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HomeMy WebLinkAboutPermit Building 1981-9-23 """ '- ,W'"~ "~~:&t..'!lo"'ii):,:,:;~t?'~{!~'._~]S=;Jl%J';~':;,.'I"-M.,~~~'(f~,~... . I _ _ ! . ..120N~TRbiCTION/PLACEMENTQw 6J'JJ~ PERM IT ;(z3 ;<077- ~/ FOR OFFICE USB ONLY " APPlica~ ~ - _:"-'-lr Perm~t #~-I-~ ~1 \,L( o Two Caples of Plans D 'j'wo Copies of Plot Plans I DHechanical Checklist .., o Plumbing Checklist [JPlan Check Info Sheet COMPLETE THIS BLOCK. PLEASE USE BLACK INK AND PRINT~ - TO"N"HIP / ~ I :;, c:J3 I SECTIO~~~ ~/? OOUT Of I.~.';IO rITp}i'~f applicable) '7 ~ I )&I~L I BLOCK ~ ~/.J7a~~. ~ ,bl'. 2 ~)5 ~/e'l\-~/~~~;?7Y77 J STRue' ~cU~lL~ ~7 , ;%. r? J ~ ., ~.L/.A2' ~L P' '2U; j ~P/t/IS.u;/A/ _ '2:r'ON'6;- i>RO~' -, ~ "~ I 'OF TORIES ~ tOF %ft'~ W TER SUPP/~~~ OW'. ^"~A~ ~ ~~' 1-4/ I -..: I . - ~~~~~ "'~'-<T'W:-~ '~~ ' ,p~:~~;:;4/~/~~' ,!?4,~~/ 97;/'3/ l~fi'Z;2? ? 'ON//JTti:,:::~!:j,- DlRE~ TO~E ''71:-::...'.7.'-;.,'' ';'l~~.P /~ ../. ./ /fi /t'/l-?/!_C 1,.~..4'-~ ~....? ./~, - ~-rA://'~./___/ --d~ ~~~~~~~4/~~ ,:,' "',' '''''.no /,/ -- :;;J"'2~e{"~'JL~\ COL:.._.,EiI,.l_ j.u..c.__1;;t J:>jl'4~'./~C~~, " ":~""; 1.lf ~ 1: I~. ,'~" . '~~J.!r"r-;'''', r HAVE C_~REFY~.Lf' E~~P~f,,?~-T~E,~C:;)MrL.ET.ED.'.ArrL,I<;A~:;:P!lr~ :Pl:l~RMIT:.J ,~n.~~~O'lh?,Cf:!.~Y,. c:.ft":i/y that _~ll,-~~f,,?:~I]~.~~11 ,~,ec{.?I1. i:LHu~- qn~ c.o.:,~c~t~t}d r t~r~tHH'" certify that any and all work p~rformed'5hall be done ~n accordan~~ "".Ltn the Ordlfl,anCfO!5 of Lane CO\JntYiltlo'thc Li\wS 0(. thr~ SlI,tc ()f.Of"~'l::JIl J>'lILallI1n'l to th"e work'de5c~1~'d he~ei'n.t'i'nd tha't".INO OC'C'uPANCY"'wi1l9~:finade~ota~y ~tnict~'re~'\o,'i'thout thc' p~mi.~sion'df.ft~ B~i'ldihg'Divi'si~n. . I further c'cetiey that. registration with{the1Builder}SrB~ardn's .fin"' ful'f :""force:'~rtdH:'f{ectUas:lre'qui'ro:;d: !jy'ORS 701. 055': that~ ifr,;tx';','mp't th"'('lbasis: "f6~ exeiiijltion is not,)d hereon, and 1'hat ~onry~subco'ntract6rs 'and~~iiip16yees Iwho: are' in: compliance' with: ORB] ,701:055' wi 11' 'hoe: used. 'on;:this; project:" I' HAVE ,READ AND CIlECY.ED THIS ~.::LIC!'~IO~~~:""1:;:.//7,':?,~;':,::'::: ~": .:::f .', ''",.,',.'': ,,,,,; '" D~., . . ~~"../ r><' - . ./t"......P".'1... ~_ /.s-'p~traccor -NAME (PleaSeprin'tJ",''''; ,~...... ./-' - ... ..