HomeMy WebLinkAboutPermit Septic Tank 1974-9-4 (2)
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LANE COUNTY
BUILDING 0
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. ,PROPERTY OWNER
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I CONTRACTOR
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BUILDING PERMIT
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MAILING ADDRESS
626, tHUI!S'fON
MAILING ADDRESS
OR MOBILE HOME USE PERMIT
PERMIT NO,
1705- 74'
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S'ftl~VltLO. OREGON
PHONE
746-"25
PHONE
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PROPERTY LOCATION - INCLUDE POST OFfICE
r;20~9 INLAND WAY
~ I PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
LOT 50 1&'0." 2 FILBERT GftOYE
t I TWP RANGE SECTION
t 18 03 11
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5TH ADDITlDtl
TAX LOT NO. CODE
CENSUS TRACT
35-lloo
APPL.
NAME
T. S'fILII
EXISTING STRUCTURES ON PROPERTY
NoNE
LEGAL ACCESS TO PROPERTY
INL""O WAV
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826, 'TNUIUlTOIl
MAltiNG
PROPERTY SlZf - FT.
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ADDRESS SPIlIN(l"'ELB, OIlEOOli
,FOR MOBILE HOME PERMITS ONLY
I No. of B'edrooms
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WIDTH
DEPTH
AREA
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STRUCTURES TO BE BUILT THIS PERMIT
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Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ.- FT. # BDRMS
VUTURE M&DI~t HOM!
New System 0 I
VALUAT!ON
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I i SEWAGE D'SPOSAl
,PUBLIC 0 SEPTIC TANK
l. ~UllDING
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f'tASTE DISPOSAL
, PLUMBING
I ~lAN REVIEW
I PARK TRAILER
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D OTHERD
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P'ftle~
PLUMBING INSTALLED ,BY
OWNER n OTHER: NAME
WATER SUPPLY
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FEES
PUBLIC 0
D OTHER
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COUNTY
BUILDING & SANITATION SP,ECI.FICATIONS ' 'pC
DRA'N FIELD REI~ED "'2 TO 11' "e
lIN, FT TRENCH WIDTH FT. OR SQ, Fn
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I, 1 MIN. SEPTIC TANK CAPACITY 900
t": WITH DIST, BOX: GAl.
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'FRONT
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OCCUPANCY
ZONE
P,UBLlC UTIl. EASEMENT
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ROAD RIGHT OF WAY
USE CLASSIFICATION
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SIDE INT. SIDE EXT.
AUTHORIZED SIGNATURE - DATE
fsl J. E. Bon ,'( C HAR8A\lIl'I
REAR
J $~eK/sANITARIAN
DATE
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; BLDG. PERMIT - WHITE
OFFICE COpy - WHITE
i : COUNTY TAX _ PINK
: PLUMBING - CANARY
'IBUILDING ~ GREEN
-'SANITATION - GOLDENROD
,
IMPORTANT:
Call 687-4065 to schedule all required inspections. All construc-!
tion shall comply with Uniform Building Code, D,E,Q. standards'
for subsurface sewage disposal and' county regulations covering,
plumbing. All buildings require a certificate of occupancy before i. ;
being occupied.
(See Details on Reverse Side).
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(POST THIS PERMIT ON MAIN BLDG. AT SITE),
LAtiE. SOUNTY~ DEPT.. OF ENVIRONMENTAL MANAGEMENT '
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
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SITE INSPECTION
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ApPROVED .Cl
DISAPPROVED .Cl DATE
REMARKS
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FOUNDATION INSPECTION
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ApPROVED r---7 DISAPPROVED 1-1 DATE
REMARKS
FRAMING INSPECTION
ApPROVED / / 01 SAPPROVED / / DATE
Rp.tARK S
LATH OR SHEETROCK INSPECTION
ApPROVED 1-1
DISAPPROVED r---7 DATE
, /J
,(f?r
REMARKS
F I NALI NSPECn ON
ApPROVED .Cl OISAPPROV.ED /7 DATE
REMARKS
CERTIFICATE OF OCCUPANCY
READY T<;> ISSUE /7 NOT READY TO ISSUE ..Cl DA'TE
REMARKS
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INSPECTOR
INSPECTOR
INSPECTOR
INSPECTOR
INSPECTOR
INSPECTOR
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Date
9/5/74
Permit No.
