HomeMy WebLinkAboutPermit Building 1978-7-28
",.
TR~~TI ,.: 18.03-02.3.3
4300
JOB LOCATION
,
18;11 INLAND HAY
2427-7~ "~
.'
LANE COUNTY PERMIT
. Acreage or Lot Si70
Contractor's O.S. #
LESS 1 ACRES
Partitioning #
) Completed
S bd' . . FILBERT GRO VE
U IVISlon -,
Lot .)u B loc~
3RD.
ADD.
~
JEAN ADELL VANTUGE
APPLICANT'S NAME AND ADDRE~C:
OWNER'S NAME AND ADDRESC:
CONTRACTOR'S NAME AND ADDRFC:C:
Mail permit to ( ) Applicant ( ) Owner
1875 ~40HAWK
Ph 747-8959
ono
Phono
Phonp
(owner, etc.) when ready.
# 79, SPRINGFIELD,
97477
) Contractor. (^^) Prefer to pick up. Call.
(r STRUCTURES NOW ON THE PROPERTY
NONE
\.. /
-THIS PERMIT IS FOR
CARPORT
WATER SUPPLY
SPR., NQF I ELD
SEWAGE DISPOSAL
# BEDROOMC:.
SEPTIC
# PLUMBING CONNECTION~
SEE 2234-78
-.
S.1. #
TH IS PROPERTY IS WITHIN ONE MI LE OF THE CITY OF SPRIlINGFI ELD
. PLUMBING BY
I hereby certify that the above statements are true and accurate, and that I h,ave the following legal interest in the property: _owner ~f 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 of this action. I hereby agree to comply with all applicable Codes relating to this permit.
Fee Paid:t FEE TRANSFER ED FROM 2234-78 Signaturp Isl JEAN XlDELL VANTUGE Dato 7-28-78
) NEW ADDRESS ( ) FACILITY PERMIT;BTO TRANSPORTATION DEPT. (X) SPECIAL PMT. AREA. MIN. ELEVATION: NA
SANITATION
J
Comments:
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth .
B"ILDING 11/1
VA..! rl
,. Ty.pe of Construction Group
C.i4L/~7 "se Classification
Comments:
?
Fire Zone
;:;
.---. .~'
1J'h
B9L.;V~Y-up:
Date:
(-c.0- (0
(FROM CILl
Date: 7 - zlB-7l
Da~.lssued: 7 L..J.:iz?V
INT. SIDE YARD.) REAR I . '(FROM PIU
By: I . Date:
PLANNING REQUIREMENTS SATISFIED. By:
ZONE: KA~r'l1 SETBACKS: FRONT :JJ
SUSAN KELLER
SIDE FACING STREET
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT S'TE
PHONE: 687-4394
C55-13
.BLDG. PERMIT -WHrTE; BUILDING - GREEN; PLUMBING - CANARV~ SANITATION - GOLDENROD; OFFICE COpy - WHITE
.~
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LANE COUNTY ~ "PARTMENT OF ENVIRONMENTAL.~'I\NAGEMENT
125 EAS, d1H AVENUE, EUGENE. OREGON 9. )
c=J PLANNING DIVISION
PartJ.ti~"dn9' .
Parcel No.
Current ?on'ing =--
[]p~nding [JComp~eted
".'.
FEE
AVERAGE PROCESSING
THlE
.'
partitioninQ Required
Other.
$
I
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,
I!
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II
Ii
$
o
HATER POLLUTION CONTROL . I at. Sites
New Slte Inepectlon(s)
50S Construction [] New [J R~pair'
Number ot Bedrooms I
Commercial/Industrial - of Employees
Other
$
$
~.
CON"STRUCTION .PER.'-tITS AND lflSPECTION
(See above for . of b~drooms(1 of employees)
o :~obi1e ~om8'
o Per~anent;
o Temporary'
_ 0 Renewal ..
.!}ir~ctu:.e,' ....t-. Sq. Ft. Valuation
~/l, S6tJ(j{ ~,;l(/IJ .
f. . I./.trn
FEE
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$
$
Total V31u~tion $
PIU!llb-in9. fixtures at $
Sewer/Water COnn. At ~
$ ~tf., 00
$
$
$
$
$
i" ,
EllC.h
r.ach
$
Suot-ataI
., State Surchdrqe
rlA~8 Check. Fee
Chanqe of Occupancy
$.
