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Home My WebLink AboutPermit Backflow Test 1978-08-25.z.z *t z 00 JOB LOCATIONTRS, T Acreage or Lot Size Contractor's O.S. # LANE COUNTY PERMIT Partitioning #-( ) Completed Subdivision Lot Blo ck APPL|CANT,S NAME AND ADDRESS Phone_ CONTRACTOR'S NAME AND ADDRESS OWNER'S NAME AND ADDRE Mailpermitto()Applicant()owner()Contractor.()Prefertopickup.Call-(owner, etc.) when ready Phone Phone STRUCTURES NOW ON THE PROPEBTY ' THIS PERMIT IS FOR , # BEDROOML# PLUI\4BING CONNECTIONL Date - UATER SUPPLY SEWAGE DISPOSAL s.l. # THlSPRoPERTYlSWlTHlNoNElVllLEoFTHEClTYoF.PLUN/lBlNGBY I hereby certily that the above statements are true and accurate, and that I have the following legal interest in the property: -owner ot record; -contract purchaser; - potentiai buyer; - reallor or agent. I lurther certify that (iI not the owner) | am authorized to act Ior the owner of record, and that said owner is aware and approves of this action. I hereby agree to complV with all applicable Codes relating 10 this permit. SignatureFee Paid $- ()NEWAODBESS () FACILITY PERMIT TO TRANSPORTATION DEPT.- { ) SPECIAL PI\4T. AREA. I\4IN. ELEVATION: - SANITATION Minimum Septic Tank Capacity (Gallons) Drainfield Required - Lineal Feet Maximum Depth BUILDING Type of Construction se Classification Comments: roup -Fire Zone Comments B Date: PLANNING REOUI REMENTS SATISFIED. By ZONE:SETBACKS: FRONT B Date Date Date lssued SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROM P/L) 5-? LANE COUNTY DEPARTMENT OF ENVIRONMENTAL TVIANAGEMENT, 125 EAST BTH AVE., EUGENE, OREGON 97401 POST THIS PERMIT ON MA!N BUILDING AT SITE c55-13 BLoG.pERMtr-wHrrE; BUtLDtNG-GREEN; pLUMBTNG-GANARy; sANtrATroN-GoLDENRoD; oFFtcEcoplu-wHtrE PHONE 687-4394 I l 10 OT}.lE R FROI,I: FLOOD PLAIII iTiIIAGi}4IiIT 0EPARTI'ItllT 0f PUBLIC ;-0lr:5 PHSirr - 687-4195 SUBJECT: BU ILOII'tG PTR}lIT HUI'tBE ?. ZffO -78 PARTITIot{ NUi,tBtR ll,ii'/7'-- -z{ T.L \,EE,A E}L\E LO-T T I PLAIi:,I i;'G PtRI.IIT PROCE35IIIG BLt<3 SUBOIVISIOT'I OTHIR slTE Ii{ FL00D HAZARo AR[A. YtS-- ilO DiTAILID STUDY NOT A SUBSTA.'{TIAL II,IPROVEI'IEIiT HII{lllrH rL00R tLEvATloil REQUIRED SITE II{ OESIGXATEO FLOOD HAZARD ARTA TXTRA PRECAUTIONS HAY BE APPROPRIATI. RECOI'S.IENbAT IONS: APPRCXIIIqTE STUDY r)ATE P,//a BY & INDIVIDUAL SEWAGE DISPOSAI 'YS RECORD taller: Complete top p rm to signature and return both copi e County Building Sanitation Department.i\o\-YA Insta s Name Io.lv rope ec Water PubU.c [ Other-List 3 0-r.,6./ { Bectrooms Baths Basement yes fl no E rt. fro well Steel f! Concrete No. Co$partnents length widrh Dianeter Depth Gal. Capacity T spos eDistribution Box:yes E NoE r on- Feet Iot Line er below pplican Nane I aili.ng Mdress Length of Lines - Ft. 1. 2. 3. 4. 5. 