HomeMy WebLinkAboutPermit Building 1976-04-22PERMIT
NOTE: NO PERMIT WItt J ISSUED I]NTIL THIS APPLIC,ATION .AS BEEN APPROVED
APPLICATION FOR:
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coNsrRUCrroN g MOBILE }IOME PLAN REVIEW C}IAi.{GE
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CONTRACTOR
Name
Name
ess
Address
Tax Lot
Phone
o. s. REG. /l
Tvp.l.l ,,.^ -2 U/
Below fo
m_,
ACCESS rO PnO-PnnrY (Road Name) N, /Yh
Subdivision
ExisEing SEructures on Property
Property Location - Address/Dlrections:
Census lract
Block
Ft
'"a1 sy"t.* d or New System Required
tv * Name of Coomunity or Public Systen
0ther Name
?roperty Acreage width8{ Depth--ljl-
o,{.-d
(il'}t4^4Jfl'att''<Lot S
\{,L
f
1on
SEWAGE DISPOSAL:
Site Inspec tion /l
WATER SIJPPLY:
Well
FEES:
BIdg.
Plumbing
3% Surcharge
lIaste Disp.
Plan Reviery
Moblle Hone
Spring
Exist
Other
PLUMBING:
Installed by
PLIJMBING FEES
CHECK
t
&, A*'
34,ffi
---;aT
@,V7-
of
PLANS FURNISHED FACILITY PERMIT
CASH I=fYES
Signature of
I'ee Received By:Date
Drainfield Required - Lineal Feet Maxlmum Dep rh
Sewage
Connection
Water
Conoection
NO
TOTAL
Mln. Septic Tank Capaci
Sewage D
P
.t>
,l)./tt^Avi-t- -
Group Fire Zone Use ClassiflcaType of Cons
Bldg Setb
Front
Center of
Slde Int.
Right of Wayffi?'*Road
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LANE COI]NTY D
Si{r"Jltcti6r
ENVI
DATE:i-2--?bDATE:DATE:
4-
F
MANAGEMENT
n Owner
I Contractor
LANE COUNTY PERMIT FOR:PERIVIIT NO
CONSTRUCTION [ ] IVIOBILE HOIVIE [ ] PLAN REVIEW I ] CHANGE OF OCCUPANCY t ]
NAIVIE ADD R ZIP CO PHONE
NAIVIE ADD R ESS CITY ZIP CODE
Census Tract
PHONE
O.S. Reg. +
Twp- Range-- Section , V,(Tax Lo
Subd ivision Lot B lock
Access to Property (Road Name)
Code
Acreage width
Depth
Existing Structures on Property:-
Directions to Property - Address:
STRUCTURE (# BEDROOIVIS}SO. FT VALUATION
SEWAGE DISPOSAL PLUIVIBING INSTALLED BY:
OWNER[] OTHERTI NAIVIPUBLIC [ ] SEPTIC TANK I I orHER [ ]F
BUILD ING
PLUIVIB ING
3% SURCHARGE
MOBILE HO[/IE
WASTE DISPOSAL
PLAN REVIEW
TOTAL
WATER SUPPLY: PROPOSED t I
EXISTING t]
PUB LIC
COIVIVIUNITY - NAIVIE
PRIVATE WELL
OTHER-SPECIFY
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
IVIIN. SEPTIC TANK CAPACITY
GALS IVI IN. DRAINF IELD- LIN. FT IVIAX. TRENCH DEPTH I NCHES
STAY 1OO' FROIVI ALL WELLS
TYPE OF CONSTRUCTION G ROUP FIRE ZONE USE CLASSIF
SETBACKS- FT. FROIVI CTR. OF rAtV
FRONT SID E EXT
FT. FROIVI PROP. LINE
SIDE INT REAR ZONE
AUTHOR IZED SIGNATURES
lsl
ISSUANCE DATE
BLDG- PEFMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GBEEN
SANITATION - GOLDENROD
IMPORTANT
Call 687-4065 to schedule all required conslruction inspections. Call 687-4061 to schedule all required
septic system inspeclions. All construction shall comply with the State Buidling Code, D.E.Q. standards
for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy before being occupied.
