HomeMy WebLinkAboutPermit Building 1976-4-27 (2)
NOTE:
'. ~ PERMIT if
NO PERMIT W. BE ISSUED UNTIL THIS APPLICA~:'HAS BEEN APPROVED
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APPLICATION FOR:
CONSTRUCTION
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Name Address
MOBILE HOME
CJ
PLAN REVIEW
CJ
CHANGE OF OCCUPANCY C=:J
r"Zl CONTRACTOR LH/(J?V IJh:i1MBN
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O.S. REG. II 9 '35l.. ;;
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Address
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~ity Zip
}:::'vgeM 97L/oZ
Ci~ Zip
Phone
CJ OWNER f3 /;"N
4-fiS--f.',6h~-
Phone
Block
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Tract
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Wid tt>LU.Depth 'i .2S. t o'J /
Twp.
J7
Range
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Section
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Tax Lot I "3~.? 0
Subdivision Lot
rty Acreage
h~'RRI' J?/)- 3 3.
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ACCESS TO PROPERTY (Road Name) De..-rrj) /}(/rll
Existing Structures on Property: J.I" V7 e.
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Property Location - Address!Directions:-ll "'.Ji ~ (4Ln- LJe-lr/l.LV1 fi-# /'c.<:' AI Y lj.
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SEWAGE DISPOSAL:
Site Inspection #
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Existing S
,....-
L..t.Lf or New System Required CJ
WATER SUPPLY:
Well Spring ______
Other
Publi CJ
Commu ity CJ
Name of Community or Public System
,
PLUMBING:
Installed by Owne
PLUMBING FilS i
iV
Other CJ Name
FEES:
Bldg.
Plumbing
29;..-
.. 3 % Surcharge
~ste Disp.
1 Plan Review
Mobile Home
.s
~
.~ TOTAL
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~ Min. Septic Tank Capacity
.ft.'1
Sewage
Connection
Water
Connection
PLANS FURNISHED
FACILITY PERMIT
cJ'i,
I
~I
o CASH
~
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Signature of Applican
Fee Received By:
-
J::::::=1 YES _~ NO .
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(J V D~te:; C(_?03.j:,
Drainfield Required - Lineal Feet
Maximum Depth
Type of Construction
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0/1/
G~"""1
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Fire Zone
Use Classification
Bldg Setbacks - from Center of Road ~ht of Way:
Front E 0 Side Int. .!5 Side~
Rear
~
Zone
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r;;N~: '),( ~~(. DATE: -m ~'::1E: 4~-7I::
Cs;':" LANE COUNTY DEPA~ i ENVIRONMEN