HomeMy WebLinkAboutPermit Building 1977-06-07*tto3,l#PERIVIIT #
JOB LOCATION
LANE COUNTY PERM!T
Partitioning #-( ) Completed Subdivision
Lot- Bloc k
TRS, TL
OWNER'S NAME AND ADDRESS
APPLICANT'S NAME AND ADDRE qq
Acreage or Lot Size
Contractor's O.S. #
Comments
Phone-
Phone-
Phone-CONTBACTOR'S NAIVIE AND ADDRES S
STBUCTURES NOW ON THE PROPERTY
THlsPERl\4lTlSFoR#BEDRool\4s-#PLul\4BlNGcoNNECTloNL'
Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when ready
WATEB SUppLY- SEWAGE DISPOSAL- S.l. #
THlSPRoPERTYlSWlTH|NoNEMlLEoFTHEClTYoF.PLUtVlBlNGBY
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 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 oI this action. i hereby agree to comply with all applicable Codes relating to this permit.
SignatureFee Paid $-
( ) NEW ADDRESS ( ) FAC|LtTy PERNIT TO TRANSPORTATION DEPT.- ( ) SPECIAL P[/]T. AREA. NnlN. ELEVATION
SANITATION BUILDING
Date
-
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
Date
Type of Construction
c"-.""*
Use classification
By:
roup Fire Zone
By Date
PLANNING REOUI REMENTS SATISFIED. By:Date lssued
ZONE SETBACKS: FRONT SIDE FACING STREET (FROM C/L) INT. SIDE YARD REAR (FROM P/L)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL IVIANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 974O1
POST THIS PERMIT ON MAIN BUILDING AT SITE
C55-13 BLDG. PERMIT - WHITE; BUILDING - GREEN; PLUMBING - CANARY; SANITATION - GOLOENROD; OFFICE COPY - WHITE
PHONE: 687 4394
Date:
TRS, TL Location
INFORMATION SHEET
( ) Site Feasibility Study for Septic Tank( ) Would like to meet on site. Call
Acreage or Lot Size-Test holes will be ready
Partitioning #( ) Completed( ) Pending
APPLICANT'S NATUE AND ADDRESS e
OWNER'S NAIVIE AND ADDRESS, if different from a nt's
CONTRACTOR'S NAME AND ADDRESS t/
ail permit or results of site feasibility study to ( ) Applicant ( ) Owner Contractor.
) Prefer to pick up. Call (owner, etc. ) when ready.
Number of sites-
(owner, etc.)
Phone 3)?
Phon O
Phone-
€
existing or proposed well, etc. lf public, name of system)
(existing or proposed septic tank, etc.) S.l.#
Address
3cT c-
L./f
l(Buinins Permit
\c)
Subdivision Lot- Block-
M
(
STRUCTURES NOW ON THE PROPER
PROPOSED USE (this permit)
WATER SUPPLY z(,st.
E Xr 5-t' , c--
cAc
c*6
SEWAGE DISPOSA
PLUMBING BY o ne-
() PROPERTY IS WITHIN ONE MILE OF CITY (S
******* oFFtcE usE oNLY BELOW THtS LtNE *.**!****.*r*
( ) New Address Necessary
ZON F
( ) Facility Permit Necessary
SETBACKS: Front Side Facing Street
(FROM CENTERLINE OF BOAD)
lnterior Side Yard Rear
(FROIVI PROPERTY LINES)
To: Planning/Building lnspector/Sanitarian/Surveyor.
This applicant appears to have a problem with
Your assistance will be appreciated.
By Permit Processing Section
Response
c55-1 2
tvrstonBy
DEPARTN/I ENT O F E NV I RON MENTAL IVIANAG EM ENT
Permit Processi ng Section
125 East 8th Avenue
687-4394
2/r4 AJ 34 i ^ s4/* \b,tk al
{ tl
)
( ) Special Permit Area. lVlinimum Elevation:
PERIVIIT #
I IiS, T JOB LOCATIO
Acreage or Lot Size- Partitioning
Contractor's O'S' #
LANE COUNTY PERMIT
) Completed Subd ivision
Lot
-
B loc
AP
OW NER'S NAIVIE AND ADDRESS
PLICANT'S NAME AND ADDRE ss Phone
Phone
PhonecoNTRACTOR'S NAME AND ADDRE
STRUCTURES NOW ON THE PROPERTY
iHtS penUtr tS FOB ,. - , # BEDROOIVIS-#PLUI\4BING CONNECTIONL
Ma il permitto ( )Applicant ( )Owne r ( ) Contractor. ( ) Prefer to pick up. Call (owner, etc.) when ready.
WATER SUPPLY SEWAGE DISPOSAL S.I. #
THlSPRoPERTYlSWlTHlNoNElVllLEoFTHEClTYoF.PLUlVlBlNGBY
I hereby certity that the above statements are true and accurate, and that I have the following legal interest in the property:
-owner
o{ record;
contract purchaser;
-
potential buyer;
-
realtor or agent. I further certify that (iI 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 relating to this permit.
Fee Paid S-Signatu re Date
( )NEWADDBESS ( ) FACtLtTy pEBMTT TO TRANSPO RTATTON DEPT.- ( ) SPECIAL PNIT. AREA. MIN.ELEVATtON:-
SAN ITATION tI?ype of construction Group F ire ZonelVlinimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet Use Classification
Maximum Depth Comments:
Comments
BY:Date:By:Date
pLANNING REOUI REIVIENTS SATISFIED. B Date Date lssued
ZONE:SETBACKS: FRONT SIDE FACING STREET (FROIVI CILI INT. SIDE YARD REAR (FROM P/L)
LANE COUNTY DEPABTIVIENT OF ENVIBONIVIENTAL I\,IANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401 PHONE: 687'4394
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. PERMIT-WHITE; BUILDING -GREEN; PLUMBING -CANARY; SANITATION-GOLDENROD; OFFICECOPY-WHITEc55-1 3
SITE INSPECTION
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