HomeMy WebLinkAboutPermit Building 1981-04-17il*P!' ---l!2
I .TOR OFFICE USE ONLY
D.r^al ci '^
re ar
C ir-,fN/PLACEMENT
PERM IT
Zone
frbnt
Partition #
, side ",ff
COI{PLETE THIS BLOCK. PLEASE USE BLACK INK AND PRINT.
f] pr,axmrxc ZONING:Parcel #e
llinimum setbacks: t",
Corments
C L interi
Date: 3-31-61 Cti)
TAX LOTPON
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copies of P16t PI ans
Applic
Permitffi"
eo("
LOCATION ADDR.ESS3520 ZIP PROPOI#D
{*".I rndustrial
Iruttic
USE OF PROPERTY
[-l commercia]-
identi a1
DESL-RIPTION? OF P ROPOSI
( )Nh trrq#rd:mo@T OF BEDROOMS3 Io o''T*t9 OF SUPPLY d
xi s ting
35ZO TELEPHONE NUMBER
S NAME TELEPHONE NUT1BER74b<*5 3CONTFACTOR'S OSR *q24>5
IF4.
FOR PERMIT, and do hereby (lcrLif, rhat a1t inform.ltion hercon is truc and correct ar)d I furthcrin accordance with the ordinances of Lane county and the Laus of the st.tte of
\ Atu+ <.B 4Rrouler
SIGNATURE
{l
r HAVE cARE['uLLy ExA-[,rrNED ,#ao*r,uruo AppLrcATroN
certify that any ild all work perfo!red shall be done oreq.)n I,,rrLajrrinqto the work described herei.n, and that NO OCCUPANCY wi II be made of any structur. without the pernission of the Buildiltg Di,zision f furthe! certj.fyLhaE.registration uith the Builder's Board is in full force and effect as required by ORS 701.055, that if exenpt the basis for exemFtion is notedhereon, and that only subcontractors and enployees who are in conpliance with ORS 701.055 will be used on this project. I HAVE RXAD AND CIIECTGD THISAPPLICATION THOROUGHLY
NAME (please prj-nt)
fl o,,.u,
fitbntracto::
I egr:nt
tr FLOODPLAIN:In flood hazard area?
Specifications:
[*. I ves see attached sheet
E
Date:
Date:fl nunar, ADDRESSTNG:CRID CooR-DINATL N
tr ITATION:t. * p? toet B. P. r 119.1G Installation Record rssued? [ v." ! r,ro
GaIIon
Tank &0n{,Lineal Feet
of Drainfield Maximun Depth
of 1'renchesIComments:
LANS EXAMINAT
Cofiunents
ryp. V-&l
lb/f
Date fuu)
Group
CONSTRUCTION AUTHORI ZED BY THIS PERMTT
Descr
(o4
#zgza, oo
9.**
-, ^^^f ', ^, - ,"a ZGJ o
Subsurface Fees
Bui.lding Fee
Sewer/Storm Drain/Water
plumbing Fixtures
Mechanical
Plans Check Fee
State Surcharge
TOTAL T'EEDFEES PATD BY:
Sq. Ft.Fixed Fee/Unit Cost
5.tD
co"l $
$
)
)
(
$
$
S 3 ZO
s l$.2O,
TOTAL VALUATION $Check
LANE CO
By:
Date:
PERMIT APP RovED By BUTLDTNG orrrt:SIGNEE 1))
UNTY DEPARTMENT OF ENVIRONMENTAL MANAGEIT{ENT / L25 EAST EIGHTH AVENUE, EUGENE, oREGoN
c74-t94 SEE REVERSE
97 401
Itlechanica] Checkf idt
fnlumuing Checklist
fletan Check rnfo Sheet
tln /7
T
tr
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r
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.Y
SETBACKS AND OTHER CONDITIONS OF APPROV
CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTiON ORDINANCE, ANDIOR OTHER REMEDiES ALLOI^IED BY LA}l.
