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Home My WebLink AboutPermit Building 1974-9-25 Ie l ?,~:.,.,.- I t..-f ' .' ."-:-' .. \ BUILDING PERMIT OR MOBI.OME MH 0 MAILING ADDRESS LANE .TY BUilDING 00< " ,Po . /.. ~..."" .":,. USE PERMIT PERMIT NO. PROPERT,y OW~ER ~Dhart. J,"C:1 CONTRACTOR SllIl10 PROPERTY LOCATION -INCLUDE POST OFFICE 144'~ DeJIlQ5l!l A\1f!n4~ PROPERTY LEGAL DESCRIPTION - METES. BOUNDS Verra Delle Lot 5 Block' 1699 South "A" MAILING ADDRESS SDrinClflcld. OraClon Twe RANGE TAX LOT NO. CODE CENSUS TRACT tt::'<V7M EXISTING STRUCTURES ON PROPERTY None SECTION 17 O~ Above 2Ll. 3,3 APPL. NAME & MAILING ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms LEGAL ACCESS TO PROPERTY De I Rose PROPERTY SIZE - FT. WIDTH DEPTH Connect to Existing TYPE CONSTRUCTION Sewage System 0 SQ. FT. :::t BDRMS 1466 0116.10 (3) New System 0 VALUATION 23.602.70 3.760.30 STRUCTURES TO BE BUILT THIS PERMIT Dwelling Garago 711 @ 5.30 ... SEWAGE DISPOSAL '" PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK ~X OTHERD 121.00 'ip.OO 1Ll.00 FEES PLUMBING INSTALLED BY OWNER D OTHER: NAME WATER SUPPLY PUBLIC ffiIl D OTHER . TOTAL I. 'i<; $----2Q6. 'i'i COUNTY BUilDING & SANITATION SPECIFICATIONS DRAIN FiElD REQUIRED MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL 900 UN. FT 150 OR SQ. FT. TRENCH WIDTH FT. 2-3 TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIl. EASEMENT Call 687-4065 to schedule all required inspections. All construc- tion shall comply with Uniform Building Code, D.E.Q. standards for subsurface sewage disposal and county regulations covering plumbing. All buildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) 'iN BLDG. SETBACKS n FT. FROM CTR. OF ROAD RIGHT OF WAY & J USE CLASSIFICATION Dwell inq FRONT 4<; REAR 7 SIDE INT. 1. SIDE EXT. AUTHORIZED SIGNATURE - DATE /5/ J.i. Boss bv C. Harbcuah J.H. Shook BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD IMPORTANT: FORM,:::' C55-1] L. (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97-401 ~ I Kb 7-7(;' 1869-74 PHONE 746-4429 PHONE AREA $27.370.90 300 DATE 9-25-74 5 if / -- .. BU\.lDING ~.ITE EVALUATION - ~~ '7 R Q3s_2t/ TAX LOT rt. I f CENSUS TRACT , ~ 1T UeY'o.- Delle.. do 13Lk I 1& /" 0 ? APPLICANT: J' II No. 0 \() 7 - Y NAME k<? !/J0fJ VT ,R, \, r,(j1 Pv c:. ADDRESS q -?- ~-7S' ~il5" " .' ( ) ( ) ( ) Building Permit Appl ication ~OWl tope. Site Inspection PHONE /(),' cJ 0 DATE f hOtt. Pre-Permit Invest.iig~ionu)Pa. 9-; 7-;?Y' Cj'-//o- ?y DATE = 1. Zoning Ordinance Compliance (Zone ) Subdivision Ordinance Compliance NOT app] icable () () () (~( A~Il~) '----- () (' l)) , () () () () NO YES NAME LANE COUNTY PLANNING DEPARTMENT 3. 