HomeMy WebLinkAboutPermit Building 1976-02-18NOTE:
CONSTRUCTION
PERMTT # J3s'-7L
NO PERMIT WILL BE ISSUED IINTIL THIS APPLICATION HAS BEEN APPROVED
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APPLICATION FOR:
T OWNER e a
Addres s
7
Name City zip Phone
4/{'
CONTRACTOR
o.s. REc. //
Tvp.
Subdivlsion
ACCESS TO PROPERIY (ROAd
s
" ", i,,-3L( 72, p ^* ro.- -./.b-{----
Name Address City
Code
Phone
I Census Tract
I,Iid th_Depth_
J<zExisting Structures on ProPertY:
Property Location - Address/Directions:
Below Office Use
EWAGE OSAL
Slte Inspec tlon /l
Sq. Ft
Exlstlng Sewage DlsPosal SYstem
pub1lc fA
6.ro
or New System Required f__l
a
,fu,+v',l*d
FEES I
Bldg.
Ph:mblng
3% Surcharge
Waste DlsP.
Plan Revlew
Moblle Hone
TOTAL
Other
PLI]MBING:
lnstalled by Owner
Cormunity Name of Conmunity or Public SYs
Ottut ffi Name o
*Y:fr',Wfr,L2\oo .ffi.
Sewage
Connection
Water
Connection
FACILITY PERMITPLANS FURNISHED
CASH
CHECK
dns d NONOYES
Signature of Appl
Fee Received By Date
Drainfield Required - Lineal Feet Maxlmum 3L''sep tic Tank CaPaci
-1^-,
Fire Zone Use Classificati.onType of Construc
BldgSetbacks- @Y:
prort ZO ' stde rnt. 5l side s"ur 7 ('?Exterior
DATE:
I
c55 - 12 LANE COI'NTY DEPARIMENT
DATE:
t=
WATER SUPPLY:
Well Sprlng
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LANE COUNTY PERMIT Fu -':PERIVIIT NO
CoNSTRUCTION t I lvloBlLE HOIVTE t I PLAN REVIEW t I CHANGE OF OCCUPANCY [ ]
n Owner Y ZIP CODE
NAI!1E ADD R ESS
tr Contractor CITY ZIP COD E P NE
NAME ADD R ESS
O.S. Reg. #
Code Census Tract -.=--Twp--- Range- section-Tax
Subdivision- Lot B lock
Access to PropertY (Road Name)
Acreage width
Depth
Existing Structures on ProPertY
Directions to PropertY - Address:
SO. FT VALUATIONSTRUCTURE (# BEDROOIVIS)
T
SEWAGE DISPOSAL:
PUBLIC[] SEPTICTANK[]
PLUIVIBING INSTALLED BY
oTHER [ ]OWNER I ] OTHER[] NAIVI tr
BU ILD ING
PLUMBING
WATER SUPPLY: PROPOSED I ]
EXISTING t]
PUB LIC
COTVIIVIUNITY NAIVE
3% SURCHARGE
IVIOBILE HOIVIE
WASTE DISPOSAL
PLAN REVIEW
TOTAL
PRIVATE WELL
OTHER-SPECIFY
CONSTR UCTION PERMITS & INSPECTIONS AND WA TER PO LLUTION CONTROL SPECI F ICATIONS
IVIIN. SEPTIC TANK CAPACITY:
GALS. IVIIN. DRAINFIELD_-LIN. FT.IVIAX. TRENCH DEPTH I NCHES
STAY 1
,FR ALL WELLS
TYPE OF CONSTRUCTION- GROUP- FIRE ZON F USE CLASSIF
SETBACKS- FT. FROIV CTR. OF r,AN
FRONT SIDE EXT
FT. FROM PROP. LINE
SIDE INT R EAR ZONE
AUTHORIZED SIGNATURES
lsl
ISSUANCE DATE
BLDG. PEBMIT _ 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 ENVIRONi/4ENTAL MANAGEMENT
COUBTHOUSE ANNEX, 135 EAST 6th, EUGENE, OBEGON 97401
Catt 687-4065 to schedule all required conslruction inspections. Call 687-4061 to schedule all required
septic system inspections. All construction shall comply with the Stale Buidling Code, D.E.O. standards
for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate ol
occupancy before being occupied.
. (See Details on Reverse Side)
c55.13
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SITE INSPECTION
Ap pnov r o
Reuanx s
//DrsepeRoverDDare I Nspecron
FOUNDATION I NSPECTION
APPRoVED D D r sappnoveo
Reuanxs
Darr I Hspecr R
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FRAMING INSPECTI
Ap pnov e o
Re ua.nx s
D r sappnoveo d,too* tfr26'/6 lxsprc
LATH OR SHEETROCK INSPECTION
Appnovro
RrttrRxs
d Drsappnove o [a Drr r t-/-7d I
IttspEc
FINAL INSPECTION
Ap pRov e o
Re ttanx s
D t sappRovtoB Darr -7 I NseecroR
CERTIFICATE OF OCCUPANCY
Rerov ro lssue
REuaRx s
D Nor Reaov ro lssue D Dore_I NspEcroR
2 go-'Fd {3/ fur,a*
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