HomeMy WebLinkAboutSpecial Inspection Septic Tank 1967-2-14
Will call
RECEIPT No.~
(XI n /
lWP....ll...RANG~.....D.LSEC~.' .44~
TAX LOT NO. 68'llIr'COD 19-20
SER I AL No. ,
REQUEST fOR SITE INSPECTION DATE Feb. 9..1967 V
MAILING ADDRESS 1366 B Moherk Blvd. TEl. No. 747-8043
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BY STEVARTREAlTY
SDrtnl'lfletd
OwNER or PROPERTY~rt. Valke,SlzE or PROP. .37 ecre LEGAL ACCESS? Co. Rd. 3
CONSENT or OwNER? III
EXISTING STRUCTURES ON PROPERTY No
SOURCE Of WATER SUPPLY: PUBLIC XX SPRING
WELL: DRILLED
DRIVEN
DUG
DESCRIPTION Of SITE (DIRECTIONS, LANDMARKS, HOUSE OR BOX NO., Ir ANY):
On Gane Fann RoecJ' - 4th lot doMl. from flarlow Rd. ellSt side - vacant lot to south
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PROPOSED USE Of SITE (E.G., NUMBER or DWELLINGS, COMMERCIAL OR INDUSTRIAL USE, SUBOIVISION):
Dwelling
L:? URBANIZING AREA.
L:? SPECIAL PERMIT AREA.
fEE:
No. or SITES I $5.00
No. or ACRES----
TOTAL---- $ 5.00
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RESULTS Of INVESTIGATION:
;1/0 1/rcr ~Ul d !Ai o.,..A- U ,(. vt V\ ce.
,',; hales,
So, -; e"v /.1 >/rfMlcl
fC<I'<t.
BEfORE CONSTRUCTION IS STARTED BRING THIS rORM TO THE BUILDING AND SANITATION DIVISION AND
MAKE APPLICATION rORA BUILDING PERMIT. Ir THE PROPERTY IS A PORTION ONLY or A TAX LOT, A
METES AND BOUNDS DESCRIPTION or THE PARCEL MUST BE rURNISHEO. EXACT SPEClrlCATIONS rOR THE
SEWAGE DISPOSAL SYSTEM WILL APPEAR ON THE BUILDING PERMIT. Two SETS or THE BUILDING PLANS
AND PLOT PLAN WILL BE REQUIRED.
LANE Co;jNTY BUI L ATlON DIV IS ION:
~ ~.." ~ . Jb 10 ~ v-- JL,;;~ 1t.7
U BUIlJOING INSPECTOR SANITARIAN 7/ ;QATE
THIS REPORT IS NOT COMPLETE WITHOUT THE SIGNATURES Of THE BUILDING INSPECTOR AND SANITARIAN.
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(55-0l6-01