4. Required Access ( ) ( ) ( ) ( ) 2. Building Site (Area, Width, Frontage, Setback) Other (see comments) 5. COMMENTS: BUILDING INSPECTION SECTION NOT NO YES NAME DATE aDOl icable ~~ 41~ 6. Plans Subm i tted ( ) ( ) (X) 1.h..4/7'1 7. Soil Stabil ity (footings) (1.) ( ) ( ) II; ( 41'/,,/ 8. Flood Plain ~) ( ) ( ) 9. Other (see COIlI11ents) (-<1. ( ) ( ) - , COMMENTS: SAN ITATI ON SECTION NOT NO YES j~~Q aDOI icable I ~ 10. Sewage Disposal ( ) ( ) 11. Us ab 1 e Area ( ) ( ) ~ 12. Water Supply ( ) ( ) ( ) 13. Other (see Corrrnents) ( ) ( ) ( ) , COMM ENTS : ~ 'J DATE 9/7:]./77 / " , \ , \ '", TO APPlI CANT: ( ) ( ) ( ) Building.Permit ; Site Inspection: Can be app roved. Cannot be approved at this time as indicated on item NO. above. Questions and further information on items 1 through 5 contact the Lane- COUNTY PLANNING DEPARTMENT. Questions and further information on items 6 through 13 contact the Lane County Buildinq and Sanitation Division. Will be held in this office until you can resolve the problems indicated. Is being returned. Your building permit appl ication fee is being returned under separate cover. ~~Jc./ Your ti/?-~ I )4 LANE COUNTY PLANNING DIVISION 135 Sixth Avenue East, Eugene, Oregon 97401 \Phone (503) 687-4186 \ I C55-28 1 LANE COUNTY ENVIRONMENTAL MANAGEMENT 135 Sixth Avenue East, Eugene, Oregon 97401 Phone (503) 687-4065 ~ ~ I. '. 2'), _ . Permit No. I?-??- ?y CURB CUT ~ , . hotE' SEPTEMBER PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY WHEREAS, the attached application has been fully considered by the Board of County Com- missioners of Lane County, and it is the opinion a nd judgment of the Board that the said application should be granted, and that a permit should be issued, now, therefore, it is hereby. ORDERED, that a permit be and is hereby issued to JACK K'PHART 16QO SOUTH A or constructing the following SPR I NGF "LO facility: OR'GON for placing, building LOT 'i BLOCK 1 V'RRA O'LL' SUBDIVISION upon the right-of-way of County Road No. . Mile Post . in strict conformity to the exhibits attached hereto, and subject to all terms, conditions, agreements, stipulations and provisions contained in the application and permit, the Rules and Regulations Gov- erning Facilities to be Permitted upon County Road Rights-of-Way, as set forth by the Lane Man- ual 50.190(2) any amendments thereto, and any other applicable regulations, law or ordinance. Specia I Provisions: 1. Driveway will be constructed in accordance with the attached drivewoy approach specifica- tions (Drawing M98-50). Permittee will be responsible for the immediate removal of all mud, dirt and debris from the roadway and right of way caused by his operation, leaving the roadway and area in a neat, acceptable condition. 2. 