WHEN READY FOR INSPECTION CALL 687-4065. A MINIMUM OF AT LEAST 24 HOUR ADVANCE NOTICE FOR INSPECTION REQUEST MUST BE .
GMN. Have the following information ready: Permit numberi job address, type of inspection, when it will be ready,
your name and phone number, and any special directions to site.
BUILDING DIVISION:
REQUIRED IIISPECTIONS
1) F0UNDATION INSPECTION: .To be made after trenches are excavated and forms erected and whqn all materials for the foundation-ffioti.Whereconcretefromacentra,lmixingp1ant(corrimon1ytermed,,transitmixed.')istobeused,
materials need not be on the Job.
Zl CoNCRETE SLAB 0R UNDER-FLooR INSPECTION: To be made after.all in-slab or under-floor building service equipment,
ci11aryequipmentitemsareinp1acebutbeforeanyconcreteispoured
or floor sheathing installed, including the subfloor.
3) FRAMING & INSULATIoN INSPECTI0NS: To be made after the roof, al1 framing, fire blocking and bracing are in place and.sandventsarecomp1eteanda.llroughe1ectrica.landp.lumbingareapproved.A11
wa]l insulation and vapor barrier are in p1ace.
4) LATH AND/oR GYPSUM BoARD INSPECTIoN: To be made after all lath'ing and gypsum board, intenior and exterior, is in place.orbeforegypsumboardjointsandfastenersaretapedandfinished
5) FINAL INSPECTIoN: To be made after the building is complete and before occupancy.
APPRoVAL REQUIRED. No work shall be done on any part of the building or structure beyond the point indicated in each
successive inspection without first obtaining the approval of the building official. Such approval shal'l be given only
uite. an inspettion shall have been made of each successive step in the construction'as'indicated by each of the inspect'ions
requi red.
N0TE: AII building permits require inspections for the work authorized, such as but not limited to:
A. BL0CK WALL: To be made after reinforcing is in place, but before any grout is poured. This inspect'ion is
required for each bond beam pour. There will be no approval until the plumbing and electrical inspections
have been made and approved.
B. LI00D ST0VE: To be made after comp'letion of masonry (if applicable) and when installation is comolete.
Instajlation shall be in accordance with an approved nationally recognized testrng agency arrd the manu-
facturer' s instal lation instructions.
C. MoBILE H0ME: An inspection is required after the mobile home is connected to an approved sewer or. septic
syitem tor: setback'requirements, blocking, footing connection, tiedowns, skirting, and plumbing
connecti ons.
(l) Footings and piers to comply with State foundation requirements for mobile homes or as recommended
by the manufacturer ,--..j.--r 1.. - !r^^r-r .(Z) f,fi,Uif. iiome minimum finish floor elevation shall be certified when required by a floodplain
management letter.(3) yoUiie nome tiedowns, when required, and skirting shall be installed and ready for inspection
wittrin ai ieast 30 diys ultur'o..rpiniv. Tiedowis and skirting shall be installed per enclosure'
D. SWIMMING p00L: Below grade when steel is in place and before concrete is poured' Above grade when pool
i s 'i nsta'l I ed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS' THIS PERMIT I.JILL EXPIRE IF HORK DOES NOT BEGIN
r^rrrHrN r80 DAys, 0R IF t,loRK IS sqsBEryqED 0R ABAND0NED foB l-tlqEq-IHAN I80 DAYS' susPENSI0N 0R REV0CATI0N MAY occuR IF THIS
piRriit tn5 isiuEo-r'r,r-tH'r"rinsi5 oF-rNcomprrrE 0R ERRoNEous INFoRMATI0N.