~."~~' ":'sIGNATURE ,'" /' DATE 0 Agent " "(1-&:1" r ", . -' , .. ',L, ,',tU..." .,"L '" u"-r")IJ..lli~p[ ,\,,;., CU,~ N''}/,' ",... m~ ~'/ ,'0 P~l\NNING/ZONIr{~",..,la~e,^;,~ _ "P~fti!,ian, # /l/~parcel #,~ Parcel Sue /h _.' ~.". ,'.., I" .. ,.,r -- U' '<f.'......... "c:e.nterdf"..r,cle._~ lli ry , "" r' ,..,. ,.... L .,-,..." . ""Ie .,j"1'~ ~" J,..""....'''''T,_v...c:. .'. . ~, _.. ....._.,.. _<,' , ',' , " .' . '" :. '. Ni~limum Setbacks: : L';- front.<JIl..l..J .. .'~L;'-side'., .. J ~~; _ interior' .1...; . rear" . ... t'bl",lt" .:'1'..... --., r '-',;l' ,." :~t: \.f~ 7l'i -j.:...:.:.. .11"....1-- J~:l 'i. t' ,'~ '''lm:J~..t.'J .----;-,: ''''j:' ':":' '..IJ l=:eJ,;~ , ,camments,nI) ~ J:::i.,;,p&, .ca~+.~ q'I.ro,"''';Q * tv.> ~HAS/'77 -XI '.,.-.L ,I- 'I~:_ 'l\1.-":,~~'~~OJl\iG"l ,IV'" Ol'CS .lIq 'U':'.6 (Oue' '. c.,~ ",Q-~ ,<;rJl ~'Tll .A,.,;>yw Y" /,It-.: /7" Date' n~-. . ',..:::; > ."',' ','.= '~7' ~NU AG'T ON ' t> ~ 8\ FLOODPLAINl: J<;;' t!l_In~f1~od ,~~a~rd;tarea?~'!2J:NO::'" Yes.~ ":~'''': ,:.;~"~,~ ~ ~. D~t~....:, :,': 2; ~ 1';;:- O ' ,,)J to jJ),S b",q'1.u~ ! 6U '~GdnJLGQ _up 2dl.~Jt.~'.J . _,JJ.. t J'\':l _J"I ~_.",' . ~IJ, -H" RURAL,.ADDRESS'I'NG': GRID COORDINAtE N E Dace, ' ~ :" (J I,'woe pJlJJ...:ilt}J ~Jl'P,1 ~'F;",.,{ nu 2fHJJ I 1-", ~to 'Jj.ll;(l ,.ll'>" 1.';0, ',. '" r, ./.'.' 'oJ)_ "J 00: Sl',NITATION.:'" '~:s!,',': # 73-~~Co B. P. t,'y(9.s:-7~' , Instaliaci'"n Recdra lSSUCd?)4Y,eS DNa IVaffi0:t&'---7(g ().W) ~l.UObh~~~ Ce'6f'io:.)..;~'tkn'tLLU:l'i1oJ)f~ 'Wi.Qp2(.(XIDlilot"Wt1irlrl'iflO/. II "C)ct8J Installation N~.... ~t~n a.Al.ct. Q..UO.lJ2 . jo" "'11i'neal Feet . - -NaX'im~creptffL.-iNt,. 1 .~{ '~P'ec~'~is:ations:'~e~K!,":-tpgp:'. lank ~.-:. JUa' !,y~r;t,:::J~ .05.D7f~,~;f;iq~d '':'. _ ,~.. . _.;" of Trenches ...JAlllA..I ,:C' C~~~~t;: ',. .... PROPOSED USE OF PROPERTY - [] Residential [Jlndustrial ~commerCia~~, OPublic $ VALUE ..,\" ~D Propose~d ~;g:Existing Tr:,LE,PHONE NU!1BER m ~ o .... (j'{) 't/~ '.) ~[ : tJ! ", ,IF ~ Comments: . '-JI...: J Jb~l.;[. wW-c..w , t' .~. ~ .... ~ . .', ", .. , ~ ~ ',', ',,' "'E~/\--l..V1 "';' <.. . 1.1.....' 1,;U'-l ..h....."". l~ ~ tj 1._1'- 7)1 ; ~~ype-"'-f:.I"'~l'V''!.sa~~M. -~L..!; useCN2fn~rI5rO'Af-f3c"_ J' . J~-: .... U;,~' : ( !...C! &~ ~<' ~ U ..I] '::" ' _~n:r ~;;{t:i.lt !;:J.. dLlJn.. '1" LJt' btj -. ;. '-, ~ 1I1~/': r.)tJ ,~ . ..' " Ii' : '~ . ~uZ ...,' '.