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Home My WebLink AboutPermit Building 1973-05-08LANE BU ILDI MoLH J;rd €oun-r-- ( JNTY NGT BUILDING PERMIT OR MHT OME USE PERMIT PERMIT NO. PROPERTY OWNER MAILING ADDRESS PHONE CONTRACTOR MAILING ADDRESS PHONE PROPERTY LOCATION _ INCIUDE POSI OFFICE PROPERTY IEGAI, DESCRIPTION -METES, BOUNDS RANG E SECTION TAX LOT NO.CODE CENSUS TRACT,3.a *zaa/ EXISTING STRUCTURES ON PROPERTY APPt. NAME & MAITING ADDRESS tEGAt ACCESS TO PROPERTY avt PROPERTY SIZE _ FT. WIDTH DEPTH AREA FOR MOBILE HOME PERMITS ONLY No. of Bedrooms Connecl to Existing Sewoge System I New System STRUCTURES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION se. FT. # BDRMS VALUATIoN It SEWAGE DISPOSAT PUBr.rC n sEPTlc TANK n oTHERn PLUMBING INSTALIED BY OWNER E OTHER: NAME BUITDING WASTE DISPOSAL PTUMBING PTAN REVIEW PARK TRAITER TOTAT FEES WATER SUPPLY PUBUC tr tr OTHER $ COUNTY BUILDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL. DRAIN FIETD REQUIRED tIN. FT TRENCH WIDTH FT OR SQ. FT TYPE OF STRUCTURE OCCUPANCY ZONE PUBI.IC UTI[. EASEMENT BLDG. SETBACKS FRONT FT. FROM CTR. OF ROAD RIGHT OF WAY SIDE INT. SIDE EXT. USE CLASSIFICATION REAR AUTHORIZED SIGNATURE _ DATE DATE BI,DG. PERMIT _ WHITE OFFICE COPY - WHITE COUNTY TAX _ PINK PTUMBING _ CANARY BUITDING _ GREEN SANITATION _ GOTDENROD Construction to comply with uniform buildin covering plumbing ond sewoge disposol. Al of occuponcy before being occupied. (See Stotement on Reverse Side) (posT THrs PERMIT ON MAIN BLDG. AT SITE) tANE COUNTY, BLDG. & SAN. DtV., COURT HOUSE, EUGENE, OREGON 9740I s I code ond county regulotions buildings require o certificote ronu tg55-13 Ho t,s€ sedroom-E Bathd eEsefrE-E*'yes n No fl 169O So. ,'d' s t. rt field 0r.s Trench widrh .betwe enlines I Filler Type Fillera.bove denth INDIVIDUAL SEWAGE DISPOCNL SYSTEM RECORD ;iiiii:i: : d"::i::: ;j* ;sj,:i ::rxcounty Buirdins sanitatio"-rlJii*.".. I II . No stal t s Name Ft. from well Steel D Concrete t ength widrh Diameter Dr vPublic@zottre r-ListvNo. Compartmen ts Depth GG GaI. Capssi ty OoasposaeDistribution Box :Yes @./No trotheitr Fee t from Lot Line t below Applican Name M ailing Address Date s-nr+ 5. 6 of 31 4 Se e '.\ / 'a'1i' ,'rl i -n for )lnitarian Use only: ElIApproved: System Installation I Oisapproved: Does Not Conform Signature Conforms to to Current Standards Standards Date:fi - /4-t.t Rernarks: Lane County Building & Sanitation Dept. 'Sani tureS - '.); / t- t' '.'.t.- . .