ANYoNE PRoCEEDING PAST THE PoINT 0F REQUIRED INSPECTIoNS I',IILL D0 S0 AT HIS ot^lN RISK
SUBSURFACE AND ALTERNATIVE SEHAGE DISPOSAL SYSTEMS
- -AL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVOCATION OF THIS PERMIT,
(r )
(2)
Permits shal'l be effective for one year from the date of issuance'
upon completing the construction for which a permit has been-issued the permit holder shall notify the
Departmentby submitting the instailation r;"5;i'i;il:" it.-oepirt enl shatl inspect the construction to
detennine if it complili!.liin the rules .o.iiinla'ir"'inii airition.' ir ih" conslt'ction does complv vtith
suchtrdTes/ u"ie.oeparifri"i:Jii.ii-i'ir;.;i;lifi;i;;;';';i;i;;;;v iompietion to.the oermit holder' 'If the'
cbnstruction does not comply with such.ur"r,'iffD;p;.fiint.nuii;riiii'the permit hoider and sha'l1 require
satisfactory comptetioi-f[ii,"" irrrrng the-ii"ilii;;i;. Fairure to meefthe rbguirements for satisfactorv
complet.on w.ithin u ".ur6niuiI iime constit;;;;';'rioiition oi oni qs+.605 to 4i4.745 and this ru'le'
Setbacks - .subsuflgce Sewaqe Disposal
From
Septic Tank Drai nfi el d
10'Interior ProPertY 1 ines
Edqe of road right-of-waY
euilaing. foundqtlgn
Hel ls,' other water sources
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TRS, TL try' oz - t?. Y t t6a'a Job Location (Street, mile post
al
IJ
YICINITY MAP Subdivision Lot ?f, Block
-FOR SANITARIAN'S USE ONLY p System Approved fl System Disapproved fl Needs Correction
COMMENTS \fhu A1., tssrcdC l'urud tu l,ils+il,b4k Unspofu,<:
)'u,uc,4,
Si re
FOR INSTALLER'S USE: Trench Depth 30"Filler Depth Below Tile 6tl
Tank Capacity fxis+;nq
lVleasured distance to well from tank from drainfield
PLOT PLAN
ate
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N/lanufacturer
F!5H'd(E
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6 AP R281981
l\ND
ntl\s$N,\i)\LDING
Sca le:SAI.IIl
m oIY
INSTALLATION RECORD AND CERTIFICATE OF 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 [Vlanagement,
Public Service Building, 125 East 8th Avenue, Eugene 974O1
€r;s}; nJ
Flors
c55-1 1
r
LANE COUNTY PERMIT FOR:PERl\ilIT NO
CONSTRUCTION [ ] IVIOBILE HOTVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
n Owner
NAIVIE ADD R ESS C ITY ZIP CODE PHONE
n Contractor
NAME ADD R ESS CITY ZIP CODE
Census Tract
PHONE
O.S. Reg. +
Tw Range-- Sectio Tax Lot- Code
B lock AcreageSubd ivision Lot
Access to Property (Road Name)
Width
Depth
Existing Structures on Property:
Directions to Property - Address
STRUCTURE (# BEDROOIVIS)SO. FT VALUATION
SEWAGE DISPOSAL:
PUBLIC [ ] SEPTICTANK [ ] OTHER [ ]
PLUIVIBING INSTALLED BY:
OWNERI] OTHER[] NAIVI F
BUILDING
WASTE DISPOSAL
PLAN REVIEW
TOTAL
WATER SUPPLY: PROPOSED t ]
EXISTING t]
PUB LIC
COIVIIVIUN ITY NAIVIE
PR IVATE WELL
OTHER .SPECIFY
CONSTRUCTION PERMITS & INSPEGTIONS AND WATER POLLUTION CONTROL SPECIFICATI ONS
I\4IN. SEPTIC TANK CAPACITY
GALS-IVI IN. DRAINF I E LD- LIN. FT IVIAX. TRENCH DEPTH I NCH ES
STAY 1OO' FROIVI ALL WELLS
TYPE OF CONSTRUCTION- GROUP FIRE ZON E USE CLASSIF
SETBACKS- FT. FROM CTB. OF r,Aff
FRONT
FT. FROTVI PROP. LINE
SIDE INT REAR ZONE
AUTHORIZED SIGNATURES
lsl
ISSUANCE DATE
BLDG, PERN4IT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING _ CANARY
BUILDING - GFEEN
SANITATION - GOLDENROO
IMPORTANT
Call 687-4065 to schedule all required construclion inspections. Call 687-4061 to schedule all required
septic system inspections. All conslruction shall comply with the State Buidling Code, D.E.Q. standards
tor subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy belore being occupied.