3. SIOEWALKS WILL BE CONSTRUCTEO IN ACCORDSNCE WITH THE ATTACHEO SIDEWALK SPECIFICATIONS AND ORAWING M98-49. THE STANDARO CURB TYPE SHALL BE CONSTRUCTED UNLESS OTHERWISE SPECIFIED. This permit is revocable at any time, and will be strictly adhered to and no work other than that specifically mentioned above is hereby authorized. This permit shall be void unless the work herein contemplated shall have been completed be- fore 9/25/75 , 1 9---.l2. Expires ,19_. Inspected and Approved Approved by Board of County Commissioners By Dat~ By & /(l~ Director of Public Works WHITE - OFFICE FILE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUILDING & SANITATION DEPT. YELLOW - REAL ESTATE C98-79 ~ ,_.._~.... .'. ~ J .. .' .' Datf' '\, . \ P!it No. _/ g{ f - '7 rj CURB CUT I , ...... PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY ... WHEREAS, the attached application has been fully considered by the Board of County Com- missioners of Lane County, and it is the opinion and judgment of the Board that the said application should be granted, and that a permit should be issued, now, therefore, it is hereby. ORDERED, that a permit be and is hereby issued to for placing, building or constructing the following facility: .J:. upon the right-of-way of County Road No. , Mile Post in strict conformity to the exhibits attached hereto, and subject to all terms, conditions, agreements, stipulations and provisions contained in the application and permit, the Rules and Regulations Gov- erning Facilities to be Permitted upon County Road Rights-of-Way, as set forth by the Lane Man- ual 50.190(2) any amendments thereto, and any other applicable regulations, law or ordinance. Special Provisions: 1. Driveway will be constructed in accordance with the attoched driveway approach specifica- tions (Drawing M9B-50). 2. Permittee will be responsible for the immediate removal of all mud, dirt and debris from the roadway and right of way caused by his operation, leaving the roadway and area in a neat, acceptable condition. .0 -c. ~ OI{;;'~;L-:Z--7{/4! 'if This permit is revocable at any time, and will be strictly adhered to and no work other than that specifically mentioned above is hereby authorized. This permit shall be void unless the work herein contemplated shall have been completed be- fore , 1 9---.:.... Expires ,19_. Inspected and Approved Approved by Board of County Commissioners By Datp By "- ~'-"'~' ' \ ,\, \ WHITE - OFFICE FILE "::::>~~BLU~..:-'RO~Dl\SUPERYISOR G ~ ~ GREEN - RESIDENT ENGINEER ORANGE - BUILDING. & SANITATION DEPT. PINK - PERMITTEE YELLOW - REAL ESTATE OJ rector \ Ofi{{>lic ~orks \'\- \' \ ~~.~O 'i-L C98-79 .. -- - ::ti/ ~~f~ 7f . . ... /L(LfJ LJ~ r.. LANE .TY BUilDING n BUILDING PERMIT OR MOBlaOME MH 0 MAILING ADDRESS USE PERMIT PERMIT NO. .,.-- ~ ~ PROPERTY OWNER PHONE ,j , ,. , . , ,. .~ ,~ " CONTRACTOR MAIliNG ADDRESS PHONE PROPERTY lOCATION -INCLUDE POST OFFICE ...., PROPERTY LEGAL DESCRIPTION - METES, BOUNDS . . TWP RANGE SECTION TAX LOT NO. CODE CENSUS TRACT " , . APPl. EXISTING STRUCTURES ON PROPERTY NAME & MAILING ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT lEG~L A~,CESS TO PROPERTY :: :.