HomeMy WebLinkAboutPermit Septic Tank 1973-06-28Bl'"MOBITE HOME USE APPIICAIIONLANE COUNTY
PERMIT TYPE _ BUILDING
P owN
NTRACTOR
PROPERIY TOCATION - INCLUDE POST OFFICE
PROPERTY LEGAL DESCRIPIION
tOT_BIOCK-SUBDIV.
TWP RANGE
DING PERMIT OR
MOBILE HOME
NG ADDRESS
MAILING ADDRESS
TAX I-OT
PERMIT >//-,OSC REG. #
CODE
DESC RI BE NG
PROPERTY SIZhWIDTH
PHONE
E
MEIES&BOUNDSEYES
ATTACHED NO
SEC CENSUS
DEPTH
36--L
APPTICANT
NAilE
AND
MAITING
ADDRESS
PROPERTY
AREA
ROAD
FOR MOBILE HOME PERMIT ONLY
Number of Bedrooms
STRUCTURES TO BE BUITT THIS PERMIT
Connecl to Existing
t TYPE SQ. FT
or New System R"q. D
ROOMS VATUATION
PTUMBING INSTALTED 8Y
owNER! OIHERnNAME
FU RN ISHED FACII-ITY PERMIT
5e.30
58.5,! Cherl
OTHER
REAR
NO
APPTICANT
OR FEET
REAR YARD
USE CTASSIFICATION
PUBI.IC UTII.. EASEMENT
YES YES NO
,TEst
BYP
tt, I SR Z:''rr
FEE
<t__
; & SANITATION SPECI TIONS
REQUIRED
,T TREN.H wrDTH FT,
ZONE
I r'ansaet rort
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Thanl'l YotJ, nsn ltt
Form # g55-12
Dole BIDG.b -'l I Dote
COPY
COPY - - e,!rrA!
COPY 3 - AUDIT
IANE COUNT I BUILDING PERMIT OR MOBITE HOME USE PERMIT
BUTLDTNG tr MH I PERMTT NO.
PROPERTY OWNER MAITING ADDRESS PHONE
CONTRACTOR MAIIING ADDRESS PHONE
PROPERTY TOCATION - INCTUDE POST OFFICE
PROPERTY LEGAT DESCRIPTION _ METES, BOUNDS
RANG E SECTION TAX LOT NO.CODE CENSUS TRACT
EXISTING STRUCTURES ON PROPERTY
APPt.
NAME
&
MAITING
ADDRESS
TEGAT ACCESS TO PROPERTY
PROPERTY SIZE - FI.
WTDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms
STRUCTURES TO BE B LT THIS PERMIT
Connect to Existi
TYPE CONSTRUCTION
New m
FT BDRMS VALUATION
SEWAGE DISPOSAT
PUBilC tr SEPTIC TANK OTHERE OWNER T1 OTHER: NAME
PIUMBING INSTAILED BY
F EES WATER SUPPTY
BUITDING
WASTE DISPOSAI.
PTUMBING
PTAN REVIEW
PARK TRAITER
PUBr.lc tr OTHER
COUNTY BUILDING & SANITATION SPECIFICA ONS
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GA[.
DRAIN FIEID REOUIRED
TIN. FT TRENCH WIDTH FT.OR SQ. FT.
OCCUPANCY ZONE PUBTIC UTIt. EASEMENTTYPE OF STRUCTURE
BTDG. SETBACKS
FRONT
FT. FROM CTR
SIDE INT.
OF ROAD RIGHT OF WAY
SIDE EXT,
USE CTASSIFICATION
REAR
DATEAUTHORIZED SIGNATURE - DATE
BLDG. PERMIT - WH ITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUITDING _ GREEN
SANITATION _ GOTDENROD
Conslruction to comply with uniform building
covering plumbing ond sewoge disposol. All
of occupo'ncy before being occupied.
code ond counlY regulotions
buildings require o cerlificole
(See Stotemenl on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SlrE)
TANE COUNTY, BIDG, & SAN. DIV., COURT HOUSE, EUGENE, OREGON 9740I
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BUILDlNG SITE E VALUAT ION
()
Building Permit Appl ication No.
S i te lnspect ion
Pre-Perm it lnvest igat ion
*.
rJZR A s ld_3rAx
CENS]JS TRACT
LOT -5-A O
C$7J APPL I CANT:
NA},IE
ADDR
(
PHONE
DATE
LANE COUNTY PLANNING DEPA RT}IENT NOT NO YES NAI1 E DATE
appl icabler)Zoning 0rdinance Compl iance(zone_)
Subdivision 0rdinance Compl iance
()
()
()
()
()
()
()
(
(
()
()
()
()
)
2
3
4
5
Requ i red Access
Bu ild ing S ite (Area, Width,
Frontage, Setback)
0ther (see comments)
COMHENTS:
BUILDING INSPECTION SECTION NOT NO YES NA},IE DATE
cable6. Plans Submitted
7. Soil Stabil ity (footings)
B. Flood Plain
9, 0ther (see Conments)
COfi},IENTS:
() ()
() ()
()
()
()
()
(
(
(fi-2f,4
SAN ITAT I ON SECT I ON
10.
n.
