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
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At
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COUNTY
QUAL ITY
c55-1r
STATE OF OREGON DEPARTI.IENT OF ENV IRONMENT
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