$ , 't~
$ 7, ~h
$
TOTAL BUILDING PERMIT FEE
$3;?,/(r;
o
.,
Minimum structural oetback.s:
6() /
,Exterior S'ida /J/ /t-
Side~. Rcar:7/.jJ#F ..
~ppl1c.:ant. O'curh cut to applica.nt
Address
.~
From centerline'o! street: Pront
From.interior lot lin~s:
o Co~'l plal:'9' sheet 'to
PUBLIC U.r;oS
o
Address
. ~ ~ini~um .Elcv,H_ion
/Mi,n t~~
! .
Elevat~on
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o
o
PUBLIC WOR.l<S, D' f'l'Icil1t.y.Per-nit
Caflh
I
Rec'd by ~~ TOT^i. $ 3:2, / 6-:-, 'W"~p'
AFFIDAVIT: If this permit is for an'agricultural building; I hereby de~i~re th~t ~s buiiding
will be used for agricult!-lral purposes 35 .-\tlo....ed by zoning and/or the State.'9':lildinq Code, and
for no other purpose. lfui.ther certify that the statements and other inform,'ltion sUbmitted on
this llpplic;...afion are true and acCUrate, and that I,h.we the follo....ing legal'interest in the
property: ;$.-owner of ,reconI'i _._contr"ct purch,'ser; .~.:..c..l(~s~ee; holnet". of an exclusive option
to .purchase; _dUly authorized to .let .(Ot. a person who hag the IOTlowin<) l,eqal..int.crcst:
; or th.>it the uo.mer of record is knm.ilr~d,.ic,'blc of thi9
~:::~~~~~?if~;i:p:~':c:::~:. Si,:n:::::~ ~::::.~ Z~~l~t inq
THIS .15 YOUR RECEIPT, AND DOES !'iOT GIVE; YOU PER."I1SSION TO'BUII:D.
FOR ~NFOR."\ATION ABOUT THE PROGRESS OF YOUR r\prLIC^TI()~l. .CALI. r!~RMlT COf1TR9L, 687~4']'J7 (687-IlEt.P)
Cneci .
.EJN1RO:j......t;:.TAL /lEALTlJ
~ne county.
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ADDRESS CONTRACTOR'S ORE. STATE LICENSf ia ~ \\\.
o ~I. COMPI.ETED PERMIT TO APPLICANT/Ol.'Nf':R/CONTKACTOK (CIRCLE ON:,KPRHER TO PICK UP. CALL 7 V'7-ff~"""" ~ ~
1. PRES~T USE OF PROPI:::RTY (residential; type of (arning; co~rcial or industrial; vacant; etc')_?~7-.2.~ 6 fll> ~ ~
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^ppolnrmo,nt [lhU'.
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OffJCt~ lls~ Only
APPLICATIO N
APPLICANT~'\;: JlrlO. \ L .W1W~*-. ~) PIIONE . "'14--7 _xqr'-1C(
ADDRESS ( ) 1~ (C-., j\, ri/.1.(] , I )I>T Cl:v 51 P7i ZTP
O\r.>ER \IF DIf"FERE.'1T) 'd'_.... .;~~ - plloNd)...... '-
\. ADDRESS I
~.,RACTOR
City
ZIP
PHONE
2. DmlJ~R2U'l1 'lJW&':3 ;?ERTY. ",n, AI". STlWCTURr.S TO BF. ~DIOLISIlr.n. .
J(\ItW:DZ;;;NS.-oR T~.,:!,';>PERTY ('CHIS ~C^TlON) ARE, \i.II'!. i!J9~~~. :~;4 > ,'~
l-rAG~} l'~ ii~,<:::"'~ ". ./11~~-~'~~ I~~ _' Y
4. FUTURE PLANS: U f/ .....
5.
PLOT PLAN. Sk@tch (a) all roads (b) bound;Hie~ of property (c) eXisting/proposed buildings Cd) existingl
proposed Se1.'age dh'pol'tal areas (d ('xistlnR!proposed ~ells (0 eXisting/proposed driveways
(g) easements (h) drntrlilgcwayo. stresCl..'\, creeks, any other pertinent features, If cOlIlmercial
or industrial, .show freestanding" signs, parking areas. INDICATE DlMEt:SIONS.
