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HomeMy WebLinkAboutPermit Building 1973-7-24 i" ~ r c""_, ----"'l' -::" " . , . . /.. 't .l r, .'f LANE COUNT&ILDING PERMIT OR MOBILE BUllOING IW MH 0 MAILING ADDRESS 1 :i::O Su:tth ",\" ~;>r I nJf! c 1<1, Orcc;o:-; ... ,': ~ ,; f .," \:_4 . , HO.USE PERMIT PERMIT NO, I..;;;: '4l~' .3)0:"1'3 PROPERTY OWNER it~;J:IGr. CONTRACTOR 3u 11 d~~s PHONE 7: ;,:)_,',;':.'.: n MAILING ADDRESS PHONE PROPERTY LOCATION -INClUDE POST OFFICE J!~:) CclrcsQ Ave. PROPERTY LEGAL DESCRIPTION - METES, BOUNDS VJrc ~~~ B~3 L-J /'" .. 7 . --z Twr11 /t03.) ______ r ~ ""----" A Pl. ctoj)i1art Bu II dcrs ....... (SECTION ). 2!}t~,3 TAX LOT NO. CODE #>55 t9C) CENSUS TRACT 2J~:';DI!)O NAME & 1690> SO:Jth "A" EXISTING STRUCTURES ON PROPERTY Non:: - LEGAL ACCESS TO PROPERTY De I rose r~ven:Js PROPERTY SIZE - FT. MAILING Sprin~flcld, Or046n ADDRESS - - FOR MOBilE HOME PERMITS ONLY No. of Bedrooms WIDTH DePTH AREA STRUCTURES TO BE BUILT THIS PERMIT ~ltJ'llll nD Connect to Existing TYPE CONSTRUCTION ;:"rEi!O Sewage System 0 SQ. FT. ;; BDRMS 11:;1..7~ (l12 (3) New System D VALUATION .'0 ...",~ i'.o,...;?' , ... _ __ _ 0_ _ ..L ~ .....,~. ~:';"'" ........... WOIw. ;.J.....~ J ,'-' ;;J --~.:...~ l' '. '~ . \ . ,t: : ..:- -:'::.. t 1 :::....:;.,.~-c- -~~ ;;;r"VJ~ ~ - ~Y;;i ,,;;,',; 10 PI~~lnJ FI~tur~s , '" "'---... 1 t_'._ . "'h'-~"'" ...w..... ..... . ~","-'....w h.......... ............ SEWAGE DISPOSAL PLUMBING INSTALLED BY PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK ttJ . OTHERD (,'_00 '0.00 'n.GO FEES OWNER 0 OTHER: NAME WATER SUPPLY .L J:'lr..:U;":J PUBLIC 0 o OTHER TOTAL . 11',. r;o COUNTY BUllOING & SANITATiON SPECIFICATiONS DRAIN fiELD REQUIRED MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAl. :;C\':q;o ell O;'IOSa I : :lO system to be UN, FT 200 TRENCH WIDTH FT, 2 I fnotcl leG r-or rcvlsc~ plot plcn. OR SQ. fT. Ilec;f ,;rcins [..,.... ,~V to n:ru:Jt. TYPE Of STRUCTURE 5 tJ OCCUPANCY Co J ZONE PUBLIC UTll. EASEMENT BLDG. SETBACKS __ fT. fROM CTR. Of ROAD RIGHT Of WAY FRONT 115 I SIDE INT, 5 SIDE EXl. AUTHORIZED SIGNATURE - DATE hI J.I:. Bess by :k:rbatl:J;' USE CLASSifiCATION REAR 51 John C ru i c:kshcn:t, n. s. DATE 7-2!)-7J BLDG. PERMIT - WHITE OffiCE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Construction to comply with uniform building code and county regulations covering plumbing and sewage disposal. All buildings require a certificate of occupancy before being occupied. (See Statement on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, BLDG, & SAN. DIY., COURT HOUSE, EUGENE, OREGON 97401 FORM:: C55-13 ~- -'.Q ~~~-;;+' ".J., v ~ . " . ~. ? .9 '<? . ,~Y'~ . . /',p' /,' '. . ,,") .I "-'b /'9. ""o- f..."", 'O~',t!' '\ \, '\ 'u. '''... 0~1 ..~.. v..~ \ '\ 'n 71\ I ';;. ,ry \ ~'. . .\.\ ,,'f-l. ~ '0 J. fI J.........'lo ~." ~ ",\, ~e') - .' . J " 6 '!> " ,\' '''J / . 5 ,,~ \t)~ ~ ,. ~;" o~"\ ~>\' /' 4 ~ 4} --(Po A ,- I E I / S 89042'~~''€ 96.68' -r- ... "? 58904Z.3501E 5 8~o I( o !:!: -----,-,. ~o' -.A.t.. ~-~r- - '" ,,0 U) C\I .....,... <D_ ~r- 0'" -~ z 8 ... in. -2 Qj .(\1 I ~ I '\ 26~,98' 7..{. ,15 ?>S ' I, ' 87,5' \.01:\ '8 ... C'b '" ' _ CD ~r- '1::, 21 ,6 . "0 -~ ~ ~to. r- ... b '" -", o o z 2-B 2.A _ _ ..-; - - ~~~@- ~--p- c N ? t\ '; ~ , tr, _ ..!' '" ~~ ~toi',A-I ... '. 