- / . ; BUILD ING S ITE EVALUATION \N rlx LoT 14 3q /€aB-z- Building Permit Appl ication No S i te lnspect ion Pre-Permit lnvest igat ion - i -v APPL I NAilE , ADDR S PHONE DATE () ) LANE COUNTY PLANNING DEPARTHENT Zoning 0rdinance Compl iance(zone-Qy_) Subdivis ion 0rdinance Compl iance 3. Requ i red Access 4. Bu i ld ing S ite (Area, Width, Frontage, Setback) 5. Other (see comments) NOT NO Ei'i't;cable -LA YES a (+ (+ (+ ) (2 (() () () () () () ()() () CO}4I'{ENTS: BUILD]NG INSPECTION SECTION 5. Plans Submitted 7. Soil Stabil ity (footings) 8. Flood Pl a in 9. 0ther (see Comments) NOT NO YES 00 appl icable () () NAI4E DATE () a) (r) (/) () () () ()()tl-- j -7) CO},IilENTS: ru NAI'IE DATE elrlu IANE \ --- JNTY BUTLDTNG I BUITDING PERMIT OR MOB. HOME MHE USE PERMIT PERMIT NO. PROPERTY OWNER MAII-ING ADDRESS PHONE CONTRACTOR MAITING ADDRESS PHONE pRopES;Sr.OCATrON - TNCLUDE POST OFFICE z PROPERTY LEGAI. DESCRIPTION -METES, BOUNDS RANG E SECTION TAX LOT NO CODE CENSUS TRACT EXISTING STRUCTURES ON PROPERTY APPT. NAME & MAITING ADDRESS LEGAI. ACCESS TO PROPERTY PROPERTY SIZE _ FT. WIDTH DEPTH AREA FOR MOBILE HOME PERMITS ONLY No. of Bedrooms Connect to Existing Sewoge System I New System ! STRUCTURES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION sQ. FT. # BDRMS VALUATION SEWAGE DISPOSAT PUBr-tC tr SEPTIC TANK n OTHERE PLUMBING INSTATTED BY OWNER n OTHER: NAME BUITDING WASTE DISPOSAT PI.UMBING PTAN REVIEW PARK TRAITER TOTAT F EES WATER SUPPTY PUBr.rc n tr oTHER COUNTY BUILDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL. DRAIN FIELD REQUIRED TIN. FT TRENCH WIDTH FT OR SQ. FT. TYPE OF STRUCTURE OCCUPANCY ZONE PUBTIC UTIL. EASEMENT BI.DG. SETBACKS FRONT FT. FROM CTR. OF ROAD RIGHT OF WAY SIDE INT. SIDE EXT. USE CTASSIFICATION REAR AUTHORIZED SIGNATURE _ DATE DATE BTDG. PERMIT _ WHITE OFFICE COPY _ WHITE COUNTY TAX _ PINK PTUMBING _ CANARY BUITDING _ GREEN SANITATION - GOLOENROD Construction to comply with uniform building code ond county regulotions covering plumbing ond sewoge disposol. All buildings require o certificote of occuponcy before being occupied. (See Stotement on Reverse Side) (posT THIS PERMIT ON MAIN BIDG. AT SITE) roau f c55-t3 IANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 9740I $- -=- SLAB FLOOR PLUMBING GROUND/ORK ApenovEo Reuanr s D Drsrppnoveo D Dnr e I Ns pe cron GAS P lP I NG GROUNDI'/ORK Ap pRov r o Reuanxs D DrsappRove, D Darr It,tspEcron ROUGH PLUMBING AppRovro m Drsrppnoveo RruaRx s oorr{' s-' ? s rNspe cron ROUGH GAS PIPING Aepnoveo D DrsappRovro D RenrRx s Dat e I nsprcron FINAL PLUMBING Apenoveo & Drsappnoveo Rr urnr s Drr ()-I ruspectoR FINAL GAS PIPING AppRoveo Reuanx s D r slpeRoveo Dat E I r'rs pE cton CERTIFICATE OF OCCUPANCY Rrrov ro lssue Reuanx s D Nor Rraov ro lssue D Dore_lxseecroR_ 7{7- 23 fom Apprmd. ludO.t Durae No. 76-t376.2.4 vETEnAilS ADrtltlilSTnAlloil INDIVIDUAT WATER SUPPTY AND SEWAGE.DISPOSAT SYSTEIIiREPORT OT I (TOP SECTION TO BE FILLED IN BY YA.) SUIDIVISION NATTE 7-s't: 7-/o- ?) IEGloNAI. OFFrcE SpringfleLd, Oregon PIOP€RTY ADDRESS 9747 1439 Vera Drive nlo. c^sE IYPE Of INSTAI.IATION NEw E ,r,r.no NAIAE Of BUITDEI Mohark-ceddenniar NArrlE Of LENDER TOTAT NUMBER SUPPTY AND SEWAGE DISPOSAI (Chcct)wA' PUBI,IC INDIVIOUATIIVING UNIIS SATHS WAIET SUPPI.Y 8Y If YES, HOW MANY? SEV/AGE OISPOSAI. 