HomeMy WebLinkAboutPermit Building 1978-07-14^17 _ ooj6
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Acreage or Lot Size
Contractor's O.S. #
APPLICAN-tr''S NAME AND ADDR
E COUNTY PERMIT
tng ) Completed Subdivision
Lot- Block_
Phone---
Phone=-
OWNER,S NAME AND ADDRESS
-
Phon
CONTRACTOH'S NAME AND ADDRESS
llail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when ready
STRUCTURES NOW ON THE PROPERTY
THIS PERMIT IS FO # BEDROOIVIS-# PLUMB I NG CONNECTIONS
\A/ATER SUPPLY SEWAGE DISPOSAL-s.l. #
THIS PROPERTY ISWITHIN ONE MILE OF THE CITY OF
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 certiry 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 allapplicable Codes relating to this permit.
Fee Paid $-Signature
PLUIVIB ING BY
-
Date
-
( ) NEW ADDRESS () FACILITY PERMIT TO TRANSPORTATION DEPT.( )SPECIAL PtVlT. AREA. tvllN. ELEVATTON:_
SANITATION BUILD ING
[Vlinimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
Type of Construction
-Group
--FireZone
Use Classification
Comments:
Comments
B Date B Date:
PLANNING REOUI R EMENTS SATISFI ED By:Date Date lssued
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEIMENT, 125 EAST 8TH AVE., EUGENE, OEEGON 97401 PHONEI 687.4394
POST THIS PERMIT ON MAIN BUILDING AT SITEc55,t3 BUTLDTNG GREEN;
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ZONE SETBACKS: FRONT SIDE FACING STHEET (FROM C/L) INT. SIDE YARD REAR (FROIVI P/L)
SITE INSPECTION
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CERTIFICATE OF OCCUPANCY
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