100.0' \436 82.48' 1460 F ... '" ':oM .... -.' o I J MO,B7' t.. " ~~'W @) '0' . r E .639,91' AVENUE 609,82' 143:'\ 95,0' .' ~SE 144~ 95,0' 14"~ 90,0' t4U- 39,82' . R "'- ",r- - '" 8"; o a> o Z '7.0' 'PUBLIC UTILITY Z - -1-- -- 95,d-- - I , . 90 42' 35" W 780,0 4 ... , . "'r- "'''' i.ocri '0 a> 5 . 135~-73 .... '" _~f... 8'" o '" oa> Z i 'b ... int.-. "'", t.o.n oa> o o ~SE~E:5TO'~' _ -90,0', 6 7 ... , N "'a> '" . - CD 8a> o o. z 8 .;.. '" , .,; 9 ... 900' --I 90.0' /r.;:;: -:;- J {:J . ;.\~L ( 8 1<1510 7 6 5 - /''.. 4. ( r l(.e lcf~{) f!1Z--- /('/i(,) \\. <"I .kk. ._;i~~;::P'\';:1 . ! *:;......-_~- IRST ADDITION TO SWANK ESTATES .' (BOOK 46. PAGE 131 ,-, ~ .. ,.. - ..-.. "':~";JI.~_1~-,,~.:",rjRr~~::.-:; _l-"'T~~,',"-::::-l~-:;',<~;.--'. -.-" , '. --------- --~_h~..~:_:.---~~~,...",:'~-,;-...-..,-",..-.~.~~____,,'...._.......,,~""'~;t;!~~,s<..~.r:...~'it~~~ 1f~~.~.:,.l: ----- -------- -. ---.......:-.. <"-,, BUILDING SITE EVALUATION . " < ' :'. ' V ()( Building Permit Application No. /3SY-7.:r () Site Inspect ion () Pre-Permit Investigation T /7 R.tJ3 S :;) Y TAX LOT ~ TRACT A-(P1TtANT~~ ~- 3 ~ 7 NAME ~/~ ~ ADDRESS' 7'-- PHONE DATE /'-/7 LANE COUNTY PLANNING DEPARTMENT NOT NO app) icable I. Zoning Ordinance Compli~e ( ) ( ) (Zone ~ ) 2. Subdivision Ordinance Compl iance ( ) ( ) 3, Requ ired Access ( ) ( ) 4. Bu i I ding Site (Area, Width, ( ) ( ) Frontage, Setback) 5. Other (see comments) ( ) ( ) YES NAME (/ --\AJO (~ (~ (~ ( ) DillE 7-11..../:> COMMENTS: = BUILDING INSPECTION SECTION NOT NO YES NAME DATE appl icab I e # 6. Pi ans Subm i t ted ( ) ( ) }K>' 7. Soil Stabil ity (foot i ngs) ( ) ( ) 8. Flood Plain ~ ( ) ( ) 9. Other (see COllV1lents) ( ) ( ) (tJ7/~ ~- ~3-~ ::= COMMENTS: , / SANITATION SECTION NOT NO YES NAME DATE app I i cab I e sA 10. Sewage Disposal ( ) ( ) II. Usab 1 e Area ( ) ( ) (~ ~Ii~~~ #'5 12. Water Supply ( ) ( ) SA. i3. Other (see Comments) ( , ( ) ( ) COMMENTS: TO APP LI CANT: Your /?f ( ) ( ) ( ) Building Permit I Site Inspectio~ Can be app roved. ?- cJ + 73 ~ Cannot be approved at this time as indicated on item NO. above. Questions and further information on items I through 5 contact the Lane- COUNTY PLANN ING DEPARTMENT, Ques t ions and further i nformat ion on j tems 6 through 13 contact the Lane County Buildinq and Sanitation Division. Will be held in this office until you can resolve the probiems indicated. Is being returned. Your building permit appl ication fee is being returned under separate cu_er, LANE COUNTY PL/INN 1 NG DEPARTMENT 135' SI)Cth "venue Eut, Eugene, llrl!9on 97"01 rtwNE: 31J2..1311 F.XI. 231 LANE COUNTY BUILDING & SANITATION DIViSION 135' Sixth ~"e'nue East, ElIllene, Olegon 971,01 !'HOWL: 3-42- I J II EXT. illl MI:\C\_'HI t' , D~tf' '.' permit' ' CURB CUT PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY WHEREAS, the attached application has been fully cansidered 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 ." ~. -I ~ \ .) for placing, building or constructing the following facility: . .., 1'--,.,.' ., ..... .,." f"'" ,~... " '- "'''' '? "0 '- ,,,. ! ,-. / ,- ..~ , :: 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 attached driveway approach specifica- tions (Drawing M98-50). 