HomeMy WebLinkAboutPermit Building 1978-08-15*ub?,l tllttr4TRS, T JOB LOCATIO
LANE COUNTY PERMIT
Acreage or Lot Si Partitioning #
Contractor's O.S. #
APPLICANT'S NAME AND ADDRE ss
Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call
) Completed Subdivision
Lot- Blo ck
OWNER'S NAME AND ADDRESS
-
PhO
CONTRACTOR'S NAME AND ADDRESS
(owner, etc.) when ready
Phone-
S.l. #
Phone-
STBUCTURES NOW ON THE PROPERTY ''
THIS PERMIT IS FOR # BEDBOOMS # PLUIV]BING CONNECTIONL
\^JATER SUPPLY SEWAGE DISPOSAL
THlSPRoPERTYlSWlTHlNoNEMlLEoFTHEclTYoF.PLUtVlBlNGBY
I hereby certily that the above statements are true and accurate, and that I have the following legal interest in the property:
-owner
oI record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. I further certily that (if not the owner) I am authorized to act for the owner of
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
( }NEWADDRESS () FACILITY PERM IT TO TRANSPOBTATION DEPT.- ! SPECIA L PMT. AR EA, I\4IN, ELEVATION:-
SAN ITATION
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
Date
BUILDING
Type of Construction Group
-FireZone
Use Classification
Comments:
By Date
Comments
By
PLANNING REOUI REMENTS SATISFIED. By Date Date lssued
ZONE SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROM P/L)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL IVIANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT SITE
C55-1 3 BLDG.pERMtT-wHrrE; BUTLDtNG-GREEN; pLUMBtNG-cANARy; sANrrATroN-coLDENRoD; oFFrcEcopy-wHrrE
PHON E: 687-4394
Date
IO
FR0r'r:
FLOOD PLAIII IITAIIAGEMENT
DEPARTI.IENT OF PUBLIC I.JORKS
PHoilE - 687-4195
SUBJECT:
BUILDING PERI'IIT NUI'IBER ZZZ /-"8
SUBDIVISIOi,I
ilAP l1-?- | ? -3 T.L. 2-q /{
PLANi'II i{G
PERi.IIT PROCESS ING
OTHE R
PART IT I OI,I NUi,IBER
OTHE R
S i IE I I'I FLOOD HAZARD AR[A. YES NO X
DiTAILED STUDY APPROX i IIATE STUDY
NOT A SUBSTAiITIAL IIiPROVEIIIIIT
MINII1UM FLOOR ELEVATION REQUiRED
SITE II{ DESIGI,IATED FLOOD HAZARD AREA
EXTRA PRICAUTIOiiS MAY BE APPROPRIATE.
.
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LANE COUNTY :PARTMENT OF ENVIRONMENTAL \NAGEMENT
125 EAST 8TH AVENUE, EUGENE, OREGON 9T'TO1
n PTANNING DIVISION Current ,"^r^rfif
Partltlonlng 0_ lPend tng f]completed
Parccl No._
Partltlonlnq Requlred
Other r
rl
AVERAGE PROCESSING
tlATEA POLLUTION CONTROL I o! Sltea
UoY Sl,t. fnBpectlon (sl
SDS Con!tructton fJ Neu
Nu.mb€r of Bedroomsr
Councrc!.al,/Industr lal -
I nepatr
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x CONSTRUCTION PER.YITS AND I}ISPECTION(Seo abov6 for I of bedroons/l of employeea)
t] :itobt 16 Hom6 , $
tr permanent
atlture r
FEE
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Reneua Ist Sg. ft. Valuatlon
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TotaI Vrluntion S
. Plunbing fixtures at
-
Sowery'irater Conn. at
{l StEtc Surchargc
Planr Check Fec
Change of Occupancy
$_ Each S
t_ [ach 3
Subtotsl $
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40.o o
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TOTAL BUILDINC PERHIT FEE
ltlnlmun rtructural oetbacks :
Froru centerl,ino of gtrect: Front 4rf '
Froo lntcrror rot rines: :l::Hdt""*@r
f[ Corm'l plans sheet to appllcant I CurU cut ro appllcant
PUBLIC IANDS tr Address W Mininm Elevirion
PUBLIC l,[oRKs D raci ll ry pernlt
EI'VI ROIII.If,IITAL IIEALTII
caah- ch"". t-e3f Bcc,d ", flrrz,a-rn ,
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AFFIDAVIT: If thls permit is for an agricultural buildlng, I hereby declare that this butldlngnill be used for agricultural purposes 3s.lIlowcd by zoning and/or ihe state Duilding Code, an6for no other purpose. I further cerLify that the slatemenis and other information submitted onthls aPPlic.+ion are true and accurate, and that I have lhc'following legal intere8t in theProl)erty: J_.*n.r of record; contrnct purchaseri lessee; holrler of an exclusive optionto purchasd; _-duly authori zeil-Lo act (or a person t^,h-rj-has thc f6f lowing leqal ineercst !lane coL]nty, or tlrat the,
i,r ownar. i f urther a(Jree
omer o f record is knowlod,lcable of thto
pIy wrth all applir:.rlrIe codcs relatingappl i cation, if I ,rm noito thiB permit.