-J"";t ~o.. 4.~b ~~:.;.:..:' ~.q..:lc'., ~~(j"l- ':Ilc.,pl .: '~j" . . uu+ !: J~,'" ~'i .....-. .. ;-..1.....-. ....._, t. ~ ,('. : e'_rI ::r, {It.,J:,~ ~ lJ 2"lV-:'l">lJ "l-'J~J " ' , J pG611 ~~q~ at .;-':~~ 2~~~~,~(q~~ ~~(-;.; ;, t.J!C C'JlJc,f:'...rrc.r:r:, ..' _':~~'~-:-. " '}.c.~" ,,~'qJ;a !"JZ;)"CWIT.I' ',-:';'- ,D~!~:~ -. ~_--1 0 1"~1. LJ ." '- ..-.. .'- -,...." \1..1 ,- "I', '_ ' ... , J: CONSTRUCTION AUTHORIZED BY THIS'PE~lIT j..' 1:;:" r r~ '-J,J~ ~-:"::r.~lJj h r"',)J5'G -' . J~'-'~c:n{.,'iu::..- Fixed Feel 'Floodplain Fee $ '~-'- " DescriPt~'on 1 j~ ....hL, C, Sq.-:...Ft:b:."I',:J Unit Cas,t.., .,', 4 PS7 'bC,'.':;l''''f:;iJ.r ,"" ,':i'.r: ~JIJ'~l1.;r" -- "-- . - '. ..-.. . -) u surace Fees $ ."." "'_' p" *A~' ..12h. ln~~~!.r'l "I~~ :: ~-.. -," n'!~-~ildi~~ F~~~" ,~, '1') l..}.\.';ls'~g!:!!;::- /' _Y. :,_''1 _,-,~ '/' ~- 5/t:/_ S~we,r/s~.orm Draini'~a~e7 S ~---d~' ' Plumbing 'Fixtures .$ '.-' - - .e:.. / , I I r:::',.j., . l?"I Mechanical ,$ ~ fiN' ,~P:.~:, ' ~' 9.5u ; "::~:::'~:::~a:::',,_' ,. ': /://..;z." , ,.','':: ";', . TOTAL',F,EE " , s....:-,~3~, " T.oTAL ~:LUATION $ ,~5c,,{t:I "FEESB:;~W oft'; / //rP~ d- r?"/ "..' 19;19/~I.:': ,;, ._, . DA'fE , . ") t::,'~,:.. ..... .....,,- /t?M ,. , 4.' '" '.'.. , '.' 'f.. ..., , . '- ., LANE COUNTY DEPARTMENT OF, ENVIRO~MENTAL MANAGEMENT /.125 ~AST.: IGHTH.AVENU~', EUGENE, OREGON 97401 ....,. 'pERMIT APPROVED. BY ~U~LDIN~, OFr:I~IAL/Dl\=,~IGNEE {pe:t.;. ORE C74-194 SEE REVERSE , . ( \ ,~ ~~ SETBACKS AND DTHER' CDNDIT.IDNS,DF APPRDVAl'MUST BE STRICTLY DBSERVED:' VIDLATlDN CAN'RESUlT IN'-REVOCATlDN DF THIS PERMIT. CITATlDN UNDER-PRDVISIDNS ,DFlANE, CDUNTY'S INFRACTION DRDINANCE:AND/DR OTHER REMEDIES AllOfIED BY lA~" ' " . _.' . ~ ._ _n. ." ~ . . ," .' ;_...r,. ~'''''''''-''''-'. ~ . ~"_;';' \ ;:.~... WHEN READY FDR INSPECTION CALL 6B7,4D65: A MINIMUM DF AT LEAST 24 HDUIi"ADVANCEfllDTICE FOR INSPECTIDN REquEST MUST BE GIVEN. Have the following.infonnation ready: Permit number; job address,\type"ofinspection~-wh~n jt wi.1J be'ready, your name and phone number, and any special directions' to site. ~ . . . ~ " " BUIlDING.,DIVISIDN: " ..