~ , PR.C?PERTY SIZE - FT. WIDTH DEPTH AREA Connect to Existing TYPE CONSTRUCTION Sewage System 0 l" . SQ. FT. :;: 8DR~S J ~ '~; ~ d New System 0 VALUATION 0, \ ( .~-) SEWAGE DISPOSAL PLUMBING INSTALLED BY PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK d. \:i'J '\ OTHERO . fEES OWNER 0 OTHER: NAME WATER SUPPLY , PUBLIC 0 o OTHER TOTAL . MIN. SEPTIC TANK CAPACITY WITH OISl. BOX: GAl. --- COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FiElD REQUIRED UN. FT TRENCH WIDTH FT. OR SQ. FT. ., ~ '~\~'l"'\'-:"" -... ,-~ ,=" ,--'l-v. '- ~ ~\~~;Q . )', ,~_\~ .\' \. " JJ ~'\ - ': \, - l' \h'l.:,(r \ . -, , TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTll. EASEMENT , " BLDG. SETBACKS FT. FROM OR. OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT SIDE INT. SIDE EXT. AUTHORIZED SIGNATURE - DATE REAR DATE " .' BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule all required inspections. All construc- tion shall comply with Uniform Building Code, D.E.Q. standards IMPORTANT: for,- s~bsurface ,,>sewage disposal and county regulations covering ~"PI-urJ:1bing~-AfI buildings require a certificate of occupancy before , ~eing occupied. )',.... '\ '" . ,\ ~. \.'>.... '\<S~..:. Detci~. on.'Rever~e .Sia-e)~-, :,-~:~ _ _~ ~ , " ~ ,'" ,,8 ~'\.,.).. ... \. \ .~ ~ \. - -\~\. \ , (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 F'ORM ::: C55-13 --. . . , " '", S!TE INSPECTION AFPROVED Ljl; REt<'.RI<e / \ DISAPPROVED ~ DATE INSPECTOR FOUNDATION INSPECTION /; ApPROVED fI71 01 SAPPROVED L-/ DATE IJ~ / r. 7tj- .171ECTOR U/' REMARKS 0/(0; "~1I1/~~/O~J.s'V'/J/ ~ I ' , E.; . , FRAMING INSPECTION /...~...'i'1/ ApPROVED ~ DISAPPROVED ;---y DATE~ INSPECTOR REMARKS ~~a ~ j"';2 J7Sr:P , ~~) roo .1, ...... LATH OR SHEETROCK INSPECTION APPROVED.0 DISAPPROVED ~ DATE /-( -'7Y' INSPECTOR a/ (if REMARKS FINAL INSPECTION . .,' vf'J 1:). ApPROVED . DISAPPROVED ~ DATE f1... '}..~, YI:J IN~PECTO/~ (......j i,Jy REMARKS.~/~~~tUf.W.--f1t rtJ}{If1:i('i~ ~~/~ .-/,(1) ,$ ~,.J.j.;/. ;;-/Cl r 1 .1'-fY( . ~ 1J--'J& /.;_ CERTIFICATE OF OCCUPANCY READY TO ISSUE ~ NOT READY TO ISSUE ~ DATE INSPECTOR REMARK 5 .A /;~/i6'l-71/ /~/t/1/3iJ~ .' " .- - LANE ANTY BUllDIN~Jl BUILDING PERMIT OR MOB.OME MH 0 MAILING ADDRESS USE PERMIT PERMIT NO. : ~~~~~, '{~. PROPERTY OWNER , r~'--j~ ~:~ .)i~.. t~ ,'0 PHONE 1:'1'1"'" .\ .",....J I 7:. ~ ~::)~ ~d :~; :ckt CiC: "-;:) ~-.r. ,..,""\ J. '. _ .'.JlO. .~. CONTRACTOR MAILING ADDRESS PHONE (~ -.., (, .. , PROPERTY LOCATION -INCLUDE POST OFFICE ~ t;.f ~)': f~:" J ('-;'""::'1 ri~~"-'~~:l PROPERTY LEGAL DESCRIPTION - METES, BOUNDS \:07G-'(j l:or go l:~)\2;; fHc;e~ 1 TWP RANGE SECTION TAX LOT NO. CODE CENSUS TRACT 1', n"1 51~ APPL. NAME & C:~/'JV:J EXISTING STRUCTURES ON PROPERTY e~J;::J LEGAL ACCESS TO PROPERTY C~ I [Leo MAILING PROPERTY SIZE - FT. ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT -::::. ~ ~ i'cc; WIDTH DEPTH AREA Connect to Existing TYPE CONSTRUCTION Sewage System 0 SQ. FT. # BDRMS 11:::";0 (;lG. 10 tJ New System 0 VALUATION :2jD(-:;').'i~' """"'"""'1 .... - ~ "......... 