6. Trench width --) sq{rt.betrreen CDlrines /1) Total ft. -1 (- Filler _lyp. I Eiller depthEbroVB qtile J i., -tch See instructi -_ l[^.rSL ltftoal €M traL ru'f"^ /tt*t- -tj,, Signature G*tt't Date For SEnitarian Use Only: E epproved; Systen Installation Conforms to Current Standards E Oteapproved: DoeB Not Conform to Current Standards &enarkrl Date: Lane County Buildlng t Sanitatlon Dept. Sanitarian I s Signature to Lane / LANE COIINTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 1- EAST 8TH AVENUE, EUGENE, ORE. ,'l 97401 PIANNTNG DIVISION Current Zon AVENACE PROCESSING pt *i,Partltlonlng f_ J-lRencttng [-lcompleted Parccl No._ Partltlonino Re qu I red Oth€r t s sr tl T HATER POLLU?ION CONTROL I of Sltea_ Nar Slto InBp€ctlon(e)_ SDS Conatructton l-1 Ney f] nepalr of Bedrooms r LaL/strlal - I o!Ioyeea s s Other qb\ CONSTRU TION PER.YITS AND IIISPECTION(See abovc for I of bedroomsr/f of employeea) t] :{obtls Ho'oe' f] permanent n Temporarv t] Reneual Ft valuatlon s t rEE s TotaI V!Iuntion)) Plunblnq fixtures at s t\oo,aq- rd o tu _- Sewery'.rater Conn. at I Each S I-'ach 3 Subtota I TOTAL BUILDING PERHIT TEE al Statc SurchargG Plans Check Fee Change of Occupancy l{lnlmura atructural setb.cks : FroE centerllno of atreet: pront Exter r+o ot, sI Froo intcrlor lot Linee: Sid "5-lde "."r 1 rq_ f cor.tu,l pl PUBLIC IATiDS PUBLIC WORKS C!%" io* s ans Bheet to appllcant Curb cut to a[)pIlcant Minimum \J5.---3 -; or that the omer of record is knowled.leablo of thrsfurther.r,Jrec to comply wlth dlI eppllr.:.r[rIe codes relat rng res9 Fac lty Pernit EIry I ROII:'..EIITAL Checl I ALTII Caah Rcc'd by AFFIDAVIT: -rf thls permit is for an agriculturat building, I hereby declare that this buildlngwlll be used for agricultural purposes as.rllowed by zoning and,/or ihe slate Building Code, and !9T n" othgr-?.uqPose. I further certify that the "iate*enis and other information submitted ontnls aPPrf$*),orf\are true and accurate, and that I have Lhc following legal intereat in theProl)erty: \&dQyger_of recordi contrict purchaser; --_lessee; h<.)lder of an exclusive opLionto purchase-__dtrIy authorizcd-Lo act for ! person wh-<i-has tho tdflr>wrng legal interest:lane coLrnty APP caE not t (r OwnCr. Ito Da licantrs Sirnature T}IIS IS YOUR RECEIPT. AND DOES }JOT GIVE YOU PERMISSION TO BUII,D Address lltinimum Elevation ,fdr,r. Hr),HHoz €7v, utcu,t,.H, Hv,Ho rOR IN I A.BOUT THE PROGRESS OP YOI'R APPI,,ICATIOTJ, CAt-I, FI.:RMIT CONTROL, 687.' ]57 (687-HSLP) 6l!'-- tl fl fl I s s s 3 1 t, o =a ,^r r-,r{ .:t/aaarlii.ir to1 t."' .1 }rr2rloalrt lfrrn Coq.lotrl I8l (r, Etr"lrEr?) ,rll go.rLnr! nuitt T0 lrrttc^rt Ott O, tSiSIff (r..ld.nrt.l I rtF A;'PLICATI (f fr' llv APtornt-.[t lt t. Oltlc lror ht; ar Tr F t ts : I T -l (r- t? tr? 7_c c6sTtAcr(ll'5 OIE. STAIT L ctrcLr 6r)l-J trz?El t0 ?rcr u?. c^LL 3 cotrclrl .r l.aatrl.l3 r.c..t!.t..) m ft o[rf,rLts[Eoa. rrcrttt ,n$c?uIr x(r c tr! no?rrn.ll rl Ar.I tI 6 !. ll*:Dlrl.,Jrt lor Tlrls tiortrn (:ills ^p?Lr ,lcAIIOr) Artr fc, r, vrr ^ a. Fu?urt ?u!r!: boradr(btordrtlrtcl (e) rll ?aotsara a-.1.