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, . This permit is revocable at any time, and will be strictly adhered to and no work other than that specifically mentioned obove is hereby authorized. This permit shall be void unless the work herein contemplated shall have been completed be- fore ,19~. Expires ,19_, Inspected and Approved Approved by Board of County Commissioners By Datf' By Director of Public Works WH ITE - OFFICE FilE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUILDING & SANITATION DEPT. YEllOW - REAL ESTATE C98-79 Datp '.:. . . , " APPLICATION FOR FACILITY PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY Your applicant. hereby makes application under Rules and Regulations Governing Facilities to be Per- mitted Upon County Road Rights-of-Way. to construct the following facility: Upon the right-of-way of County Road No. ' . at the following location: , 'I . as shown on the exhibits which are attached hereto, in strict conformity to the state- ments of the exact nature and amount of work to be done. and to the description of the facilities contained in said exhibits. Your applicant will be the beneficial owner of the facility as constructed. or otherwise primarily liable and responsible to members of the public for its proper maintenance. repair. operation and use. Your applicant accepts all terms. conditions. agreements. stipulations and provisions, in Rules and Regulations Governing Facilities to be Permitted Upon County Road Rights-of-Way. dated March 31. 1960. and any amendments thereto. and any other applicable regulation. law or ordinance. , ./": ,. " , . I '. ". ~ / .............. {, ~. /"" Signature " / , - Address WHITE. OFFICE FilE GREEN. RESIDENT ENGINEER PINK. PERMITTEE BLUE. ROAD SUPERVISOR ORANGE. BUILDING AND SANITATION DEPT. YELLOW. SURVEYOR Phone No, !:J''''';'S''-'''''''~Jfl. PROPERTY OWNER " , ;::, '; ili LANE COU~T_~ILDING BUILOING 0 MH 0 MAILING ADDRESS ( ',- " : ~ ! ~ PERMIT OR MOBILE Hctt USE PERMIT PERMIT NO, " PHONE . :::~ :(;;, .' .,~,~' L' /l" ,,," I "_, ~ l) ,~ ~\; CONTRACTOR MAILING ADDRESS PHONE PROPERTY LOCATION -INCLUDE POST OFFICE ::."~:! '".~~~~..~'::; ~':J~). PROPERTY LEGAL DESCRIPTION - METES, BOUNDS 'n:~ ~:J ~:) :;u~, :- TWP RANGE 11 '.~ \./,'J SECTION ~)!j TAX LOT NO. CODE CENSUS TRACT ,",',\ ,1'\''- .)L; I' APPL. NAME & MAILING ADDRESS EXISTING STRUCTURES ON PROPERTY ~:~'>~:~~;>~: l;~~B D(:-:)~j .. ~ 1:' ''', (~, ,.I)~" ..,," ~ ......../....1 '" . LEGAL ACCESS TO PROPERTY C~:3~7:~':~' [~:;:;~::,_, L:)rv~~' )ucS(" ~~;.~~:/'~:~ PROPERTY SIZE - FT; WIDTH DEPTH AREA FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT r:: , ,~ 9 ~ :~:/' Connect to Existing TYPE CONSTRUCTION ::vr ::.; Sewage System 0 SQ. FT. :;; BDRMS ~U:;--;'.V,; \ t~~ .4~~ New System 0 VALUATION -', ' " , I t.' ,'" l . ,~'. l ~ ' ~ , , " ......;\,.., ~ J ~F~'.~' -: ," ,,~~)~,',";;,-jV ~'~'J"'-..l B": )2::.~~)G:>; ~'~':~~::~.~':j , ~ , ;; '-" .H;~ \ ....J. \/ il L' I W W , ..;, ' " '.-, SEWAGE DISPOSAL . OTHERO ,~) r'~1 FEES PLUMBING INSTALLED BY OWNER 0 OTHER, NAME WATER SUPPLY .' PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK Q "'\ .'.,,> _'... ,\~ J PUBLIC 0 o OTHER ~)1_1.'" TOTAL . ii, ~i; _ i<) MIN. SEPTIC TANK CAPACITY COUNTY BUILOING & SANITATiON SPECIFICATiONS DRAIN FIELD REQUIRED ~;~~}:~\so (~, ~'T ::lr' ': ~:-;:~ r' ~": ':"~'~ 1 ;;.) l)-'; L1N, FT L l!~ TRENCH WIDTH FT. a' ;~'t'!J'~il~ ~ " )e!