8Y SASEMENT NO E ,,, CAN AIIIC OR OTHEI AREA IE MAOE INIO ADDITIONAI. EEDTOOMS? YES nno I in below informotion opplicoble to subiect INSTRUCIIONS: lf new insiollolion, inrpect for complionce with opproved cxhibiB ond rccord ony obrrvrd infiormotion nol rhown on, or which voric: from, thc opprovad axhibitr. lf existing instollotion, furnish os much of the intormotion or moy bc ovoiloblc. At opplicoblc ur intpcclot't lkltch on rcvcruc. INDIVIDUAL WATER SUPPTY Dirl,oncc io norGrl public woiar moin,-fat. Sizc of moin, -inchcr. lndividuol wclls I ore ! orc nol cutlomory in neighborhood. Giva morl rocent rccond of foilure of wcll: in immediote vicinity lo furnirh odequote rupply of wolcr Propcrticr in neighborhood I orc ! ore nol bcing dcvclopcd with both individuol wol,er-supply ond rwogc-dilpo:ol lystems. Lolrizc:-fr:etwidc,-fecldecp.DrcllinglclbockfromfrontP7op.rly lndividuol wolar rupply from: I Drillcd well. ! Driven wcll. ! Dug wcll. ! Bored wcll. ncorcrl lot linc ot I fronl, I rido, ! roor, brt; corl aron i.w!r,-fcd; tilc t.mr,-fract rPtic r.cpog. pit,--f6t; c6ttml,--icot; olhcr rcurcct of posiblc pollution, Approximotc deptfi of pumping lcvcl of woter in wcll,-fcct. r\pproximote yicld, -gollonr pcr minule. Scoled wotcrtight to dcpth of - feel. Exterior spocc oround cosing seoled wilh: fl Camcnt grout. D Puddled cloy. f| Ordinory bockfill. Wcll covcr: f] Concrctc. ! Wood. ! tritetol. Openingr in well cover wolcrtight: ! Ycr. ! No. Pump: I Shollow wcll. E D..p wcll. length of drop pipc,-feet. Pump copocity,-gollonr per minule. Locotcd in: ! Bo:omcnt. ! Pump room oft borcmcnl. ! Pump houg obove ground. fl Pump pit. Pump room properly droincd, ! Ycr. I No. Pump mounling wotGrlighl: ! Ve:. f] No' Type of storoge: ! Prcssure. ! Grovity. CoPocity,-gollon:. Hor boclcriologicol exominotion of woter bcen mode? ! Ycr. ! No. lf onswcr ir "yes." givc dotc----, 19-. Quolily of wolar ! i3 ! i3 nol sotisfoclory for humon consumPlion. lnil,ollotion I docr I do.3 nol comply with opproved cxhibih, if ony. Dcplh ol coring,-fcct. fat. fael. fcct; dirporl Dirloncc of well from: Building foundotion,-- Wcll conrlruclion: Diomalcr.