
ll. Usable Area
12. Iy'ater Supply
ll. 0ther (see Comments)
NOT
appl icable
NO YES NA},lE
( ) -( )00
\A
${)
(
(
()1 (
COMHENTS
TO APPL I CANT
z,14
b(rr"r Bu i ld ing Perm i 1 / 5 i te lnspect ion*r(\)
)
)
)
Can be app roved
Cannot be approved at this l. inre as ind icated on iten, N0 above.
Quest ions and further infornrat ion on itenrs I through 5 contact the Lane-
CoUNTY PLANN ING DEPARTMENT. Q.uest ions and turther informat ion on iffi 6
t hrouqh I 3 cont act t he Lane !-ot1.,[Y._qj]-lg, ,lg-gi{Sarr itat ion D iv is ion
Will be held in this off icc until you can resolve llre probl enrs ind icatt:d.
ls being returned.
Your buildinq pernr it appl ir.at ion fee is being returned under separate ct:r'er
LANI' COTINI Y I'I /\NN ING DEPART}.IENT
llf Siltlr Avonue East, Eugerte, 0tegtrn 97401
1?ylrrnE 3lll. l.lll tjxl.231
IANI COUNTY I]IJILDING 6 SITNITATION DIVISION
135 S i x[h AvErrur: East, Ettt;etr.', or eclon 9740 I
I'llL)Nt: 342-llll ['xT. l{ll
zt-1455-
BU ILD ING S ITE EVALUAT ION r /7
CE},'US
R
{-v-3-'*->{
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(
DATE
I
IANE COUN BUILDING PFRMIT' OR MOBITE Hu.vtE USE PERMII
PERMIT NO.
PROPERTY OWNER
CONTRACTOR
PROPERTY TEGAL
APP[.
NAME
&
MAII-ING
ADDRESS
BUILDING
POST OFF ICE
METES, BOUNDS
MAILING ADDRESS
MAITING ADDRESS
MH
I
pnoprnrv LocATloN -INCI.UDE
DESCRIPTION _
RANG E
TAX LOT NO CODE
EXISTING STRUCTU
t rclt lccess ro
NTS ON PROPERTY
PROPERTY
CEttSUS rnnCr
AREA
SECTION
PROPERTY SIZE _FT.
PHONE
PHONE
FOR MOBILE H
No. of Bedrooms
Ome Pen,UtrS O NLY
DEPTH
Co nnect lo Existing Sewoge New SYstem
BDRMS VALUATION
TYPE CONSTR UCTION se. FT
STRUCTURES TO BEB ILT THIS PER MIT
\
Pt tll,tBtNO INSTAILED BY
SEWAGE DISPOSAT
OTHER: NAMEowNER n
PUBHC tr SEPTIC TANK OTHERE
FEES WATER SUPPLY
BUITDING
WASTE DISPOSAL
PI-UMBING
PtAN REVIEW
PARK TRAITER
PUBTIC tr N OTHER
TOTAT
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAL.
TYPE OF STRUCTURE
COUNTY BUILDING & SA
DRAIN FIEID REQUIRED
tIN. FT
NITATION SPECIFICATIONS
TRENCH WIDTH FT,
ZONE
USE CTASSIFICATION
OR SQ. FT.
PUBTIC UTII.. EASEMENT
I
FROM CTR. OF ROAD RIGHT OF W
OCCUPANCY
BLDG. SETBACKS , FT
FRONT REARSIDE INT,SIDE EXT
DATE
AUTHORIZED SIGNATURE _ DATE
BLDG. PERMIT _ WHITE
OFFICE COPY _ WH ITE
COUNTY TAX - PINK
PLIJMBING - CANARY
BUILDING - GREEN
SAN'IAT/C)N - GOLDENROD
Construction to comply with uniform building
covering plumbing ond sewoge disposol. All
of occuponcy before being occupied.
code ond countY
buildings require o
reg u lot
ce rtif
I(See Stotement on Reverse Side)
Ar sffE)
OREGON 9740I
,""::::1,'::: :::,,, ON /}4AIN BIDG
IN, DIV., COURT HOUSE, EUGENE,
WIDTH
-r-*E!
S ITT INSPICTION
AprnovEo D
RrulRr<s
FOUNDATION INSPTCTION
D r sapp ED Dare
3--7
I rusprcroa
Ir.rspe cron
APPRovE
Rrua Rx s
D DrsappRove o F-J DarE
Drsappnoveo D Dnrr 6-
4^r9'7/e_
-Z Qt
FRAMING INSPECTION
A ppn ov
Rr uanx
EO
LATH OR SHE
Ap pnov e o
Rrurex s
K I NSPECTION
Dr sappnoveo ,f -/t,7/,,,,.,-,o^Dare
I Nspecr eI
c,/,
FINAL INSPECTI
AppRovEo
Reuanx s
Dtsappnoveo o^r, {'&{'il I ruseEcton
t,[.RT\T IC,ATI Oi OC,C,UPANCY
l-1 Nor Rrrov ro \ssuE
Rerov To lssuE t
D Drre lNSPEcroR
REurnt<s,
t
\1(
l?0.
b
4
v I
.4 fiartI
frW
w
,l
IANE COUN
BUTLDTNG I
BUITDING PERMIT OR MOBIIE
MHI
HOrvlE USE PERMIT
PERMIT NO.
PROPERTY OWNER MAITING ADDRESS PHONE
CONTRACTOR MAITING ADDRESS PHONE
PROPERTY TOCATION _ INCTUDE POST OFTICE
PROPERTY LEGAI. DESCRIPTION _METES, BOUNDS
RANG E SECTI O N TAX LOT NO CODE CENSUS TRACT
EXISTING STRUCTURES ON PROPERTY
APP[.