: ; ::': I :~~I: :-:+,' ~~:f~: ::[1 :: : '~::: (: . "1>- :": : 'I :.: :'-("~T~~:'r::~c;..1 ::-~~'''~~i' T:: ':'::: '-:7:1
H T:: ~l"~::'~~~~;I: :.~~-jl~:' -: :~,~!:~~~:: I: ,:::.:: 'I' _..: ul:~ ;:: ~;~: >~: :'-,.1
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. ii, ,.....1 + I .'1 I ' I I 1:1: .,.,::,1
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I 1 . I' t i . .. '! " I : . : : :': ;';!
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i ,,-.... -.- ,-: i-'u..::" :'[.::. ::-:-:- -:'.-;-;- -:-:~.: ::f :Ii
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6. TOTAL LOT SIZE ORACiliAci- UO':toh~~'~"(7':-,sml:~c;j~~1~S~~~,:~~P1~;~)"':_'J,''^--':71~
3. !1ETtIOD OF SI:I.'AGF. DI5POSAL I .~' ".I J (l / , / H d""~-) V /0' \ _,
9. PROPOSED WATER SPPPI.Y WELL_ si'k-iNG__ STREAM LAKE . PUBLIC: (1., ~ lr)ll r:l~ (nrrTI 1f?< (\j11'11r11.
10. EI.r.crRTClTY FtJR.'IJSIIED BY ~
II.
I::,.:,:.
(.: I.
_..,:,,_1.
i.
I'
"ATURAL (;,\5 BY
12.
fiRE DISTlUt:T
I). . SCIlOOL DISTRICT
14. PLUMB1:-\G BY
*"'''''''*''''''''''''''''''**'''''''''**'''''''''u,''''''''''''''''''*'''''' 00 NOT l.'RITr. BELOW TilTS tINE "''''''''''*'''''''''''''''''''''''''''''''''*''''''*'''''''''**'''*''''''*'''
BEfORE YOUR APPLIr~\nO~ CA~~ BI': PROCf:SSW YOU l'lUS'T fUIWISil:
8~xll PLOT PLANS _______LEGAL DESCRIPTION
(DIMEN5IO~t:D)
BY
fl..\TE
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
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JOB LOCATION
'"'.?..... t .:.,w:~lD t"::"....
. _.,/. ~ -l
LANE COUNTY PERMIT
Acreage or Lot Size_
Contractor's O.S. #
1.ese 1
.:ICn;;3
Partitioning #
) Completed
F 'L[]~nY G;;:; \I;;
Subdivision -,
Lot .;IV B loc~
tJ 1'), S?C1I(.:cl' I ef.C, 97h77
3~~.
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J:;:ArJ A.r;r:LL V:.t:YUSE
APPLICANT'S NAME AND ADDRE""
OWNER'S NAME AND ADDR""" ,
CONTRACTOR'S NAME AND ADDRESC:
Mail permit to ( ) Applicant (/) Owner
, . ,:OlJlr
STRUCTURES NOW ON THE PROPERTY_
1875 ~,:;,>:!\~;~
. "'l~.., ".....r:::--
("t~'"\;.;
Phonp ( ~ ./..1,
Phono
Phono
(owner, etc.) when ready.'
) Contractor. t") Prefer to pick up. 'Call
TH IS PERM IT IS FOR
CArn>O:lT
WATER SUPPLY
SPR H~(;l>' I[;!.{)
SEWAGE DISPOSAl
# BEDROOMC:
SepYlc
# PLUMBI NG CONNECTION5--
Dee 22}'l-78
S.1. #
!)PHO;:JOY'lrLD
THIS PROPERTY IS WITHIN ONE MILE OF THE CITY OF
,PLUMBING BY
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 of this action. I hereby agree to comply with all applicable Codes relating to this permit.
I"!l:e taAtJC,E:C1lrO "0014 2234-"{3 S' t /5/ Ji::ACJ iD1RI.. VAiJWG! 0 7-23. 70
Fee Paid ~ Igna urp ato
i"$A
) NEW ADDRESS ( I FACILITY PERMIT TO TRANSPORTATION DEPT. (n I SPECIAL PMT. AREA. MIN. ELEVATION:
SANITATION
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
BYI1:.:)iING dA
:;:. , ...."I.y.pe of Construction /"1 (;roup
c..:,tr ... / Ilse Classification
Comments:
?
Fire Zone
Comments:
f)~
By: : Date:
PLANNING REQUIREMENTS SATISFIED. By:___
ZONE: "A-"'" SETBACKS: FRONT .I"
<:J J A Jtt'.-L..... .