~ Vi...,.\1:SCfJ ~gGZ :)\c:~. OR SQ. FT. ~~:;:..... : (L .~:) !.,,-,\. .",) WITH DIST. BOX: GAL LO U('?C"~. TYPE OF STRUCTURE " v . OCCUPANCY I C J ZONE PUBLIC UTlL. EASEMENT BLDG, SETBACKS __ FT. FROM CTR. OF ROAD RIGHT OF WAY FRONT 0~)' SIDE INT. f ~ SIDE EXT. AUTHORIZED SIGNATURE - DATE Isl J.;,. ~;....<j3 bv C~f:);j~~!J:~ USE CLASSIFICATION REAR ;J' J:"'::~:l bfUI <":':Gh2:1:~, l1. G. DATE j'u:~.'~~ v3 BlDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUilDING - GREEN SANITATION - GOLDENROD Construction to comply with uniform building code and ~ounty regulations covering plumbing and sewage disposal. All buildings require a certificate of occupancy before being occupied. (See Statement on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 97401 F'ORM ~ C55-13 c <'"." '=::l'~'~--~ ~ ., . ... SLAB FLOOR PLUMBING GROUNDWORK ApPROVED /7 DISAPPROVED C1 DATE INSPECTOR REMARKS GAS PIPING GROUNDWORK ApPROVED / / 01 SAPPROVED C1 DATE INSPECTOR REMARK S ROUGH PLUMB I NG INSPECTOR~ ApPROVED Iv I 01 SAPPROVED C1 DATEQ... '7.7'3 REMARKS ROUGH GAS PIPING ApPROVED C1 01 SAPPROVEO C1 DATE INSPECTOR REMARKS FINAL PLUMBING REMARKS?<J^ .J:-.~""" C1 rit'T(/jb.-2.' 2..,211 NSPECTOR ~.I./ ~ cr" ""((j J/_~.-.~7 ~ ApPROVED ~~ DISAPPROVED FINAL GAS PIPING ApPROVED C1 DISAPPROVED / / DATE INSPECTOR REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE C1 NOT REAOY TO ISSUE /7 OATE INSPECTOR REMARKS .,," ~ -I' I "'~'l/ . . FHA F'(1RM NO, 2573 1\\. ~1 ~ ~ U.S. DEPARTMENT OF HOUSING ANO URBAN OEVELOPM T , _ R~V' /7 ~o. A- I FEOERAL HOUSING ADMINISTRATION .,;.'i. . lo1/~. HEALTH AUTHORITY APPROVAL \)\\\ ~ ,J ((?'J NO,~UIYIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTE'1I~ ~~ p~ PART I-TO BE COMPLETED BY FHA I ~J) Insurlni Office I FHA Case N~l , 1/ c,/ Form .Approved Budget Bureau No. 63-R0296 f2fn'1r.:>n. 1b lLJ If' II 11/ Ie: 1-':--, co 's ///1 <'l:'n . -,- J.lj 1~/3 Mortiaaee ~ Name, Addre.. and Zip Code I FIRST NATIONAL BANK OF OREGON 665 Main Street Springfield, Oregon 97477 Mortgagor or Sponsor: 'I LEMKE, Elroy R. & Hattie A. l.HU~ '.I'll........... Property Address: 11148 De1rose S~ingf1eld. Subdivision: -..."",~ I ~ t;"I'Wi r:;:pT ,. Avenue Oregon 97477 Lot No. L .J Lot 7, Block 3, Vera Delle 7 - T!11:'A.L......lil,U{D....Q nV'N: (IN'T< I R :~nQu< 1- RA;HS BASEMENT ~ New Installation Can Attic or other Area be made int"O""additional bedrooms? (II YOB. how many?) DYes ~ No o Yes ~No SYSTEM DESIGNED FOR WATER SUPPLY BY, ~ Public System SEWAGE DISPOSAL BY, o Public System D Community System o Individu~l No. or Bedrooms Garbae:e Disposal 3 PART II. - TO BE COMPLETED BY HEAL TH_D,E,)l~ENT_ HEALTH OEPARTMENT INSPECTOR'S SKETCH e. t. 135~ ~- ----- o Community System ~ Individual CiX Yes o No. 1-- '- - 1_ _ _ _ _ 1--- 1--- \--- --1:::: , 1- 1- _ _ _ _ _ 111 :==t=:: C~ I ,- It is the'opinionof the 0 State c:: County Locai Department of Health that this individual water-supply system o is 0 is not satisfactory as a domestic water supply for the subject property. i I It is the opinion of the with proper maintenance: [Xi Can be expected to function satisfactorily. and is not likely to create~ ioss . ary condition DATE SIGN RE K/. 