Loading...
HomeMy WebLinkAboutPermit Building 1975-7-23 (2) LANE COUNTY SPECIAL PERlVtIT ABF.~" NOTE: NO PERMIT. BE ISSUED UNTIL THIS APPLICAe HAS APPLICATION FOR: PERMIT 1F BEEN APPROVED ~o" 3 ~;~ ~,.AL, OWNE~' SJ1'1I'I-'A ~ Name CONSTRUCTION P , MOBILE HOME C=:J PLAN REVIEW C=:J cff II) ,B.llC cMlJ lJ ~AA.. Address city" CHANGE OF OCCUPANCY c=J ,.,t/()/ Zip "<<)<c,~.\= Phone ~ Name .r'Am ~= Address City. Zip Phone c====J CONTRACTOR O.S. REG. n Twp. ,17 Range /) ~ Section ,;'~----Tax Lot 3~dO Code 4t ~ t../ r Property Acreage Census Tract Existing Structures on Property: -,\1\ ACCESS TO PROPERTY (Road Name;" /Je:/.l f)"yj!lAJ I' I lit) We. e Property Location - Address/Directions: ~ ~~~ Subdivision Lot Block Width~Depth :J Yt> (oIllL"I'J f)~ J)t.A /JI1'1l:JAJ l" - ..ero/P/l(/ ~, / e:J nf) A6-lJ 1i2/~r :P~T /A)"'l:::.k~p"~r/.rn / r~~ 1HZ f' iJd jl' (f:.~e' Ffl ~ k' R..z,. "",J , Below fo r Of f ice Use OnJxxxxxxxxxxxxxxyor,.,r,r,r,nr,r,rxxxxxxxxxxxxxxxxxxxxxxx,.",r",r.r,.,"{xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx ./": /1 /) - r .... 'j' ~ Sq. F@/~. 10 flBedrooms Valuation ~~ ~~ oz; 9,.,/.~o L;NE (:O"J~!..f .3FE(:;lAL PERlifJ.lI A!llii~ SEWAGE DISPOSAL: Site Inspection # Existing Sewage Disposal System ~ or New System Required c====J WATER SUPPLY: Well Spring Other Public [=:::J Community ~~ Name of Community or Public System (f(" ~ .~..;/.. ) Bldg. Waste Disp. Plumbing Plan Review Mobile Home ,3% Surcharge J(I.() 0 PLUMBING': Installed by Owner [=:::J Other C=:J Name_ FEES: PLUMBING FEES: - # of Fixtures Sewage Connection Water Connection ,; PLANS FURNISHED FACILITY PERMIT ,1" ~H 17' YES C=:J NO [=:::J YES ~ NO TOTAL M,:J{) [=:::J CHECK Signature of Applicant: Fee Received By: C'} ~.A'. 17 . .- Date:.~~= , r Dra1nfield Required - Lineal Feet . Maximum Depth ~~~, ..,..,.,11 ~:;.",) .. -- . ~..eu.... ~ . "P"J ',~ .~ If) Type of Construction ;{ AI Group / Fire Zone Use Classification Bldg SetbactsJ': from Center of Road Right of Way: Front ~A SideInt.~ -"_:"..___:'-.r , Rear ~' Zone...tt6r OS.12 LANE COUNTY '7';;~7s- M~U;- ;t.:;~:? ~ ENVIRONMENTAL fk.NAGFJ1E;;- . P