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HomeMy WebLinkAboutPermit Building 1975-06-04PERI"IIT /T.NOTE: NO PERMIT T{Ii- BE ISSI,ED UNTIL THIS APPLIC,ATIT TAS BEEN APPROVED APPLICATION FOR: CONSTRUCTION I'IOBILE }IOME PLAN REVIEW CHAi.IGE OF OCCUPANCY 5 S, J^J sod- , 7t7-oso/ ["^"Addres s City IZfp --TE""eCONTRACTOR Name Address City zip Phone o. s. REG. /i rr I\^rp l{Section OL,Zrax Lot 26oA tq- Subdivision Lot Code TracC Bloc k*_____Property Acreage Wldth_Depth_ ACCESS T0 PROPERTY (Road Existing Structures on Property: Property Location - Address/Dire Below for Offlce Use SEWAGE DISPOSAL: Slte Inspectlon # WATER SUPPLY: Well Exlsting Sewage Disposal Public 0ther Cotrmunity PLI.]MBING: Installed by Sq. Ft ,.or Ner^, System Requlred Spring t5, - ty or Public System FEES: B1dg. Waste Dlsp. Plunblng Plan Revlew Moblle Home 1Z Surcharge Other Name TOTAL lf -' Mln. Septlc Tank Capacl PLWBING FEES Sewage Connectlon FURNISHED CASH YES Signature of Appl Fee Recelved By: Dralnf Req'uired - Lineal Feet Water Connectlon FACILIfi PERMIT YES Date Maximuu Depth Type of Construc Fire Zone____U"e Classification Bldg Setbacks - from Center of Road Right of Way: Front Slde Int. Side Exterior Zone c55- t2 LANE COUNTY OF ENVIRONMENTAL MANAGM,IENT DATE:PIANNING:DATE:BUILDING: OWNER / E{ Surname ffip. Range SeciTon ffiffi eo?e Census T-J- Recei pt No.Owners Consent Yes No REQUEST FOR SITE FEASIEILITY STUDY THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK: Name and Address Nol_3lTes $ $ No. Acres TOTAL ( Te e eNo P rope rty ze Ex st i ng Structures roPose Water UPPI Y P ropos e Use o rope r ty r n z Yes No ty? No ng rea I s P rope rt1, W t nOneM eo a What Cit ?Yes 0ther PP i cants I nterest n Property Legal Access - Road Name Permi t Area No Special Yes Publ ic District Sprinq Wel I S oec if Property Location: (Directions) APPROVED NOT APPROVED BEFORE CgNSTRUCT!0N l5 STARTED bring this form to the Department cf Environmental Management and nnake appl!cation for a bui!ding permit. lf the proPerty is a por- tion only of a tax lot, a metes anC hounds description of the Parcel must be fur- nished. Exact specifications for the sewage disposal system will aPPear on the building permit. Two sets of building plans and a plot plan will be required. LANE COUNTY DEPT. OF ENVIRONHENTAL MANAGEMENT I35 EAST SIXTH AVENUE, EUGENE, OREGON 97401 Authoiized Signature c55-32 Date 0wn /37J"',/5 IANE COUNIY BUIIDING PERMIT OR MOBILE HOME USE PERMIT 1772-75 PROPERTY OWNER MAILING ADDRESS Spn rxor rgLo 0nroox PHOI.I E CONTRACTOR MAILING ADDRESS PHONE PROPERTY TOCATION _ INCTUDE POST OFFICE PROPERTY TEGAL DESCRIPTION _ METES, BOUNDS RANG E SECTI ON TAX LOT NO ?&? CODE CENSUS TRACT 03 Auvrnez EXISTING STRUCTURES ON PROPERTYAPPt. NAME & MAITING ADDRESS Slur LEGAT ACCESS TO PROPERTY Sourm ?xo PROPERTY SIZE - TT. WIDTH DEPTH AREA FOR MOBILE HOME PERMITS ONLY No. of Bedrooms Connect to Existing Sewoge System New System ! STRUCTURES TO BE BUILT THIS PERMIT : TYPE CONSTRUCTION sQ. FT. # BDRMS VALUATIoN SEWAGE DISPOSAT PUBTIC tr SEPTIC TANK OIHERE PTUMBING INSTALTED BY OWNER n OTHER: NAME FEES WATER SUPPI-Y PUBUC tr tr oTHER BUITDING WASTE DISPOSAT PTUMBING PTAN REVIEW PARK TRAITER TOTAL $' COUNTY BUILDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY wtrH Dtsr. BoX: G,A[. Ex t srs DRAIN FIEI.D REQUIRED LIN. FT TRENCH WIDTH FT. .. :. ON SQ. TT. TYPE OF STRUCTURE OCCUPANCY ZONE PUBTIC