HomeMy WebLinkAboutPermit Septic Tank 1975-12-10
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~ ~d NOTE:
Ii. ~ CONSTRUCTION 0 MOBILE HOME
W c=J OWNER ~/h?/~J'/"/'''w/;
. . Name -"
c=J
Lf!J/J /~~p"
, ..
Address
PLAN REVIEW
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3/9<J-1S
PERMIf"fl
BEEN APPROVED
(frLj'\)
CIW;GE OF OCCUPANCY [==:J
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L?
NO PERMIT"L BE ISSUED UNTIL THIS APPLIc6N HAS
APPLICATION FOR:
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City
Zip
.:;"9'....r--l/ .?7....r-
Phone
[:=J CONTRACTOR I
Name
,5"'a./?? .....e--
Address
S' a~-e-
City Zip
Phone
O.S. REG. II
/-94/
,
Twp. 17 Range 3 Section 2...!?'
Subdivision I:>~k/ Ct:Yd' Cdl7'jp.LLot
Tax Lot
Code
Census Tract
ACCESS TO PROPERTY (Rosd Name)
~
,
AN/,{p;-,<",__ k4"e
p/J-/?'...//
Block
Property Acreage
/~
/ .
~ d41R
/
Existing Structures on Property:
Property Location - Address/Directions:
5?KO
Anob~8t1
~J//<'J:l ,
~ ~~-'-Ar?'d',
, --{;;9.+ ",,~.~ ~''''''JI ~
/". .1f'11 r~ ~ c::r-x./
al'L /t~!" r ') <1 "tJJ ,;~A #,q/J,tA. :; t,)
SEwAGE DISPOSAL:/" (/-
. "
Site Inspectlop #
Below for Office Use OnlvXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX'\I'X'lO'}'"XXXXXXXXXXXXXX:XXXXXXXXXXXXXXXXXXXXXXXXXXXX
Sq. F-t-~.(j;.'f?/O DBedrooms Valuation
/032.. /0. "-"1" / 3 J c; '?/,C;-; J('.
~62. " V'V- / {j, (/I/!?" tf'l ,
/' A / /l "r/ q tJG2.'iib
..d.A-I/td fpv,;",::'~*/,{~1lL b~ '--'
Other
Public
Connnunity
or New System Required ~
Existing Sewage Disposal System
WATER SUPPLY:
Well Spring
Name of Community or Public System f?~~
FEES:
Bldg.
Waste Disp.
Plumbing
Plan Review
9" d. 0 0
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PLUMBING:
Installed by Owner
Other ~ Name
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,
PLUMBING FEES:\
9 b of
Sewage
Connection
Water
Connection
Me bile Home
3% Surcharge
PLANS FURNISHED
FACILITY PERMIT
~ L.:J NO . ~I NO
Signature of Al4:;,;t~ ~~_~/.?'
Fee Received B~ r ' Date:/.-:J- qJ7.<r
ME Tank cap~z, t tlffl D~ain,field Requited - Lineal Feet ift> Maximum Depth ::l6
~ ~I// a.. "",,,-,,~,,._.) ~ 10'-~ fY"~7 ~~ ----1 ~~
_ ~ /U.dA".e::;.,~ --<.,,~_,_:r/--....L r./)r:-
tr / . ~ -
.<. "-
o CASH
~
TOTAL
_/ t1iJ.~
Type of Construction
6;1
Group
/ Iff ...:i
.
Fire Zone
Use Classification
Bldg Setbacks - from Cent~__~~Jnad Right of Way: ~ I'
Fro<<~ Side ~ r I Sida ~t I b ' rP /I /::' Rear 7 I P J4 G' Zone I- /
i~~G:.!Il~'1{ DATE: .~X4. ~~rn;..?~~(/~.,~
C55.12 LANE COUNTY DEPAR'lMENT ~ENV~ONMENTAL ~AGEMENT