HomeMy WebLinkAboutPermit Building 1977-07-06\\sr-\\
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Job Location 2 g 9s //t/AYg/,0F 1)/qz*/r,//*Et F,/ ?)TRS, TL
Wtitten Directions
( ) Building Permit
Acreage or Lot Size-
Partitioning #- ( )Completed( ) Pending
INFORMATION SHEET
( ) Site Feasibility Study for Septic Tank. Number of sites-
Test holes will be ready
Bacrrt.*1 C,-c'^r:
Subdivision Lot
-
Blo
APPLICANT'S NAME AND ADDRESS
OWNER'S NAME AND ADDRESS, if different from a licant's
.ONTRACTOR'S NAME AND ADDRESS
ail permit or results of site feasibility study to () Applicant ( ) Owner ({) Contractor
) Prefer to pick up. Call (owner, etc.) when ready.
STRUCTURES NOW ON THE PROPER
PROPOSED USE (this permit)
-)(/,
WATER SUPPLY
PLUMBING B
l PROPERTY IS WITHIN ONE MILE OF CITY
Phone ?41C2/ ?
Phone 7 46 F52 I
Phoneq\,.*c:\
Contractors O. S.# t/o7
B
o
existing or proposed well, e tc.public, name of system)
Address
SEWAGE DISPOSAL (existing or proposed septic tank, etc.) S.l
******* oFFlcE usE oNLY BELOW THtS LtNE *lrr*r,r****r
) New Address Necessary
N tr
( ) Facility Permit Necessary
SETBACKS: Front Side Facing Street lnterior Side Yard
-
Rear
(FROM CENTEBLINE OF BOAD} (FROM PROPERTY LINES)
To: Planning/Building lnspector/Sanitarian/Surveyor.
This applicant appears to have a problem
Your assistance will be appreciated.
By Permit Processing Section
Response:
By
DEPARTMENT OF ENVI RONMENTAL MANAGEMENT
Permit Processing Section
125 East 8th Avenue
687-4394c55-12
Division
( ) Special Permit Area. Minimum Elevation:
PERTVIIT #
TRS, TL JOB LOCATIO
Partition ing
LANE COUNTY PERMIT
Acreage or Lot S t7P ) Completed Subdivision
Contractor's O.S. #Lot Blo ck
APPLICANT'S NAME AND ADDRE ss Phone
Phone
Phone
O\A/NER'S NA\4E AND ADDRESS
CONTRACTOR'S NAME AND ADDR trec
Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when ready
STRUCTURES NOW ON THE PROPERTY
9lsPERMlTlSFoB,#BEDRoolV]S-#PLUlv]BlNGcoNNEcTloNL
WATER SUPPLY- SEWAGE DISPOSAL- S,I. #
THlSPRoPERTYlSWlTHlNoNEI\xlLEoFTHEClTYoF.PLUlVlBlNGBY
I hereby certifv that the above statement 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 further certily that (if not the owner) I am authorized to act Ior 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 $- Signature
() NEW ADDRESS () FACILITY PERMIT TO TRANSPORTATION DEPT
Date
() SPECIAL PIVIT. AREA. IVIIN. ELEVATION
SAN ITATION
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
Date
BUILDING
Type of Construction
Use Classification
Comments
By
I
roup Fire Zone
mments
By Date
PLANNING REOUIREMENTS SATISFIED. By Date Date lssued
ZONE SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROIM P/L)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL I\4ANAGEMIENT, 125 EAST 8TH AVE., EUGENE, OREGON 974O1
POST THIS PERMIT ON MAIN BUILDING AT SITE
C55-13 BLDG.pERMtT-wHrrE; BUtLDtNG-GREEN; pLUMBTNG-cANARy; sANrrATroN-GoLDENRoD; oFFrcEcoplr-wHrrE
PHONE:687-4394
PERMIT #
TRS, T
Acreage or Lot Size
Contractor's O.S. #
JOB LOCATIO
Partitioning #
LANE COUNTY PERMIT
) Completed Subdivision
Lot
STBUCTURES NOW ON THE PROPERTY-
Block-
APPLICANT'S NAIVIE AND ADDRE ss Phone-
OWNER'S NATVIE AND ADDR Phone
PhoneCONTRACTOR'S NAIVIE AND ADDRE
Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call (owner, etc.) when ready.
.1IS PERMIT IS FO # B ED ROOIVIS-# PLUIVIB I NG CO NNECT IO NS
WATER SUPPLY- SEWAGE DISPOSAL . S.I. #
THlSPRoPERTYlSWlTHlNoNEIVllLEoFTHEClTYoF.PLUN/lBlNGBY
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 further 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 ielating to this permit.
Fee Paid S-Signatu re Date
NEWADDRESS () FACILITY PERMIT TO TBANSPORTATION DEPT.- { ) SPECIAL PMT. AREA. [NIN.ELEVATION
SANITATION BUILDING
lVlinimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
lVlaximum Depth
Date
Type of Construction
-Group
Use Classification
Comments
Fire Zone
mments
By:By Date
PLANN ING REOUI REIVIENTS SATISFIED. By Date
ZONE: SETBACKS: FRONT SIDE FACING STREET (FROM C/L) lNT. SIDE YARD REAR (FBOtVt P/L)
LANE COUNTY DEPARTMENT OF ENVIRONI\4ENTAL IVANAGEIVIENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401 PHONE: 687-4394
POST THIS PERMIT ON MAIN BUILDING AT SITE
c55-13
trqq
Date lssued:
SITE INSPECTION
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CERTIFICATE OF OCCUPANCY
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