- -~".. :;--,. REOUIRED IIISPECTIDNS ,.,,!1-.. "_' :.' ''" . .... , 1) FDUNDATIDN INSPECTION:, To be'made,'after trenches;are excavated and forms erected and when all 'materials_for the foundation, "are ~~Iivered on the,Job.' .Where ~oncrete' from a central mixing plant (coll1l1only 'termeCi:~'tr'ansit ri1i?<ed") yg".to"'.be'u-sed',-: ~:. '"mate.nal.s need not be.on. the. job. .' .~ ~ - ~ .. . . ' . ."! ... . 2) CONCRETE SLAB OR UNDERcFlODR INSPECTION: To be made after all 'in-slab or under-floor building service equipme~t.'~ conduit, piping' access'ori-es "and other a"ncH1ar.9Iequipment item~-"'are in cplace...but before any .concrete is' pour~d...~' . or..f1oor'sheathing_ ins.talled. including>the.~:-subf1ooro>.,.."o"", ...~. .' '. '~.- .:..... ........ ....:.....-""t'" _:.... ._ - ,..:....:'-.:.', ;,-. jO' 3) FRAMING &' 'INSULATIDN INSPECTIONS: 'To be made after the roof. all framing;' fire blocking and braCing aJ.l pi pes. fi rep'Cace's ,ana- 'crl1mn~ys: and~yen..ts,are'-coiTipl ete and al r rough el ectri ca l' and .plumbing are /~;o.1.1-inJ;.1I1';;a.t_inn,..nnd_V.aDQr:...ba.r:rj.eLar:e_in:jtla<:"e:',~ . ~ ~"I'" ,". -~~,. 't-. .,,;. '!. . ~.' : . '~. .." . I I are in~place .and ~p~oved, '~!n . \ "ce '. fir; t~:ff ;'0'9 , ' ~; ) " ..~... :i} Ii :i I j I I , .\ r i ~'I' " . , " \, " , ""4>,1 '-- ,'.,... :it "', . ,Ii 4!: j r I J<#' ~- .}~ .\~. ..-.1 .,~.,'~'F-.;:.'. ',\~j ~.:.o.~'~-A .~?~:t ",,;,,~.....' ..f~, I, .{ L ",,;":. \ , .... n' ~ ,"~ ; f " o o ',' '/ f_ ..-:~- , TRS, TT 'Plat Plan Subdivision Lot Block '~~~~UJ~~~ ~~b I~ ;;:~ 1:~P;:~ ., ~~~~ll~ /t)6'f$"I,;~, 'r ~ ?::> ').~ ~ Vicinity Map C74-1S0 Job Location (Address) ,;2..0 S 7 Permit # For Permit # For Permit # For .::r A) J.. /fA.) D kIA: Y ~ , Permit # For Permit # For Permit # For dS' 17- Ii/- I~Lf I ~ 'J~ f2> ~ I ~ ,\ _:..? J o;Y\ " ~ . N ~ \' \'- I ( '\~ ~.7 ~ . I ., -. \ ..... " .r ~ . ~.... ~"""""------',,"- ..... L. , '{'(\ , '-- ~'_.._'- -~._-~--'-""-~.~~~."-"'~~~-,..~~..~..,..~ BOLD. . SL'P kI1eci.. APPLICATION # ?()f'J'7- "1:.1 LOCATION 7()c/'7 ...-Mlal\lv;( ~ U NAME ,~\..u J\ \r\.eR 'l-Or...?lf Lc0s."r (r [)J }({p (,> (JQ. ADDRESS Cfl\.(?)/ ZI P CODE The Lane County Building and Sanitation Division cannot proceed with processing your application because: 1. ra- Incomplete appl ication (items deficient), ~~~~~~ ~~ tal\ ' flifb ~e>~::;,~~~,'~.