HomeMy WebLinkAboutPermit Building 1976-9-28
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LANE COUNTY PERMIT Fee
PERMIT NO'c~,73:}>'/ >.
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CONSTRUCTION [] MOBILE HOME [] PLAN REVIEW [ ]
CHANGE OF OCCUPANCY
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ADDRESS CIT~
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ZIP CODE
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NAME
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CITY
ZIP CODE
PHONE
O.S, Reg. #
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Range !-1:L Section
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SubdiVISion /,,'). ,it<, J~,u Lot
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Census Tract
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Block
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Acreagf'
Width
Access to Property (Road Name): C.,-:.> 1':l"c..,II-",.... ~,.J
Depth
Existing Structures on Property: ;/:,i'" t~.<; ,,_
Directions to Property - Address:
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STRUCTURE (# BEDROOMS)
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SQ. FT.
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VALUATION
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SEWAGE DISPOSAL:
PUBLIC [] SEPTICTANK [
BUILDING /~.n (~
PLUMBING
3% SURCHARGf ' (/~~
MOBILE HOMf
WASTE DISPOSAL
PLAN REVIEW
OTHER [ ]
PLUMBING INSTALLED BY:
OWNER [) OTHER [) f\!!\~~~
WATER SUPPLY: PROPOSED [ ]
EXISTING []
[ ] PUBLIC
[ ] COMMUNITY - NAME:
[ ] PR IVATE WELL
[ ] OTHER - SPECIFY'
TOTAL
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CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY:
GALS MIN.DRAINFIELD UN. FT. MAX. TRENCH DEPTH INCHES
TYPE OF CONSTRUCTION
GROUP
FIRE ZONI=
STAY 100' FROM ALL WELLS
USE CLASSIF.
SETBACKS - FT. FROM CTR. OF r!W:
FRONT SIDE EXT.
FT. FROM PROP. LINE:
SIDE INT. REAR
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AUTHORIZED SIGNATURES:
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BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT:
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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 State Buidling Code, D.E.a. standards
for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy before being occupied.
ISSUANCE DATE:
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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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LANE COUNTY PERMIT ae
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PERMIT NO.c'-"'<,;!ViYP/,b . .
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CONSTRUCTION [] MOBILE HOME [] PLAN REVIEW [] CHANGE OF OCCUPANCY [ ]
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ADDRESS cn">1 ZIP CODE
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NAME
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ADDRESS
CITY
ZIP CODE
PHONE
.O.S. Reg, #
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Range.....;;} ", Section
Subdivision t::I ;j'''^ ji//.I?f"~:'" Lot
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1.;'1 :;; Tax Lot Code
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"J Block & Acreagf'
Census Tract
Width
Access to Property (Road Name)'. .,f.d,' 'f" <,.;f <.}. . ..'
......::\>, . . ~-1"'''' ..;~. ,> <~i.....r
Depth
Existing Structures on Property:
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rY- ~ t: -.} "J~
Directions to Property - Address:
~,;;t, .' .,,';
, 'r:~' L..,'-",
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(, i'b rr. ;', ",p ';\,1 <2),9 (J.h
STRUCTURE (# BEDROOMS)
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J,.-..,1_...1'.,'.... ~_i:r/.:,r,.'. Ji--R II- ,~t\.. .-.#.
SQ. FT.
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'7! t<9 c.., t I:'. ~ .
VALUATION
.,H'.f!: A:' ",.j.. -if ,::jj . ....
~t, h \T ':ij..o.-e-O '",:, "'. .JP ...,.1 ~~::t.t'1
SEWAGE DISPOSAL:
PUBLIC [] SEPTIC TANK [
L! .-:to
BUILDING 1.;'''-,' kJ} ,,j
PLUMBING
3% SURCHARGF dV;'!.;;'!'
MOBILE HOMF
WASTE DISPOSAL
PLAN REVIEW
OTHER [ ]
PLUMBING INSTALLED BY:
OWNER [1 OTHER [] NAME
WATER SUPPLY: PROPOSED [ ]
EXISTING []
[ ] PUBLIC
[ ] COMMUNITY -NAME:
[ ] PR IVATE WELL
[ ] OTHER - SPECIFY:
TOTAL
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-L'j, .\ll1' j)
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY:
GALS. MIN.DRAINFIELD I.IN. FT. MAX. TRENCH DEPTH INCHES
TYPE OF CONSTRUCTION
GROUP
FIRE ZONF
STAY 100' FROM ALL WELLS
USE CLASSIF,
SETBACKS - FT. FROM CTR. OF r!W:
FRONT SIDE EXT.
FT. FROM PROP, LINE:
SIDE INT. REAR
ZONF
, ? -
dV/h:
AUTHORIZED SIGNATURES:
Isl ~\fj ~)A"n,"<I"j/:
Ii '<I ;#..
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
ISSUANCE DATE:
A<>..I ~) 't~ ..; ~:>" 'i J ,,". (I r" r, ".!:. j 'J:.;j''' j 0 -t;;'0.J #J~ ". .
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"'. "".. €-f (ji' r'" if' ,. .-
Call 687-4065 to schedule all required construction inspections. Call 687-4061 to schedule all required
1M POR T ANT: septic system inspections. All construction shall comply with the State Buidling Code, D.E.a. standards
for subsurface sewage disposal and the State Plumbing Code. All buildings require a cectificate of.
occupancy before being occupied.
(See Detai Is 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
ApPROVED / /
DISAPPROVED /
REMARKS
FOUNDATION INSPECTION
ApPROVED /
/ DISAPPROVED /
REMARKS
FRAMING INSPECTION
ApPROVED /
_e
/ DATE
INSPECTOR
/ DATE
INSPECTOR
/ DISAPPROVED / / DATE
INSPECTOR
REMARKS
LATH OR SHEETROCK INSPECTION
ApPROVED /
/ DISAPPROVED /
REMARKS
c
FINAL INSPECTION
/'
ApPROVED .~ / 0 I SAPPROVED /
REMARKS
CERTIFICATE OF OCCUPANCY
/ DATE
INSPECTOR
/
DATE/=1ft.....? ?INSPECTOR
READY TO ISSUE /
I NOT READY TO ISSUE /
/ DATE
REMARKS
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I NSPECT.OR
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