HomeMy WebLinkAboutPermit Building 1978-03-13u&6fsPR-
TRS, TL JOB LOCATIO
Partitioning
LANE COUNTY PERMIT
Acreage or Lot Size
Contractor's O.S. #
( ) Completed Subdivision
Lot Block-
APPLICANT'S NAME AND ADDRE qq
OWNER'S NAME AND ADDRE
CONTRACTOR'S NAME AND ADDR Phon
Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when ready
Phone-
Phone-
e
STFUCTUFES NOW ON THE PROPERTY
I
THIS PERMIT IS FO # B ED ROOIVIS-# PLUIVIB I NG CO NNECT IO NS
WATER SUPPLY-- SEWAGE DISPOSAL- S.I. #
THlSPRoPERTYlSWlTHlNoNEMlLEoFTHEclTYoF.PLUIVlBlNGBY
I hereby certify that the above statements are true and accurate, and that I have the lollowing legal interest in the property:
-owner
of record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. I further certify that (if not the owner) I am authorized to act lor the owner ot
record, and that said owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit.
Fee Paid $-Signatu re Date
() NEW ADDRESS () FACILITY PERMIT TO TRANSPORTATION DEPT.( ) SPECIAL PMT. AREA. MlN. ELEVATION:
-
SAN ITATION BUILDING
Type of Construction
-Group -FireZone
Use Classification
Comments:
Comments
By Date:By:Date
[Vlinimum Septic Tank Capacity (Galtons)
Drainfield Required - Lineal Feet
Maximum Depth
PLANNING REOUI REMENTS SATISFIED. By Date Date lssued:
ZON E SETBACKS: FRONT SIDE FACING STREET (FROM C/L) INT. SIDE YARD REAR (FROM P/L)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST BTH AVE., EUGENE, OREGON 974O1
POST THIS PERMIT ON MAIN BUILDING AT SITE
C55-13 BLDG. pERMrr - WHrrE; BUTLDTNG - GREEN; pLUMBTNG - GANARy; sANrrATroN - coLoENRoD; oFFrcE copy - wHrrE
PHONE:687-4394
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SITE INSPICTION.
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CERTIFICATE OF OCCUPANCY
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Nor Rerov ro lssue Drre I NSPEcToR
TBS; TL
Acreage or Lot Si
Contractor's O.S. *
APPLICAN T'S NAME AND ADDROWNER'S NAME AND ADDRESS
CONTR ACTOR'S NAME AND ADDRESSMail per mitto ( )Applicant ( )Owner (
STRUCTURES NOW ON THE PROPERTY
LANE COUNTY PERMIT
_() Completed Subdivision
Prefer to pick up. Call (owner, etc.) when ready
JOB LOCATIO
Partitioning #
) Contractor. ( )
Lot----_- Blo ck
Phone '
Phon o
Phone-
liHIS PERMIT IS FOR
U/ATER SUPPLY
THIS PROPEBTY IS WITHIN ONE MILE OF THE CITY OFI hereby certify that the above statem ents are true and accurate, and t_contract purchaser ; _ potential bu yer; .-- realtor or a gent. Irecord, and that said owner is aware and app roves of this action. I hereby a
Fee Paid g
# B ED ROOIVS-# PLUIVIB I NG CONN ECT IO NS
SEWAGE DISPOSAL S.I. #
PLUIVIB ING BY
-hat I have the following legal interest in the property:
-owner
of record;further certify that (if iotir,u o*n..t'i'am authorized to act for the owner ofgree to comply with all applicable Codes relating to this permit.
( ) NEW ADDRESS () FACILITY PERMIT
Signature
ON DEPT
DateTO TRANSPORTATI _(SANITATION
Minimum Septic Tank Capacity (Gallons)Drainfield Required r_inear-peervvrrv,J,
rvraxtmum Depth
BUILDING
Type of Construction _Grou p
-Fire
Zone
se ClassificationtLommentsComments:
B
Date
PLANNING RE OUIR EME NTS SATISF IED. BZONESETBACKS: FRO NT
LANE COUNTY DEPARTMENT OF ENVIRON MENTAL VTANAGEMENT, 125 EAST
B Date
Date Date lssuedSIDE FACI NG STREET FROtvt c/L) tNT SIDE YARD REAR (F ROM P/L)
8TH AVE., EUGENE, OREGON g74O"I
DING AT SITE
c55-1 3 aLDG. pERM,r - wH rE; "",.::.:i::::J::JJ'J.:i Kil;:l:ITATION - GOLDENROD; OFFTCE COpy _ wHtTE
PHO :687-4394
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INFORM ATION SHEET
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( ) site Feasibirity study for septic Tank. Number of sites_
Partitioning#.---=-- ( ) Completed
Test holes be ready.
( ) Pending
Subdivision
Lot
APPLICANT ,S NAME AND ADDR ESS rOWNER'S N AME AND ADDRE SS, if different ma licant'sCONTRACTOR'S NAME AND ADDRESS'p il permit or results of site feasibility study to
(X) guitaing permit
Acreage or Lot Size
) Prefer to pick up. Call
STBUCTURES NOW ON THE PROPE ilxt g
PROPOSED USE (this permit)
WATER SUPPLY t FLD ;/7
Applicant ( )Owner ((owner, etc. ) when ready
) Contractor
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Phone
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Contractors O. S. #
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existing or proposed well, etc. lf public, name of system)
(existing or proposed septic tank. etc.) S.l
Address
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SEWAGE DISPOSA
PLUMBING BY !,+
(X) PROPERTY IS WITHIN O NE MILE OF CITY
*t****++*************+***********i+****OFFIC E USE ONLY B ELOW THIS LIN( ) Facility permit Necessary ( ) Special Permit Area. Minimum ElTBACKS:
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lnterior Side Yard
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OPERTY LINES)To Planni nglB ui lding I nspector/San itariajllf fo0Jrcant appears to have a probyour asststance will be appreciated.
Response By Permit Processing Section
By
DEPARTMENT OF ENVI RONMENTAL MANAG EMENTpermit processing Section
125 East gth Avenue
687_4394
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