-inchcr. Tolol deplh,--fcd. Typc of cosing, INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRlrrtARY IREAITVIENT conrirlr of p Scptic tonk. f] Cospool Scptic tonk: Dirtonce from wcll,-- fcat' Motoriol,Numbs ol comPortmcntr 1 gollonr.Tobl liquid copocity, l()!',(/ - golbns. Copocity inlct comportm'nl,- ln:idc lcnglh,sfmt. lnridc width, Ir tcct' tiquid Ccrspolr Disionc. from, Wcll,-fcct; fioundotion,-fccl; n.ortrt lol lim ot fl front, I lidc, I rcor, lnridc diomctqr,-frct. Dcplh,-fccl. liquid coPocity,-9cllons. Lining molcriol . SECONDARY IREATMENI conrirt: offl Distribution box ond.! Tilc dirposl ficld. ! Sccpogc Pitr. Othcr Tilc disporol field, Distomc from: Wcll,-.--feet; foundotion,- -fml; nmrcrt lol linc olI frcnt, ! sidc, f] rmr,- -fat' Toiol length of rit" tin.r, I Ih fcct. Numbcr of lincr, ? Dirlronce bclwcen linas, 8 fcet' Totol eftectiva obsrption orm in bollom of trcnchcc, l )lf rquorc fcct' Tronch widtfi' ll inchc:' Lcngft of coch linc,_fcct. Depth, top of tila io fini:h grodc,-incher. fl Grovcl. f]Erokcn slonc. I Cindcrr. Othcr Numbcr of pib, - Ouhidc diomctct,-lcct Dcpth,-fcct' lining molariol Dirl'onc. ftom: Wcll, - fcct; fioundotion,-fcct; ncorcll lol lim or f) frcnl' I ridc' ! reor'-f'cct' lf rxitting inrtollotion, givc oll lhc following odditionol informolion ovoiloblcr Dirlroncc io ncorcll: Public rcwcr,-lc.t' Community 3ylitm,--fcct' Approximole rlopc,-fcct pcr IOO fcct. Typc of filtcr molcriol: Dcpth of fillar motrriol Sccpogc pilr: Approrimolr dircction of rurbcc droinogc of lot, Soil i* fl toom. ! Sondv loom. E Clov. bcncoth tilc, 6 inchr \opfi ol filtcr moicriol ovcr tilc, 2 inchcs I Sondy cloy. I Coorr rond or grovcl. ! Hordpon' fl Rock' Olhcr Numbcr ol bolhroomr,-. h lhcrr o boom'nr? E Vtt' E] No' lorcmanl droinr io Fixturu in borcmcnl: ! toundry tmv. E Toilcr' ! 8olhtub fl Showcr. f] Nonc. I Floor droin. ! Sump pump. Loundry wodc di:ponl: Oir.Gl lio ! Socpogc pil' Olhcr Through rump pitto: fl Scptic lonk. I Sccpogc pitr. lr boting drcin pmvklod? ! Ycr. f] No. Drcinr io: ! Surfocr' fl Dry rell' I Sump in borm'nl' Othrr Dovnrpoulr ot oruotvoy drcin io: f) Sur0occ dirchorg'' I Dry woll. Olhcr .fccl.Dcpth ol houtc rwrr bolow finirh grodr ol PARI I (Continued on laversc) EXtlTtNo lTocK! oF va FoRM 2t-'10! Mai. teco, wlLL !E UIEOYA FORM JAN I9I!25499s COM/I UNIIY LOntrnu€c, I I '1,, INSPECIOR'S SXEICH (Sftov by rletch bclov oay rnrilim, ffrdingt not lully &ilbd oa olhor i&.) COfalrlENlll (Nof ony rupploaoafol ptdinat inlorfrdiq, ll coaditiom qo fooad wiich aoy nuh ia oa opinio lhot t^. tlrtad it uaadirlaroq, d..qiba in d.loil.) }{S'BCTION Of INDIVIDI.,AT V'AIEI SUI?IY SYSIEAA TAAOC IY: ! .r^r. E aor* E .