HomeMy WebLinkAboutPermit Building 1976-07-23PERIVIIT NO
CONSTRUCTION I ] IVIOBILE HOME [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
ZIP CODE
n Owner
NAIVIE ADDRESS CITY PHONE
n Contractor
NAIVIE ADD RESS
O.S. Reg. +
Twp- Range- Section-Tax Lo
CITY ZIP CODE
Census Tract
PHONE
t Code
Lot B lockSubd ivision
Access to Property (Road Name)
Acreage Width
Depth
Existing Structures on Property:
Directions to Property - Address
STRUCTURE (# BEDROOIVIS)SO. FT VALUATION
SEWAGE DISPOSAL:
PUBLIC[] SEPTICTANKT]oTHER [ ]
PLUIVIBING INSTALLED BY:
OWNERT] OTHER[] NAN4 E
WATER SUPPLY: PROPOSED t ]
EXISTING t1
PUB LIC
COIVIIVIUNITY . NAIVIE
PLAN REVIEW
TOTAL
PRIVATE WELL
OTHER SPECIFY
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
IVIIN. SEPTIC TANK CAPACITY
GALS IVI IN. DRAINF I E LD- LIN. FT IVIAX. TRENCH DEPT I NCH ES
TYPE OF CONSTRUCTION GROUP FIRE ZONE USE CLASSIF
SETBACKS FT. FROI\1 CTR. OF r,Aff
SIDE EXT.
FT. FROIVI PROP. LINE
SIDE INT REAR
-
ZONEFRONT
AUTHORIZED SIGNATURES
lsl
ISSUANCE DATE
BLDG. PEFMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANABY
BUILDING _ GBEEN
SANITATION - GOTDENROD
IMPOBTANT
Call 687-4065 to schedule all required construction inspections. Call 687-4061 to schedule all required
septic system inspeclions. All construction shall comply with the State Buidling Code, O.E.O. standards
for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate o,
occupancy belore being occupied.
(See Details on Reverse Side)
POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY. DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6Ih, EUGENE, OREGON 97401
---tLr - COUNTY PERMIT FC
BUILDING-
PLUMB ING
3% SURCHARGE-
IVIOBILE HOIVIE-
WASTE DISPOSAL
STAY 1OO' FROI\1 ALL WELLS
BUILOTNG SIT E EVALUATION
d b //z
s 2t/TAX LOT
7oo t
/od oL
Not
Iic ble
rl IT/
-suao tYls
\0
>t BUILDING PERHIT APPL ICATION NO.
SITE INSPECTION
PLANNING DIVISION
Zon i ng 0rd i nance Cornp I iance: Zone
Subdivision 0rdinance Compl iance
LOT BLOCK:
cK'D BY, ruj3 , /1g 7/
Setbacks from
Front
-ch=of-rciiid
Side Exterior
Setbacks fronr interior I ines:
Side
Rear
()APPL ICANT
DATE
I
2
3
4
5
Reoui red Accessguitaing Site (Area, }Jidth, Frontage)
Other (see conrnents)
)
)
(
(
No Yes
CI 1'I' 6( ) (l)( ) (l)( ) (l)( ) (r)
?A.tCOHHENTS:
a Ot)
u
Y T-TATPI rcAr I
BUILD ING IN.SPECTION D IVIS ION
. Plans Submitted
. Soi I Stabi I ity (footings)
. Flood PIain
. Other (see corments)
Yest()
();*"a
A
Not
licable No
7
8
9
0
r)
)
()
()
()CKI D
7- /i-yuCOHHENTS:
}JATER POLUT I ON Not
Aool icable No Yesr) Tp-
()
ROL
I l. l'leets Department of Environmental
Qual ity Standards.
12. Other (see comments)() ()CKIO BY:
DATE
COH}4ENTS:
TO APPLICANT:
Your Building / Site lnsPection:
(tYcan be aPproved,( ) Cannot be aPProved at this t ime as indicated on item N0.
you can reso
above.
w Ab
Questions and further informa tion on items I throug h 5 contact the LAN E.
COUNTY PLANN ING D I V !-S,! !N " Quest i on s and fu
BUILDING
rther informati on on i temil
Er-oGE-lZ contatt the LANE D SANITATION DI 0N.
ve the prob(
(
)
)
Will be held in this office unt
ls being returned.
c55-28
Your bui ldin
ems
S
n cated.
