HomeMy WebLinkAboutPermit Building 1978-06-22(,bt 'l
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hlritten Directions 4
INFORMATION SHEET
( ) Site Feasibility Study for Septic Tank. Number of sites(X Building Permit
Acreageor Lot sir"/5o X70 Y 2? X,f3X12- Testholes ll be read
Partitioning #n/A ( ) Completed Subdivision
( ) Pendi
APPLICANT'S NAME AND ADDRESS Zc-
NER'S NAME AND ADDRESS, if different from applicant's
L{0a Lot
e l'Phone ?q7 3 ]5-7
Phone--
Phone-ry
)
Mail permit or results of site feasibilitystgr{r to ( ) Applicant.ffiwner (
D<) i'refer to pick up. Call 71 ? - 3e f 7 ( owner, etc. ) when readv
NTRACTOR'S NAME AND ADDRESS
STRUCTURES NOW ON THE PROPERT
PROPOSED USE (this permit)o
WATER SUPPLY
) Contractor
Contractors O. S. #
(existing or proposed well, etc. lf public, name of system)
(existing or proposed septic tank, etc.) S.l
Address
SEWAG E DISPOSAL
PLUMBING B
,}{PROPERTY IS WITHIN ONE MILE OF CITY
E ONLY BELOW THIS LlNf ********I**** ** *++******* r* *x** + *+* ** ** ++ +*****r******++*************+****++******* QpplCE US
{rt New ecessa ry )Facilit
FrontSETBACKS:
To: Planning/Building lnspector/Sanitarian/Surveyor
Permit Necessa ry
Side Facing Street
(FBOM CENTEBLINE OF ROAD)
v pecial Per
lnterio
ROP
mEl
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Rea
This applicant appears to have a problem
Your assistance will be appreciated.
By Permit Processing Section
Response:
By
DEPARTMENT OF ENV I RONMENTAL MANAGEMENT
Permit Processing Section
125 East 8th Avenue
687-4394
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Plcrt Plan
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Permlt #For
Permlt For
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Permlt #
Perml-rtl
Perml"tt
For
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For
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Acreage or Lot Size
Contractor's O.S. #
APPLICANT'S NAME AND ADDR
JOB LOCATION
LANE COUNTY PERMIT
Partitioning ) Completed Subdivision
Lot Bloc k
Phone--
OWNER'S NAME AND ADDRE ss Phone
PhoneCONTFACTOR'S NAIVIE AND ADDRESS
Mailpermitto()Applicant()owner()Contractor.()Prefertopickup.Call-(owner, etc.) when ready
\I/ATER SUPPLY SEWAGE DISPOSAL--s.l. #
ETRUCTURES NOW ON THE PROPERTY
THlsPERlv]lTlSFoR-#BEDRooli]S-#PLUlV]BlNGcoNNEcTloNL
THlSPBoPERTYlSWlTHlNoNEl\i]lLEoFTHEclTYoF-,PLUMBlNGBY--
I hereby certily that the above statements are true and accurate, and that I have the lollowing legal interest in the property:
-owner
ol record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. I further certify that (if not the owner) I am authorized to acl for the owner oI
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 $Signature Date
( INEWADDRESS ( ) FACILITY PERMIT TO T RANSPO RTATION DEPT.- ( )SPECIALPIVIT.AREA. lvllN. ELEVATION:
-
SAN ITATION
N/linimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
BUTLDTNG LANE CS
Type of Construct n
,!At FERffilI A*EE
roup
-Fire
Zone
}iTY SPEUi
to
Use Classification
Comments:
Comments:
Date
PLANNING REOUI REMENTS SATISFIED. By:
B Date
Date lssuedDate