(See Details on Reverse Side)
POST THIS PERMIT ON MAIN BLDG. AT SITE
LANE COUNTY. DEPT. OF ENVIRONN4ENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
PLUIUB ING
3% SURCHARGE-
MOBILE HOME-
SIDE EXT.
a/Q( surLDrNG eERHrr AppLrcATroN no" Ht-?6t-
()SITE INSPECTION
PLANNING DIVISION,Not
I icable
Zoning 0rdinance Cornp I iance: Zone
Subdivision 0rdinance Compl iance
Requi red Access
Building Site (Area, Width, Frontage)
Other (see cornments)
COI{ilENTS:
r l-1 Roz s l{ rnxLor_
suB0tvtSt0N:
LOT: Z\ BLOCK:
-
APPL I CANT
DATE
A No Yesr) Tg' 6.()6e()t6()J{
() ()
CKID B
Setbacks
Front
Side Exterior
Setbacks frorn inter
S ide
Rear
ror nes:
(
(
(
I
2
3
4
5
)
)
)
)
PLANNING DIVIS
BUILDING INS t0N Dtvtst0N
7. Plans Submitted8. Soi I Stab i I i ty (foot i ngs )9. Flood PlainO. 0ther (see conunents)
Not
I icable No Yesr) TT() ()
() ()
() ()CKID BY:
DATE
COHMENTS:
WATER POLUT ION CONTROL
I l. l{eets Department of Envi ronmental
Qual ity Standards.
12. Other (see cunments)
COilHENTS:
Not
Appl i cabl eTr No Yesr) qT
() ()()CKI D BY
DATE
TO APPL I CAN.T:
Your Buildin
Ffcan be a( ) Cannot b
Ques t i on
COUNTY P
g / Site lnspe
pproved.
e approved at
s and furtherC
f ,1'rtl
ction:
this time as indicated on item N0.
-
above.
information on items I through 6 contact the LANE-
0N" Questions and further information on items 7
U 0 S
t rough 2 contact t e COUNTY BUILDING AND SANITATION DIV
Ui I I be held in this
ls being returned.
ermit li ion fee is
ce unt you can reso ve the prob
u
135 Sixth Avenue East Eugene Oregon
'H,NE.
597_4065
LANE COUNTY PLANNING DIVISION PHONE:
97401
587-4186
c55-28
Your bui ldin
ems n cated.
BUII NG SITE EVALUATION
-1 b
NOTE
CONSTRUCTION
PERMIT /I
NO PERMIT WILL BE ISST'ED I'NTIL TIIIS APPLIC.ATION HAS BEEN APPROVED
APPLICATION FOR:
MOBILE TIOME PLAN REVIEW CHAI{GE OF OCCUPANCY
Name
f;e- ffib u, l4itls;oe Dt,&tec^rc Qzqo { 3.lr'"1z /
ztp
CONTRACTOR
Address
ess Clcy one
O.S. REG. /I 7 243
Twp Section \q Tax Lot
sr*divtston 79t40U lofur'rrec P'a*r-- to a5 Census Tract
?roperty Acr eage__width_Depth_
Name
t
,C
Exlsting Structures on Property /LJld^.s*-
Property Location - Address/Dlrections:{3o rU e
PubIic
Offlce
SEWAGE DISP
Site lnspectlon
WATER SUPPLY
Well
Bldg.