~KL- .tV C{L~
Date: 7 - 2 8-7 if
:)USAtl t\El.!.cm
SIDE FACING STREET
Date: (-<:0- (f,)
(FROM CIL)
Da!e, Issued: 7 M-.ff;t7Y
INT. SIDE YARD" REAR I . TFROM PILI
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
PHONE: 687-4394
C55-13
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. PERMIT -.WHITE; BUILOING - GREEN: PLUMBfNG - CANARY; SANITATION - GOLDENROD; OFFICE COPY - WHITE
~.
"
~LANNING OIVISJON
partitionin9 ,
LANE COUNT.,Y DEPARTMENT OF ENVIRONMENTAL MANAGEMEt'JT
~ I
125 E, 8TH AVENUE. EUGENE. OREGON )1
Current ZoninQ
Of>('n~inq
FEr
....VERAGE PROCE:SSWG
Ttru::
Dcompletcd
parcal tlO.~
PftrtltlonfnQ Required
Otherl
~ HATlR POLLUTION CONTROL
I o~ Sites
$
$
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$
$ !i
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NeW' Site In8pcct1~a)
5DS Construction ~ Ne~ [J .R.~~alr
Number o( Bedrooms I ~
Commercial/Industrial - t o~ frnployec9
Other '7,f-- 7/ V
$
rn
CONSTRUCTION PE.R."IITS }l.ND II/SPECTION
(See above ror t of bedrooms/lot employees)
~ ~~obl1e. HOIllG"
~ Permanent
0. Temporary _ ._ _ __
o Renewal ________ ~
Struet": _~Sq~t,_V'lu.t'iQ" $ _ ~
C7;~ -~-~:tA=::~);~Yd,~,~
~'C>td_"""lU"tic>n , ~ '.-./--1-/
,.,.- ~U',""",l~....:, V . C.
Pll.L"Tlbinq fixtures at S Each $ //J
Scwer!Water Conn. ~t ~ r.ach ~ ~
Subtotal $
$ /, ~ (..
$ '7. .:/0
$
FEE
$
.3. /, .:)0
....J
.- //
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"
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~\ 'State Surch~rge
Plans Check Fee
PU~LIC LANDS [] hJdrc5s
J4 ~'inir:\Um
Perr:lit
t:lcviltion
'i9. 0 (." 0
..,
$
II !i
Address
'"
<'
"
IMinimurn Elevation I
!
$
V'9 c' (.,
Change of Occupancy
TOThL BUILDING PERMIT FEE
Mlnim'wo .tructural oetbacks:
From centerline ot 9trc~t: Front
/Is- f d
Side !-;-;
Rl'ar' _~/.
o Curb cut to oppl1cant
Ex te r ior
From interior lot lines: Side
[J Co~'l plan~ sheet to appllcilnt
I;lJ
o
o
PUBLIC WORY.S ,LJ FncililY
ElN I RO~l,".[:IT"L I![AL TII
CQllh
Ch"Cl I
,~c:5;>.3-
Rc(; '1.3 by
~
/,r;"
TOT^"
AFf'IDAVIT: I[ this permit is for an agricultural building, I hereby dec~,1re that this building
will be us~d tor agricultural purposes as .1110weJ by zoning and/or the State Building Code. and
for no other purpose. I further certify that the statements and other inform,'ltion submitted on
this application. are true and accurate, and that I have the following legal interest in the
property: owner of recorJ: c:onLr:lct purch,lser; If'5see; 'hnlrler of i\n exclusive option
to purChi\se;-__dllly authorizlJo-i.-o ,H:t fOl' '" person ....h-O-h,'!1 the roIlo....ing le',,,,l interest:
; at' th.'t the U"-'T1f?r of record is k.no'oJlr~,lqe.'blQ of this
:lm not'lii',~ o";r;c-r~i: flJrther ~;J./. to comply With_illl apPlic:ll"ll:.' C e.on~rlC' r tinq
~f,plie^nt's 5i,]n"'ure ,//--e'd!'_~?ZP'$ d---7~-'~.
~ '7 - .~ '
~ne county
appliCdtlon, if I
to this pt.!rmlt.
OHe 7. ~7- 7 X
TillS IS 'tOUR RECEIPT, A.ND DOES ~OT GIVe YOU PCR.'1rS510N TO BUILD,
FOR INFOf'-"tATIO:-.l ABOUT THE PRuGRE~S Of 'lO!!R APrLtC^Ttt)'l, CAL!;' pr':RMtT cornROL, 6B7~4)57 (6a7-!l~LP)
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k"u'ptj{lni~1 "'1('n Cl'JlIrlt~"'l'd . ~
Appolntmt-:.nl TJHtl'.