(al rac-rtr ?L t.,tott, lajl rl lltnjr (d) erlrtropoll artararar... lt coe rct rrtr t tn1,/proporrd bulvrur (f) rrtrtrnt/p otrrar Fart lomt ,a.t u IrDtcr?z DtEt{!tot3 c) tl a.y ra aa n9Jatraa a rrrlr rt ?f tl nt! rrt r or.P c aa ) rl (. ai rl ra .l . t.nd t lnrja por drr Cl. (h) rh ot, raI ,ra,rl.l...ral 'l ::l:: arlt-' I'1'::.l .. ,l::: 'i'ji.t... I I T J T g Eg E$ a I G ...? I I-l :-. I.t. l. il ,.1, ':l .:1. (D^TT .l 1 I , I I iit: It..t: I I .! I -:! I I i I I I I :l 'a :..: .l 'f,l l.! 't l.:'' l.i:.l:i::l"': im liiii Lf: I I i.. I Ii':t,.t. I It'a. r- I I I I I I I Ij I I I I I l -l l(rL t 3sl[cTt I I ITSIsc DYLTtl, ,ot^t Lo, 3trt or Acra(:r t lloPosrD r:rtFt st, 10. l!.tr.TrtcrTt rurii! ll. lAtuflt crs ,y It, rttt Dt5?r tcr srxui ._ .- [rrE _- . tuil.:c i rcI '.,t.1, l]. 1Cf0(,L Dl$I lr. ,tt |trsc l? aataaaaaatttaitaaaalrataa.atta t " D0 l{r1T !.'iITt ltt.(Ia Tlll! LIX! ......i...t........t.......r..r rllt, r!||| lttllcrrl(x crr x rlocEs::[D You rl'sr ft'rlrrsr! 6\ril ?LOr rtrrs ---Lrc^L D[3.-lr?rtor(Dtr.rsroNt0) k''€ ?X LANE COUNTY DEPARTMENT OF ENVIRONMENT AL ANAGEMENT 1?5 TAST 8TH AVTNUE, EUGENE, OREGON 9740I n :'t tt .lt l,i .a ( iitt L I I i I I I I l. LfllloD of srr-^c! I I I I I I i . r' LOT i i ELOCK l_i], lir c r\'I B KIPiJAflI BU 1'P.tr,E. 8t'>+*- lq'- | \- RE LOCA.I ION OF SE F- ,c- Dp.AtN u i }..8.,.' /'NOIL: PA QTI A T I l ,?r I I J + I I I I I i ; (r)t EV 's'Ttt{e} 8.E-st Dtr,'\<{L L-- I i t I I L r t I rI I I I I i i rilr l__L_ 'TRS;T t t7-$-21 Job Location (Street, mile post)L/E> Uere ln Subdivision Lot- Block - PIot Pt1\n br,txe'L 8ll [/ 3 FOR SAN|TAR|AN,S USE ONLy: Rryff|n Aooroved COMMENTS: //////, .$dlt0t ff System Disapproved fl Needs Correction Date:S nature FOR INSTALLER'S USE: Trench Depth Zz Filler Depth Below Tile Tank Capacity lVanufactu lVleasured distance to well from tank from drainfield Scale: J\q, -l kl Qosc t\IE Lir*i/ :" ,s ^t*jano i$It \^ u.IF o I N N IJJElF z (9 6 anut EE:or<\ \\\ -]tI -7 q -h- ^\-\)\A $s {g q, .= '6 =o E(oz J'Pc(o() ao- m Lg GPoc Iq +o-6 o INSTALLATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat- isfactory completion of a subsurface sewage disposal system at the above location. Return this form to: Permit Processing Section, Department of Environmental Mlanagement, Public Service Building,'125 East 8th Avenue, Eugene 974O1 \.*r"t ?5n0rl pt L ar'l 5> "t 1 atllt ,1gwro, -\1 ol> Df c55-1 1 t )prls th lle ) .\: d.., .r) ' *c}.9 ^trtro7Fd JJ TRS, T ,3,Z *lLoo JOB LOCATIO Acreage or Lot Size Contractor's O.S. # Signatu re () NEW ADDRESS () FACILITY PERMIT TO TRANSPORTATION DEPT LANE COUNTY PERMIT Partitioning #-( ) Completed Subdivision Lot Block- APPLICANT'S NAME AND ADDRE ss OWNER'S NAME AND ADDRESS CONTRACTOR'S NAME AND ADDRESS Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call (owner, etc.) when ready Phone- Phone-- Phone-- s.l. # STRUgTURES NOW ON THE PROPERTY THlsPERMlTlsFoR#BEDRooML#PLUlv]BlNGcoNNEcTloNL )WnTEn SUPPLY SEWAGE DISPOSAL THlSPRoPERTYlSWlTHlNoNEMlLEoFTHEClTYoF.PLUtVlBlNGBY I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: -owner of record; -contract purchaser; - potential buyer; - realtor or agent. I lurther certily that (if not the owner) I am authorized to act for the owner of record, and that said owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit. Fee Paid $-Date - () SPECIAL PIVIT. AREA. IVIIN. ELEVATION SANITATION lVlinimum Septic Tank Capacity (Gallons) Drainfield Required - Lineal Feet Maximum Depth BUILDING Type of Construction -Group Use Classif ication Comments ire Zone Comments Date PLANN ING REOUI REIVIENTS SATISFIED. By Date Date lssued ZONE SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROIM P/L) LAN E COUNTY DEPABTI\4ENT OF ENVIRONI\4ENTAL |\4ANAG EMENT, 125 EAST 8TH AVE.. EUGENE, OREGON 97401 PHON E i 687-4394 POST THIS PERMIT ON MAIN BUILDING AT SITE BLOG.PERMIT-WHITE; BUILDING-GREEN; PLUMBING-CANARY; SANITATION-GOLDENROD; OFFICECOPY-WHITEc55-1 3 By:By:Date: F SLAB FLOOR PLUMB ING GROUND,./ORK Apeeov r o Re t{rnx s Drsrppnovro Dlr e I rusercroR GAS PIPING GROUND/ORK Aepnov r o Reua Rx s D DrsappRovro D Dare,I Nspecron ROUGH PLUMBING Appnovro n DrsrppRove , D oart /&-d77f,tn RrxeRr s SPECTOR ROUGH GAS PIPING APPRoV E D RexaRx s D DrsappRovrD n Dnre I ruspecron FINAL PLUMBING AppRoveo m DrsappRoveo Reuanx s y'-a-zr /P1+Drrr I NspecroR FINAL GAS PIPING AppRov e o REulRr s DTSAPPRovED DnTr I ruseEcron CERTITICATE OF OCCUPANCY Rraov ro lssue Rrurnx s D Nor Rraov ro tssue D Dare I NsPEcroR // OWNER'S NAME AND ADDRE ccAPPLICANT'S NAME AND ADDRE ss TRS, T Acreage or Lot Size Contractor's O.S. # Comments By: JOB LOCATION LANE COUNTY PERMIT Partitioning #-( ) Completed Subdivision Lot- Block- Phone--- Phon CONTBACTOR'S NAME AND ADDR Mail permitto ( )Applicant ( )Owner ( )Contractor^ ( )Prefertopickup. Call-(owner, etc.) when ready STRUCTURES NOW ON THE PROPERTY---- THlSPERMlTlsFoR#BEDRooML#PLUlv]BlNGcoNNEcTloNL l SEWAGE DISPOSAL\A/ATER SUPPLY- Fee Paid S- s.t. # TH IS PROPERTY IS WITH IN ONE I/] ILE OF THE CITY O F-. PLUMB ING BY ---I hereby certity that the above statements are true and accurate, and that I have the {ollowing legal interest in the property: -owner of record; -contract purchaser; - potential buyer; - realtor or agent. I lurther certify that (if not the owner) I am authorized to act for the owner of record, and that said owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit. Signatu re Date ()NEWADDRESS () FACILITY PERIV] IT TO TRANSPORTATION DEPT.- I SPECIA L PMT. AR EA. NIIN. ELEVATION SAN ITATION BUILDING Type of ConstructionlVlinimum Septic Tank Capacity (Gallons) Drainfield Required - Lineal Feet Maximum Depth Date a"r.n""* Use classification By rou p Date ire Zone PLANNING REOUIREMENTS SATISFIED. By Date Date lssued ZONE SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROM P/L) LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST BTH AVE., EUGENE, OREGON 97401 POST THIS PERVIIT ON MAIN BUILDING AT SITE C55-1 3 BLDG.pERMtT*WHrrE; BUtLDTNG-GREEN; pLUMBtNG-cANARy; sANrrATroN-GoLDENRoD; oFFlcEcopy-wHrrE PHONE: 687-4394 Phone-- r-l\- -/ I rspEcron S I TE INSPECTION Appnov r o Reulnx s Dr sappnoveo Dare FOUNDATION INSPECTION APPRoVED D DrsAPPRovEo -7 Drre I Hspeclon Remr nx s -22-7"'4 FRAMING INSPECTI A ppRov E o Dr sappnovEo Detr ?