*,, H€Atm ^t Tt{ottw vA cor nrANcE rNSPEctot DATE Of INS|ECTION S|G|{AIURC Of |XSPECflNG OfflCtAt flTt E INSPECIION Of INDIVIOI,'AT SEWAGE.OISPOSAI SYSIEM MAOE BY. E.or*r, tr vA co^ PUANCE tNSPECtOttrSIAIEIOCAT HEATIH AUTHOITTY oAtE of rNs?ccnoN STGNAIUm Of IMiPtCItXG Offtct^t /s/ c?t.l? cRAu IIII.E Snrrt'rrRtllt PARI II-TOR U$ OT IHE HTAI.IH DTPARIINTI|I OTTICIAT REYIEWI]IG NEPONI IAS€O ON THE INTO$AATION TEPORTID HETEON AND OIHER AYAIIA8II INfOTT^AIION, lI 13 rHE OPlNlOt{ Of IHE (Cfixt) TXAI IHIS INOIVIDUAI, WAIER SUPPTY SYSTEM IS: trSIAIE COUNTY LOCAT OCPARTmENI Of HEAl.tll SAIISfACIOIY AS A DOTESTIC WAIIT 5UP?IY TOI I}IE SUIJCCT PTO?ERTY NOT SATISfACTOTY AS A DOMESIIC WAIET SUP?IY fOA THE SU3'ECT PIOPEITY E ,.,tilff .i[TsRJ8,3'iio,"N s^Trsf^croilr.Y AND rs Nor u(Er.Y ro CREATE AN ! a^*ro, !E ExpEcrEo ro FUNcroN s^TlsrAcroRrty ]AsEO ON T}IE INfOIAAIION TEPOIIEO HEREON, AND OIHET AVAITAITE INFOTTAIION, lI ts rHE o?tNtoN o; IHE (chc0 D ,r^r. E .or*r, n .oa^. DEpA.TME*, or ttE^I.fi ?HAT IHIS INDIVIOUAI SEWAGE.DISPOSAT SYSTEM, WIIH PIOPCI }TAIMENANCE:) REA{AnXS DA R.SRBYCH Supenvts ING Slru trAn tlru IITIE 7-j-73 DAIE PAnI il-roR USE 0t YA offlC[ I hove rcvicwed fic foregoing ond lhe pertinent VA Complionce lnrpeclion Report ond recommend thot the indivkluol wotcr rupply ryriam be conridercd ! Acceptobla fl Not occeptoble individuol rewogc-dirporol ryrtem be concidcrcd I Aceptoble ! Not occeploble rA ArKs DATE SIGNAIURE Of CHICf, APPTAISAI SCCIION rU. S. GOVERNMENT PRINTING OFFICE: 106? O - 252-tS5 (27o) I I il I ill II ',iL il '111,.1 i I I I li irli ! I il it i I +i tr I 7? 7-7) Date No. PERM IT IN THE BOARD OF COUNTY C()MMISSTONERS OF LANE COUNTY WHEREAS, the attached application has been fully considered by the Board of County Commissioners of Lane Co[nty, and it is the opinion and judgment of the_ Board that the said application should be granted, and that a permit should be issued. now, therefore, it is hereby ORDERED, that a permit be and is hereby issued to for the placing, building and constructing of the following facility upon the right-of-way of County Road No. - in strict conformity to the exhibits attached thereto, and subject to all terms, conditions, agreements, stipulations^and pro visions contained in the application and permit, the Rules and Regulations Coverning Facilities to be Permitted upon County Road Rights-of-Way, dated March 31, 1960 and any amendments thereto, and any other applicable regulation, law or ordinance. Special Provisions: Ttris permit is revocable at any time, and will be strictly adhered to and no work other than that specifically mentioned above is hereby authorized. This permit shall be void unless the work herein contemplated shall have been completed before Inspected and Approved , 19 -. Expires , 19_. Approved by Board of Commissioners By By WHITE GREEN OFFICE FILE RESIDENT ENGINEER Director of Public Works PINK . PERMITTEE ORANGE.BUILDING & SANITATION DEPT ELUE . ROAD SUPERVISOR YELLOW . SURVEYOR c98 - s2 / Date ____ Date APPLIEATION FOR