HomeMy WebLinkAboutPermit Building 1985-08-14W? RPcX
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PROPOSED USE OF PROPERTY
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pertaini.ng to the work described herein, and that NO OCCUPANCY will be nade of artl strircture without the pemission of the Building Division. I fur-
ther cerlify that registration with the Builderrs Board is in fulL force and effect as required by ORS 701.055, that if exempt the basis for exemption
is noted hereon, and that only subcontractors ed employees who are in conpliance with ORS 701.055 will be used on this project. I HAVE RIAD AND
THIS APPLICATION
DATEase
certLfy that aLl inforration hereon
p,rr"h"""., S(rthorized agenE with
the ordrrdncer\of Lane Couty and
andtrue t_correc and thatdoarrdIYCAREFULLTHEEXAMINEDAPPLICATIONCOMPLETEDPERMITI'OR herebyHAVE
ofevidence authorict.ofowner record COII rareanthe tytheintertyTlega1followingprope
the ofLaws Statethe ofworkshal 1d donebe n w1accordanr:e th OregonIf:rthe!that aIledcertifyany perf ome
Date:
rnstaLlation Record Issued? f] v"= fl ""
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COMiIENTS:
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COM}IENTS
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TATION: S. I. *B. P. #
NATION: Type
Minimrm Setbacks:
I{AS BEEN BASED
Lineal Feet
of Drainfield
Maxinm Depth
of Trenches
Installation Gal1on
Soecifications: Tank
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READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION
f-l pr.atqllrtlc,/zoNrNc i zoneAfr(.(- partition
ON THE FOLLOWING CONDITIONS:
Parce-L i
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DATE
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
7 ( Z.- 12s EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR I.NSPECTION INI'ORMATION cr4-2s R%
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ACTIV-,.Y INFORMATION S-IEET
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COMPL TE THIS STCTION. INCOMPLETE FORMS I.JILL BE RTJTCTEDI
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FOME_TETEPHME ?BUSINESS TELEPHONE #FOMTTETEMTNFT
2 PROPERTY ADDRESS
( IF DIFFERENT
3 rvlarr sl FAFIEEL NLTMBE
( REQUIREp INF0RI4ATIoN)
Fl (from tax maps in Department of Assessment and Taxation
or from tax s t)
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TOWNSH I P
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8
ZONTNG-
INfi
TorNsErp mN6E sEe-rroru ffi ZONING
MilNSHIP R-AICE SEETMN ffi MN]XG
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:ACRES
4 SUBDIVISION (if applicable)Lor /2
5 REQUEST (s;tate exactly what you plan to do)AdJ ; {, "-^A | /a', -zL'
s
t6 DIRECTIONS TO SITE l.4
** FoR STAFF USE 0NLY **
NUMBER
DATE
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ZONE/LAND USE:
BY: _ DATE:- TIME IN:- 0UT:-
LAND MANAGEMENT DIVISION / 1?5 E. 8th AVE., EUGENE, OR 9740I / 687-4061,
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PERSON MAKING REQUEST
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BY PERMIT
TRS#DATE ISSUED:q
I NTERI OR O, REAR
PERMIT#2228 -CS
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ER
IX
SDS APPRO\XAL REQUIRED
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FRONT C1 SIDE
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N LE INSP
Date Co ont Date I nspector
Approved Da Correcti on Da te Ins pector
UNDERSLAB PL BG.tr /UNDERFLR PLBG.II I NSPECTI ONApproved Date Correction Date i nspector
OTHER INSPECTIONApproved Date Comecti on Date Inspector
ROUGH P BrNG (TOP OUT) rNSPApproved Da te
ION
Correct'ion
ECT
Date I nspector
Correcti on Date Inspe ctor
ROUGH ME CHANI CAL
Approved Date Correcti on Date Inspector
I NSULATI ON / VAPOR BARRI ER INSPECTION
App roved_Date /Correcti on Date I nspe ctor
LATH / GY
Approved
BOARD INSPECTION
Date Correcti on Date Inspector
FINAL M ECHANICALD /HO0D STOVE tr,
Approved Date Correcti on Date Ins pector
FINAL ING iNSPECTIONApproved Date Correcti on Date I nspecto r
EH P
rove d Date lZ-?-ffi/ /Comection Date Ins pecto
CERTI F ICATE OF IEMPORAR CERTI FI CA OF OCCUP YApproved
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Date
PANCY tr
Insp.Approved Date Ins p.
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