~ DD Verification of existing system required (see attachment), ~v,"~~' Two test holes (2'x4'x5' deep) required for expansion or repair of existing sewage disposal system in the area of the proposed drainfields. - Address andlor directions to application site, - Proposed number of ,bedrooms in dwelling. 2r Approvable plot plan (see attachment). 'IPlot~lo,^ Dz\-o..l\S./1 Notification of date test holes will be ready, ' '.......... . . , -- .... .. .: 4, 12I Other: Plot- alan ,'\'J }~mli1Orl ()~\Ur\\A()\' r? QOI2'vnTt (l p,,/r(((\)m..-, , ~c. II[\T (JI)r\HI!dj.,VJ, Pioro.\~ I I1AffiAf'10, (L ,((do Ol""~-, /.'),(,'" ~t 1/;;"-!2,nl Ir':i<,': , ~ ~z~ )( II ti 'rorw n , Sh0v0 (Thll(J.~jirh~ ,~Dt1(> iTh~.Ie d 'd!l('J ~ r5;o p A (M Ji1A AJL11Q) ntJf)(Vlod 'Cf~flIO! IMn17JOPOll(Jl/l 110'mt\:i 4f)~ '71()\(?:\' PltlLJ'1vJ.l Wl H ~ u",t;JIl-JvVl/A AA1AJpW(J1j;(;)/ )lIUAJif.MPt IVAA-fu.iU! S1YUrdUAV, "(0) .Y\)/J~(ld iOA..IJr17, ) ...:::.- ,- .. , (7;;) /9')1 I1Anj/lAhoJd 1I11l!fi/PrI'1J)A:tt-1JAvlJJ ~ 'U"" A-tj'.j4lJ) An. ij )(JdfJ2hlifdJ SIGNATURE X"3() to0:m 1.:2, ,\Md. n DATE -, /of.1"J..:2frt;(o from J( toli'.-:41 PHONE OFFICE HOURS If no response has been received in regards to this, matter by / Il( Oct- the application will be denied, [ , (I , " ' lS-lAb~ dcut~ BUILDING AND SANITATION DIVISION I ENVIRONMENTAL MA:IAG[11ENT DEPARTMENT COURTHOUSE, PUBLIC SERVICE BUILDING I 125 EAST BTH AVENUE I SJU~~NE~OREGON 97401 I PHONE (503)687,406 (.J:J' ~ ,.. " : .- -;:::-... :-:.q;' ~ " ,("I, . ~, :<( ,\.~.~ I' 'J :,~ Sol ~~ \ ' J" , ,~""I-" ,._'~ ~1 -, "'~C::I -;;' "",:> .-- _.., C' '..:- (,7~~"(fI ~ ~"~- \ g~p iO \i'~'''' }:-.2". .\~\6 ~ l:~0.Z: ~~\' ' ~ lJof7h " -- j.,DT"52- 8) Dc)< Iff \ / ' /' , ~. .. q, , ~q" '6,0., '32- ;,~~I:' . ~ 'r.<\"~' \ Lr'1f-~, ' /---- --'l -\ ~ '-... .\ \. r' ',I) , '- \ \ ~'\\ ,I~, ,\_~ '. \.lIlt ~ " " ~ \ \ '(\ /- ~,'V\ ~ r--, i . , " ., ,""'" \ _ 'J-' o.,W ....." < _';>':-1 t:J_U../t./l1 , .F.~' ...!.;I_f?-. t- ' r;I '- -0 ifi\j.L~1 1fT .;lo 5'7_:r:..&,J,f1AJ..pw It.'t:.-.$-f'~~~ , ' ~I e."'> :1- ~ '?.' c.d , ~t., ~..... '-S( (\ ~ ~ '/ :? -'< I..)) .)'., \,- I \ J " R";- ~ 'M. SLtl.SfI ~I!., '737- 2,2.2. ~ '- J ~ .!. .! 