711 C 1;.;10 ~ ~.;;~~. ~) .,./...J.-$.A'e.., <:'J ()r-9 h'--", ('~' iJd._ 1'--.. " SEWAGE DISPOSAL PUBLIC 0 BUIlDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER , OTHERD n~I.O;) ",1.r1 ?!). ~~ FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC tiJ 0 OTHER SEPTIC TANK oU ~ r.:'" . . .):) TOTAL s ;~:>. ~~ MIN. SEPTIC TANK CAPACITY COUNTY BUilDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED WITH OIST. BOX: GAl. ('0~ .....,..A... lIN. FT ISO TRENCH WIDTH fT. 2...] OR SQ. FT. ;;eJ TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIl. EASEMENT '-j~~ o [) J BLDG. SETBACKS u FT. fROM erR. OF ROAD RIGHT OF WAY FRONT l.;.~ SIDE INT. :J SIDE EXT. AUTHORIZED SIGNATURE - DAlE lei (~.(]. :':;;:1!3 ::~J C. (~.):"~)(~:':":l REAR 7 USE CLASSIFICATION [;~ii!o() J.U. nt~t;~~ DATE (\"-JI")::~"lv\ (' p/' <-' <-~" . ' .. BlDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY lAX - PINK PLUMBING - CANARY BUilDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule all required inspections, All construc- tion shall comply with Uniform Building Code, D.E.Q, standards IMPORTANT: for subsurface sewage disposal and county regulations covering plumbing. All buildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) FORM:: C55-13 (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 , SLAB FLOOR PLUMBING GROUNDWORK . . ApPROVED / / 01SAPPROVEO C1 DATE INSPECTOR REMARKS GAS PIPING GROUNDWORK ApPROVED ;---? DISAPPROVED C1 DATE INSPECTOR REMARK 5 ROUGH PLUMBING DISAPPROVEO C1 DATE/~ ~?t INSPECTOR~...ct <,L ,,; ~ Jt WI! ~~O'r!!P /? J1 h"...-z.. UU'" ~1 , <".o~".".r u_/"'~'<::. ..v~_O 5'../.~...,d _~ ApPROVED ~ REMARK S ,,1f b ,. ., ~J...-r ROUGH GAS PIPING ApPROVED C1 015APPROVEO C1 DATE INSPECTOR REMARKS FINAL PLUMBING ''''I' -2t-7""""~ ApPROVED ~ DISAPPROVED C1 REMARKS FINAL GAS PIPING ApPROVED C1 DISAPPROVED ;---? DATE INSPECTOR REMARKS CERTIFICATE OF OCCUPANCY REAOY Tn ISSUE C1 NOT READY TO ISSUE C1 DATE INSPECTOR REMARKS , PROPOS.WAGE DISPOSAL SYSTEM RECORD ~ ..... INSTALLER: Complete top part ?f form to signature and submit both copIes h applicati'on. ::,\, I ~J'?t- AAA-oY ., PE ITNO.\?-'(c.I4.'~\\ INSTALLER'S NAME P~ERTY ADDRESS ~C).' "-- """''' Q.,.. old . No. Living Units Bedrooms Baths Basement Water S~pp~-- Yes No Public ~Other-List Septic Tank: Ft. from well Steel 0 Inside Dimensions: Ft. ~~~~h \" ~idt, \ DiJamete~ DePt NAME ~("\,.~ ~ ~<:C::> ~,...~ "--i ." Feet from MAILING \\~C\.l) ~". . ~\\ /L WEll ADDRESS0 c::::...- (\. Lot Line ~~,......r.~IP'l.~~' Front Le..')9.th of Lin~Ft. \jrenci. I Totar'Sq. I Ft. Between 1~1l21(13. 4. 5. 6. IWidth.2. Ft. ~670 Lines /~ 'lot Plan (see instructions): . Concrete rn~o. Compartments I Gal. CapacIty 1M /(1. cP tJI Tile Disposal Field: ../ Distribution Box: Yes ~ No Other Distribution-Type Foundation Side IFille~/-1Filler Depth Tvpe/--7IAbove Tile? Rear IF III er Be I ow InJrller;;' In. t- !J &1- /<. t'fJ/T ~v /-- -- - II (il f/..