I 7().s-~ 7 'I'
CURB CUT
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PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
WHEREAS, the attached application has been hilly considered by the Board of County Com,
missioners of lane County, and it is the opinion a nd 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
T. STILES
, 826THURSTON
or constructing the following
, 'LOT 50
BLOCK 2
SPRINGFIELD, OREGON
facility:
,FILBERT GROVE
for placing, building
5TH ADD I TI ON
INLAND WA Y
upon the right,of,way of County Road No. " Mile Post "
in strict conformity to the exhibits attached hereto, and subject to all terms, conditions, agreements,
stipulations and provisions contained in the application and permit, the Rules and Regulations Gov,
erning Facilities to be Permitted upon County' Road Rights,of,Way, as set forth by th~ lane Man-
ual 50,190(2) any 'amendments thereto; and any other' applicable regulations, law or ordinance.
Special Provisions:
,1, Driveway will be constructed in accordance with the attached driveway approach specifica'
tions (Drawing M98-50),
2, Permittee will, be responsible for the immediate removal of all mud, dirt and debris from the
roadway and right of way caused by his operation, leaving the roadway and area in a neat,
acceptable condition, '
3. SIDEWALKS WILL BE CONSTRUCTED IN ACCORDANCE WITH THE ATTACHED SIDEWALK
SPECIFICATIONS AND DRAWING M98 - 49~ THE STANDARD CURB TYPE SHALL BE
CONSTRUCTED UNLESS OTHERWISE SPECIFIED:
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This 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 confemplated shall have been completed be,
fore
915L7')
, 19----15
Expires
,19_.
-
Inspected and ,Approved
Approved by Board of County Commissioners
By
Date
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WHITE - OFFICE FILE
GREEN - RESIDENT ENGINEER
PINK - PERMITTEE
BLUE - ROAD SUPERVISOR
ORANGE - BUILDING & SANITATION DEPT.
YELLOW - REAL ESTATE
,C98-79
d
By
Director of Public Works
, INStALLER;. Complete
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,I NSTAL?}R: S NAME, .
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No/Living Uni,ts ,.Betlrooms Baths' Baseinent;, 'Water ,S,up'p p'll}:",,' :, >
, //' ~ '. ( , Yes ., .'No ?, Publ ic .IV-Other-List". '
~~~~~~~a:~:1 ':;..: St~,JD"..,~o~c~ete'~~'~'~partm~~~s-{'i':~',:a': C'ap~crty '/(9:00>:'
Inside Dimensions: Ft;' Tile Disposal Field~' ,','
Lenqth ',<?-, Width;:; 'Diameter:", Depth < 'D'istributio~Boxi'jYe;/ >' ,No
, . ,OWN~R . 0 '.. , 'O,ther ,Distri~u,tion'fT,Ype:
'NAME' 'r..,STILES' . '" '
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" PROPOSED SEWAGE DISPOSAL SYSTEM RECORD-(.."', ,',," '.- '..'
top part' of forrn .to si'ghature and submrt both ,J:Uies'wit'h 'appl ication .' ,'..
. :' ',' , : " . ,. "il PERMIT NO: 1705-74....
, PROPf.R '~ ,AOORt~~ U
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I,NLAiJD ',WAY
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Feet from' ' .. -;.. ",
, 8265' "THURS, ,ToN.' . 'WE'l'1 'F d t'
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. . .~ '- . Lot L rne-: -. . . "'..
. ,SPR 'NGF I E't.:o. 'OREGON ,.' , ,', :Front ',<: 's i'de'; '-;'. . .. Rear.,
; Length of Lines-Ft..7.5'IT~ench I .'Jotal, Sq':"I' ,~;, Be~ween," 'IFi'n"e~IFi 1,ler~epth:.. .IF!;ller B';'IOW, ,
',I.~ 3. 4",5.,6., Width,:') Ft. ~OO"'Llnesh-" Tvpe'j,.t-Above,Trle1InJrile kin..
