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(BUtLDING PERr,llT APPL lCAT|ON N0 . 34
( ) slrE lNsPEcrloN
PLANNING DIVISION CK|DBYTF n'e^-na
6. Setbacksf rqi c/l of road:
Front {a
R s TAX LOT
-22 BDIVISION:
APPL ! CANT
OTL BLOCK:
Not
Iicable
I
2
3
4
5
Zoning 0rdinance. Cornpl iance:Zone
Subdivision 0rdinance Compl iance
No
1-l()
()
()
()
Yes
fll
Requi red Accessguitaing Site (Area, width, Frontage)
Other (see cornments )
()
()
()
Side Exterior -r
Setbacks frorn interior I ines:
S ide E_
Rear
COI{MENTS:
?
PLANNING DlVlslON ACTION PENDING: YES( ) N0(APPL I CAT ION#)
BUILDING INSPECTION DIVISION
Plans Submitted
Soil Stabil ity (footings)
Flood Plain
Other (see conments)
Not
App!rse!-!-e
7
8
9
0
()
ili
No
1-)()
Yest() ()
() ()CKID BY ZI
COI'IHENTS:
ITATER PoLUT ION CONTROL Not
I l. l{eets Oepartment of Envi ronmental
Qual ity Standards.
12 . Other (see cornments )
Aool icable- No Yes
-(T r) rT
() ()() CK'DBY:L
DATE
COHHENTS:
TO APPLICANT:
Your
r{:
Building / Site lnsPection:
an be approved.
annot be approved at this t ime as indicated on item
I through
N0- above.
6 contact the LANE-3*1t(Que stions and further information on
t
NTY PLAN D IV IS ION
rough 2 contact t
Will be held in this ce unti
u rned .
s rther information on i tems 7
S ION.SAN TATION D
you can reso vet e prob
Quest i on
NE COUNTY
i tems
and fu
ILDING
)
)ls being ret
Your bui ldin rmi t a lication fee is b
135 Sixth Avenue East Eugene Oregon
'H'NE.
597-4065
LANE COUNTY PLANNING DlVlSl0N PH0NE: t
97401
687-41 85
c55-28
ems nd i cat ed.
OATE
PERIVIIT NO
CONSTRUCTION [ ] IVIOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
n Owner
NAIVIE ADD R ESS CITY ZIP CODE PHONE
E Contractor
Ranqe- Sectio Tax Lot- Code
B lock Acreage
ZIP CODE PHONE
Census Tract
Width
Depth
NAIVIE ADD R ESS CITY
O.S. Reg. +r
Tw
Subdivision Lot
Access to Property (Road Name)
Existing Structures on Property:
Directions to Property - Address
STRUCTURE (# BEDBOOIVIS}SO. FT VALUATION
SEWAGE DISPOSAL:
PUBLIC [ ] SEPTICTANK [ ] OTHER [ ]
PLUIVIBING INSTALLED BY
OWNER I ] OTHERTI NAIVI E
BUILDING WATER SUPPLY: PROPOSED I ]
EXISTING t]
PUB LIC
COIVITVIUN ITY . NAIVIE
PLUIVIBING
3% SURCHARGE
IVIOBILE HOIVIE
WASTE DISPOSAL
PLAN REVIEW
TOTAL
PRIVATE WELL
OTHER . SPECIFY
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICA TIONS
IVIIN. SEPTIC TANK CAPACITY
GALS IVIIN. DRAINFIELD LIN. FT IVIAX. TRENCH DEPT I NCH ES
STAY 1OO' FRON4 ALL WELLS
TYPE OF CONSTRUCTION GROUP FIRE ZONE USE CLASSIF
SETBACKS FT. FROIM CTR. OF rAff
FRONT SIDE EXT
FT. FROIVI PROP. LINEr
SIDE INT.
-
REAR ZON E
AUTHORIZED SIGNATURES ISSUANCE DATE
BLDG, PEBMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANABY
BUILDING - GREEN
SANITATION - GOLDENFOD
IMPORTANT
POST THIS PERMIT ON MAIN BLDG. AT SITE
LANE COUNTY. DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
Call 687-4065 to schedule all required conslruction inspections. Call 687-4061 to schedule all required
septic system inspections. All construction shall comply with the State Buidling Code, D.E.O. standards
foi sub6urlace sewage disposal and the State Plumbing Code. All buildings require a, certificate of
occupancy before being occupied.
(See Details on Reverse Side)
LANE COUNTY PERMIT F(
StTE INSPECTION
AppRovEo
Rruanx s
D r srppRoveD Dare I ruspecron
FOUNDATION I NSPECTION
APPROVED Dr sappRoveo Dar e Ir.rspEcron
Reuanx s €u tft44.-74'' 7 -'
FRAM I NG
Appnoveo
Rg ttaRx s
I NSPECT I ON
D Drsrppnove, D Darr .llrsprcron
LATH OR SHEETROCK
Appnov r o
Rrulnx s
I NSPECT I ON
D r s rppRoveo Dar e I NSPEcToR
FINAL INSPECTION
AppnovEo & Drsrppnovro
REuaRr s
Dnr e I NSPEcro
CERTIFICATE OF OCCUPANCY
Reaov ro lssuE
REuaRx s
D Nor Rrrov ro lssuE D Dore-
?ot-fb l-/ t
I Hspecron
D
!
u
E
4
I D
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