HomeMy WebLinkAboutPermit Building 1976-04-22PERMIT /T 7s7-26
NOTE: NO PERMI1 :LL BE ISST]ED T'NTIL THIS APPLIG-ION HAS BEEN APPROVED
APPLICATION FOR:
MOBILE TIOME PLAN REVIEW CIIAI.IGE OF OCCUPAIICYcoNSrRucrroN fr
OWNER DO sL 77
Name s City zLp
CONTRACTOR
o.s. REG. /l
City
Code Census Tract
lockfrtoperty Acreage Width-Depth-
*r. /7 *,,e.J\g-.s""tiooffi/Lf-1^*rct4
€***LotSubdivlsion
ACCESS TO PROPERIY (Road Name)
Existing Structures on Property:
Property Location - Address/Directions:
for 1ce Use
I
ItSq Valuatlon
L/J_
sal System Ff or New system Required
d
SEWAGE DI
Slte Inspec tton //
IIATER SI]PPLY:
Well
FEES:
B1dg.
Phmbing
3% Surcharge
Waste Dlsp.
Plan Review
Moblle llorne
Spring
,Ld
Exist
PLIJMBING:
Installed
PLIJMBING
ty
wK Name of Corrmunity or Public Systen
Name &-'-
-
of Fixtures Sewage
Connectlon
PLANS FURN]SHED
CASH tly'l_yES
CHECK Signature of Applicant:
Fee Received
Drainfield Required - Lineal Feet
Water
Connection
FACILITY PERMIT
NO YES
Date:
H NO
TOTAI
Maxlmurn Depth
P
Sewage D
$pe of Cons Fire Zo ne---------use Classlflcatlon
Bldg Setbacks - from Center of Road.,D,lght of
slde InE. 5
way
S Rear
1t
LAI{E COTTNTY D
SANITATION:
OF ENVI
I
Zone
L.BUIPIANNING:DATE:DATE:
6
DATE:
cs5-r2
&l.oo
*4,Ln
M1n. Septlc Tank Capacity-
LANE COUNTY PERMIT FC PERI\1IT NO
I Owner
CONSTRUCTION [ ] IVIOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
NAIVIE ADD R ESS CITY ZIP CODE PHON E
tr Contractor
NAIVE ADD R ESS CITY ZIP CODE
Range-- Section-Tax Lot-.--- Code-Census Tract
Lot B lock Acreage Width
Access to Property (Road Name)Depth
PHONE
O.S. Reg, +
Tw
Subd ivision
Existing Structures on Property:
Directions to Property - Address
STRUCTURE (# BEDROOIVIS)SO. FT VALUATION
SEWAGE DISPOSAL:
PUBLIC [ ] SEPTICTANK [ ] OTHER [ ]
PLUIVIBING INSTALLED BY:
OWNER[] OTHER[] NAIVI tr
BUILD ING
PLUIVIB ING
3% SURCHARG E
IVIOBILE HOIVIE
WASTE DISPOSAL
PLAN REVIEW
TOTAL
WATER SUPPLY: PROPOSED t ]
EXISTING t]
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
IVIIN. SEPTIC TANK CAPACITY
GALS IVIIN. DRAINFIELD LIN. FT MAX. TRENCH DEPT I NCHES
STAY 1OO' FBOiVI ALL WELLS
TYPE OF CONSTRUCTION GROUP FIRE ZONE USE CLASSIF
SETBACKS FT. FROIVI CTR. OF rAV
FRONT SIDE EXT
FT. FROIVI PROP. LINE
SIDE INT R EAR ZON E
AUTHORIZED SIGNATURES
/s/
ISSUANCE DATE
BLDG, PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANABY
BUILDING - GFEEN
SANITATION - GOTDENROD
IIVIPORTANT
Call 687-4065 to schedule all required construction 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 MAIN BLDG. AT SITE
LANE COUNTY, DEPT. OF ENVIRONIVIENIAL MANAGEMENT
COUBTHOUSE ANNEX, ,135 EAST 6th, EUGENE, OREGON 97401cs5-1 3
] PUB LIC
] COVIMIUNITY-NAIVIE:
] PRIVATE WELL
] OTHER-SPECIFY:
t
t
t
t
BU;LD st EVALUAT I ON dvl
Not
Aool i cabl e
,1^22"w()
Frontase) ( )()
//,a3 Lor-J7/2_/4TR TAX
.,/
N BU t LD tNG pERH I T APPL t cRT tox tlo .-7{s SION:
L0T:_ BLOCK:_
()SITE INSPECTION APPL I CANT
DATE
PLANN ING D !VI
CKID BY:h/4, ?-/ q:7q
6. Setbacks-Trom c7f-of-ioEd:Front 57)
Side Exterior
Setbacks from inter or nes:
Side
Rear
COI{}IENTS:
l. Zoning Ordinance Compl iance:
2. Subdivision 0rdinance ComPl i
3. Requi red Access
4. Building Site (Area, t.Jidth,
5. 0ther (see conxnents)
No Yes
CI TD.( ) (l)( ) (I)( ) (D( ) (l)A
..?
