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Home My WebLink AboutPermit Building 1977-08-30Er\-Bn-aJ --/tas,t Job Locat e //a I,Iritten Directions INFORMATTON SHEET (X) guitaing Permit ( ) Site Feasibility Study for Septic Tank. Number of sites-- Acreage or Lot Size Test holes will be ready Partitioning#- ( ) Completed Subdivi( ) Pending APPLICANT'S NAME AND ADDHESS OWNER'S NAME AND ADDRESS, if different from appli t's CONTRACTOR'S NAME AND ADDRESS Mail permit or results of site feasibility study to (X Applican (X)Owner ( )Contractor( ) Prefer to pick up. Call ( owner, etc. ) when ready STRUCTURES NOW ON THE PROPER PROPOSED USE (this permit) WATER SUPPLY Lot - Block- Phone Phone Phone 2y'/-s t,al() Contractors O. S. # (existing or proposed well, etc. lf public, name of system) Address SEWAGE DISPOSAL (exisring or proposed septic tank, etc.) S.t PLUMBING B aa ( } PROPERTY IS WITHIN ONE MILE OF CITY ( 'r+ *+ t+ r* ra It +* * * r* * ** * + * *+ * * * * * **+ ** ++ * * * * Q ICE USE ONLY BELOW THIS LINE ****it*+****+ *i * **++* r***+* +*** *+++++ ** ++ ++ ( ) New Address Necessary ZON E ( ) Facility Permit Necessary i ) Special Permlt Area. Minirnurn Elevation SETBACKS: Front Side Facing Street lnterior Side Yard Rear - (FROM CENTERLINE OF ROAD)(FROI\{ PROPERTY LI NES) To: Planning/Building lnspector/Sanitarian/Surveyor. This applicant appears to have a problem Your assistance will be appreciated. By Permit Processing Section Response: * Poyy'zy' By DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Permit Processing Section 125 East 8th Avenue 687-4394t.7-o3-Zy'-r/1, Voo - /?o4c55-12 a tvrsron PERIVIIT # TRS, T JOB LOCATIO LANE COUNTY PERMIT Acreage or Lot Size Contractor's O.S. # Partitioning # APPLICANT'S NAIVIE AND ADDR OWNER'S NAME AND ADDR Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call Fee Paid $Signature ) Completed Subdivision Lot- Bloc CONTRACTOR'S NAIVE AND ADDRESS Phone Phone Phone (owner, etc.) when ready STRUCTURES NOW ON THE PROPERTY- THIS PERMIT IS FO # BEDROOIVIS-# PLUTVIBING CONNECTIONS _ WATEB SUPPLY- SEWAGE DISPOSAL- S.I. # -., THlSPRoPERTYlSWlTHlNoNElVllLEoFTHEClTYoF.PLUIVlBlNGBY I hereby certify 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 lurther certify that (if not the owner) I am authorized to act for the owner of record, and that 9id owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit. Date - ()NEWADDRESS I FACILITY PE RMIT TO TRANSPORTATION D EPT.- () SPECIA L P[NT. AR EA. IV]IN. ELEVATION SANITATION lVlinimum Septic Tank Capacity (Gallons) Drainfield Required - Lineal Feet lVlaximum Depth BUILDING Type of Construction Use Classification Comments: roup ire Zone Comments Date:B Date Date lssuedPLANN ING REOUI R EN/IENTS SATISFIED By Date ZONE:SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROM P/L) LANE COUNTY DEPARTIVIENT OF ENVIRONIVIENTAL TVIANAGEN/IENT, 125 EAST BTH AVE., EUGENE, OREGON 974O1 POST THIS PERMIT ON MAIN BUILDING AT SITE C55-13 BLDG. pERMtr - wHtrE; BUtLDtNG - GREEN; pLUMBtNG - GANARy; sANtrATtoN - GoLDENRoD; oFFtcE coprr - wHtrE PHONE:687-4394 trqq FSS By: TRS, T JOB LOCATIO LANE COUNTY PERMIT Acreage or Lot Size Contractor's O.S. # Partition ing APPLICANT'S NAME AND ADDR FSS OWNER'S NAME AND ADDRE ss CONTRACTOR'S NAME AND ADDRE Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call PERMIT # Lot_ Block_ (owner, etc.) when ready STRUCTURES NOW ON THE PROPERTY THIS PERMIT IS FO # B ED ROOIVIS-# P LUIVIB I NG CO NNECT IO NS WATER SUPPLY- SEWAGE DISPOSAL--=__-- S.t. # THlSPRoPERTYlSWlTHlNoNEMlLEoFTHEclTYoF.PLUIVIB ING BY -I hereby certily 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 (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 relatinq to this permit. Fee Paid $- Signature () NEW ADDRESS () FACILITY PERIVIIT TO TRANSPORTATION DEPT ( ) SPECIAL PlVlT. AREA. IVttN. ELEVATTON:_ SANITATION [Vlinimum Septic Tank Capacity (Gallons) Drainfield Required - Lineal Feet lVlaximum Depth BUILDING -----'----- rvpe or const'd,lli?i**" Group Comments: ire Zone Comments By Date B Date: PLANN ING REOUI REMENTS SATISFI ED By Date:Date lssued ZON E SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (F ROIVI P/L) LANE COUNTY DEPARTIVIENT OF ENVIRONMENTAL IVIANAGETVIENT, 125 EAST 8TH AVE., EUGENE, OREGON g74O1 POST THIS PERMIT ON MAIN BUILDING AT SITE BLOG.PERMIT-WHITE; BUILDING-GREEN; PLUMBING-CANARY; SANTTATTON-GoLDENRoD; oFFtCECOp'',-WHtTEc55-1 3 PHONE:687-4394 Phone Phone-- Phone=---- - I Date I SITE INSPECTION Ap pRov r o Rtuanx s I SAPPROVEO Dar E I rseectoR FOUNDATION INSPECTION AppRovro D Drsrppnove o F7 Darr I ruspecroR Rslrn Rx s FRAMING INSPECTION NS P E CTOR 7 Ap pnov e o Reuanx s Drsrppnoveo D Drr E LATH OR SHEETROCK AP PRov E D RrxrRxs I NSPECT I ON D r sappRoveo Dar e I rseecron FINAL INSPECTION AP PRov E o DlsAPPRovEo NS P E CTOR Rruanr s CERTIFICATE OF OCCUPANCY Reaov ro lssuE n Nor Re eov ro lssur n Do"-lNsPEcroR- oorr{- f 74 ReuaRx s D D D