HomeMy WebLinkAboutPermit Building 1976-04-16PER}TIT If q3 t?6
NOTE:NO PERMIT }[LL ISST]ED I]NTIL THIS APPLIC.ATION J BEEN APPROVED
APPLICATION FOR
CONSTRUCTION MOBILE IIOME PI-A,N REVIEW CHAI'IGE OF OCCUPANCY
I j
OWNER
Name Address Phone
X lccrss ro PRoPERTY (Road Name) N, tlft il
(e*r"tirre structures on Property:-9
x Property Location - Address/Dlrectlons:
11
r-p
ft _r J OX
CONTRACTOR
Address Phone
O. S. REG. /I oo
{ *r.p 13,4 rax Lot code I T-cl / census rracr
)S perty Acrea ge__Wldth_Depth_Subdivlsion
Below r ice
Slte Inspection 6 -6 Existlng Sewage DLsposal
SEWAGE
Pub1lc
Other ComunL
FEES:ING:
Installed by
Bldg.
Plunbing
3Z Surcharge
Waste Dlsp.
Plan RevLew
Moblle llone
PLIJMBING
TOTAI CHECK
or New System Requlred
Name of Conmunity or Publlc System
FI
O
WATER SI,]PPLY:
Well Spring
*--<e Sewage
Connectlon
PI.ANS F'I]RNISHED
Signature of Appl
Fee Received By:
Water
Connection
FACILITY PERMIT
'5b
\a OCr-, \
tem
Mln Septlc Tank CaPacl
Type of Construction
.red -
Fire
Feet
Zone Use Classiflcatlon
BIdg Setbacks - from Center of Road Rlght of tlay:
irde rnt. 5 slde Exrerlor-l--!. "J
t-R)€-
^"" d 4 {n d;G
css-r2 LANE COI.'NTY DEPAR OF EIWI
-q,
MANAGEMENT
a
DATE:
7
DATE
l--1
r.p q7
5!-oth"r l---l Name
-l
LANE COUNTY PERMIT FOR:PERA4IT NO
CONSTRUCTIONT] MOBILEHOTVIEI ] PLANREVIEWT ] CHANGEOFOCCUPANCYT ]
ZIP COD PH ONEECITY/ner ADDR ESSNANlE
ZIP
width
Depth
PHONEE)ntractor RESS CITY
NAIVIE
Reg. +
Code Census Tract
Range-- Section
-fax
Lo
Block
less to ProPertY (Road Name)
Lotd ivision
isting Structures on ProPertY:
rections to ProPertY - Address
-RUCTURE ( # BED ROOIVIS)
VALUATIONSO. FT
PLUIVIBING INSTALLED BY
JEWAGE DISPOSAL NAIVIOWNER [ ]OTHER t ]
PUBLIC I SEPT IC TANK [ ]OTHER [ ]
WATER SUPPLY: PROPOSED t ]
EXISTING i ]BUILDING
PLUTVIBING
3% SURCHARGE
TVIOBILE HON/IE--
PLAN REVIEW
TOTAL
PUB LIC
COMMUNITY-NAME:
PRIVATE WELL
OTHER-SPECIFY:
WATER PO LLUTION CO NTROL SPE CIFICATIONS
MAX. TRENCH DEPT I NCH ES
STAY 1 00'F ROIVI ALL WELLS
CONSTRUCTI
IVIIN. SEPTIC TANK CAPACIT
GALS. IVIIN. D
TYPE OF CONSTRUCTION
ON PERMIT
RAIN F IE LD
S & INSPECT
GROUP
IONS AND
LIN. FT
FIRE ZONE USE CLASSIF.
R. OF r/W
IDE EXT.
FT. FROM PROP. LINE:
SIDE INT. ---------------.-- REAR ZONE
SETBACKS- FT. FROIVI CT
FRONT S
lsl
c55 -13
I ANE COUNTY. DEPT'
couRrHouse lut'lc^'rg5 Ensr otn EUGENE
MANAGEMENT
. oBEGON 97401
ISSUANCE DATE
a certificate of
AUTHORIZED SIG NATU R ES
le all required
E.o.standards
IMPOBTANT
POST THIS PERM IT ON MAIN BLDG AT SITE
OF ENVIRO NMENTAL
-=_--\
'Ji*,i*=.W'.",
,LANNtNG DIVISIO
EVAL UAT I ON
6utt otlc pERltr AppL IIAT,rffi.