Plot'Plan:(see';nstructionsJ:' '." " "g,
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MAILING
.."ADDRESS
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Date ;",~"il'J,- '7;..{"" .Siqriature., ~"IS.-,;.,.,:'L ,'. ,;:-
,CERTIFICATE OF SATlSFACTO~/COMPL.ETlori' '4"" '
For ,San'itari an Os'~ On'l y,: . , , ' " . {/',. ..' , ' '.: 'Date: '/0 :,::2-1-7 1:
, 'I n accordance "with, 1973 Ore'gonlaws ,Chapter' 835. Se<;t i on 2J4 th i s' :certLf.' cate. i s issued.,' . '.
as evidence of satisfactory :coinpleti.6n ~f a, subsur~ace, sewage dispo,sal" system,at the above'"
location ' ',' .,;<.... ,:,'" '"..' '.:, " c, ',"" ,,', '
, ~.Approited!: Syst'eml~'sf~ll;ltion conf,ri'rms', to cur.~e~,t sta'ndaras H
.. ,0 Disapproved: 'Does:riht conform tp, current standards' ," , ',>'.,,'
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\ S i g~ature: :' '
" ~.,., .. , ' NE',COUNTY "
,';stATE OF.OREGON 'DEPARTMENT'OF. ENVJRONMENTAL ,QUAL ITY
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PERMIT1I j 7 o.)~7 y
lANE' COUN:rY . , ./
Buildirig 0<----
DEPARlMENI' OF ENVIRON'1ENTAL MANAGEMENT, Mobile Horne
APPLICATION FOR BUILDIN;PERMIT OR MOBIlE HCl1E USE
No permit will be issued \IDtil this application qas been approved,
NatE:
PLEASE PRINT
PROPERlY LOCATION
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.s;::;q",...e-~ ?J' Q.A
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1WP '_(7 \~ RAN:;E 03 SEe. J I TAX WI' 11 '. CODE CENsus TRPpra..s-- U:o A
WI' NO, c3"Z>.. BLOCK d- SUBDIVISION r-: I" 11 eie r 6' ~a lJ"'<.. /~ /h/ n(
" PROPERlY SIZE . .
ACCES~ TO PROPERTY I It /..:1 '1..1 Lu a y WIDTHlU_~JJM-lrl;;Z.a:Q9R ~-:->
DESCRIBE EXISTIN:; STRUCTURES ON nu;/PRul:'=r " .~ I .f\~
AP~~LJJ1;1,./t;.e..C,l~L~~ ~~,f;'bS ' PH~'l<fbc)D.2-6
mN:rnAcr6R..J ,MAlLIN;
NAME ' ADDRFBS
PHONE .
BELCW FOR OFFICE, USE ONLY''<*>'C''-''''''***:,;,;,;,;,;, ;,A,~ A:.;, ;.;. :.:. :.:.:.;, ;,:.:.:, :.*1,;, :,1. 1,;. I. 1,1.;ckkkI,*,,*,',I. I, I.;,;,;, ;,1,1, I, .\:cI-.,*****,~ ,
Structures to be built/Mobile Horne sq,., tt, .4,ibe'drooms valuation
~~ ~L?X,r/ r~_~~"q~,i/o,',~
::iewage L>ispDsal: n A :.L ) . . ,
Site Inspection 11 (l'/wu' "" Existirig seWage disposal system O,br neW 's;st~ required x...: '
t.Iater S~l~: , v 0 ./ ./0'(7
Public?-District Name ,_~~y , .Well,O Spring 0 Other
~
'Bldg,
Waste Dis..
Plu:nb irig
Plan Review
Trailer
1% surcharge
,
'I:;'ees ';
Plu:nbirig Installed by .CMner Other' Name:
PIUtnbirig Fees ' Sewer connection Water connection
irof fixtures' inspection fee' inspection fee
,'~Cash fians furnish,ed : , FilCl.m:'lity P Dnit;:
".liCheck 'Ye"Ilti, No Q~. "es ___
. ' , Signature of Applican~ . te
TOTAL 6?J, 00 ,,: , Fee rece~ved b~~ 'd?t '9-.:2 ~ -7 Y
Min, Septic tank capacity Drainfield required, ' '. (
witf1 dist, box:, Gallons crOOLineal Feet /,(;'0 'Trench'Depth.t~:1 or Sq.,Ft. ]66
f<7J >'c-O '
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Type ot Structure 'Occupancy Fire Zone Use Classification
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. Blgd, sJ=~ac,~,t: from center of roadr~gh! of "!fly , , ( D,f/L-L-, 7', "..