1. . ' ",,' -,,'. " ~_.~ . " ,l ,,~ " ~. " ' :-:. . :~('i .- '.. -,~. . " ~ .,,1 . " ~, ....'... ,-:; -'. "! " , " " f'.:". "'" ,. '. " '. ~ .. '". '1!.' ,~ .' ' '. t ' ' ',' , ,!., , , ">,' ',I .. , '," ~. , " " 10 .'!." ", ;,'~ ".i' , , ", ,- " 4', . i,!, 0", :.- ... ',,}' ~.~. ,..I. 12, . ......1 .' .' .[ ,; ',.1 14 . ~L;~ h " i,(" . " " ~. . . : <. .~'.?' ; . '.~ .' .. ,." 16 .f .--. ,: . ~ ...'.' . '''-.,,; ,J., .- . ., '" ...... 18, j,_ !1j'l\,. '".- ~ .' .. , ':' tt :,J ,I, ~ .'..;'~ -, :,", ,v .'~' ~ " ,.'. ..... . .: " . ;1' ";0" " '..:./ '" ..;-' .... {, -'. .~:~ ""'. ~ .. ~'t~ , " .' ;, " !!:. . 10, ,1 ru ~,~' ',I "'. " ; . .::,., _. ";~ " [ H , 12 " ,'", " ~' 14'-.' '''.L " " "', L{.~NE. COUNTY ''"1''1 'I..'..T".'I'[)"'II../.. , .', l:"lt-' .." ..-... L.HI~ I .~ ,::. '_, ,:, r. ~M .,: }',_ .", I'"j .^' . TL;~;1 BO:'q12'20()7~)() ,SUJ:<DIIl FIlJ<[RI , _ .' . ,_ I. . NEW BLDC TYPE GAR~ USf R BDRMS'O 'CODE APPL NO ACfION'DESCRJPTION . '..'.,. ~BP , C(::li~PCH<r . F~OH, ,,,::' , "'/"j':'1['f:; 1..1 C) ""1 f:" -., . . ,1_! ... ..;.... . I ._ 'BP. PARK, ,'PEF'T ENV, r~1GT" 'F~EC[ I F'T . :~: 2(-)77f~ i VA TEO':?22B i ,Mnm ;:!(1'5"{ INL:.M~D :v.)AY,. SPfn'NG:FIELD;:, (:mEGDN, GROVE,:m,-! ADDITION ' LDT ~';2 'BI...I< " [);'""':1"',', 0(')' <"'\",)/"'1"1:"" " A,r..' Y',j''' r.,{," ':"HI')""f:':' orr:' ''''''''R : ' ,.L , ,., . I. ,.)- I .. '\. 1_ ,,:. ,. 'Ir.I~' I....!., .:r ,:;.. \...." I! I'{.., '._' I ~'.. ,;.. ,:.: \.. , ;: ','S.Q 1':'1" Wn"f CD,q' Vf',LU(;TIIJN F:EE:' ',DAYS ,:'. .;")(-YO . ~} ~ 'I. (-) ::506.0 '! '!. " i :'~ lJ 14 'J ,: u' ....: .'.... " :- " , ' ". , ."i: '.. ' " .; , F:L' MECH ""S'.Uh~" 1,(; NiL 2()77B.,i i\iE:t\ll:~ ~ : F.=- (X,'rl:jl~~E;.:,?:..:;_.: " " ~- ....' 'NOl~': "I')" "'Ie""'-')I' .., '1 t...~. i'-.(I\:::.L I,~ '~,'~: ' dECH(,NIC(iL:' .FEE STriTE SUI~CI'IARG[ I::'L (.','" c''1"li::TII ',::'1::'1::' ."l'1 ,;....... '.' ,.1...1... 3'()6{) i :~., 00 "E(.iCH ;c, ?B.OO: i, \.:'- .!. , ,PC!< FP, '.- . 4% ::;O~.~~ , ' ~'1',,'12 '.' I'.:' . , " ,j4,~00 .i(),.(.)O .< . !. 4 -~ . l~ . , . ',,' ,'~ .. ',' . < . o u '. i.,,~ . ,J12~"'~' S '. '~ '.. " .') '- 1f1' ....'... "'I"f"i.' ,"j".; .' o i~LH . F~tl , F I::" :1 EST " SDS .5'I 'l- ..,.> I"cfi." 