-'jp J \~- JJ - _ _ .J ../". --- ~ '\V~ 1- ~tgfr Date /L- 'L- 7/~ V Signature g....'S,--: .Jf' ,7.-!)_",-~~/ . . .cERTIFICATE OF SATISFACTORY COMPLETION ......-/ <oJ For Sanitarian Use Only: D~\:-:2-....IO ~ 7 f In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certificate is issueb as evidence of satisfactory completion of a subsurface sewage disposal system at the above location ~Approved: System Installation conforms to current standards c==J Disapproved: Does not conform to current standards Remarks: +/1] t/Jrr C55-11 s ~~~'s Signature L~ COUNTY STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY .~~ NOTE: . lANE COONlYe au DEPAR1MENI' OF ENVIRClI:'MENTAL ~ Mobile Hotre ABkICATION FOR BOUDIN; PERMIT OR MOBIlE HCME USE 7$t wil75~Q:ln1til;~tion has been approved. . PERMITif / PC <7-? if Building / --- PLEASE PRINT PRuruni LOCATION iwP_J 7 RA!"{;E 03 SEC, .:)'1 TAX wr if- _ COOE - CENSUS TRJ>Cr~-FL)/~ wr NO. ..,- BLOCK I SUBDNISION tIo""1Rb l;-~ J) A /J If) l' SIZE ACCESS TO PROPERlY ~ /K ~ WIDIH 3~ uU Ln q <:; OR ACRElGE DESCRIBE EKISrm:; STRlJ!: ON1'lliE PRunKri (l(bn.c.- APPLICANr J / d.. MHILIN; 0 ~ --/ /_{J l'W1E ""f?,d/ ~ e-d' ADDRESS ~r~', ~ PROOF: UJlu~R . MAILING I r. (I Y r' l'W1E /(e/I!4- u~1 L. AuU=S--'" fo S"o//{L, 4 PHONEIJ~-<lcf~r BELaV FOR OFFICE USE ONLY*****:. :.:.:.:.:. :.:.:. :.:.kk"J...'.:.:. :.;. ;.;..;.;;.....;.;.;.;.;.;.;. .;;.;.;.;.;. ;.;..;.; "kkJn'.:.:.:.:.:.;.:.;.;.;. ;.;. ;.;.;.;.;. ;.;. :5trYFtures_ t9?J3e bl.!ilt/Mobile Hotre sq. ft. ~",IO iFbedroans valuation .A~' -'/c /(/hC_ __J.1 9~c.,,_.,.t;n / . feJ,5 :7 - " ~~ 0 7/ J' s<< '7 (,t;>-. 30 d . / .). /J /V' ?'t; ,... Sewage Disposal: . Site Inspection iF, ~ Existing sewage disposal systan 0 or new systan required J8(.... , Water ~S?9ll: Q " Public ~strict NaIre I_'J a..:..Arrn....>-' /.2 J. 0 0 Fees ~ () / ,57; I 0 0 Plurrbing Installed by <Mner Other Name'. ~ _~ (/, I) CJ Plumb~ Fees Sewer cormection atet" connection /0 if\of fixtures inspection fee.:J. inspection fee.;}, n c.mh \ Plans furnish ~eck " \ . Yes..l&-.No / ____ Signature of Applican TOTAL /i OrP'I5..) Fee r~ce;ived by Min. Septic tank capacity. Drainfield te~ed with dist. box: Gallons 9DO Lineal Feet 'If)O \ Well 0 Spring 0 Other Bldg. Waste Dis. Plumbing Plan Review Trailer 1% surcharge /. ,.,7) Fa~i ity Pennit Yes No 0 AI rv./ dat~'t~..-r te ~ //1' /7 c./ ~, I I IV , , Trench Depth 21" 3 or Sq, Ft. 3 0 0 'Type ot Structure........... Occupancy.;r~ Fire Zone..3 Use Classification..,.,......./,.{...2 Blgd. setbacks-tt. trem center ot road- right of way Front y.s- Side Int...s- Side Exterior Planning date ~ :J-/~-7l/ . / ~'\tl~) Rear / Zone I< "74 J date Buil~ J date 9../J. '3./711 C-A..rf~~"N."JI( '1/)...;1,7/1 . .?-~ ~ .'1;ik- C55-12