, Front 1/'.....'), / i :>l.U,-, D.lL, Swe txtenor ',' '=<LL-..JA Y1L, Zone ~-MU..
. ~: 8~~~ (FUQ ~12x:{~~~~~d~'N'r(
C55-12,
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Cr "~-LANE COUNTY PERMITFO
hi J-I. '51/- 7,6 ,'I,
PE, R~~'~, NO, 1(;' :
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",COf\!STRUCTION [] M081LE HOME [I] .;t~y~W",,[] C~ANGE~F OCCUfliNC-Y.[ ]
o Owner Q~...i7 r-1A/A'-'.dA/ d: d;;L~"" "-, , ~ -__L.L-=".f;-=/
~ I NAME - - O'ADDRESS ( - ~ CITb ZIP~CODE PHONE
o Contractor !/)IJV1,-ri?Ah 111,~J1(1, dJ~?l1(i ..';I1/1/-I./r'17 J ,d-A___pr;./
~NAME . - ADDRESS - -- -- CITY ZIP CODE' PHONE
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OS Reg, #
Twn . /YRange 2-_ Section
5t:-tad cf! ' /\ 'J'1f'b 'r-()
Su5division 4-,; Ith,rl-0Uz.'r.OT _"' I ' Bloc~
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Access to Property (Road Name)' ~..Iu/-1I1"V
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Tax Lot
Code
Census Tract
STRUCHJRE (# BEDROOMS) P A
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Width
Depth
Existing Structures on Property:
Directions to Property, Address:~ 1/1 de;
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SQ, FT,
VALUATION
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SEWAGE DISPOSAL: /7 (J S - 7 @
PUBLIC [J SEPTIC TANK [..I--OTHER [ J-I
BUILDING
PLUMBIN(;
3% SURCHAR'GF
MOBILE HOM"
WASTE DISPOSAl
PLAN REVIEW
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Li{.... 'n-n
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PLUMBING INSTALLED BY:
OWNER [I OTHER [J NAM"
WATER SUPPLY: PROPOSED [ I
EX ISTING []
[I.-I_PUB L1C
[ ] COMMUNITY. NAME:
[ I PRIVATE WELL
[ I OTHER, SPECIFY'
TOTAL
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CONSTRUCTiON PERMITS & INSPECTiONS AND WATER 'P(:)L1~UTiON C.o'NTROL SPECIFICATIONS
MIN. SEPTIC TANK~CAPACITY:' '"
GALS, ~d""'/ MIN, DRAINFIELD ' L1N, FT, ...A. MAX, TRENCH DEPTH. _I(NCHES d
-m-l'....,~. ~~p ""Jr...&. _ ~_ tI.Jl,oo...M/t.,oJ'd..A!.;;8 ./2.</..,;,;::1:"":""'# .,..-fl.' Iu.."~.o,
t11;j~:P, ,..P..........- I~'\' M_t( ,..,If! nAb'?;; ,.,,/ hI...hA~..f-JV' ""...J.J1f' <""'.......41<..... ~.!IJ__,
. ~ v I () - V' ~I "ST,o;y 1001FROM AtLWELLS
TYPE OF CONSTRUCTION .AAl,./- GROUP FIRE ZONe USE CLASSIF,
IMPDRTANT:
FT, FROM PROP, LINE: In,.-
SIDE INT, ~ I REAR /1) y{J "ZONF
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ISSUANCE DATE: n;
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a ,.. ' f J ',.... I 'l. - 7'(,.. f/ f/ ' ,
Call .687.4065 to schedule all required construction inspections, Call 687-4061 to' schedule all required
septic system inspections. All construction shall comply with the Slate Buidling Code~ D,E,a. standards
tor subsurface sewage disposal and the Slate Plumbing Code. All buildings require a certificate 01
occupancy before being occupied,
124
SETBACKS; p, FROM CTR, OFrlW: . J...- I
FRONT ~ c:;- I SIDE EXT, (..f-..::;,
, -,
AUTHORIZED SIGNATURES:
Isl Uq (. I /~Q-7r:.-.
