HomeMy WebLinkAboutPermit Building 1977-10-072rrn7
Vfritten Directions
Location
(\) Building Permit
Acreage or Lot Size
-
Partitioning #- ( )Completed( ) Pending
APPLICANT'S NAME AND ADDRESS
OWNER'S NAME AND ADDRESS, if d
INFORMATION SHEET
( ) Site Feasibility Study for Septic Tank. Number of sites-
Test ho wl
Subdivision
nb-7q5.1
ifferent from a licant's
Pho ne
Phone
PhoneCONTRACTOR'S NAME AND ADDRESS
Mail permit or results of site
I ) Prefer to pick up. Call
Applicant ( )Owner ( )Contractor
(owner, etc.) when ready.
(x)
Contractors O. S. #
STRUCTURES NOW ON THE PROPE
PROPOSED USE (this permit)
WATER SUPPLY rDb {.t
I /e-
existing or proposed well, etc. lf public, name of system)
SEWAGEolsPoSAL(existingorproposedsepticrank,etc')s.l
PLUMBING BY Address
t\t enoeeRrY ls wllllN o$
*..)+.r oFFtcE usE oNLY BELOW THtS LtNE ****+*r*l****
) New Address Necessary
NE-
( ) Facility Permit Necessary
Front
-
Side Facing Street
(FROM CENTERLINE OF ROAD)
( ) Special Permit Area. Minimum Elevation
lnterior Side Yard Rear
(FROM PROPERTY LINES)l SETBACKS
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
DEPARTM ENT OF ENV I RONMENTAL MANAGEMENT
Permit Processing Section
I25 East 8th Avenue
687-4394c55-1 2
D ivision
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feasibilitv studv to
APPLIC/+^IT
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PERMIT #
TRS, TL
Acreage or Lot Size-
Contractor's O.S. #
JOB LOCATIO
LANE COUNTY PERMIT
Partitioning #-_-_---( ) Completed Subdivision
Lot Bloc tl
APPLICANT'S NAME AND ADDRE
OWNER'S NAME AND ADDRESS
CONTRACTORlS NAME AND ADDRESS-
Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Calt
STRUCTURES NOW ON THE PROPERTY
Phone---
Phone-- -Phone-
THIS PERMIT IS FOR = B E D R OO I\4S-- # P L U I\,{ B I N G CO N N E CT I O I\J S_--
\TJATER SLJPPLY SEWAGE DISPOSAL S.i. #
THIS PROPERTY IS WITHIN ONE MILE OF THE CITY OF- PLUI\4BING BY
I hereby certify that the above statements are true and accurate, and that I have the follo\,l/ing legal interest in the propeny:
-owner
of record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. Lurther certify that (if not the owner) I am authorized to act for the owner of
rccord, and that said owner is aware and approves ot this action. I hereby agree to comply with all applicable Codes relating to this permit.
Fee Paid $-Signatu re Date
( }NEWADDRESS () FACILITY PERI\4IT TO TRANSPO RTATION DEPT.-- l SPECIAL PMT, AREA, MIN. ELEVATION:
--SANITATION BUILDING
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
!t4aximum Depth
Type of Construction
Comments
roup
--Fire
Zone
;-""*
Use classifir:ation
B Date By Date
PLANN I NG REOUI R EIVIENTS SAT ISF I E D By,Date Date lssued
ZON E:SETBACKS: FRONT SIDE FACING STREET (FROIVI CiL) INT. SIDE YARD REAR (FROM P/L)
LANE COUNTY DEPARTMENT OF ENVIBONMENTAL TVIANAGEI\4ENT, 125 EAST 8TH AVE., EUGENE, OREGON g]4O1
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. PERMTT - S/HtTE; BUtLOtNG - GREENi pLUMBtNG _ CANARv; SANTTATTON -, GOLDENROD; oFFlcE COp\/ _- WrtrTE
cs5-1 3
PHONE:687
(owner, etc.) when ready.
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TBS, T JOB LOCATION
Partitioning #
LANE COUNTY PERMIT
Acreage or Lot Si 7.e ) Completed Subdivision
-Lot _ B lock-=-Contractor's O.S. #
APPLICANT'S NAIVIE AND ADDRE ss
OWNER'S NAME AND ADDRESS
CONTRACTOR'S NAT\4E AND ADDRESS-----_--
Phone
Phone- -Phone-**
Mail permitto (' ) Applicant ( ) Owner ( ) Contractor. ( ) Preferto pick up. Calt-
-HIS PERf\,1IT IS FOR
-
* SEDROCI",]S- _# PLUI\iIBiNG CCNNECTiOI!.1--
WATEB SUPPLY SEWAGE D|SPOSAL s.t. #
THIS PROPERTY ISWITHIN ONE MILE OF THE CITY OF-PLUIVIB ING BY
I hereby certi{y that lhe above statements are true and accurate, and that I have the follo!rying legal interesr in the property:
-owner
oI record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner oireclrd, and that said owner ,s aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit.
Fee Paid $Signature Date
( }NEW ADDRESS () FACILITY PERI\4IT TO TRANSPORTATION DEPT.-- l SPECIAL PMT. AREA. I/IN, ELEVATION:
--SAN|TAT|ON ' BUILD tNG
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
l,4aximum Depth
Type of Construction ___Group ' _Fire Zone
Comments
By
Use Classific;at!on
Date
PLANNING REOUIREMENTS SATISFIED. B
B
SIDE FACING STREET
Dare
Date lssued
(FROIVI CiL) INT. SIDE YARD BEAR
v:Date
ZONE SETBACKS: FRONT (F ROI\1 Pi L)
LANE COUNTY DEPARTTVIENT OF ENVIRONMENTAL IVIANAGEIVIENT, 125 EAST BTH AVE., EUGENE, OREGON 974O1
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG'PERMlr-ulri i.fe: BUILDING-GREEN; PLUMBTNG-cANARy; sANrrAT'oN-,coLDENRoD; oFFrCECop.r'--vvFrrEc55-1 3
PHONE:687-4394
(owner, etc.) vyhen ready.
STRUCTURES NOW ON THE PROPERTY--
nomments:
E
S ITT INSPECTION
AppRov e o
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l Nspt clon
FOUNDATION INSPECTION
APpRovED n Drsappnoveo f'a Darr ItrspEcron
Rr urnx s
FRAMING INSPECTION
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LATH OR SI.IIETROCK
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Rrxanxs
I NSPECT I ON
DrsAPpRovEo Da tr Ittsprcron
rINAL INSPICTION
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CERTIFICATT OT OCCUP^NCY
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