Plunblng
3% Surcharge
Waste Dlsp.
Plan Revlew
Moblle Home
TOTAL
Sprlng _
by Omer
FEES:
of FixLures Sewage
Connection
YES
Signature of
Fee Recelved By:
Water
Connectlon
FACILITY PERMIT
YES NO
Date
- -rf\C'-c) =-
NO
-Jr_S-/-
. Fr.
t
\I
Exlst
IJMB
Drainfield Required -oFeeESeptlc Tank Capacl
Type of Construc Fire Zone Use ClassiflcaElon
Bldg SetbackF - frou Center of Road Right of Way:
Frontt/,4t-wiJ"e*t!ii.'-----,.,-'.Reer|',.^',-*..^,-..*-zon"_&-J--
c55- t2 I,A}IE COI]NTY DEPARTIVIENT E}WI RONMEN TAL MANAGEI',IENT
DATE:DATE:DATE BUILDING:
w
AccEss To PRoPERTY (noad nan{ L/bLettO*
ottrer I
Acreage or Lot S t7e Partitioning
Contractor's O.S. #
APPLICANT'S NAME AND ADDRE qq Phon
OWNER'S NAIVIE AND ADDRESS Phone
CONTRACTOR'S NATIE AND ADDBESS Phone
Mailpe'mitto()Applicant()owner()Contractor.()Prefertopickup.call-(owner,etc.)whenready.
TRS, TL JOB LOCATIO
LANE COUNTY PERMIT
Fee Paid $Signatu re
l NEW ADDRESS () FACILITY PERMIT TO TRANSPORTATION DEPT
PERTVIIT #
) Completed Subdivision
Lot- Block-
STBUCTURES NOW ON THE PROPERTY
THlsPERMlTlSFoR#BEDRooMS-#PLUl\4BlNGcoNNEgTlotii-
WATER SUPPLY SEWAGE DISPOSAL s.t. #
THlSPRoPERTYlSWlTHlNoNEMlLEoFTHEclTYoF.PLUtV]BlNGBY
I hereby certify that the above statements are true and accurate, and that I have the following Iegal interest in the property:
-owner
of record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. I further certify that (iI 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 herebv agree to comply with all applicable Codes relating to this permit.
Date
( ) SPECIAL PIVIT. AREA. lvllN. ELEVATIONi
-
SAN I ATION
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
Date
BUILDING
Type of Construction
-Group
Use Classification
Comments:
By
ire Zone/to30
Comments
By
PLANNING REOUIREIVIENTS SATISFIED. By Date Date lssued
ZONE SETBACKS: FRONT SIDE FACING STREET (FROM C/L) INT. SIDE YARD REAR (FROM P/L)
LANE COUNTY DEPARTMENT OF ENVIRONIVIENTAL IVIANAGEI\4ENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT SITE
c55-1 3 BLDG.PERMtT-WHtrE; BUTLDTNG-GREEN; pLUMBTNG-GANARy; sANrrATroN-GoLDENRoD; oFFrcEcopy-wHtrE
PHONE:687-4394
Date:
{/
PERIVIIT #
TRS, T
Acreage or Lot Size
Contractor's O.S. #
OWNER'S NAME AND ADDRE
JOB LOCATIO
LANE COUNTY PERMIT
Partitioning #-( ) Completed Subd ivision
Lot- Block
APPLICANT'S NAME AND ADDRE qq
CONTBACTOR'S NAME AND ADDRESS
Phone
Phone
PhoneMail permitto ( )Applicant ( )Owner
STRUCTURES NOW ON THE PROPERTY
( ) Contractor. ( ) Prefer to pick up. Call (owner, etc.) when ready
THIS PERIVIIT IS FO # B ED ROOIVIS-# PLUIVIB I NG CO N NECT IO NS
WATER SUPPLY SEWAGE DISPOSAL-s.t. #
THlSPRoPERTYlSWITHlNoNElVllLEoFTHEclTYoF.PLUlVlBlNGBY
I hereby certity that the above statemenls are true and accurate, and that I have the lollowing legal interest in the propeny:
-owner
of record;'contract purchaser;
-
potential buyer;
-
realtor oragent. lfurther certify that (i{ notlhe owner) I am authorized to act {or the owner ofrecord, and that said owner is aware and approves of this action. I h;reby agree to compiy with all applicable cojes reiating to this permit.