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BLDG. PERMlT - WHITE
OFFICE COPY - WHITE
COUNTY TAX- PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
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(See Details on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG, AT SITE)
C55.13
LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
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CONS:rRUCTION [
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,0 wner, ,/ ,"', '.., ,-
, NAME
'0 Contractor I) J,'}", 7-P....-t i'L
. NAME
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'17'PE.RJI:1I~Q.'::"f:"" , 7/ :
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] MOBILE HOME [ ] ,J'LIi\l}8EVIEW [/] ~~HANGE OF OCCUP.AN0Y [ ,]
,'J /J-rV/'!''f '.../'''('''.,~-; '1Ji!"'~.1J<!/~r~,A ::h:4l;
1'L/!LA'k...e...L/ .r.:F.,;:,: i'li!f~~.'!et;..;:;..-:r,'" li,lhr::;~rFP:F1
r )'ADDRES~ I CITY,;:;) -- ZIP CODE ~HONE ~~--:-
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ADDRESS CITY ZIP CODE
...01
L~NE COUNTY PERMIT Fa
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PHONE
, O.S, Reg, #
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,wr, '. / ange cJ Section
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Subdivision '"", I! ,'r' 1/' Lot
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Access to Property (Road Name):
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Tax Lot
Code
Census Tract
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Acreagp
Width
Existing Structures on Property:. ,.~. fJ <:,
Directio'ns to Property , Address:"~)/) uti
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Depth
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STRUCTURE (# BEDROOMSI /-,} "
/-;-:J . 1:'" .. ;,y;' ,t) [l.eU
11,; , ,II '( :".1 I" (. <'
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j ,r ,~I' I ~
SQ, FT,
u
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VALUATION
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>'SEWAGE DISPOSAL: J 70S
.. PUBLIC I] SEPTIC TANK I...J.......OTHER
BUI LDIN"
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PLUMBING
3% SURCHARGF
, MOBILE HOM" '
WASTE'D ISPOSAL
PLAN REVIEW
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PLUMBING INSTALLED BY:
OWNER I I OTHER I 1, ~IAMF
WATER SUPPL Y: PROPOSED [ ]
EXISTING []
It-I--PUBLlC
[ ] COMMUNITY, NAME:
[ ] PRIVATE WELL
[ ] OTHER, SPECIFY:
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TOTAL
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CONSTRUCTiON PERMITS & INSPECTIONS AND WATER POLLUTiDN CONTROL SPECIFICATIONS
MIN, SEPTIC TANK CAPACITY:
GALS'.-J~,,-- MIN, DRAINFIELO
")1'/~6L.. ~,L ~L ~e..
:J"",f. ,...e..,...,w:_ H\' ,A,,.,.,e. ,~.iF
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TYPE OF CONSTR UCTION
A f I-f.
GROUP
L1N, FT, MAX, TRENCH DEPTH. INCHES ./
:~I1Jf,a~.i;. ..z..L~L..i:t;.t.............. <' .f).\ , ~iJ.
':';'n,.,;J'..,:';/ ,.(/,J1p..u...L ,,/.1,' /M.',,A;- :;..., -...o;.r~. j).".~ /tl_,.
I t' V "'I STAY 100' FROM A'LL WELLS
FIRE ZONE USE CLASSIF,
SETBACKS, FT., FROM CTR, OF r/W: 1,-,. I
FRONT ~'/ '"> I SIDE EXT, ,~,;;)
FT: FROM PROP, LINE:
SIDE INT, .-- { REAR
/,,-,,(, ':1- 0 .'1
I' ( 'QONF I........ rr
AUTHORIZED SIGNATURES:
Isl (( C 11- '.f- 70-,
f//)
~,' (I'.
/1 , ISSUANCE DATE:
~A'L /1-.I(),7{., 'J'::' r...-;..f. /t{"
/7' , /1-'1."'" (
Call,687-4Cl65 \oscnedule all required construction Inspections. Call 687-4061 to' schedule all required
IMPORTANT: septic system inspections. All construction shall comply with the Slate Buidling Code, D.E.Q. standards
for subsurface sewage disposal and the Stale Plumbing Code. All buildings require a certificate of
occupancy before being occupied.