o^r. ?-/ g-Z&Applicant'a Silna
THIS IS YOUR RECEIPT, AND DOES }IOT GIVE YOU PERMISSION TO BUILD.
POR INPORT,UTION ASOUT THE PROGRESS OF YOITR APPI,ICATIOT , CALI, PI,:RMIT CO}JTROL, 687-' 357 (687-IIELP)
Address
Minimum Elevation
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Please Print - Retum Appllcarior
Receptionist l^hen ConFleted
APPLICANT
ADDRESS
OIIIiER (IF DIFFERENT)
ADDRES
Appoinrknt Dat(.
APPLIGATIcl I\I Office Use OnIy
7//d,7PtrPHONE
Clty
CONTRACTORIS ORE. STATE LICENSE
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ADDRESS CI
CoNTRACTOR _ PHONE
fil*"' 'o*'I./ PRESENT USF
,ETED PERMIT TO APPLICANT/OWNER/CONTRACTOR (CIRCLE oNE)[X
rcial'or
PRETER TO PICK UP
OF PRO (rgsl tlal; type of famlng; core indEtrlal; vacant; etc \
)
\
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STRUCTURES NOI,' ON TIIE PROPERTY. NO'I'E AN\' STIIIJCTURES TO BT] DEMOLIS}IED
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3.TE PI.ANS }'OR THIS PROPERTY (THIS APPLICATION )
^RE:
4. FUTURE PLANS:
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5. PLOT PLAN, Sketch (a) all roads (b) borndaries of property (c) exlst lng/proposed buildingsproposed sewage(g) easements
dlsposal areas (c) exist lr.rB/proposed wells (f) exlsting/prgposed(h) drainageways r st reans,creeks, any other pertlnent features. lfor 1nd6tr1al, show freestandl ng s1gns, parklng areas. INDICATE DIMENSIONS.
(d) exlstlng/
driveways
com rcla 1
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14.
SITE I NSPECTION TEST HOLE
-9 - 2a
PROPOSED I.IATER SUPPLY
EI,ECTRICITY FURNISIIED BY
WELL '. SPRINC--.STREAM LAKE
-. , PUBLIC:E*'/EB
I{ATURAL CAS BY
FIRE DISTRICT
I
F.-+--.