FAtrILITY PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY Your appli hereby rnakes application under Rules and Regulations Governing Facilities to be Per- mitted Upon County Road Rights-of-Way, to construct the following facility: Upon the right-of-way of County Road No., at the folloruing location as sho,un on the exhibits which are attached hereto, in strict conformit{ to ttre state- ments of the exact nature and amount of work to be done, and to the description of the facilities contained in said exhibits. Your applicant will be the beneficial owner of the facility as constructed, or othenvise primarily liable and responsible to members of the public for its proper maintenance, repair, operation and use. Your applicant accefis all tems, conditions, agreemerts, stipulations and provisions, in Rules and Regulations Gorerning Facilities to be Permitted Upon County Road Rights-of-Way, dated March 31, 1960, and any amendments thereto, and any other applicable regulation, law or ordinance. Signature WHITE . OFFICE FILE GREEN . RESIDENT ENGINEER BLUE - ROAD SUPERVISOR ORANGE. BUILDING AND SANITATION oEPT. YELLOW . SUBVEYOR Address Phone No. LANE \-JNTY BUILDING PERMIT OR MOB,* HOME USE PERMIT PERMIT NO.BUTLDTNG I -t tH PROPERTY OWNER MAITING ADDRESS PHONE CONTRACTOR MAIIING ADDRESS PHONE PROPERTY TOCATION _ INCLUDE POST OFTICE PROPERTY TEGAL DESCRIPTION -METES, BOUNDS RANG E SECTION TAX LOT NO CODE CENSUS TRACT EXISTING STRUCTURES ON PROPERTY APPt. NAME & MAITING LEGAT ACCESS TO PROPERTY PROPERTY SIZE - FT. WIDTH DEPTHADDRESS .- FOR MOBI HOME PERMITS ONLY AREA No. of Bedrooms Connect to Existing Sewoge System !New System fl STRUCTURES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION SQ, FT. # BDRMS VALUATION SEWAGE DISPOSAT PTUMBING INSTATLED BY PU BLIC BUITDING WASTE DISPOSAI- PTUMBING PtAN REVIEW PARK TRAITER SEPTIC TANK OTHE OWNER OTHER: NAME FEES WATER SUPPTY PUBLIC ! tr OTHER ( TOTAL COUNTY BUILDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL. DRAIN FIETD REQUIRED TIN. FT TRENCH WIDTH FT OR SQ. FT \ TYPE OF STRUCTURE OCCUPANCY ZONE PUBI.IC UTIt. EASEMENT BI.DG. SETBACKS FT. FROM CTR. OF ROAD RIGHT OF WAY rRONT SIDE INT. SIDE EXT. USE CLASSIFICATION REAR AUTHORIZED SIGNATURE _ DATE DATE BLDG. PERMIT _ WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PTUMBING _ CANARY BUI[DING _ GREEN SAN ITATION _ GOI-DENROD Conslruction to comply with unif orm building code ond county regulotions covering plumbing ond sewoge disposol. All buildings reguire o certificole of occuponcy before being occupied. (See Stotement on Reverse Side) (posT THrs PERMTT oN MArN BLDG. AT SITE) TANE COUNTY, B!DG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 9740I ronu Jt 655- 13 S I TE