/
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BLDG. pERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
. (See Details on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)'
C55.13
LANE COUNTY. DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, 'OREGON 97401
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SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED /' i DISAPPROVED ;---?
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REMARK S
GAS PIP I NG GROUNDWORK
ApPROVED. / / DISA~PROVED ;---? DATE
REMARKS
ROUGH, PLUMBING
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DATE
A~P.ROYED ';. / DISAPPROVED / /. DATE~
REMARKS
ROUGH'GAS PiPING'
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ApPROVED ~ DISAPPROVED L:::7 OATE
REMARKS
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FINAL PLUMB I,N~"
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OTSAPPROVED "1 ~ /
Rt'M~RK S
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FINAL GAS PIPING
DATE
ApPROVED' / / DISAPPROVED '.' I 't": DA"TE
REMARK S
CERTIFICATE OF OCCUPANCY
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INSPECTOR
INSPECTOR
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INSPECTOR
INSPECTOR
INSPECTOR'
J~EAD:!'. T.O' ,ISSUE I _ { NOT READY TO I'SSUE / 'I DATE
REMARKS
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INSPECTOR
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'LANE COUNTY PERMIT 'FO.,...
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It! PERMIT Jc'j'~ " .' "
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CON~~~UC,TIO~ [ l,.., MOBILE HOME [)l .~.H-~~8EV~\%)~J~k~A~9~~~J~~~~~ [ l.
,0 Owner G7~.l~;:i' 11~.u./6t1,6[,,'" ;"f!/!;:~~t~~;1_i/!V!~~~~ffi:;.l;"~,"f~;7~i;"".ti~~!~N~
o Contractor /;'//1,-,,' 'f-Il~'" J.L'" ')1'1 ..I~I /;.,;.~'''({ r:i/~(-" /} .."__ ..:;..;.I>~// ;'"~~..t ~_' i'~ //L~"""""
~. ".-. . 'v NAME ADDAESS CITY ZIP CODE PHONE
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O,S, Reg, #
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Twn . I tJ ,Range C:/
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Access to' Property (R oad Name)'
Section
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Tax Lot
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Census Tract
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Acreage
Width
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Depth
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Existing Structures on Property: .;.;!, /J ,"'"
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Directions to Property, Address: ",;, /." 1 '; ,,~",..' /, t !). k'
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STRUCT'URE (# BEDROOMS) ".::,1/
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VALUATION
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SEWAGE DISPOSAL: /7 () 5 / (-:~: 'I
PUBLIC [] SEPTIC TANK ["'j-OTHER [
BUILDINr.
PLUMBING
3% SURCHARG C
MOBILE HOMF
WASTE DISPOSAl
PLAN REVIEW
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PLUMBING INSTALLED BY:
OWNER [] OTHER [] NAMC
WATER SUPPLY: PROPOSED, [ ]
EXISTING []
[*PUBLlC
[ ] COMMUNITY, NAME:
[ ) ,PRIVATE WELL
[ ] OTHER, SPECIFY'
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TOTAL
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CONSTRUCTION PERMITS & INSPECTIONS AND WATER POU:UTION C,ONTROL SPECIFICATIONS
MIN, SEPTI,C TANK,CAPACITY:' '"
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GALS...,.."/'",.>..... MIN, DRAINFIELD "
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TYPE OF CONSTRUCTION
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A!l'#" GRO'u'i'" "
L1~, FT,~ 'MfX TRENCH-PEP,TH ',_ , I~CHES t/'. .'\'
i~At~xL "Z:.-ki""iJd;"~'d' <:I.J.\. I',c.-u.r,
~MA~ i'~' 'AJ.~,i,jA~;~l~l.l!Jr._ ;!tt~';l ~~jJ!' '~~~~\':A,:4~~:'"
I :r 'V ' STAY 100"FROM ALL WELLS
FIRE ZONE USE CLASSIF,
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SETBACKS } J." Ff OM CTR, OF r/W:
FRONT !-'{-, SIDE EXT,
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AUTHORIZED SIGNATU,RES:
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",.:" .. .... l' ,~'>t~if~~; ISSUANCE DATE: ;'~l' .J
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Ca!~6137.4065 to schedule all required c~nstruction inspections. Call 687-4061 to~si::hedule all required
IMPORTANT: 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 01
occupancy before being CJ:Ccupied. .