ermit I ication fee is b tn
V RO AL
135 Sixth Avenue East Eugene Oregon 97
PHSNE, 537-4o65
LANE COUNTY PLANNING DlVlSloN PHoNE: 687
40r
-4t 86
//,)
n Owner
LArr,c COUNTY PERMIT FO,.:PERIVIIT NO
CONSTRUCTION i ] MOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
ZIP CODENAN/IE ADD B ESS CITY PHONE
D Contractor
NAIVIE ADD R ESS
O.S. Reg. +
Twp- Range- Section-Tax Lo
C ITY
Code
Acreage
-
ZIP CODE
Census Tract
PHONE
t
Subd ivision Lot
Access to Property (Road Name)
B lock Width
Depth
Existing Structures on Property:
Directions to Property Address
STRUCTU R E ( # BED ROOIVIS)SO. FT VALUATION
SEWAGE D ISPOSAL:
PUBLIC [ ] SEPTICTANK [ ] OTHER [ ]
PLUMBING INSTALLED BY:
OWNER[] OTHER[] NAM E
BUILDING
PLUIVIBING
3% SURCHARGE--
IVIOBILE HOTVIE
WASTE DISPOSAL
PLAN REVIEW
TOTAL
WATER SUPPLY: PROPOSED I 1
EXISTING t ]
PRIVATE WELL
OTHER-SPECIFY
CONSTBUCTION PERMlTS & lNSPECTIONS AND WATER POLLUTION CONTRO L SPECI F ICATIONS
IVIIN. SEPTIC TANK CAPACITY
GALS.IVIIN. DRAINFIELD LIN. FT IVIAX. TRENCH DEPTH I NCH ES
STAY lOO' FROIVI ALL W EL LS
TYPE OF CONSTRUCTION- GROUP FIRE ZONE USE CLASSIF
SETBACKS-FT. FROM CTR. OF rAV
FRONT SIDE EXT
FT. FROIVI PROP. LINE
SIDE INT REAR
-
ZONE-
AUTHORIZED SIGNATURES ISSUANCE DATE
BLDG. PERMIT _ WHITE
OFFICE COPY _ WHITE
COUNTY TAX _ PINK
PLUMBING _ CANARY
BUILDING _ GHEEN
SANITATION - GOLDENHOD
IMPORTANT
Call 687-4065 to schedule all required conslruction inspections. Call 687-4061 to schedule all required
septic system inspections. All construction shall comply with the State Buidling Code, D.E.Q. standards
for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy before being occupied.
(See Details on Reverse Side)
(POST THIS PERM!T ON MAIN BLDG. AT SITE
LANE COUNTY, DEPT. OF ENVIRONMENTAL i/ANAGEMENT
COURTHOUSE ANNEX, .I35 EAST 6Ih, EUGENE, OREGON 97401
--\r-l
] PUB LIC
] COIVIVIUNITY . NAIVIE:
E-.Ei5EI,C
I rusprcroR
SITE INSPICTION
AppRovroDDrsAppRovEoDDarr
Rruanx s
-
FOUNDATION I NSPECTION
APPRovED
REuanxs
D Drsrppnove o Fl Darr I Hspecton
FRAMING INSPECTION
Appnoveo D Drsappnoveo D DarE
RexnRr s
l nseecton
LATH OR SHEETROCK INSPECTION
Ap pRov r o
RrMaRxs
D DrsaPPRovE o F-a Dar e I NSPEcToR
FINAL INSPECTION
Ap pRov e o
REuanx s
D t sappnoveo I NspecroR
CERTIFICATE OF OCCUPANCY
Rraov ro I ssuE
REuaRx s
Nor RErov ro lssuE DarE I ruspecroR
D Dorr-
-.--=c
PERlrrr ,,fl/- gl
NOTE: NO PERI'TTI WI:I ]E ISSI'ED TINfiL TIIIS APPLICATIC .IAS BEEN APPROVED
APPLICATION FOR:
CONSTRUCTION MOBILE }IOME E PLAN REVIEW CIIAI.{GE OF OCCUPANCY
OI^INER ol
Name dress Ci zip
Clty
o.s. REc. tt /-
Twp 0 Sect :*^-Q lf , fuJ1,*Lot /oo o-y\*u"o census rr^"r Jo €O loA
I^Jld th_Depth_Subdlvision Lot B Acrea?ACCESS TO PROPERTY (Road Name)
Existing Structures on Property:.
Property Location - Address/DlrecEi.ons 7.Y t/
r Offlce Use
Ft?[z -2
SEWAGE DISPOSAL
Site Inspec tlon /i ExlsEing S
WATER SUPPLY:
Well
FEES
Bldg.
Plunblng
3Z Surcharge
Waste DlsP.
Plan Revlew
Mob11e Hone
Spring ru Name of Conmunlty or Publlc System
Name
wf
PLUMBING:
Installed by
PLIJMBING FEES
/l of Flxtures Sewage
Connectlon
Water
Coonection
FACILITY PERMIT
Date:
Dep th
PLANS FURNISHED
./o, oo
TOTAL
Mln s Tank 1
YES
Signature of Applicant:
Fee Recelved By:
1e1d Requir ed - Lineal Feet
fB *o YES FCZNo
'{?1'
e of Cons Flre Zone Use Classif ication-
Setbacks - from Center of Road Right of Way:
N/ t+*tide rnt. slde Ext 7nn o_
DATE:DATE:
LANE COT]NTY DEPARTMENT EIWI RONMEN TAL I'{ANAGM{ENT
DATE:
)a
*
r--.1
Comunity
PubIic
I
t
CASII
/0t oo i CHECK
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