INSPECTION Appnov E o RrttaRx s D r sappnovro Dare I ruspecron FOUNDATION INSPECTION AppRoveo REurnxs d DrsappRovro 7 Darr ,f- /?"2 J I rspecro FRAM I NG Appnov e o RE uanx s I NSPECT ION E Drsrppnoveo D I Nspecr LATH OR SHEETROCK INSPECTION Appnovro ReuaRxs D DrsappRoveo fa Dare I Hspecron FINAL INSPECTION AppRov e o Reuanxs D r s appno o Dar r I NSPEcToR 7 '/o -Pt 7 CERTIFICATE OF OCCUPANCY Reaov ro lssuE ReNenx s D Nor REaov ro lssue D Dore_lrseecron_ 7t/?-/?/ leF Z O l$d) \- -/ oote /" /,'73 n LANE CC TY BUITDING PERMIT OR MOBITE JME USE APPTICATION PERMIT TYPE _ BUILDING ER PROPERTY TOCATION _ INCTUDE POST OFFICE PROPERTY I.EGAI DESCRIPTION tOT-BTOCK_SUBDIY. TWP RANGE APPI.ICANT NAME AND MAITING ADDRESS MOBILE HOME OSC REG. # ADDRESS fur- PERMIT -7? r/PHONE PHONE METES & BOUNDS ATTACHED AREA YES NO . TAX LOT CODE TRACT)o-E DESCRIBE EXISTING STRUCIURES ON PROPERTY IF ANY tEGAt PROPERTY _NAtE oR # PROPERTY DEPTH FOR MOBILE HOME PERMIT ONLY Number of Bedrooms Connect to Existing Sewoge System or New roN SQ. FT, Re BEDROOMS VAI.UATIONTO BE BUITT PERMIT SEPTIC TANK a TYPE OTHER @z- /a* 3) 2 /, r'za PUBTIC BTDG. WASTE DIS. PI.UMBING PI,AN REVIEW PARK TR[R. TOTAT OTHER E WATER SUPPTY PUBI.IC FEES RES NECIION FEE PUBTIC WATER CONNECTION FEE PI-UMBING INSTATTED BY OWNER OTHE PTANS FURNISHED FACIT PERMIT NO F EES cAsH I CHECK .CV ;r) DATE . DATE/-go -<t P COUNTY BUILDING & SANITATION SPECIFI NS MIN. SEPTIC TANK CAPACITY WITH DIST. BOX' GAI. OF STRUCTURE DRAIN FIETD REQUIRED TIN. FT.TRENCH WIDTH FT OR SQUARE FEET REAR YARD ) /a Ja l'll OCCUPANCY ZONE L\ A PUBTIC UTIT. EASEMENT BLDG. SETBACKS _ FT. FROM CTR, OF ROAD RIGHT OF WAY FRONT rl SIDE INT. 5 SIDE EXT SANITARIAN Dote PLANNING a Form # css-tz 5 Dote BTDG. INSP USE CI.ASSIFICATION 1J -fJ Dote Direclions to Find Property: COPY I _ OFFICE COPY 2 _ JOURNAI- COPY 3 - AUDIT ,1 n, A^TIVITY INFORI\4ATI^N SHEET 6I1- COMPLETE THIS SECTION.I NCOMP LETE FORMS t,lILL BE REJECTED! -r4lheod. ) It 31 t I +ld NZ 9rV r s 1'r'tl lvl-s-q ) > HTiMilTEIEPF-ONEI_ ^q3'/ L 1 )- {7a E H L IY !"-S {I R 1->I2 PROPERTY ADDRESS ( IF DIFFERENT F 3 MAP B PAFICEL NUMEIEFI (from tax maps in Department of Assessment and Taxat'ion 'o.-i"0, tax statement) REQU I RED INFORI,IATION) ##, ## ffis'Z ZoNtneTP TOINSMP MNGE SECTION ffi ffi 70NIns MTN-SITIP MNGE SECTMN ZoutNo l TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:o\ACRES q SUSOIVISION ('if aPPl icable)!L^f1-ll".LOT BLOCK 5 REQUEST (state exactly what you plan to do) 4-t< hIe-,V\c +g,r*) NJ *o $olu"J,^-,ld or C{o I +s 6 DIRECTIONS TO SITE at. lb* N/oy \o \.L +. D-lrosz (<, ** FOR STAFF USE ONLY ** ZONE/LAND USE: L4-33 LAND IVIANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 / 687-4061 +ld ffi . lt -loc +o I I