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HomeMy WebLinkAboutPermit Miscellaneous 1978-9-8 ,- --~ , ..--- .-/ TRS, TI /7-a.3-/$" PERMIT # 3 RtJ I'J JOB LOCATION Acreage or Lot Si," Contractor's O.S. # L'ANECOUNTY PERMIT \... .// . Partitioning # c; ( ) 'Completed Subdivision Lot . ..../,~ B 100c~ APPLICANT'S NAME AND ADDRE~" OWNER'S NAME AND ADDRES" CONTRACTOR'S NAME AND ADDRF"'" Mail permit to L ,<) Applicant ( ) Owner , .,'; Phone Phon", Phone (owner, etc.) when ready. , , 'r; rO. . ,'.; - ,- '/. , , (}() Contractor. 'J 'Prefer to pick up. Call STRUCTURES NOW ON THE PROPERTY .HIS PERMIT IS FOR . . ' . -~,.- ~ :; 8EDROOMS~F PLUMBING CONNECTIOf\j~ .... ".,. WATER SUPPLY , SEWAGE DISPOSAl .~. -,.~/ S.1. # ? .". - . THIS PROPERTY IS WITHIN ONE MI LE OF THE CITY OF " "',E';' . 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 $ .::f> Signature'/ ) NEW ADDRESS ( ).FACILlTY PERMIT TO TRANSPORTATION DEPT. Date .. SANITATION (, J SPECIAL PMT. AREA. MIN. ELEVATION: .~ments: Minimum Septic Tank Capacity (Gallons) Drainfield Required. Lineal Feet ~,1aximum Depth BUILDING Type of Construction I 'se Classification Group Fire Zone / Comments: By: Date: By: Date: PLANNING REQUIREMENTS SATISFIED. By: - - " Date: .' /of Date Issued: ZONE: SETBACKS: FRONT :..1 SIDE FACING STREET ..., (FROM CIL) INT. SIDE YARD > REAR LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401 POST THIS PERMIT ON MAIN BUILDING AT SITE BLDG. PERMIT - WHITE; BUILDING - GREEN; PLur..-1B1NG - CANARY: SANITATION _ GOLDENROD; OFFICE CO;:>Y _ WrllTE - , . \fFROM P/L)' PHONE: 6\94 C55.13 LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 o PLANNING DIVISION Partltlonln9 . Parcel No. Current Zoning Dpending , /}//I-r-9/;,b~ OCompleted roE AVERAGE PROCESSING TIME PartitioninQ RCQuired Other, $ $ c=J HATER POLLUTION CONTROL . ot SItee Mev Site Inspection(e) SDS Construction [] New [] Repair Number of BedroomSI Commercial/Industrial - . of Employee. Other $ $ '" .. ~ " ~ .. " l> " ~' ~ <: .. n ~ " :; '" ~ ~ 0 0 I" " - I ~ i , ~ I I ~ ~ $ t2?I CONSTRUCTION PERMITS "ND InSPECTION (See above tor . of bedrooms/. of employees) o "obUe Homo' $ o Permanent o Temporary o Renewal ~sq, Ft, =i=-iJ d i No ;j ~2- 2- FEE Valuation q~o $ //J,/J/? $ s $ Total Vslu~tion ~ Plumbing fixtures at ScwerlWAter Conn. ^t $ $ $ Each $ $ r:ach S Subtotal $ $ , L/IJ $ $ " > " .. ., State Surcharge Phne Check Fee Change ot Occupancy TOTAL BUILDING PERMIT FEE $//J,lj/J 0 .., 9-;1:2-?Y ~ , Address I co t; lMinimum Elevation I Minimum .tructural eetbacks; From centerline at street: Front Exterior From interior lot linas: Side [] Comm'l plans sheet to applicant Sid:~ t o Curb cut to applicant 0 PUBLIC LANDS 0 Address 0 Minimum Elev;1tion 0 PUBLIC WORKS 0 Facility Perrnit 0 &NV1 RONffi:NTAL HEALTH bY~ $ CoIuh Chort I"~~ Rec'd TOT^" $ /0, cL/J , AFFIDAVIT; If this permit is for an agricultural building, I hereby declare that this building will be used for agricultural purposes as allowed by zoning and/or the State Building Code, and tor no other purpose. I further certify that the statements and other information submitted on this application are true and accurate, and that I have the following legal interest in the property; ___o~~of record; contract purChaser: lessee: holder of an exclusive option to purchauel ~uly authorizeo-to act for a person w~has the !OIlowing legal interest: : or that the owner of record is knowledgeable of this appUcatlon, U I am not the owner. 1. further agree to COm~lY w' th all applicable codes relatin9 to thio permit. ~ /7. ' /J AI' Dat.~-g-7L Applicant's Siqnature~~7A~..&'~ ~__.~r . ~1 roR \ THIS INFORMATION ABOUT IS YOUR RECEIPT, AND THE PROGRESS O~R DOES NOT GIVE YOU APPLICATIO~. CALL PERMISSION TO 8utL~ PERMIT CONTROL, 6~S7 1687-RELP) ~ne county ~ ".... hi... ...,_ a,.,U,."_ ,. .~,.,"_I.' ~ (.....1..... ....,..'..'-..1 .... O"h. .... 0.1, APPLICATION _u..... E'':!",--v.-? ~i.;'-.Lh'v,:/):i;.' \'i-V;.I?e ",,_ij~-6S- 7 Y _ _... ,qq (5 "W, /1 it. <".----Br..,~~>- "' <J7</O>--. ..... 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