Fee Paid $-Signatu re Date() NEW ADDRESS I FACILITY PERMIT TO TRANSPORTATION DEPT () SPECIAL PIVIT. AREA. IVIIN. ELEVATION
SANITATION
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
BUILDING
Type of Construction
c"..nr*t,.
Use Classification
roup
-Fire
Zone
Comments
B
PLANN ING REOU
Date
IREIVIENTS SATISFIED. By
By Date
Date Date lssued:ZONE:SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROM P/L)
LA NE COUNTY DEPARTIVIENT OF ENVIRONIVIENTAL TVIANAGETVIENT, 125 EAST BTH AVE., EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG' PERMIT*wHlTE; BUILDING -GREEN; PLUMBING -CANARY; sANtTATtoN-coLDENRoD; oFFtCEcop17-wHtTE
c55-1 3
PHONE:687-4394
SITE TNSPECTION
AP PRov E o
REuaRx s
Dr SAPPRovED Dat e
FOUNDATION I NSPECTION
DISAPPRovED *--Bzl I ruspectonAPPRovED
REur nx s
Dare T--7
FRAMING INSPECTION
AppRov r o Dr slppnoveD I usprcron
ReNanx s
LATH OR SHEET I NSPECT I ON
Dr SAPPRovED I uspectonAp eRov E o
ReM rnx s
FINAL INSPECTION
Ap pRov e o
Reltanxs
DrsAPPRovEo I Nspecron
CERTIFICATE OF OCCUPANCY
Rraov ro lssuE
RrulRx s
Nor Rerov ro lssue Drre I rusprcron
d ffiJl ,*,,,,,o*$g4,
D Dare r '?'?'J
,*,tr--!{47
D o^,,fa -77-7?
Permit No'CURB cuI
Dote
I PERNTTT
IN TI{E BOARD OF COUNTY COMMISSIONERS OF LANE COUNTT
*HEREAS, the q*oched opplicotion hos been {ully considered !y the Boqrd of county com'
missioners of Lone County, ond it i, th:':;';Li-;:t 't'in;;;;;f'*" at"td thot the soid opplicotion
should be gronted, ond ihot o p"r-it ,iJ-uld be it""d'= now' therefore' it is hereby'
ORDERED, thot o permit be ond is hereby issued to
for plocing, building
or constructing the following focility'
UPO n the right-of-woY of CountY Roqd No Mile Post
IN S'trict conformitY to the exhibits ottoched hereto, ond subiect to oll
ond permit,'
lerms, conditions, ogreements,
stipu lotions ond Provisio ns contoined in the oPP licotion the Rules ond Regulotions Gov-
lities to be Pe rmitted upon Co Rood Rights-of-Woy, os set forth by the Lone Mqn-
uol 50..l90(2) onY
Speciol Provisions:
unty
ondomendments thereto,ony other oPPlicoble regu lotions, low or ordinqnce.
I
2
3
erning Foci
fore
Drivewoy wiil be constructed in occordonce with fhe ottoched drivewoy opproqch specifico'
tions (Drowing M98-50)'
Permittee will be responsible for the immediote removol of oll mud' dirt ond debris from the
roodwoy ona ,ighili ;il.oured by his operotion, leoving the roodwoy ond oreq in o neot,
occeptoble condition.
