HomeMy WebLinkAboutPermit Building 1976-02-23LANE COUNTY PERMIT FU,.:PERIVIIT NO
CONSTRUCTION [ ] IVIOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
n Owner
NAIVIE
n Contractor NAME
ADDRESS C ITY ZIP CODE PHONE
ADD R ESS
O.S. Reg. +
Twp=- Range-- Section-Tax Lot=- Code
Subdivision Lot B lock
CITY
Acreage
-
ZIP CODE
Census Tract
PHONE
Access to Property (Road Name): - ,, ,,,
width
Depth
Existing Structures on Property
Directions to Property - Address:
STRUCTURE (# BEDROOIVIS)SO. FT VALUATION
SEWAGE DISPOSAL:
PUBLIC [ ] SEPTICTANK [ ] OTHER [ ]
PLUIVIBI NG INSTALLED BY:
OWNER[ ] OTHER[ ] NAM E-
BUILDING
PLUIVIB ING
3% SURCHARGE
IVIOBILE HOIVIE
WASTE DISPOSAL
PLAN REVIEW
TOTA L
WATER SUPPLY: PROPOSED I 1
EXISTING t]
PUB LIC
COVIMIUN ITY . NAt\4E
PB IVATE WE LL
OTHER.SPECIFY
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
IVIIN. SEPTIC TANK CAPACITY
GALS IVIIN. DRAINFIELD LIN. FT I\4AX. TRENCH DEPTH I NCH ES
STAY 1OO' FBOM ALL WELLS
TYPE OF CONSTRUCTION G ROUP FIRE ZONE USE CLASSIF
SETBACKS- FT. FROIVI CTR. OF rAff
FRONT SID E EXT
FT. FBOIVI PROP. LINE
SIDE INT REAR
-
ZONE-
AUTHORIZED SIGNATURES
lsl a
ISSUANCE DATE
BLDG. PEFMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX _ PINK
PLUMBING - CANABY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT
POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY. DEPT. OF ENVIBONN4ENTAL MANAGEMENT
COUBTHOUSE ANNEX, 135 EAST 6th, EUGENE, OBEGON 97401
Catt 687-4065 to schedule all required construclion inspections. Call 687-4061 to schedule all required
septic system inspections. All conslruction shall comply with the State Buidling Code, D.E.Q. standards
Ioi sub6urface sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy betore being occupied.
(See Oetails on Reverse Side)
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!-f aut LD tNG PERH lr APPL I cAT
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APPL I CANT
DATE
PLANN I NG D tvlsl0N
Zoning 0rdinance Cornpl iance: Zone
Subdivision 0rdinance Compl iance
Not
I icable No CKID
6. Setba
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COI{}{ENTS
FuArfirHc orvtsloN Acrlo
BU ILD I NG INSPECTION D tv ls !0N
Plans Submitted
Soil Stabil ity (footings)
Flood Plain
0ther (see cornnrents )
tNG: YES (T-No(l APPL I roN#
Not
Appl i cell e
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8
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Yes
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COHMENTS:
I'ATER POLUT !ON ROL Not
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No
1-l W
Yes
ll. ileets Department of Environmental
Qual ity Standards.
12. Other (see comments)() ()
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DATE
COI{HENTS:
TO APPLICANT:
Your B uilding / Site lnsPection:
NTY PLA Dlvlsl0N"
rough 2 contact the
-,flk K:n be approved.
nnot be approved at this time as indicated on item
Questions and furt her information on items I through
and further info
NO- abov
5 contact the LANE-
rmation on items 73t
Quest i ons
E COUNTY B D NG ANO t0N D !u 0N.
( ) tti I I be held in this ce unt i I you can reso vet eP
c55-28
135 Sixth Avenue East Eugene Oregon
pHoNE. e9l-ho65
LANE COUNTY PLANNING DlVlStON PH0NE: 5
I ems
s
cated.
e.
ls being ret
Your buildin rmit a lica ion fee is
urned.
AL
97401
87-41 85
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I NSTALLER:
PROPOSI. JET.,AGE DISPOSAL SYSTEM RECORD
Complete top part of form to signature and submit both copies with application.
PERilIT NO
GG431 Rowan
v
Sept i c
Ft. f rorn wel I
rooms Basement
Yes No
5 ater v
0ther-L i st
Steel tr Concrete
Publ i c
m No. Conpartments I Gal. Capacity / OO O
ng Un ts
n5 e
Len th
OWNER
NAHE
}4A IL ING
ADDRESS
Not
eet rom
t/ll
ne
str ut OO-
F 0
Front Side o
COHPL
For Sanitarian Use 0nly:
ln accordance with 1973 Oregon Laws Chapter 835, Section 214 this certifi ls
as evidence of satisfactory conpletion of a subsurface sewage dlsposal system at
I ocat i on.
ffi epproved: System lnstallation conforms to current standards
F Oisapproved: Does not conform to current standards
Remarks:
r o
ow
ile tn
ot an
te: -J- 5'ru
i ssued
the above
t
Diameter - D
s ons:
t.,idt Distrib Yes
e sPosa
6
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4 t.Jidth
ren ota
Ft @o
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Lines
Ft. Between er D
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see nst ruct on5
tol LilF,(l fr\
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tot I
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tar an
LANE COUNTY
STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY
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