'OTH' .:.j ~.. " 1 ()02:::)'1,.: 11 .; 'i::::'t={t{;:: :S'EQU:.:~. .' !. '1' "~T(,'d<tN' DY, ....... IS'S -=1 TOTliL FEf:,:)("( --.J . CCH1PLETION' !.WiT .' ". , " " , , '!I .' .l '.~ < ... .'; 1:- .% " - ", " .... f' '.., " ,5 ~ 0, ~ 3 ,~ _ ,4 '.' " , 0". ; . " , . <'. ... .., \ 4 ", " ~, NOTE, - 'ttAiJ-frl ' /!; CON1 rRUCTION NO,,,RMIT WILL BE ISSUED UNTIL THIS APPLICATION HAS BEEN I PERMIT f~DS -'V APPROVED P . APPLiCATION FOR: CJ MOBILE" HOME DO PLAN REVIEW CJ CHANGE' OF OCCUPANCY' ,C=J CJ OWNER M~niel. 'Alfred E,' 192R7 .Ja~1)!"r ),O"l.ell..R,!-., T.'1T-!Pl,l ~_Name- AddrF"~ q, ~ c=J CONT~~~ ~~''Y-l~d~~~jCityO O,S. REG. II ~ ~_ ~ Twp,/~ b Range 3 LJ~,t Section .Q. 0/- /1 ,Tax Lot Code .\ -<.:;..J,"<a.,,~ Subdivision ":) Lot < ~ ..:2 Block ~.;. Property Acreage Q]I.'i7 Ql1.=22.~h ~ ,Zip..., '" Phqne '--/2A,~ '~'"'" -.JUN' " c,w - Zip r ~6tia-'175D Census f, /' ," Tract .,,\-'/"1, , , Ildd, I,.. ".. 7'~ ..;1 D ..,- 7- p,'; j,,,~f ,c;'.. n d.. IAJiLl,.,,"! ILJ1<1Lo/ ., $'v b, d: i oj Width______Depth ACCESS TO PROPERTY (Road Name) i N/"'H.J 1.0 <''f .~ Existing Structures on Property: All) ..I", Property Location - Address/Dir~ctions: Jt;;el~W fo.. OHice Use On!YXXXXXXXXXXXXXXXXXXXXXXXXXXXX~XXXJoo(]ao(J{XXXXXXXXXX~- XXXX~~XYH"\'"\r'r'r"xxxxxxxxxxxxxxxxxxxxxx .." "'- - "_ ~ - ~.. -~ 1 ..--- ~ . - Sq. Ft. ,IIBe~rooms. Valuation ~~~... " '~U J..i,~ <-..1....",-,,- \:), ~ ,.4. ,,-'Z ' ~,\ \-'''''.lA (~'--<"....~'. -- - /' ~ . / SEWAGE DISPOSAL: '\~ ,I .' / Site Inspection II ~..., ~isting Sewage Disposal ~Istem JZJ, WATER SUPPLY: 7~- 8'<9(0 PUbliC;t[zJ , . Well Spring _ Other, comm7 b, Name of Community or Puhlic System - o~ ~~w sy~tem Required ~ FEES: . PLUMBING: Installed by Owner Other.c====J Name Bldg. - \ Cc:x _~- ~ -- ... PI 'TM~ING FEES: Waste Disp. Plumbing Plan Review Fixtures Sewage Connection Water Connection- Mobile Home PLANS FURNISHED FACILITY PEID-HT 1% Surcharge TOTAL ~r50' \r~ ~t~::SOf'A~P1~~Jt)~; _ " )yeceived By: .A Dat~'~ i I ~Q.b Mi}Jo Septic Tank Capacity 9a"O . Drai~ield, Re)j~r~d -, LiJlea1 Feet I s'O Maximum Depth~[' .J!..~ ~ ~ _'1'..2{(";';L,A/J ,o.Mf ~, ~.AA~ ~ AlAI1A...-' ~ ~ "" \S.iJS ',' I' , " ," \ /\/f,ll:=:: '1n,,^ nonHYIA~ Il YIC 1c.~UDrJ 1-YJ,QJ!cl1MCV on,,,r OJ}&Yl.INa./- AdJ/l/L "'in <;r 7"2,-/?