HomeMy WebLinkAboutPermit Septic Tank 1969-3-3
WILL CALL WHEN HOLES
ARE READY.
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REQUEST FOR SITE
. ThlP. 17 RANGE 01 SEC...li.
TAX LOT NO. hl~CODE___
INSPECTION DATE I!lar...h 1 101:0
RECEIPT No. <;U.lh
BY
AII"n, /lp,ol
MA I LING ADDRESS )'~ North ~t"
TEL. No. 746-,0'1
OWNER OF PROPERTY A~
CONSENT OF OWNER?
EXISTING STRUCTURES ON PROPERTY
SprlngflAld, Oregpn 97477 -7
SIZE OF PROP.---1\1; .. ,~ LEGAL ACCESS? y.... o.~n.. ~..rry
Is PROPERTY CONTIGUOUS TO ANY CITY LIMIT? { u~
rm,... -1/
SOURCE OF WATER SUPPLY: PUBLIC" SPRING WELL: DRILLED
Oakway
DESCRIPTION OF SITE (DIRECTIONS, LANDMARKS, HOUSE OR BOX NO., IF
Road onto Deadman's Ferry on right side - one vacant lot.
DRIVEN DUG
ANY): Right on Game farm
PROPOSED USE OF SITE (E.G., NUMBER OF DWELLINGS, COMMERCIAL OR INDUSTRIAL USE, SUBDIVISION):
1 Bldg Site
~ URBANIZING AREA.
~ SPECIAL PERMIT AREA.
BBlkc
FEE:
No. OF SITES--L-
No. OF ACRES
TOTAL-
$ 5.00
* 5.00
RESULTS.2!: INVESTIGATION: f CAlf {7 ;{~ 6:3 ~C..- /J; Id-fo Ld r 'vtf Via
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T~(i' IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE BUILDING
PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK:
BEFORE CONSTRUCTION IS STARTED BRING THIS FORM TO THE BUILDING AND SANITATION DIVISION AND
MAKE APPLICATION FOR A BUILDING PERMIT. IF THE PROPERTY IS A PORTION ONLY OF A TAX LOT, A
METES AND BOUNDS DESCRIPTION OF THE PARCEL MUST BE FURNISHED. EXACT SPECIFICATIONS FOR THE
SEWAGE DISPOSAL SYSTEM WILL APPEAR ON THE BUILDING PERMIT. Two SETS OF THE BUILDING PLANS
AND PLOT PLAN WILL BE REQUIRED.
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\ANE CgUNTY BUILDING AND SANITATION DIVISION: Of)
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\j BUILDING INSPECTOR I ' SANITARIAN
THIS REPORT IS NOT COMPLETE WITHOUT THE SIGNATURES OF THE BUILDING
3~ 6 - (" y
DATE
INSPECTOR AND SANITARIAN.
US-097-OJ