Sidewalks will be constructed^in accordance with the attached s'idewalk
soecificat.ion, Iia"i;;;i;a rqge-+g. The Standard curtTvpe shall be
;;;i;;i.a-unress otherwise specif ied'
This permit is revocoble qt ony time, ond will be strictly odherd to ond no work other thon
tf'r"t tp".lTl*ify -entioned obove' is hereby outhorized'
This permit sholl be void unless the work herein contemploted roll hove been completed be-
tnspected ond APProved
,'19-. ExPires r9_.
Approved by Bord of County Commissioners
By
Dote
By
/HITE - OFFICE FITE
..TTOW - REAL ESTATE
PINK _ PERMITTEE
ORANGE- BUITDING & SANITATION DEPT.
Director of Public Works
c74-L29
1
t[%-?7
TRS, T
hlritten Directions 3r
{} aritoing Permit
Acreage or Lot Size
Partitioning #- ( )Completed( ) Pending
APPLICANT'S NAME AND ADDRESS FF-ss Bo
OWNER'S NAME AND ADDRESS, if different from applicant's
CONTRACTOR'S NAME AND ADDRESS
Mail permit or results of site
K) Prefer to pick up. Call
feasibility study to (X) Applicant (,{) Owner ( ) contra"tor
?41^-zaa{ (owner, etc.)'when ready.'conrractors o. s. # 72 /3
)J ortr-
Job Location o
INFORMATION SHEET
( ) Site Feasibility Study for Septic Tank. Number of sites
Test holes will be ready
Subdivision rd ai>o.t.ISe,'>e < ?r+"-t f-'s 2 { Btock /
-tr..:e
^Phone 3 </J -7 3 1/
Phone
Phone
# Bedrocrns
<fo
STRUCTURES NOW ON THE PROPER
PROPOSED USE (this permit)
'-Lg-)bc.r\-{cL
WATER SUPPLY Fr.rs t+b existing or proposed well, etc. lf public, name of system)
SEWAGE DISPOSA r S,erhR (existing or proposed septic tank, etc.) Si. #81:29
Address
?PLUMBING BY (
il PROPERTY IS WITHIN ONE MILE OF CITY (?
****** oFFtcE usE oNLY BELOW THjS LtNE r******++***r
{ ) Newf$ress Necessary
zoNE /\ |
( ) Facility Permit Necessary ( ) Special Permit Area. Minimum Elevation
SETBACKS: Front Side Facing Street lnterior Side Yard Rear
-
{FROM CENTERLINE OF ROAO) (FROM PROPERTY LINES)
To: Planning/Building lnspector/Sanitarian/Surveyor.
This applicant appears to have a problem with
Your assistance will be appreciated.
By Permit Processing Section
Response
By
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Permit Processing Section
'125 East 8th Avenue
687-4394c55-12
D ivision
Dote .afuVT
ORDERED, thot o permit be ond is hereby issued to
4q 0 t),
or constructing the following focility:
uo 3
Permit No.tbq3- 77
CURB CUT
orn
for plocing, building
25 LV-I
Mile Post
PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE 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 iudgment of the Boord thot the soid opplicotion
should be gronted, ond thot o permit should be issued, now, therefore, it is hereby.
*
;20 u4Uoa
uPon the r I oy of unty Rood
rD6€P-<
rpon Co
hereto,
t
/
in strict conformity to the exhibits otto ched hereto, ond ect to oll terms, conditions, ogreements,subi
ondstipulotions ond provisi ons contoined in the opplicotion permit, the Ru
unty Rood Rig os set
les ond Regulotions Gov-
forth by the Lone Mon-
ond ony othe regulotions, low or ordinonce.
l. Drivewoy will be constructed in occordonce with the qttoched drivewoy qPProoch specifico'
tions (Drowing M98-50).
2. Permittee will be responsible for the immediote removol of oll mud, dirt ond debris from the
roodwoy ond right of woy coused by his operotion, leoving the roodwoyond oreo in o neot,
occeptoble condition.