BLbG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
(See Details on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG, AT SITE)
:~ .
C55.13
LANE COUNTY. DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE. OREGON 97401
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SITE INSPECTION
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DISAPPROVED ~ DATE
ApPROVED ~
INSPECTOR
REMARKS
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FOUNDATION INSPECTION
ApPROVED /
I DISAPPROVEO ~I DATE
INSPECTOR
REMARK 5
FRAMING I NSPECT I ON
ApPROVEO' I; DISAPPROVED / / DATE INSPECTOR
REMARKS
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LATH OR SHEETROCK INSPECTION
ApPROVED I I DlsAPPROV,EO /I DATE INSPECTOR
REMARKS
FINAL INSPECTION
ApPROVEO /iSl D'SAPPROVEO ~ DATE /-.,.L 7 7 INSPECTOR
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE ~ NOT READY TO ISSUE ~ DATE
REMARKS
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INSPECTOR
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NOTE,
NO PERMI1
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iLL BE IssuED UNTIL THIS APPLICn,iON
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PERMIT f/,,?1i' ~p.;z.-7p
HAS BEEN APPROVED
APPLICATION, FOR:
CONSTRUCTION c====J
MOBiLE HOME ~
PLAN REVIE~' c====J
CHANGE OF OCCUPANCY C:=J
c=J OWNER
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Name.
'P. (). flJ d )( '? Co :> liA .-v J)tf "J
Address q.ty
tJ,ec: tf'7<; I /
Zip Phone
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c===J CONTRACTOR
1/f/J!:-;/,e="/2.,V
Name
;JJ.)'/E IIo/J'/ES S,cR I/,!-;; S'M1cc
Address City
/l-s /lBa 1/6
Zip Phone
O.S, REG, II
Twp.
Subdivision;:dl"A. b~/JjlG. !;/\J,J.J/~ot
R U",e-l <5 ed \IE' S--ft.
Range ~ection Ifpi) ITro ~ Tax Lot
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Code
Census Tract
St1
Block -'S :2
Prop^erty Acreage
Width 112- Depth ~
ACCESS TO PROPERTY (Road Name)-'..IJI/tl.AU:;'
Existing Structures on Property: ~et1~~(.
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Below f.0f) 0 f f ic~, 'u s e OnI YXXXXXXXXXXXXXXXXXXXXXXX}VqOCXxxxxxxxxxxxxxxxxxxxx'ixxXXxxxXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
IV", IJ. '-'/l/J /7' /J ,:-L./ Sq. Fe. ..' IIBedrooms Valuation,
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Property Location - Address/Directions:
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WATER SUPPLY:
'Well
?xisting Sewage Disposal
Public
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system~0o:New ~stern
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Required
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, SEWAGE DISPOSAL:
Site Inspection #
Spring
Other
Community CJ
Name of Community or Public System
Bldg,
Plumbing
3 % Surcharge
Waste Disp.
Plan Review
Mobile Home
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PLUMBING:
Installed by Owner c====J Other CJ Name
FEES:
PLUMBING FEES:
# of Fixtures Sewage.
Connection
Water
Connection
TOTAL
i,,4h r f9 ~J CJ' CASH
i?Y &r 3/!) ~.
PLANS FURNISHED
FACILITY PERMIT
c====J YES
c=J NO
c====J YES CJ NO
Signature of
Fee Received
APPl~T,a t: .
By:
)
Date)/-~~ 76
Min. Septic Tank Capacity
Drainfie~d Required - Lineal Feet
Maximum Depth
Type of Construction
Group
Fire Zone
Us~ Classification
Bldg Set~acks - Irom Center of ~~ of Way:'
Front d},C; ,Side Int.Side Exterior
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PLANNING:
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LA-
DATE:
SANITATION:
DATE:
BUILDING:
DATE:'
,
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
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