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APPLICATUON
APPl.lCANT-="5.:7CU\i\ (1 clQL.l L tW1/V\.+, L0.\--LJ
ADDRESS ( ) t/)r{~ ~\ (j /1n '.' )lh""::It: }7"'1
O'or."ER (IF DlFFERL'U).-/ . (
Dffjce 1!8e Only
PIlONE J "'14--7- XCfL:JC(
Clty">tL7i ZIP
~)-~
. PilOSE.
ADDRESS
~\lJ'..R.ACTOR
Citv
ZIP
PHONE
ADORF.SS COl/TRACTOR'S ORE. STATE LICENSE
o M,,\~ COMPLETED PERMIT TO APPLICANT!O\.;':H:R!CONTMCTOR (CIRCLE ONE)[J PREFER TO PICK UP. CALL
1. PRESt>:T USE OF PROPERTY (residential; type of fan:dng; cOl!:lllerc1al or industrial; vacant; etc.)
1.
DESCRlliE STl\t1CTlIIU:S' NOW ON TlIE PIWI'EIlTY.
rw'!'!:: AN\" STIWCTURES TO liE [}1:}!OLlSHEfJ.
l.,\ m-IEllIf'TE P".AIIS FOR T~I'.IPROPERTY (TIlIS APPLICATION) ARE, (l)n5+n!-1 ~. D., ::r
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FVTURE rLANS:
s.
PLOT PLAN. Sketch (a) All rOil!!s (b) bound".rles or property (e:) existing/proposed buildings (d) existing/
proposed BeIoIBge disposal areas (c) (,l';lstlng/proposed ....ells (f) eXisting/proposed driveways
(g) easements (h) drlllnilgeways, streslII!I, creeks, any other pertinent features. If commercial
or- indu.'itrial, show freestanding" signs, parking areas. INDICATE DlMEr:SIONS.
'-~:" !:--l ;r~r'~ i" ',' r'''1 ,.~:-!". ..,....j .,,--r-..'. r";~~r :..:-:-~!~.
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TOTAL LOT SIZE 'OR-A~RE;'(;E'- (ji.'[)S . i SIn:
~E1"HOD OF Sl:W,\GE DISP()SAL~f)h('t4.C'lJ~Or1:
l'1.:arOSE/) \.J,lTf/l .sUI'f'U' \.JELL SP~~NG STI/f:AM
Et.tCTRICITY fUR.'HSllED BY
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BEFORE YOUR APPLTC\TIOl" CMl BE l'ROCf.SSED YOU MUST FUI{NISII:
8'~xl1 PLOT PLANS ~LEGAL DESCRIPTION
(DI/1ENSJO:-:ED)
BY
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LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
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LANE. COUNTY PERMIT
Acreage or Lot Si7Q
Contractor's O.S. #.
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Partitioning '!.#
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Subdivision
Lot
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APPLICANT'S'NAME AND ADDRFC:C:
OWNER'S NAME AND ADDRESC:
CONTRACTOR'S NAME AND ADDRESC:
Mail permit to ( .) Applicant ( ) Owner
.lean ~dol1 Vcntur.;e. :1.675 ~~hevk {} 79. flprin!jfiald, Orceon' 91fhb~a. 747-8!>S9'
Phon~.
Phon~'
) Contractor., ( ) Prefer to pick up. Call (owner, etc.) when ready',',
STRUCTURES NOW ON THE PROPERTY none
THIS P~RMIT IS Fb~-~Ca~~) I!l::ltall sns. MooUe .&= :3ine!Gui<1o
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# BEDROOMS~# PLUMBING CONNECTIONS--
'WATER SUPPLY
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SEWAG E D ISPOS,lI1 proj?Qoc(1
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THIS PROPERTY ISWITHIN ONE MILE OF THE CITY OF
PLUMBING BY
I hereby certify that the above statements are true apd 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 of this action. I hereby agree to comply with all applicable Codes relating to this permit. '
-. Fee Paid $ ,99.06 Signature /a/ JCCtl Adell lJllil~C2GQ. Data 7/12/73
.( )NEWADDRESS ( )FACILlTYPERMITTOTRANSPOHTATIONDEPT (Xl SPECIAL PMT. AREA. MIN. ELEVATION: .'