T_APPilTAT t0N#
BUILDING INSPECTION DIVIS !ON
7. Plans Submitted
8. Soi I Stab i I i ty (foot i ngs )
9. Flood Plain
O. 0ther (see comments)
Not
I icable No
li CKID BY:JZ.h
r)Yes'ffi
(')
()
()
()
()
()I
COHHENTS:
ITATER PoLUTI0N C0NTRoL
I l. l'leets Department of Environmental
Qual i ty Standards.
12. Other (see comments)
Aool i cabl-e No Yes
-(r r) r-I
Not
() ()()CKID BY:
DATE
COHHENTS:
TO APPLICANT:
Q'
ing / Site lnspection:
approved.
be app roved at this time as indicated on item N0.above.
ons and further information on items I through 5 contact the LANE-
PLANNING OIVISI Questions and further informa tion on itemil
2 contact t NEC BUILDlNG AND SAN TATION DIV SION.
you can reso vet eP ems I cated.
futft,#'i,tit
135 S ixth Aven ue East Eugene Oregon 97401
PHONE:687-4065
c55- 28
LANE COUNTY PLANN tNG DlVlSt0N PHONE: 587-4186
#(-,
Your !uild
-,fu-tan ue
;^ ( ) Cannot
Quest i
Your bui ldi
(
Uill be held in this
ls being returned.
ce unt
I ica
PERIVIIT NO
CONSTRUCTION [ ] IVIOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
NAIVIE ADD R ESS CITY ZIP CODE
n Owner
PHONE
n Contractor
NAME
O.S. Reg. +
Twp
Subd ivision Lot
Access to Property (Road Name)
ADD R ESS CITY
Acreage
ZIP CODE ONE
Range- Section-Tax Lot.----_ Code- Census Tract
B lock Width
Depth
Existing Structures on Property:
Directions to Property - Address
STRUCTURE (# BEDROOIVIS)SO. FT VALUATION
SEWAGE DISPOSAL:
PUBLIC [ ] SEPTICTANK [ ] OTHER [ ]
PLUTVIBI NG INSTALLED BY:
OWNER[]OTHER[] NAIVI E
BUILDING WATER SUPPLY: PROPOSED I ]
EXISTING I]
PUB LIC
COIVIN4UN ITY - NATVIE
PLUIVIB ING
3% SURCHARGE
MOBILE HOIVIE
WASTE DISPOSAL
PLAN REVIEW
TOTAL
PRIVATE WELL
OTHER .SPECIFY
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTBOL SPECIFICATIONS
IVIIN. SEPTIC TANK CAPACITY
GALS IVIIN. DRAINFIELD-LIN. FT IVIAX. TR ENCH D EPTH I NCH ES
STAY 1OO' FROTVI ALL WELLS
TYPE OF CONSTRUCTION GROUP FIRE ZON USE CLASSIFE
SETBACKS- FT. FROIVI CTR. OF rAff
FRONT SID E EXT
FT. FROI\4 PROP. LINE
SIDE INT REAR ZONE
AUTHORIZED SIGNATURES
lsl
ISSUANCE DATE
BLDG. PEBMIT - WHITE
OFFICE COPY _ WHITE
COUNTY TAX _ PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT
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, O.E.Q. standards
for subsurlace sewage disposal and lhe State Plumbing Code. All buildings require a certiricate of
occupancy before being occupied.
(See Details on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY. DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401c55-t 3
LANE COUNTY PERMIT FC.
SITE INSPECTION
Ap pRov r o
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D t sappRoveo Darr I Nspecron
Drre f-b "l G I Hserct
FRAMING INSPECTI
Appnov r o
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Dr sappRovro o*,f, fi- /(t I NsPEcr
tJ
/
LATH OR SHEETROCK INSPECTION
Ap pnov r o
Rexlnx s
D DTsAPPRovE o F-a Dar r I Hspecton
F I NAL I NSPTCT ION
Ap pRov E o
Reuanx s
,o.,r,1--fi, - /b rNSpEcroD I sAPPRovEo </
CERTIFICATE OF OCCUPANCY
Reaov lo lssue
Rrurex s
Nor Reaov ro lssug D Dare
7rf 7'7b abzo 7,&J
I NSPEcToR
D
FOUNDATION TNSPECIION
-/-
APPRovED H Drsappnoveo 77
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