-24 -I rsercr <?*.- "yy"k-€.'"-,-*i)&*:-Re KS LATH OR SHEETROCK Ap pnov r o Reurax s I NSPECT I ON D r slppnovro I rspecton a-<D oert /-/o -aZ v FINAL INSPECTION Ap pnov r o Reuanx s 4-r-l - txsprcronD r sappRoveo Darr CERTIFICATE OF OCCUPANCY Reaov ro lssur Rruanx s Nor Rrrov to lssue D :<t4 D Dor._lusercton- IANE COUNTY BUITDING BUILDING E MH E PERMIT OR MOBITS HOME USE PERMIT PERMIT NO. PROPERTY OWNER MAILING ADDRTSS PHONE CONTRACTOR MAII,ING ADDRESS PHONE PROPERTY IOCATION - INCTUDE POST OFFICE PROPERTY I.EGAI. DESCRIPTION _METES, BOUNDS RANG E SECTI ON TAX LOT NO CODE CENSUS TRACTdzdo EXISTING STRUCTURES ON PROPERTYAPPT. NAME & MAITING ADDRESS I.EGAT ACCESS TO PROPERTY PROPERTY SIZE - FT. WIDTH DEPTH AREA FOR MOBILE HOME PERMITS ONLY No. of Bedrooms Connecl to Existing Sewoge System f New System ! STRUCTURES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION sQ. FT. # BDRMS VALUATIoN SEWAGE DISPOSAT PUBTTC ! SEPT|C TANK .[]. OTHERI PI"UMBING INSTALI.ED BY OWNER n OTHER: NAME s F EES WATER SUPPTY PUBUC tr N OTHER BUITDING WASTE DISPOSAL PTUMBING PTAN REVIEW PARK TRAITER TOTAL COUNTY BUILDING & SANITATION SPECIFICAIIONS MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAT. DRAIN FIEI.D REQUIRED tIN, FT TRENCH WIDTH FT OR SQ. FT TYPE OF STRUCTURE OCCUPANCY ZONE PUBTIC UTIL. EASEMENT BI,DG. SETBACKS.- FT. FROil CTR, OF ROAD RIGHT OF WAY FRONT SIDE INT. SIDE EXT. USE CLASSIFICATION REAR AUTHORIZED SIGNATURE _ DATE DATE BLDG. PERMIT - WH ITE OIFICE COPY _ WHITE COUNTY TAX _ PINK PTUMBING _ CANARY BUITDING - GREEN SANITATION - GOTDENROD Construction to comply with uniform buildin covering plumbing ond sewoge disposol. Al of occuponcy before being occupied. code ond county regulotions buildings require o cerlificole s I (See Stotement on Reverse Side) (POsT THIS PERMIT ON MAIN BIDG. AT SITE) LANE COUNTY, BIDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 9740I ronu lfcs5-t3 B U I I-D ING S ITE EVALUAT ION fu"kY.t /7^ 3s *z rAx Lor cerusUS Tmtr --*-<^-,t--/lt#r- - W S=r(*f I fr ) () Buildins Permit Appt icat i"" n". Ry'Z7-Zi S i te lnspect ion Pre-Permit lnvest igat ion APPL I C NA}'1E ADDR S PHONE DATE L/INE COUNTY PLANNING DEPARTHENT NOT NO YES NA}1 E Di\TE 2 ').) 4 5 appl icable Zon ing Ord inance Comp I i ance fI -(zone rR4 ) Subd iv is ion 0rd inance Comp I iance ( ) () (,/ () ({ () ({Requ i red Access 8u i ld ing S ite (Area, L/idth, Frontage, Segback) 0ther (see comments)() () () ) COI,II{ENTS: BUILOING INSPECTION SECTION 6. Plans Submitted 7. Soil Stability (footings) 8. Flood Pl a in 9. 0ther (see Comments) NOT NO I6i't icable*rT-( )(r () YE5 m () NA.I4E DATE t{ () () ()/ *l/*r$ COHHENTS: SAN ITAT ION SECT ION 10. Sewage Disposal ll. Usable Area 12. Iy'ater Supply ]r3. 