) strt NsPEcTtr,u
s_rax Lor,v,s,9-LOT:BLOCK:
APPL ICANT
DATE
Not
Aool i cabl e
"Wfr:ry
()
tage)
[ ]
CK|D BY: "
'Z 24
Setbacks rcm c
Front
Side Exteri
Setbacks from inter or nes:
l. Zoning Ordinance Compl iance: Zon
2. Subdivision Ordinance Compl iance
3. Requi red Access
4. guitaing Site (Area, t.,idth, Fron
5. Other (iee cornments)
No Yesr) rD 6.()(\i)
[]fl]( ) (!Side
Rear
F
-7
ING
BU DING I
COHHENTS I
PECT I 0 lv ls l0N Not
I icable No
)
)
)
7I
9
0
Plans Submitted
Soi I Stabi I itY (footings)
Flood Plain
0ther (see conments)
Yes
T,()
()
CI()
()
()CKID B
I
ER POLUT l0N CONTROL
Youar Building / Site lnsPection:
Cannot be aPProved
Not**# t ri6
I l. l{eets Department of Envi ronmental
Qual itY Standards'
12. o-a["t i'"" "*rnents)
() ()()CKI D BY
DATE
CO}THENTS:
TO APPLICANT:
Can be aPProved'at this time as in dicated on item N0
Qu estions and furt her information on i tems I through 5 contact t
GD vls ON. Questions and further informa tion on items 7
t 2 conta ct the E COU NTY BU LOING A ND SAN ITA TION DI vlsl0N.
( ) },ill b e held in this off ce unt I you can reso ve the P
ls bei ng returned.
erm it I i cation fee is b
NT
135 Sixth Avenue Ea st Eugene 0r eson 97401
PHONE:68 7-4065
above.
t\q1
h c
c55-28
(
You r buildi
LANE COU NTY PLANN ING DIVISION PH0NE: 687-4185
ems cated.
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C0ltilENTS: - , ,
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CONSTRUCTION [ ] tIlOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY t ]
CITY ZIP CODE
PERIVIIT NO
r Owner
NAME ADD R ESS PHON E
tr Contractor
NAIVIE ADD R ESS
O.S. Reg. *
Twp- Range- Section-Tax Lo t
Subdivision- Lot B lock
Access to Property (Road Name)
CITY ZIP CODE
Census Tract
PHON E
Code
Acreage Width
Depth
(\
Existing Structures on Prop
Directions to Property - Address:
STRUCTUR E ( # BED ROOIVIS)SO. FT VALUATION
SEWAGE DISPOSAL:
PUBLIC[] SEPTICTANK[]OTHER t ]
PLUIVIBING INSTALLED BY:
OWNER[] OTHER[] NAIVI E
BUILD ING
PLUIVIBING
3% SUBCHARGE
IVIOB ILE HOIVIE
WASTE DISPOSAL
PLAN REVIEW
TOTAL
WATER SUPPLY: PROPOSED t
EXISTING t
PUB LIC
COVIMIUNITY NAIVIE
PRIVATE WELL
OTHER. SPECIFY:
CONSTRUCTION PERMITS & INSPEGTIONS AND WATER PO LLUTlON CONTROL SPECI F ICATIONS
IVIIN. SEPTIC TANK CAPACITY
GALS IVIIN. DRAINF I ELD-LIN. FT MAX. TRENCH DEPT I NCH ES
STAY 1OO'FRO I\4 ALL WELLS
TYPE OF CONSTRUCTION- GROUP FIRE ZONE USE CLASSIF
SETBACKS- FT. FROt\4 CTR. OF rAV
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
Call 687-4065 to schedule all required construction inspections. Call 687-406.1 to schedule all requr
septic system inspections. All construction shall comply with the State Buidling Code, D.E.Q. stand
for subsurface sewage disposal and the State Plumbing Code. All buildings require a certifica'
occupancy before being occupied.
(See Details on Reverse Side)
POST THIS PERMIT ON MAIN BLDG. AT SITE
LANE COUNTY, DEPT. OF ENVIBONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OBEGON 97401
LANE COUNTY PERMIT FOR:
\-
SITE INSPECTION
Ap pRov r o
Rruanx s
Drslppnoveo Dare I rseecron
FOUNDATION I NSPECTION
AppRoveo D Dr sappRovro
Reuanxs lr
TE I Nspecto
/
FRAM I NG
Appnoveo
Re ulRx s
I NSPECT I ON
DrsappRovro D Darr c)c
LATH OR SHEETROCK PECT I ON
AppRovro
RrulRx s
Dtsa ED IDarI Hsprct
- 7f -Fb
F I NAL I NSPECT ION
Ap pRov E o
/
Reuanx s
// o 4/\-D r sappRoveo DaT e I ruspecroR
CERTIFICATE OF OCCUPANCY
Rreov ro lssuE
RrurRx s
Nor Reaov ro I ssue
{ab-7b'A4/-r7@4L-2 (92
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