ZONE SETBACKS: FRONT SIDE FACING STREET (FROI\4 C/L) INT. SIDE YARD REAR (FROIVI P/L)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL I\NANAGEMENT, 125 EAST BTH AVE., EUGENE, OREGON 974O1
POST THIS PERIVIIT ON MAIN BUILDING AT SITE
c55-1 3 BLoc. pERMtr - WHrrE; BUTLDTNG - GREEN; pLUMBTNG - cANARy; sANrrATroN - coLoENRoD; oFFrcE copy - wHrrE
PHON E: 687-4394
By:
SITE INSPECTION
Appnov e o
Re t'trRx s
DrsAPPRovEo e/ DEre 7: 1Z -7 i rrspe croa
TOUNDATION INSPECTION
Ap pRov e o n ,^,,7/2-78D r saepnoveo I NSPEcToR
Reurnx s
FRAMI NG
Appn ov E o
Rr uenx s
I NSPECT ION
Dr seppnoveo 7-tz-ft I HspccroRDarr
LATH OR SHEETROCK
Ap pnov e o
Rettanx s
I NSPTCT I ON
Dr sappnoveo I nsrecton
FINAL INSPECTION
Appnov E o
Rrurnx s
Dr srppRovro Dare I xseecro
CERTIFICATE OF OCCUPANCY
Reaov ro lssuE
Rruanx s
D Nor Reaov ro lssur D
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Drre I NSPEcToR
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Pennlt #For
Permlt For
Permlt f-For
Permlt #
Permlt
Permit
ForPlcrt Plan For
For
Subdivision,
Lot
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Tfii, T L ta?Do JoB LocATlo
Acreage or Lot Size
Contractor's O.S. #
Partition ing ) Completed Subdivision
Lot Block-
LANE COUNTY PERMIT
APPLICANT'S NAME AND ADDRE ss Phon
OWNEB'S NAI\4E AND ADDRESS Phone-
CONTRACTOR'S NAME AND ADDRES q Phone-
Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call (owner, etc.) when ready
iTBUCTURES NOW ON THE PROPEBTY-
THIS PEBMIT IS FOR ' # BEDROOML# PLUMBING CONNESTIONL
\^JATER SUPPLY SEWAGE DISPOSAL s.t. #
THlSPRoPERTYlSWlTHlNoNEMlLEoFTHEClTYoF.PLUtVlBlNGBY
I herebv certi{y that the above statements are true and accurate, and that I have the following legal interest in the property:
-owner
of record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. I further certify that {iI not the owner) I am authorized to act for the owner oI
record, and that said owner is aware and approves o{ this action. I hereby agree to comply with all applicable Codes relating to this permit.
Fee Paid S-Signatu re
( } NEW ADDRESS ( } FACILITY PERMIT TO TRANSPORTATION DEPT.- ( } SPECIAL PMT. AREA. MIN. ELEVATION
SANITATION
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
Date
B u I LD rNG tAttt coir$lil sPE{lAt FEBnf,lI Al(LA
Use Classification
Comments:
Comments:
By By Date
PLANNING REOUI REMENTS SATISFIED. By Date:Date lssued
ZONE SETBACKS: FRONT SIDE FACING STREET (FROI\4 C/L) INT. SIDE YARD REAR (FROM P/L)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT SITE
C55-13 BLoc. pERMtr - wHtrE; BUtLDtNG - GREEN; PLUMBtNG - GANARy; sANtrATtoN - GoLDENRoD; oFFtcE cop\/ - wHtrE
PHONE 7-4394
Date
-
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unp lA$Loco- \ -3 r,u.ro7
TO:
LANE COUNTY PLANNING
CONSTRUCTION PERMITS & INSPECTION
OTHER
FROH:
SURVEYORS OFFICE . FLOOD PLAIN !{A|.IAGEMENT
DEPARTT'IENT 0F PUBLiC LANDS PHONE: 687-4195
SUBDIVIS I ON
SUBJECT:
PARTITION NUI'IBER
I (.,9 7--78BUILDING PERMIT NUMBER
OTHER
REC0I,8'1ENDAT I0N :
THE ABOVE SUBJECT.IS IN A SPECIAL PER}'IIT AREA.
THE ABOVE SUBJECT IS INCLUDED IN THE H.U.D. U:NNMERED ''A,,ZONES.
REMARKS t\ArLl . tr Loora EL-tr=va:rt or.-\Ll6-f fZ-E-6 I r r rz E_I) %rTE-
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