0ther (see Comments) NOT N0 YEq() a)() 6 () Lrl E DATE aool icable*-rr- ) () () (T ) COMH ENTS TO APPL I CANT: Your Bu ild ing Permit / S ite lnspect ion; N can be approved . l- 4 - I # tlS - ( ) Cannot be approved at this t in,"--J{ indicated on iten, N0 above. Quest ions and further infornrat ion on itenis I through 5 contact the Lane- COUNTY PLANN ING DEPARTMENT" Q.ues t irins and furtlrer infornrat ion on iffi 6 t hrouq h l3 contact the Lane CourrLy 8ur i ld irr g .irrd San i t at ion D iv i s ion. Will be held in this off icc until you can resolve tlre problems indicat'ed. ls being returned. Your buildinq pernr it applitrat ion lee is being returrred under separate cur'er. LANf COIJN"I Y t'I /\NN ING DEPARTMENT l3t Si,xtlr Avcrrue East, Eugene, 0regon 9740 I l'ntrNE 3Ir2" llll f;xt. 211 IANE COUNI.Y I]I.JILDING 6 S/\NlTATlON DIVISION l3t S ixt,h Av€rrur.: East n Errtyetr,', 0r eqon 974Ot PHL)NI: 342*|]lt txr. qrt M55 - 28 () t6tu () () () 'Dote Permit No CURB CUT PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF IANE COUNTY WHEREAS, the_ottoched opplicotion hos been fully considered by the Boord of County Com- missioners of Lone County, ond ii is the.opinion ond iuigment of the Btord thot the soid oppiicotionshould be gronted, ond thot o permit should be issued, now, therefore, it is hereby. I I ORDERED, thot o permit be ond is hereby issued to for plocing, buildingor constructing the following focility: upon the right-of-woy of County Rood No. _ WHITE _ OTFICE FILE GREEN - RESIDENT ENGINEER PINK _ PERMITTEE o, ond subiect to oll terms, conditions, ogreements, icotion ond permit, the Rules ond Regulotions Gov- od Rights-of-Woy, os set forth by the Lone Mon- y other opplicoble regulotions, low or ordinonce. Mile Postin strict conformity to the exhibits ottoched heret sfipulotions_ ond provisions contoined in the oppl erning Focilities to be Permitted upon County'lio uol 50.190(2) ony omendments thereto, ond on 2 Speciol Provisions: Drivewoy will be constructed in occordonce with the ottoched drivewoy opprooch specifico-tions (Drowing M98-50). Permittee will be responsible for the immediote removol of oll mud, dirt ond debris from theroodwoy.ond right of woy coused by his operoiion, leoving the roodwoyond oreo in o neot, occeptoble condition. This permit is revocoble ot ony time, ond will be strictly odhered to ond no work other thon thot specificolly mentioned obove is hereby quthorized. This permit sholl be void unless the work herein contemploted sholl hove been completed be- fore 19-. Expires 19 lnspected ond Approved Approved by Boord of County Commissioners By Dote By BTUE _ ROAD SUPERVISOR ORANGE - BUITDING & SANITATION DEPT. YETTOW _ REAL ESTATE Director of Public Works c98-7 9 Dote Building Permit APPLICATION FOR FACILITY PERMIT (Appliconl's Nome) hereby moke opplicotion under Rules qnd Regulotions Governing Focilities to be Permitted Upon County Rights-of-Woy, to construct the following focility: Upon the right-of-woy of County Rood No.ot mile post on the side of the roqd, or - os shown on the exhibits which ore ottoched hereto, in strict conformity to the stotements of the exoct nqture ond omount of work to be done, ond to the description of the focilities contoined in soid exhibits. The opplicont will be the principle owner of the focility os constructed, or