12.
t3.
Sewage Disposal
Usable Area
Water Supply
0ther (see Comments)
NOT NO
Ei'6't i cab le -(l ()
YES NA}{E DATE
e{
A
*
()
(
(
()
()
()
()
COH}lENTS:
TO APPL I CANT:
You r
(')
()
Building Permit / Site lnspection:
Can be approved.
Cannot be approved at this time as indicated on item N0
Questions and further information on items I through !
COUNTY PLANNING DEPARTMENT. Questions and further info
above.
contact the Lane-
rmat ion on iG,; 6
through l3 contact the
Will be held in this of
Lane Count Buildin
ce unt I you can reso vet
and Sanitation Division
p rob I ems cated.
ls being returned.
Your building permit appl ication fee is being returned under seParate cover.
L/\NL CoUNTv pLANNING DEpARTMENT LANE COUNTY BUILDING s SANITATION DlVlSlON
l'ir) Sixth l\rente Iast, Euqerre, Oregon 97401 135 Sixth Avenue East, Eugene, 0r'egon 97401
t,ilrlNl : tlr?-Hil rxt. ?'il Pll0Nl-: 142-llll EXT. 4ll
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T"VF
=
IANE COUNI
BUTLDTNG f
BUILDING PERMIT OR MOBILE HO.USE PERMIT
PERMIT NO.
PROPERTY OWNER
MH
MAIIING ADDRESS PHONE
CONTRACTOR MAIIING ADDRESS PHONE
PROPERTY LOCATION _ INCI.UDE FA5T QTFIC,E
PROPERTY TEGAL DESCRIPTION _ METES, BOUNDS
RANG E SECTION TAX LOT NO CODE CENSUS TRACT
EXISTING STRUCTURES ON PROPERTYAPPI..
NAME
&
MAITING
ADDRESS
TEGAT ACCESS TO PROPERTY
PROPERTY SIZE - FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connect to Existin Sewo e
TYPE CONSTRUCTION
New System I
BDR MS VALUATION
m
STRUCTURES TO BE BUILT THIS PERMIT SQ. FT
SEWAGE DISPOSAT
PUBr.tC [l SEPTTC TANK n oTHERfl
PTUMBING INSTALLED BY
owNER n oTHER: NAlv{E
BUITDING
WASTE DISPOSAT
PLUMBING
PtAN REVIEW
PARK TRAII.ER
$FEES WATER SUPPTY
PUBLIC tr E OTHER
TOTAL
COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST, BOX: GAT.
DRAIN FIETD REQUIRED
TIN. FT TRENCH WIDTH FT OR SQ. FT
TYPE OF STRUCTURE OCCUPANCY ZONE PUB[IC UTII.. EASEMENT
BIDG. SETBACKS FT. FROM CTR. OF ROAD RIGHT OF WAY
TRONT SIDE INT. SIDE EXT.
USE CTASSIFICATION
REAR
AUTHORIZED SIGNATURE _ DATE DATE
BIDG. PERMIT _ WHITE
OFFICE COPY _ WHITE
COUNTY TAX _ PINK
PtUMSING _ CANARY
BUITDING _ GREEN
SANITATION _ GOI.DENROD
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 THls pERMlr ON MAIN BrDG. AT SITE)
TANE COUNTY, BTDG. & SAN. DIY., COURT HOUSE, EUGENE, OREGON 9740I
FoRM=C55-t3
r I
-
SITE INSPECTION
AppnovEo
RruaRx s
D r sappRovro Dare Ir.rspEcroR
FOUNDATION I NSPTCTION
AppRoveo
REua Rx s
Drsappnoveo Darr I Nspecton
FRAM I NG
Appnoveo
Rr uenx s
I NSPECT I ON
Drr r I NSPEcToR
LATH OR SHEETROCK
Appnoveo
ReurRxs
I NSPICT I ON
Dr sappnoveo Dar E I NSPEcToR
FINAL INSPECTION
AePRovEo D DrsappRove, D
Reua nx s
Darr I NsercroR
CERTIFICATE OF OCCUPANCY
Reaov ro I ssue
REuanx s
D Nor Rraoy ro lssuE D Dore_lNsee cron_
l_- DrsAPPRovE, D