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-