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HomeMy WebLinkAboutPermit Building 1976-06-16t%* BE ISSUED I]NTIL THIS APPLICATI: NO PERMIT SII CONSTRUCTION MOBILE }IOME OWNER CONTRACTOR Name o.s. REG. /l *r. 17 *n "3-1LSection PERMTT # /1 ?/*76 BEEN APPROVED 1p Phone ,7 Phone 7& t2 8r'67 Scensus Tract Name of CourmunLty or Publlc System Name Water Cormection APPLICATION FOR: PLAN REVIEW ess Address Tax Lot f Block Ft Exlsting Sewage Pub roperty Acreage W nr@"pthJz7!/ ity Code P ACCESS TO PROPERTY (Road Name) Existing Structures on Property: Property Location - Address/Dlrections Below Offlce SEWAGE DISPOSAL: Site Inspec tion /l 41if"t., E[. or New system Required f-lW}'IATER SIJPPLY: Well B1dg. - Plunblng 3% Surcharge Waste Dlsp. Plan Review Mob1le Hone Spring _lty PL Ins PLTJME Other S"^",; Prl- CASIi CHECK Dralnfleld s PLANS FURNISHED YES Signature of Applicant Fee Recelved By: - Li.neal Feet YEq Date: NO NOI TOTAL {, AO .7 by Owner FEES: ING ! ll ot lYpe of Construction Flre Zone Use Classificat LANE COI'NTY D TI,IENT ENVIRONMENTAL Zone Bldg petbacks - from Center of Road Right of Way: Front Side Int. Side Exterior Rear PIANNING DATE:,TION:DATE: cs5- 12 ? FACILITY PERMIT Min. Septlc Tank Capacity_ \\ LANE COUNTY PERMIT FOR:PERIMIT NO CONSTRUCTION [ ] MOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ] NAME ADD R ESS CITY ZIP CODE { n Owner PHONE tr Contractor NAIVIE ADD R ESS CITY ZIP CODE ae{.F Range- Section ? Tax Lot- Code- Census Tract Lot Width DepthAccess to Property (Road Name) PHO NE O.S. Reg. + Twp Subdivision Existing Structures on Property: Directions to Property - Address STRUCTUR E (# BEDROOIVIS}SO. FT VALUATION SEWAGE DISPOSAL: PUBLIC [ ] SEPTICTANK [ ] OTHER [ ] PLUIVIBING INSTALLED BY: OWNER[ ] OTHER[ ] NAM tr BUILDING 3% SURCHARGE MOBILE HOt\4E WASTE DISPOSAL PLAN REVIEW TOTAL WATER SUPPLY: PROPOSED t ] EXISTING t ] PUB LIC COMIVIUNITY. NAME PRIVATE WELL OTHER .SPECIFY CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS IVIIN. SEPTIC TANK CAPACITY GALS.IVIIN. DRAINFIELD LIN. FT IVIAX. TR ENCH D EPTH I NCH ES STAY 1OO'FROt\4 ALL WELLS TYPE OF CONSTRUCTION G ROUP FIRE ZON E USE CLASSIF SETBACKS FT. FROIVI CTR. OF rM FRONT SIDE EXT FT. FROIVI PROP. LINE: SIDE INT. - REAR ZONE AUTHORIZED SIGNATURES lsl ISSUANCE DATE BLDG. PEBI"4IT - WHITE OFFICE COPY - WHITE COUNTY TAX _ PINK PLUMBING - CANARY BUILDING _ GREEN SANITATION - GOTDENROD IMPORTANT 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 conslruction 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 subsurlace sewage disposal and the State Plumbing Code. All buildings require a certilicate of occupancy before being occupied. (See Details on Reverse Side) B lock Acreage - PLUIVIB ING LANE COUNTY PERMIT FOB:PERIVlIT NO CONSTRUCTION [ ] IVIOBILE HOME [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ] NAIV]E ADD R ESS CITY ZIP CODE ! Owner PHONE D Contractor NAIVIE ADD R ESS CITY ZIP CODE Range- Section-Tax Lot- Code-Census Tract Lot - B lock Acreage Width DepthAccess to Property (Road Name) PHONE O.S. Reg Tw Subd ivision Existing Structures on Property: Directions to Property - Address STRUCTURE (# BEDROOTVIS)SO. FT VALUATION SEWAGE DISPOSAL: PUBLIC [ ] SEPTICTANK [ ] OTHER [ ] PLUIVIBING INSTALLED BY PLUIVIB ING - BUILDING 3% SURCHARGE IVIOB ILE HOIVIE WASTE DISPOSAL PLAN REVIEW TOTAL OWNER OTHER NAfVI E WATER SUPPLY: PROPOSED t ] EXISTING t] PUB LIC COMIIVIUNITY- NAIVIE PR IVATE WE LL OTHER-SPECIFY CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS IVIIN. SEPTIC TANK CAPACITY GALS.IVIIN. DRAINFI ELD-.- LIN. FT MAX. TRENCH DEPTH I NCH ES TYPE OF CONSTRUCTION-==.-- GROUP F IR E ZONE-- USE CLASSIF SETBACKS. FT. FROt\4 CTR. OF TAff FRONT SIDE EXT FT. FROI\4 PROP. LINE: SIDE INT. - REAR ZONE AUTHORIZED SIGNATURES lsl ISSUANCE DATE BLDG. PEBMIT _ WHITE OFFICE COPY _ WHITE COUNTY TAX - PINK PLUMBING _ CANARY BUILDING _ GREEN SANITATION _ GOTDENROD ITVIPORTANT POST THIS PERMIT ON MAIN BLDG. AT SITE LANE COUNTY. DEPT, OF ENVIBONMENTAL II,4ANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OBEGON 97401 Cail 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.Q. standards foi subsurface sewage disposal and the State Plumbing Code. All buildings require a certiticale of occupancy before being occupied. (See Details on Beverse Side) STAY 1OO' FROIVI ALL WELLS SITE INSPECTION AppRovEo D DtsappRove, D Reuanxs Dare I Nseecron FOUNDATION INSPECTION ArpRovto Rruanx s D r s appnoveo Dar r l nspectoe FRAMING INSPECTION APPROV E o Reulnx s D DrsrppRovEo D Drt r I NSPEcToR LATH OR SHEETROCK Ap enov r o RruaRxs I NSPECT I ON Dr sAPPRovEo Dar e I NsPEcroR F I NAL I NSPTCT ION Ap pnov e o Reuaax s Dr sAPPRovEo I NSPEcToR CERTIFICATE OF OCCUPANCY Rraov ro lssue RruaRx s D Nor Re aov ro lssuE D Dore_lNspEcroR_ D Darr-