NAME
&
MAILING
ADDRESS
tEGAt ACCESS TO PROPERTY
PROPER,TY SIZE - FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connect to Existing Sewoge System !New System tr
STRUCTURES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION se. FT # BDRMS VALUATIoN
PIUMBING INSTATLED BY
SEWAGE DISPOSAI
OTHE OWNER OTHER: NAME
PUBTIC
BUILDING
WASTE DISPOSAT
PTUMBING
PTAN REVIEW
PARK TRAITER
SEPTIC TANK
FEES WATER SUPPLY
PUBUC n I
(
OTHER
TOTAL
MIN. SEPTIC TANK
WITH DIST. BOX: GAL.
TYPE OF STRUCTURE
COUNTY BUILD
RIGHT OF WAY
SIDE EXT
TURE _ DATE
ING & SANI
REAR
TATION SPEC
TRENCH WIDTH FT
IFICATIONS
CAPACITY
Fr. rnol,t crR. oF RoAD
aurnontzeo stcNa
DRAIN FIETD REQUIRED
IIN. FT
OCCUPANCY ZONE
USE CLASSIFICATION
OR SQ. FT,
PUBTIC UTIL.EASEMENT
BLDG. SETBACKS
FRONT SIDE INT
BLDG. PERMIT - WH ITE
OFFICE COPY _ WHITE
COUNTY TAX - PINK
PIUMBING _ CANARY
BUILDING _ GREEN
SANITATION _ GOLDENROD
Conslruclion to comply with unifo.rm building
J.".iiis pfumbing ond sewoge disposol' All
;; ;;;r;"'".y befire beins occuPied'
DATE
code ond countY regulotions
buildings require o certificole
(See Stotement on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG' AT SlrE)
LANE COUNTY, BTDG. & SAN. DIV'' COURT HOUSE' EUGENE' OREGON 9740I
oRM j c55-13
2
SLAB FLOOR
PLUMB ING GROUNU,./ORK
4AppRoveo / (,-/ DrsappRovro
Ret,tanxs
oortS-!o a"t I Hsprcron
GAS P lP I NG GROUND^/ORK
AP pRov E D
ReuaRx s
D r sappnovEo Dare I rusprcron
ROUGH PLUMBING
A ppnov t o
Reua Rx s
ROUGH GAS PIPING
APPRoVE o
ReuaRr s
R DrsappRoveo D oorql-?Q Ir.rsprcro
I NspEcronD DrsappRoveo D Dar e
FINAL PLUMBING
Appnov e o
Reurnx s
FINAL GAS PIPING
AP PRov E o
Reua ex s
Reaoy ro lssue
RruaRx s
ry Drsappnove, D Dar
Dare
Ir'rspe ct
I ruspEctonD Drsappnovro D
CERTIFICATE OF OCCUPANCY
D Nor Reaoy ro lssuE D Dare I Hsprcton
srd
LDINGIANE COUNTY )l
PERMIT TYPE - BUILDING I
PERMIT OR MOBITE HOMI USE APPLICATION
PERMIT #/?o-7EMOBILE HOME J] OSC REG. #
PHONE
MAILING ADDRESS
POST OFFICE
PROPERTY OWNER
PROPERTY LOCA'_ INCLU
PROPERTY LEGAI. DESCRI
tOT_BIOCK_SUBDIV
TWP RANGE
0
ING
CODE
DESCRIBE EXISTING STRUCTURES ON
PHONE
METES&BOUNDSNYES
ATTACHED tr NO
oR#
AREA
R
\,
SEC.TAx roT #CENSUS TRACT
DEPTH
IF/Je,I
APPLICANT
NAME
AND
MAITING
ADDRESS
TOAC
PROPERTY
FOR MOBILE HOME PERMI T ONLY
Connect to Existi
TYPE CONSTRUCTION
Sewoge System I or New SYstemNumber of Bedrooms
ES TO BE BUI LT THIS PERMIT SQ.VALUATION
.5
aH@tz 28(3,
31, oG
PLUMBING INSTALTED BY
SEWAGE DISPOSAI
PUBTIC N OTHER
FEES WATER SUPPTY
OWNER OTHER NAME
PLANS FURNISHED FACIIITY PERMITSEPTIC TANK
BTDG.
WASTE DIS.
PLUMBING
PTAN REVIEW
PARK TRI.R.
PUBTIC
PLUMBING FEES
d ,,*rr*r.
OTHER
C.aa SIGNATURE OF APPTICANT
FEE RECEIVED BY
PE
YES NO YES NO
TE,/3,
CASH E
CHECK FEE
PUBLIC WATER
CONNECTION FEE o/TOTAT
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAL.
COUNTY BUILDING & SANITATION SPECIFICATION
DRAIN FIELD REQUIRED
TIN. TT. TRENCH WIDTH FT OR FEET
Lo
b
TYPE OF STRUCTURE
BLDG. SETBACKS - FT. FROM CTR. OF
OCCUPANCY
RIGHT OF WAY
REAR YARD PUBLIC I.JTIL. EASEMENTZONE
FRONT SIDE INT SIDE EXT. -REAR
A N
Form # css-tz
PTANNING DOIE BLDG. INSP
USE CTASSIFICATION
-ll Dqle
Directions ro Find PropertY:
COPY 'I - OFFICE
COPY 2 _ JOURNAL
COPY 3 _ AUDIT