other- wise primorily lioble ond responsible to members of the public for its Proper mointenonce, repoir, operotion ond use. The opplicont occepts oll terms, conditions, ogreements, stipulotions ond pro- visions, in Rules ond Regulotions Governing Focilities to be Permitied Upon County Rood Rights- of-Woy, os set forth by the Lone Monuol 50.'l9O(2), ony omendments thereto, ond ony other op- plicoble regulotion, low or ordinonce. Sig noture Address Zone mor WHITE - OFFICE FITE GREEN _ RESIDENT ENGINEER PtNK _ PERMITTEE c98-78 BIUE - ROAD SUPV. ORANGE_BIDG. & SANIT YEttOW _ REAL ESTATE lo Permits Processing Noted Dole Noted Directo r Principol Engineer Subdivision Engineer Permit Engineer Weighmoster Phone No. # l, _ IANE COUNTY BUTLDTNG E BUITDING PERMIT OR MOBIL, rIOME USE PERMII PERMIT NO. PROPERTY OWNER MAITING PHONE CONTRACTOR MAILING ADDRESS PHONE PROPERTY TOCATION - INCLUDE POST OFFICE ri..Sr* PROPERTY TEGAT DESCRIPTION -METES, BOUNDS RANG E SECTI ON TAX LOT NO CODE CENSUS TRACT EXISTING STRUCTURES ON PROPERTY APP[. NAME & MAITING ADDRESS LEGAL ACCESS TO PROPERTY PROPERTY stzE ASL,\f\s WIDTH AREA FOR MOBILE HOME PERMITS ONLY No. of Bedrooms Connecl to Existing Sewoge System ! New System ! STRUCTURES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION sQ. FT. # BDRMS VALUATIoN SEWAGE DISPOSAT PUBTIC N SEPTIC TANK N oTHERn PLUMBING INSTAILED BY OWNER E OTHER: NAME BUILDING WASTE DISPOSAI PTUMBING PTAN REVIEW PARK TRAITER FEES WATER SUPPLY PU BI.IC OTHER TOTAL COUNTY BUILDING & SANITATION SPECIFICATIONS IV{IN. SEPTIC TANK CAPACITY WIIH DIST. BOX: GAL. DRAIN FIELD REQUIRED UN. Fr- .TRENCH WIDTH FT.OR SQ. FT. TYPE OF STRUCTURE OCCUPANCY ZONE PUBTIC UTIt. EASEMENT BTDG. SETBACKS FT. FROM CTR. OF ROAD RIGHT OF WAY rRONT SIDE INT. SIDE EXT. USE CLASSIFICATION REAR AUTHORIZED SIGNATURE - DATE DATE BTDG. PERMIT _ WH ITE OFFICE COPY - WHITE COUNTY TAX _ PINK PI.UMBING _ CANARY BUITDING _ GREEN SANITATION _ GOLDENROD 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 THts PERMTT ON MAIN BLDG. AT S!TE) LANE COUNTY, BTDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 9740I FoRM # c55-,3 MH I_I FT.- DEPTH $-_- E SITE INSPECTION Ap pnov E o Ret'lanxs DrsappRoveo Dare I ruspecron i FOUNDATION INSPECTION APPRovEo @ DrsappRove o 77 Darr ReuaRx s t-F Ittspe c & 7-,o FRAMING INSPECTI AppRovro Rero**t,* Dr snppnoveo Dr I NSPEcToR e, -7, LATH OR SHEETROCK INSPECTION Ap pRov E o Rrxnnxs Drsappcove o Fa oorr 4'LL'7t/I Nseecton ct I FINAL INSPECTION Ap pRov r o Reuanx s Drslppaoveo oor, (i'J /'7 f ,f- LI Nspe CTRTIFICATE OF OCCUPANCY Reaov ro lssuE RrunRxs D Nor Reaov ro lssur D z t/0 7-7I /t/d3 Drre l xspectoa r - ./'4-I /{.71 =D D / IANE COUNTY BUTLDTNG E BUITDING PERMIT OR MOBIL. .,IOME UsE PERMIT PERMIT NO.MH PROPERTY OWNER MAII.ING PHONE CONTRACTOR MAILING ADDRESS PHONE PROPERTY TOCATION _ INCLUDE POST OFFICE PROPERTY TEGAT DESCRIPTION _ METES, BOUNDS RANG E SECTION TAX LOT NO.CODE CENSUS TRACT EXISTING STRUCTURES ON PROPERTY APPL. NAME & MAITING ADDRESS LEGAL ACCESS TO PROPERTY