HomeMy WebLinkAboutPermit Building 1974-3-28 (2)
LANE COUNTY_DING PERMIT OR MOBILE HOM_ APPLICATION '1/
PERMIT TYPE - BUILDING \K MOBILE HOME Dose REG. # PERMIT # 3rl/-1'/
clROP TY OWNER pMAllING ADDRESS f<~ tiIfIf. ~ONE
~ ttxJ ~AA_ ~'I- /0 ;3# 7-~4 r6)~O-7L~ CfM1, bR re&lW 7 h/~
ONTRACTOR ,?td MAILING ADDR~S PHONE
cf.-?27-/~rI$r)7~~ /6 Ss /h~,h~( rf'JI 9'7~/J? ~Sg- 1t/'1t)
PROPERTY LOCH - INCL/,;';OST 0'Ji?~ / r
PROPERTY LEGAL DESCRIPTlON# /7 4/ J' .,L^,) /J Ad;? J I(J ,/ Ad? /J METES & BOUNDS 0 YES
LOT - BLOCK - SUBDIV.. ./~d..vn.R Iv V.-t;/J' {i-n'J7I-(?/ ro ,/V0I14/.//.h?1"J-/ ATTACHED 0 NO
TWP RANGE v SEC. TAX LOT # CODE CENSUS TRACT -
/7 3 /1/ /9tJo ~- 01 '2/ eCl I<;I.A
APPLICANT ~ '~J/ DESCRI~E YX'~TlN? _S~RU34RES ON P(JRO:RnX; A'1 ,:;, ,/.- // /, .
NAME ~~~ .-,d~ (~H.l1//////. r/h ~ ('r7;/AAfl UAA/.Ld:/ 'Y.H'J~
AND /~;?C; ~~h '/ /!/tT1Zd / LEG'L ACCESS TO PROPERTidJ NA;~ 0:9...1 (7
MAILING /) ~ P PERTY SIZE- 10TH ~~~hC" AREA
ADDRESS /G',4'dP?/I/?hf'J,t?,4d7'J r'7-f/d7 /<'7d X 25'0/
FOR MOBIu H~( PERMIT ONLY 1
Number of Bedrooms Connect to Existing Sewage System 0
STRUCTURES TO BE BUILT THIS PERMIT ~t)_ /J TYPE CONSTRUCTION SQ. FT.
< 5Hb;/h~ '/'J?tf"
- (7
or New System Req. 0
# BEDROOMS VALUATION
SEWAGE DISPOSAL
PLUMBING INSTALLED BY
PUBLIC 0
BLDG.
WASTE DIS.
PLUMBING
PLAN REVIEW
PARK TRLR.
$.
SEPTIC TANK 0
Q.!:;I'),-')
FACILITY PERMIT
I>'
YES.pI' NO 0 YES 0
St6NATURE OF APPLICANT ;;f
V /'
CASH 0 fiEWER FEE RECEIVED BY ~
CHECK d'CONNECTlON FEE AlA ~
m PERMIT # I
PUBLIC WATER
CONNECTION FEE
COUNTY BUILDING & SANITATION SPEClflCATlOI)IS
DRAIN FIELD REQUIRED (I /
lIN. FT. TRENCH WIDTH FT. V OR SQUARE FEET
NO">I<f
-' - DATE
A-:2(}-7f/'
~ DATE
.;q -2o-7~
FEES
OTH ER 0
WATER SUPPLY
PUBLIC 0 1\)( OTHER
PLUMBING FEE~
_ FIXTURES N ~
OWNER 0 OTHER 0 NAME
PLANS FURNISHED
TOTAL
25.0D
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAL.
TYPE OF STRUCTURE OCCUPANCY
$// GI
BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY
ZONE
REAR YARD
PUBLIC UTlL. EASEMENT .
USE CLASSIFICATION
FRONT ~
SANlnRJ~f\
SIDE INT. ~ SIDE EXT.-
Date ~~ Date
( '.;7rV ..3 -~.2 -7/
REAR :;r-
BLDGJ:-~~
Date
'3 /l-"/ h 'I
,
Directions to Find Property:
COpy I - OFFICE
COPY 2 - JOURNAL
COpy 3 - AUDIT
1Yb
I),r"-~I!1.,n.d
(.4-('11/
Form # CSS-12