HomeMy WebLinkAboutPermit Miscellaneous 1978-9-8
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PERMIT #
3 RtJ I'J
JOB LOCATION
Acreage or Lot Si,"
Contractor's O.S. #
L'ANECOUNTY PERMIT
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Partitioning #
c; (
) 'Completed
Subdivision
Lot
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B 100c~
APPLICANT'S NAME AND ADDRE~"
OWNER'S NAME AND ADDRES"
CONTRACTOR'S NAME AND ADDRF"'"
Mail permit to L ,<) Applicant ( ) Owner
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Phone
Phon",
Phone
(owner, etc.) when ready.
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(}() Contractor.
'J 'Prefer to pick up. Call
STRUCTURES NOW ON THE PROPERTY
.HIS PERMIT IS FOR . . '
.
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~ :; 8EDROOMS~F PLUMBING CONNECTIOf\j~
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WATER SUPPLY
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SEWAGE DISPOSAl
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S.1. #
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THIS PROPERTY IS WITHIN ONE MI LE OF THE CITY OF
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. PLUMBING BY
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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.
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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
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. \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
,
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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
$
$
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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
$
$
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., State Surcharge
Phne Check Fee
Change ot Occupancy
TOTAL BUILDING PERMIT FEE
$//J,lj/J
0
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9-;1:2-?Y ~
,
Address I
co
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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 .
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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
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