PROPERTY SIZE - FT. WIDTH DEPTH AREA FOR MOBILE HOME PERMITS ONLY No. of Bedrooms Connect to Existing Sewoge System f New System ! STRUCTURES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION sQ. FT. # BDRMS VALUATION SEWAGE DISPOSAT PUBIIC tr SEPTIC TANK n oTHERn PTUMBING INSTAIIED BY OWNER N OTHER: NAME BUITDING WASTE DISPOSAT PTUMBING PI-AN REVIEW PARK TRAILER F EES WATER SUPPTY PUBUC tr tr OTHER TOTAT COUNTY BUILDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GA[. DRAIN FIEI.D REQUIRED tIN. FT TRENCH WIDTH FT.OR SQ. FT. TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIL. EASEMENT BI,DG. SETBACKS FT, FROM CTR, OF ROAD RIGHT OF WAY FRONT SIDE INT. SIDE EXT. USE CLASSIFICATION REAR AUTHORIZED SIGNATURE _ DATE DATE BTDG. PERMIT _ WH ITE OFFICE COPY - WHITE COUNTY TAX _ PINK PTUMBING _ CANARY BUIIDTNG _ GREEN SAN ITATION _ 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 THrs PERMTT ON MA|N BrDG. AT SITE) I.ANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 9740I ronu # 955- 13 SLAB FLOOR PLUMBING GROUNU/ORK AP PRoV ED Rruanx s /J Drsrppnovco fr Dar e I rus pE cron GAS PIPING GROUND^/ORK Ap pRov r o Reuanx s D r sappRoveo n Dare I rusprcron ROUGH PLUMBING AppRoveo N DrsappRovro D oord.--7-7?._ Rrunnxs lNsprcr ROUGH GAS PIPING Appnovro Reuaar s D DrsrppRoveo D DarE I NseEcron F I NAL PLUMB I NG AppRoveo N DTsAPPRovED Rr uanx s aorr('/O ) q I NspecloR {, FINAL GAS PIPING AppRov eo ReuaRrs D t sappRoveo Dare I NspectoR CERTIFICATE OF OCCUPANCY Rraov ro lssuE Reua nx s D Nor Reroy ro lssue D Dare I rsprcroR {IANE couNTy BUTTDTNG pERMrr oR MoBrrE r.vME "fl#,CATIONPERMITTYPEBUILDING( PROPERTY OWNER MOBILE HOME Ll osc REG. #PERMTT #/a 7-MAITING ADDRESS MAII.ING ADDRESS PHONE PHONE PROPERTY I.OCATION _ I NCLUDE pOSr orrtce453'/4 iu n /)e_tR k-- PROPERTY TEGAI. DESCRIPTION TOT-BLOCK_SUBDIV..3 METES&BOUNDSEYES ATTACHED NOTWP APPI.ICANT NA/v{E AND MAII.ING ADDRESS RANGE sEC.TAX I.OT L-' CODE CENSUS TRACT D. DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY ACCESS TO PROPERTY _ ROAD NAME OR ,OtZ,t u(, PROPERTY SIZE_WIDTH DEPTH AREA FOR MOBIL HOME penmrr Number of Bedrooms STRUCTURES TO BE EUITT THIS PERIi{IT Connect to Existi n9 Sewoge System I or New System Req.ITYPE CONSTRUCTION SQ. FT.# BronooMs VATUATION SEWAGE DISPOSAT a 3 /6 7 v PIUMBING INSTATTED BY PUBI,IC SEPTIC TANK OTHER FEES WATER SUPPIY OWNER OTHER NAME PTANS FURNISHED FACII.ITY PERMIT BI.DG. WASTE DIS. PI.UMBING PI.AN REVIEW PARK TRtR. TOTAI. 4 ,,54 , rY)PUBTIC OTHER PTUMBING FEES FIXTURES ,a0 YES . oo x NO YES NO SIGNA DATE CASH E CHECK FEE 73 PUBI.IC WATERt6"^ii.uiiiilili',, / , 50 COUNTY BUILDING & SANITATION SPECIFICATI ONS MIN.C TANK CAPACITY DRAIN F TIN. FT. REQUIRED WITH D 8OX: GAT. TYPE OF STRUCTURE OCCUPA BI,DG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY TRENCH WIDTH IT. ZONE L OR SQUARE FEET YARD USE CTASSIFICATION PUBTIC UTIT. EASEMENT Form # cs5-12 SIDE EXT,nern 5 Dote NT / sror rNr reclions to Find Property: Dote Dote BLDG. COPY I -OFFICE COPY 2 - JOURNAT COPY 3 - AUDIT ) /