(See Details on Reverse Side)
POST THIS PERMIT ON MAtN BLDG. AT SITE
LANE COUNTY. DEPT, OF ENVIBONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OBEGON 97401
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SkSnoture
- TOT USE Of SANITATIAN ONLY:
Srrt", cagortarly til t: vill aot [1 furrti,.n tctr;focrori!;, oed ir theref;re o:prorei icr;: -;::ncy,;t' ''''.,'cre'j
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BUILDJNG S ITE EVALUAT ION J$c
BUILOING PERHIT APPLICATION NO
SITE INSPECTION
PLANN!NG DIVISION
T ??s ,Fto*LOTfr'w-?GC
K SUBD V I S l,-..:
APPL I CANT
LOT:
()
DATE
Not
icable CKID
6. Setba
Setba
No Ybs
I-t 1T
iiiili
l. Zoning 0rdinance Compl iance:
2o Subdivision 0rdinance Compl i
3. Requi red Access4. Bui lding Si te (Area, }Jidth,
5. Other (see comments)
Zon
Frontage)
()
()
()
()
cks rom c
Front
ItrEI-ETIE?TE?
cks from inter
Side
Rear
I
or nes:
CO!{MENTS:
PLANNING DIVISION ACTION PENDING: YES( ) N0(T-APPilTATroffi
BUILDING INSPECTION DIVIS!ON
7. Plans Submitted
8. Soi I Stab i I i ty (foot i ngs )
9. Flood Plain
O. 0ther (see conments)
Not
Appl icable No(l
(/)
()
()
I
Yesffi()
()
()
r)()
()
()CKt D BY - 22.tl
I.'ATER POLUTION CONTROL
ll. l{eets Department of Environmental
Qual i ty Standards.
12. 0ther (see comments)
Not
Appl icable No
TT
YesrT1-)
() ()()CKID BY:
DATE
COH}.IENTS:
TO APPLICANT:
You
\.)
,{,.f[J"'
()
r Building / Site lnspection:
Can be approved.
Cannot be approved at this ti
Questions and further informa
me as indicated on item N0
tion on items I through 5 contact t LANE-
PLANN I 0 s l0N Questions and further informa
t rough 2 contact t COUNTY BU I LD I N AND SANITATION D s l0N
Will be held in this ce unti you can reso ve the prob
above.
tion on itefrE7
c55-28
Your bui ldin
135 Sixth Avenue East Eugene 0regon !
PH0NE. 697-4065
LANE COUNTY PLANNING DlVlSlON PHONE: 58
ems nd i cated.
) ls Ueing returned.
rmit a I i cati fee is tu
7401
7-4t 85
I
COHMENTS:
I Owner
PERIVIIT NO
CONSTRUCTION [ ] I\,IOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY t ]
NAME ADD R ESS CITY ZIP CODE PHONE
D Contractor
ADD R ESS
O.S. Reg. +
Twp- Range- Section-Tax Lo
NAIVIE CITY ZIP CODE
Census Tract
PHONE
t Code
Subd ivision _-- Lot
Access to Property (Road Name)
B lock Acreage Width
Depth
Existing Structures on Property:
Directions to Property - Address
STRUCTURE (# BEDROOIVIS)SO. FT VALUATION
SEWAGE DISPOSAL:
PUBLIC [ ] SEPTICTANK [ ] OTHER [ ]
PLUIV]BING INSTALLED BY:
OWNER[] OTHER[] NAIV]E
BUILD ING
PLUIVIB ING
3% SURCHARGE
IVIOBILE HOIVIE
WASTE DISPOSAL
PLAN REVIEW
TOTAL
WATER SUPPLY: PROPOSED t
EXISTING t
PUB LIC
COIVIIVIUNITY NAIVIE
PR IVATE WELL
OTHER - SPECIFY
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
IVIIN. SEPTIC TANK CAPACITY:
GALS.-- VI IN. DRAINF IELD LIN. FT tVIAX. TRENCH DEPTH- INCHES
TYPE OF CONSTRUCTION GROUP FIRE ZONE- USE CLASSIF
SETBACKS FT. FROIVI CTR. OF rAN
FRONT SIDE EXT
FT. FROIVI PROP. LINE:
SIDE INT.
-
REAR ZONE
AUTHORIZED SIGNATURES
lsl
ISSUANCE DATE
BLDG, PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX _ PINK
PLUMBING - CANABY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT
POST THIS PERMIT ON MAIN BLDG. AT SITE
LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
Call 687-4065 to schedule all required construction inspections. Call 687-4061 to schedule all required
septic system inspections. All construction shall comply with the State Buidling Code, D.E.Q. standards
for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy before being occupied.
(See Details on Beverse Side)
c55":3
r
LANE COUNTY PERMIT FOR:
STAY lOO' FROIVI ALL WELLS
Appnov E o
RruaRxs
DI SAPPROVED Dare I ruspecroR
SITE INSPECTION
FOUNDATION I NSPECTION
APPROVED
REur nx s
Dl SAPPRovED Dr I ruspecron
FRAMING INSPECTION
Appnoveo
Re uanr s
I SAPPROVED D DarE I Nsprcron
LATH OR SHTETROCK I NSPECT I ON
Dr sAPPRovEo Drr e I useEctoRAp pRov r o
RrltaRx s
FINAL INSPECTION
AppRov r o
ReuaRxs
DI SAPPROVED Dar r I ruspecton
CERTIFICATE OF OCCUPANCY
Reaov ro I ssue
Rruenx s
Dare I usprcron
/0 f- F6
Nor Rraov ro lssue
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