3. Sidewalks will be constructed in accordance with the attached s'idewalk
specifications and drawing M98-49. The Standard Curb Type shall be
constructed unless otherwise specified.
erning Focilities to be Permitted u
uol 50.190(2) ony omendments tl
Speciol Provisions:
fore o----)
lnspected ond Approved
thts-of-Woy,
r opplicoble
This permit is revocoble ot ony time, ond will be strictly odhered to ond no work other thon
thot specificolly mentioned obove is hereby outhorized.
This permit sholl be void unless the work herein contemploted sholl hove been completed be-
>(wlu $w18.
Dote
PINK _ PERMITTEE
ORANGE_BUIIDING & SANITATION DEPT.
Expires 19_.
Approved by Boord of County Commissioners
By
UeE
By
WHITE - OFFICE FILE
YEI.TOW _ REAL ESTATE
Director of
c74-129
I
-77PERTVIIT #
TRS, T JOB LOCATIO
Partition ing
LANE COUNTY PERMIT
Acreage or Lot Size
Contractor's O.S. #
) Completed Subdivision
Lot Block-
APPLICANT'S NAIV]E AND ADDR FSS Phone=--
OWNER'S NAME AND ADDR Phon c
CONTFACTOR'S NAI\4E AND ADDRESS Phone-
N4ail permit to { )Applicant ( }Owner ( }Contractor. ( )PreIerto pick up. Call- (owner, etc.) when ready.
STRUCTURES NOW ON THE PROPERTY
THlSPERl\1lTlSFoR#BEDRoo[4S-#PLUlVlBlNGcoNNEcTloNS-
THlSPRoPERTYlSWlTHlNoNElVllLEoFTHEClTYoF.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 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 relating to this permit
Fee Paid $
()NEWADDRESS () FACILITY PERMIT TO TBANSPORTATION DEPT.- 1 ) SPECIAL PMT. AR EA. I\4IN. ELEVATION: _-
SANITATION BUILD ING
Type of Construction
-Group
\I/ATER SUPPLY SEWAGE DISPOSAL
-
S.I. #
Use Classification
Comments:
BV Date
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
lVlaximum Depth
Date
ire Zone
By
PLANNING REOUI REMENTS SATISFIED. By:Date Date lssued
ZON E:SETBACKS: FRONT SIDE FACING STREET (F RONN C/L) INT. SIDE YARD REAR (F ROM P/L)
LANE COUNTY DEPARTIVIENT OF ENVIRONTV]ENTAL IVANAGEIVIENT, 125 EAST BTH AVE., EUGENE, OREGON 974O1
POST THIS PERMIT ON MAIN BUILDING AT SITE
C55-13 BLDG. pERMtr - WHtrE; BUtLDtNG - GREEN; pLUMBtNG - GANARy; sANtrATtoN - coLDENRoD; oFFlcE coPY - wHtrE
)
PHONE:687-4394
)
trqq
Comments:
,//c,0o
SrEAE:f LOOR
PLUMB ING GROUNCT./ORK
Appnoveo E
Re tianx s
DTSAPPRovED D ,*17hilz.{?*I rseecron
GAS PIPING GROUND^/ORK
Ap pnov e o
REurnx s
D r sappRoveo Dere I rspecron
ROUGH PLUMBING
AppnovrD /t,// DrsappnoveoJ+-'frkI rusprcron
Reua nx s
ROUGH GAS PIPING
Ap pnov e o
ReuaRx s
D DrsAPPRovEo D Dar r I rusercron
F I NAL PLUMB I NG
APPROVED E DISAPPROVED
RrManxs A*d
n Darr 7-7-Zl
-
I NspectoR
L-./,A
FINAL GAS PIPING
Ap pRov e o
RExanx s
D r sapeRoveo D DarE I Nsprcton
CERTIFICATE OF OCCUPANCY
Reaov ro lssuE
Reuanx s
D Nor Reaoy ro lssue D Darr I Nspecron
-I
D ,*,_rh/r/
,?l