HomeMy WebLinkAboutPermit Building 1976-09-21n Owner
LANE COUNTY PERMIT FOF -.
PERN/IIT NO
CONSTRUCTION [ ] IVIOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
NAIV]E ADD R ESS CITY ZIP CODE PHONE
n Contractor
DENAADD R ESS CITY NE
O.S. Reg. *
Tw o
Subd ivision Lot
Access to Property (Road Name)
Ranse-- section 33,llru* to, 4 6 Code Census Tract
B lock Acreage Width
Depth
Existing Structures on Property
Directions to Property - Address:
STRUCTURE (# BEDROOIVIS)SO. FT VALUATION
SEWAGE DISPOSAL PLUIVIBI NG INSTALLED BY:
owNER[] OTHER[] NArVrPUBLIC I I SEPTIC TANK I OTHER t ]E
BUILD ING
PLUI\48ING
WATER SUPPLY: PROPOSED I ]
EXISTING I 1
PUB LIC
COMTVIUNITY . NAIVIE
3% SURCHARGE
I\NOBILE HOIVIE
WASTE D ISPOSA L
PLAN REVIEW
TOTAL
PR IVATE WELL
OTHER.SPECIFY
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
IVIIN. SEPTIC TANK CAPACITY
GALS IVIIN. DRAINF I ELD- LIN. FT IVIAX. TRENCH DEPTH
TYPE OF CONSTRUCTION GROUP FIRE ZONE USE CLASSIF
SETBACKS- FT. FROIVI CTR. OF rAtV
FRONT SID E EXT
FT. FROIVI PROP. LINE
SIDE INT R EAR ZONE
AUTHOBIZED SIGNATURES ISSUANCE DATE
BLDG. PEBMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANABY
BUILDING - GREEN
SANITATION _ GOLDENROD
TMPORTANT
POST THIS PERMIT ON MAIN BLDG. AT SITE
LANE COUNTY. DEPT. OF ENVIRONMENTAL MANAGEMENT
COUBTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
Call 687-4065 to schedule all required construction 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 subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy before being occupied.
(See Details on Reverse Side)
c55 -I 3
I NCHES
STAY 1OO' FROIVI ALL WELLS
LANE COUNTY PERMIT FO PERI\,1IT NO.
] CHANGE OF OCCUPANCY [ ]
tl-*-{W4'
CONSTR UCTION OBILE HOME I ] PLAN REVIEW I
'fu,ffi,\,n Owner
NAI\4E ADDBESS C ITY ZIP CODE PHoI\ E
tr Contractor
O.S. Reg. +
NAME ADD R ESS CIIY
Range- Section Tax Lot Code-
Acreage
-
ZIP CODE
Census Tract
PHONE
Twp
Subd lvision
-
Lot
Access to Property (Road Name)
\J B lock I Width
Depth
Existing Structures on Property:
Directions to Property - Address
STRUCTU R E ( # BED ROOIVIS)SO. FT VALUA TION
SEWAGE D ISPOSAL:
PUBLIC[] SEPTICTANK
PLUMBING INSTALLED BY
OTH ER OWNER OTHER NAt\4
WATER SUPPLY: PROPOSED t ]
EXISTING I ]
PUB LIC
COVIIVIUN ITY . NATVIE
F
BUILDING
PLUIVIBING
3% SURCHARGE
IVIOBILE HOIVIE--
WASTE DISPOSAL
PLAN REVIEW
PRIVATE WELL
OTHER-SPECIFY
TOTAL %,s;
..I CONSTRUCTION PERMITS & lNSPECTIONS AND WATER POLLUTIO N CONTRO L SPECI F ICATIONS
IVIIN. SEPTIC TANK CAPACITY:
GALS. IVIIN. DRAINFIELD-==-LIN. FT MAX. TRENCH DEPTH I NCHES
STAY 1OO' FROIVI A WELLS
TYPE OF CONSTRUCTION GROUP tr e .r#USE CLASSIFFIRE ZON
SETBACKS- FT. FROIVI CTR. OF r/!V
FRONT SIDE EXT
FT. FROIVI PROP. LINE
SIDE INT B EAR ZONE
AUTHO IZED SIGNATURES
eroc. FeR[,4tt - wHlrE
OFFICE COPY - WHITE
COUNTY TAX _ PINK
PLUMBING - CANARY
BUILDING _ GBEEN
SANITATION - GOLDENROD
IMPORTANT
ISSUANCE D TE
Call 687-4061 to schedule all required
State Buidling Code, D.E.Q. standards
All buildings require a certilicate of
Call 687-4065 to schedule all required construction inspections.
septic system inspections. All construction shall comply with the
foi sub6urface sewage disposal and the State Plumbing Code
occupancy berore being occuPied.
(See Details on Reverse Side)
(POST THIS P ERM!T ON MAIN BLDG. AT SITE)
LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OHEGON 97401
c55-13
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