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Minimum Septic Tank Capacity (Gallons) . '~....'/ '.Jypeof Construction. -: "roup
Drainfield Required. Lineal Feet rv.t.t ",-,', Use Classification
. Maximum Depth r ~ Comments.7t.10orr.;; : If."",." f~",\.lf\ 7'.~ Ic,<.:..t. h,.......-:;:.
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Date: 712. 7,' ;\
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Date Issued:
(FROM CILI INT. SIDE YARD S' REAR S'
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(FROM PILI
SIDE FACING STREET
"" LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401. PHONE: 687-4394
POST THIS-p'ERMIT ON MAIN BUILDING AT"SITE'
C55.13
BLDG. PERM1T -WHITE; BUILDING ~ GREEN; PLUMBING - CANARY; SANITATION - GOLDENROD; OFFICE COPY - WHlT"E
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Job Location (Street, mile post) ly'91 :tA/i./f}--,lJL.
Subdivision:J 1/P/J-./.d, 'i::.t..h~Ad"~411-v4'
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Lot .3 t{;. Block~
FO R SAN ITA R IAN'S'USE ON LY: ~hJ.ty.mAPpr~ved. ~System q.isappr?ved.. 0 .Needs Correction.
CqMMENTS: ... . //flt;IJfJ~ . ". .' .
Sighature: ...A<'7~t: D'ate:cr?!2?
FORINSTALLER'S:USE:, Trench Depth ,~~il"... Filler Depth Below T-rr.{/.. ,/ v
, Tank Capacity./l1Otl t"19-1 Manufa'cturer '1i./,'IIAIJI;II~ (,:...~~",' . . OJ ""
Me~~ured dist~'nce to:;'1I f;om tank. . '. froml~rai'nfiel" ~ ~ _.( 'OfL'rrt :'1>
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INSTALLATION RECORD .AND CERTI FICATE .OF SATISFACTORY COMPLETION
When signed by the County Sanitarian,this certificate is evidence as per ORS 454.665 of.sat-
isfactory completion of a subsurface 'sewage disposal system at the above location.
Return this fo~m to: Permit Processing Section, Department of Environmental Management, .
Public Service Building, 125 East 8th Avenue, Eugene 97401
C55-11
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Acreage or Lot Si70
Contractor's 0 .S.' #.~
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Partitioning #
LANE COUNTY PERMIT
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APPLICANT'S NAME AND ADDREsS
OWNER'S NAME AND ADDRESS
CONTRACTOR'S NAME AND ADDRESS
Mail permit to ( ) Applicant ( ) Owner
Jc:.-.:l AC0.11 voot.c.soo 1J;75 ~=::1:"'Cj~
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S,'l?1.;:)rfio3.:l. Orer:c;\ 97477
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STRUCTURES NOW ON T.tII PBOPERTY .
THIS PERMIT IS F6R ('''''!:pOrt', tn.ai:.'lU GDS, >ccbl1lo
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# BEDROOMS~# PLUMBING CONNECTIONS U
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'WATER SUPPLY'
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SEWAGE DISPOS.I'I
propoz:o(l
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THIS PROPERTY IS WITHIN ONE MILE OF THE CITY OF
PLUMBING BY
.-
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 of this action. I hereby agree to comply with all applicable Codes relating to this permit.
Fee Paid :l: 09.C6 Signature /0/ J= t!.o:c!l \1~et:GCtJ Datp 7/r;,/TJ
I NEW A'6DRESS ) FACILITY PERMITTO TRANSPORTATION DEPT. (XI SPECIAL PMT. AREA. MIN. ELEVATION:..
SANITATION
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Fire Zone
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Minimum Septic Tank Capacity (Gallons)
Drainfield Required, Lineal Feet
Maximum Depth
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PLANNING REQUIREMENTS SATISFIED. By:
ZONE: SETBACKS: FRONT
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Date:
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Date:
:/'&411'->
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SIDE FACING STREET
(FROM CILl
Date Issued:
INT. SIDE YARD :;. REAR j'
(FROM Pill
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
PHONE: 687-4394
C55.13
POST THIS PERMIT ON MAIN BUILDING AT SI.TE
BLDG. PERMIT - WHITE; BUILDING - GREEN; PLUMBING - CANARY; SANITATION - GOLDENROD; OFFICE COPY - WHITE
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