(~c., \/1'AI'd~~I(',I\. rpD..;.WL,,,,uJ, ~V.;l"\ II0plfli'HMA11'nAM_ "tt;^ I\fl~'Mf.l~d'a1TlnJA. JC'INI/,t1 /(~(<)r;r<);1 ~pe of Construc\ion ,<J - . Gro~ -Fire Zone Use Cla~ification .J \. .J. , Bl~.Setbacks - from Center of Road Right of Way: F~ \ ~vj.,,~;~DATE: ,A/iX~, ~]55'12 LANE COUNTY DEPARTMENT OF <<~ Stat'.. E!Eli~-il"\r_ Rear Zon~ /M---II1# . ~~~~- DATE: , .:1- /,,) ,7(. BUILDING: DATE: <, ' ENVIRONMENTAL MANAGEMENT 'J!' " .~, r; I'NSTALLER: ',C ' , " ~'- -'<-">?;i;r1fJj' j.' g 0 r -7 g .p~OPOSEO SEWAGE 0 I SPOSAL SYSTEM RECORD , Complete top par'., ; form to signature and submit I " copies with appl ication. PERMIT NO. 1.;1i'5.7h FP.ED r'l<..D/I N I E: L (,G 3~:;i,g7.)~L~1e.JZ... , /.. <'>1Ar<.-l.-l---', 0-'1, q 1 'IS' '). P f-. '13 ')-1)..<I-~ Wa :er Supply , Public ~er-List PRUP~KIY ~UUKt~~ CJ.D57 I ~ lC<.ro.\. l\P.y; ,~"'-/))~ (':h, Baths Basem6nt Yes No \!NSTALLER'S NAME 'TED SOP 7E LfA (lJ No.~i.ivin9Units :Bedrooms Septic Tank: Ft.from ,well 'Inside ,Dimensi'ons: Lenqth 'Midth OWNER NAME Steel 0 Ft; '0 i ameter Concrete ~. Compartments 'j,Tlle Disposal Field: Depth Distribution Box: Yes lOther Distribution-Type " ,Feet from WEll C /I ,Lot Li ne 'I '! 'r t/,>I' Front ""I Total Sq. I Ft. Between Ft. E::cCJ Lines 10 Gal. Capacity ICOO No MAl LI NG ADDRESS :\ ,r, 1~ Length of L i nes-Ft'. "Trench 1%52,(.53. 4. 5. 6. Width 'lo~ilan {see' instructlonsl: "leel ~eo (eon CJj..5Y'i P('c.!~fiL 12rl Foundation Side ,If) Rear 10 IFiller IFiller Depth IFiller Below T'/Pe!I/,;:>- Above Ti Ie &in./Ti Ie!,' in. .. , 36,co '.!>' C'> /c'I> --- ,( AI()RTH L. 0 7 5.;; blOCk <1/ G ~ ~~ \0 \l"5~ , , ,~ If) \J'. . /0/ '(J'- \9 ~ 10' r :'<?'QhX C(. ~o/' -!) ,;..Q' -.:. ~ .... '" / ~ 0.;' '~.J e...,,\(L~ ~oi vJ A "J rf'J/..AflJD Date;)'h.4R .00,'7b S I <,nature i ' CERTI F I CATE OF SATI SFACTORY COMPLETION For Sanitarian Use Only: Date: In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certificate is issued as evidence of satisfactory completion of a subsurface sewage disposal system at the above location. ~ Approved: System Installation conforms to current standards o Disapproved: Does not conform to current standards Remarks: C55 -11 /f ~k- /// San i tar i an I sS i gri;tture LANE COUNTY STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY " . .~ . ~~.., .:;;:~~ ~---~-