UTIL. EASEMENT BI-DG. SETBACKS FT. FROM CTR, OF ROAD RIGHT OF WAY SIDE EXT USE CLASSIFICATION FRONT SIDE INT.REAR AUTHORIZED SIGNATURE _ DATE DATE Joxr,r Sxoox/slr r TAR I AN 6/g/ts BI.DG. PERMIT _ WH ITE OFFICE COPY _ WHITE COUNTY TAX _ PINK PTUMBING _ CANARY BUITDING _ GREEN SANITATION - GOTDENROD Call 687-4065 to schedule oll required inspections. All construc' rion sholl comply with Uniform tiuilding Code, D.E.Q. slondqrds IMPORTANT: for subsurfoce-sewoge disposol ond counly regulolions covering plumbing. All buildings require o cerlificole of occuponcy before being occupied. (See Detqils on Reverse Side) (posr rHls PERMIT oN MAIN B[DG. AT SITE) IANE COUNTY, DEPT. OF ENVIRONMENTAT MANAGEMENI COUN,THOUSE ANNEX, I35 EAST 6Ih, EUGENE, OREGON 9740I ronu * 655- 13 Tl 0 BUILDING PERHIT APPLICATION NO. ( ) srTE TNSPECTToN PLANN!NG DIVISION l37z^7S T R S TAXLOT SUBOIVISION:LOT:_ BLOCK:_ APPL I CANT DATE Not Appl i cabl e CK!D BY:6. Setbacksffi Front Side Exterior Setbacks from interior I ines: Side Rear COI{HENTS: l. Zoning Ordinance Compliance: Zone- 2. Subdivision 0rdinance Compl iance 3. Requi red Access4. Bui ld i ng S i te (Area, I.Iidth, Frontage) 5. 0ther (see comments) () () () () () No Yesr)rI() () () () () () () () PITN=NTNC-D-iVISffi( T NO (APPTTE-AT tON# BUILDING INS !0N Dlvlst0N Plans Submitted Soil Stabil ity (footings) Flood Plain 0ther (see conments) Not Aool i cabl e-*--rr () () () No Yesr) rT7 8 9 0I () () () () () ()CKID BY: DATE COMMENTS: T.'ATER POLUT ION CONTROL COHHENTS: Not Appl icable Nq CI T C) ()() I l. Heets Department of Envi ronmental Qual i ty Standards. 12. 0ther (see cornments)CK'D BY: E '6tq Your }{1) TO APPLICANT: Building / Site lns Can be approved. Cannot be apProved a Questions and furthe NTY Will be held in this ls being returned. rmi t a pect i on : t this time as indicated on item N0 r information on items I through 5 contact t e E- above. NG DIVISI Qu estions and further information on items t rough 2 contact t he LANE UNTY BUILDI AND SAN IT 0N Dlvls ) ) (ce unt you can reso vet eP I ems lica ton NV t35 Sixth Avenue Ea PHONE:597-4065 c55-28 Your bui ldin LANE COUNTY PLANN tNG DlVtSl0N PH0NE: 587-4186 cated. BU r-Dlil.i SITE EVALUATI0N f l' )OSED SEI,/AGE DISPOSAL SYSTEH REilI II'ISTALLER:te top part -, form to si nature and submit bo-ies with appl ication. c Ir\.5ip PERM NO JSSourH 2xo Sept Ft. ns No. Livin g ni ts Bed Ba s asement ter u v 0ther-L i stYes No Publ i c c ank: f rorn wel I Steel tr Concrete No. Compar ents Gal . Capaci ty ons:t 'wn ND\dh e sPosa e Len D i ameter D h Distribution Box: Yes No t er str ut On-Pe NA}.IE Rnv Auvanrz I.IAILING ADORESS rs 2r.t Feet trEl I rom C{\s Foundat i Lot L ne S ide tna e h mens i.ic 4 l.Jidth nes- 6 d r r L I er e ovJ ile tn above P ot an e TE OF For Sanitarian Use Only: Date: ln accordance with 1973 0regon Laws Chapter 835, Section 214 this certificate is iss as evidence of satisfactory completion of a subsurf,ace sewage disposal system at the t oca[R^Approved : System I nstal I at i on conf orms to current standards ,fi Oisapproved: Does not conform to current standards Remarks: r t, i dth3 'ot Ft etweenlaot Lines 1n see nst ruct ons DRtuc 'J At 18 $orG.Sc EN{' tflut" I I I /I n<' \ r + rD' L- )4' L lr/ltl5 a ,"it h e € poa lowr o rcK 40, t vl AP- $e\hh" s \ 6 \ sA Y\od a an COUNTY QUAL ITY c55-1r STATE OF OREGON DEPARTI.IENT OF ENV IRONMENT gnature I /n,-1 t Jho p 7f