SCHOOL DISTRICT-
PLInIBINC BY
t***********************1******* DO NoT wRITE BULOl.l TIIIS LINE **********r************r*******
BEFORE YOUR APPLIO\TION CAN BE PROCESSED YoU MUST FURNISH: _8!*ll PLOT PLANS LECAL DESCRIPTION
(DIMENSIONED)
bne coJnty
BY Di\
LANE COUNTY DEPABTMENT OF ENVIRONMENTAL MANAGEMENT
125 EAST 8TH AVENUE, EUGENE, OHEGON 97401 Gn2q'b12r
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lfritten Directions
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( vf guitoing Permit
Job Location ,/4n/
OFF
Hnyaen 6t,ofi
Acreage or Lot Size
Partitioning #( ) Completed( ) Pendi
APPLICANT'S NAME AND ADDRESS
OWNER'S NAME AND ADDRESS, if diffE ,.as
cDO€ -
!NFORMATION SHEET
( ) Site Feasibility Study for Septic Tank. Number of sites--
Test holes will be ready-
Subdivision ilnq.rfefaEllp 4cn.cS Lot lO Block /
J fli 37 {30 6,9
\ B"oL 3{ P zl
sr
ND ADDRESS
f easibility stud
E f2'
o
rom licant's
Pho ne
Phone
Phone
-4L - 2788
3z{-?3;/,.ffiFFACTOR'S NAME Al'( )ai)/ermit or results of site
Yt Prefer to pick up. Call
v licant ( )Owner ( )Contractor
(owner, etc. ) when ready Contractors O. S. #
STRUCTURES NOW ON THE PROPE (3ac
PROPOSED USE (this permit)e o
WATER SUPPLY 2 '€&exrst ing or proposed well, etc. lf public, name of system)
sEwAGE DtsposAl ,A SeParc 5.1si-L'^ Aaf,-.ab? &)- do C..rFCi#rstins or proposed septic tank, etc.) s.t
PLUMBING BY N/1 Address
( 4 PROPERTY IS WITHIN ONE MILE OF CITY
*.r*r** oFFlcE usE oNLY BELOW THIS LINE rr*r+*r*rrar*
, ) New {ddr;ss Necessary ( ) Facility Permig
zoNE k'/+ sETBAcKs: Front y'S'Necessary ( ) Special Permit Area Minimum Eleva on
Side Facing Street lnterior Side Yard Rear
(FROM CENTEHLINE OF HOAD)(FROM PROPERTY LINES)
To: Plaoning/Euilding lnspector/Sanitarian/Surveyor.
This applicant appears to have a problem with
Your assistance will be appreciated.
By Permit Processing Section
Response:
c55-12
4'69 tvrslon
00?
By
DEPARTMENT OF ENV I RONMENTAL MANAGEMENT
Permit Processing Section' 125 East 8th Avenue
687-4394
a) tJn TD 3y' r,,1.
t SPat,ornaq
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TRS, T L
Acreage or Lot Size
Contractor's O'S' #
APPLICANT'S NAME AND ADDRES s
OWNER'S NAME AND ADDRE ss
CO NTBACTOR'S NAME AND ADDRESS
Ma il permitto 1 )Applicant ( )Owner ( ) Contractor. ( ) Prefer to pick up. Call
JOB LOCATION
LANE COUNTY PERMIT
Partitioning #-( ) Completed Subdivision
Lot Block-
Phone
Phone--
Phone-
(owner, etc.) when ready.
STRUCTURES NOW ON THE PROPEBTY
)TH|sPERN4lTlsFoR#BEDRool\4s-#PLuMBlNGcoNNEcTloNs--
\AJATER SUPPLY SEWAGE DISPOSAL s.l. #
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 {urther certity that (if not the owner} I am authorized to act for the owner of
;cord, 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 $Signature
( ) NEW ADDRESS () FACILITY PERMIT TO TRANSPORTATION DEPT il SPECIAL PIVIT. AREA. IVIIN. ELEVATION
Date
-
SANITATION
lVlinimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
Date:
BU ILD ING
Type of Construction
-Group -Fire
Zone
Use Classification
Comments
By Date
Comments
By:
PLANNING REOUIREMENTS SATISFIED. By Date Date lssued
ZONE SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROM P/L}
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL NIANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 974O1
POST THIS PERVIIT ON MAIN BUILDING AT SITE
C55-13 BLDG. PERMIT - WHITE; BUILDING - GREEN; PLUMBING - CANARY; SANITATION - GOLOENROD; OFFICE COPY - WHITE
PHONE:687-4394
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I rspecron
SITE INSPECTION
App Rov r o
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FOUNDATION I NSPE ON
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LATH OR SHIETROCK INSPECTION
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DrsappnovE o F7 o^r, f,ZZ4f I xseecton
FINAL INSPECTION
AppRov ro
Reuanx s
D t srepnoveo oart ,/O -.{-Z I txspe croR
CERTIFICATE OF OCCUPANCY
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