'il. 10-2-73 I CHARD Bit; ~.A o State ~ County o Local Department of Health that this individual sewage-disposal system D Cannot be expected to function satisfactorily TITLE SUPERYISING SANITARIAN ~ NOTE: The health authority should complete the appropriate opnion statement above and affix date, signature and title in the spaces provided. I Use of the above grid for Health Department Inspector's sketch as well as use of the back of this form is at the opinion of the health authority. PART III, -FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the Individual water-supply system be considered 0 Acceptable 0 Not Acceptable Sewage dispnsal be considered 0 Acceptable 0 Not Acceptable. OATE 'SIGNATURE o CHIEF ARCHITECT o DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA FORM NO. 2573 Rev. 10/70 REPORT OF INSPECTION-INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMAIY TREATMENT consists of fi)cSepti(: tank. 0 Cesspool. Sept\< ,....., Distance from well, T<Hal liquid capacity Inside length, C_h DistancC' from: Well. feC't; foundation. Inside: diameter, fttl. Depth SlCONDAI' TRIATMENT consists of ~ Tile disposal lielJ. feet. Material 1000 CONCRETE Number of compartments 1 fl'C'l. Inside width l'allons. Capacity inlet compartment ,feet. Liquid depth, gallons. feC't. feet; nearest lot line at 0 front, 0 side, 0 rear, feet. LiquiJ"capadty. gallons. lininl( material f..., o Sttpage pits. Other Tile Disposal '1.leI: Distance from: We.lI, feet; foundation, feet; ne;l(cSI lot line at 0 fronr, 0 side, 0 rear, Total lC'n~h of tile lines, 200 (eel. Number of lines, ~ . Distance bet"',. lines, Trench width 24 inches. Total effective absorption area in bonom of [rC'nch~s 00 Lc-ngth of each lin~, 4o-~.5-'0" feet. Depth, top of lil~ to finish grad'" Type of filter material: [J Gravel. 0 Broken stone. Oth..., Depth of fiher malerial ~n~ath tile, h inches. Depth of filter mat~rial over til" s.._ "'"' 10 f..., f..., ~nuare f~. inchts. 2 inch~s. Number of pits__. Distance from: Well, . Outside diameter feet. feet; building foundation, Depth, feet. Lining material feet; neatest JOt lin~ al 0 front. 0 side. 0 rear, f..., Impectlon mad. by: 0 Stale. ex County. Date of inspe'l:tioll SEPTEMBER 24 o local Heahh Authority. Inspecled b: 19-13 /5/ JOHN CRUICKSHANK, R.S. SANITARIAN (TlTLI!) REPORT OF INSPECTION-INDIVIDUAL WATER.SUPPLY SYSTEM Oi"l,u.(e to nearest public water main, feet. Size of main inches. IndiviJual wdls 0 an' 0 <ire nO( customary in neighb9rhood. Give most recent ft:cord (If failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighhorhood 0 are 0 are not being developed with both individual w3ter.supply and sewa~e.disposal sys~ms. LIt size: feet wide. _feet deep. Dwelling set back from front property line f('Ct. Individual water supply from: 0 Drilled well. 0 Driv~n well. 0 Du~ well. 0 Bored w~lI. DIatOM. a. w.1I fro....: Ruilding foundation, cast iron ..ewer feet; tile sewer feet; cesspool fC'Ct; nearest 101 line at 0 front. 0 side, 0 rear feet; septic tanl- feet; feet; other sources or possible pollution, disposal field, f..., f..., feet; seepa~e pit Well cOftStructlon: Diameter, inches. Total depth. feet. Type of casin':' Depth of casing, feet. - Approximate depth to pumping level of water in well feet. Approximate yield. j:allons per minut~. .. Scaled watertight to d~pth of feet. Extertar space around casing sealed with: 0 Cement grout. 0 Puddled clay. 0 Ordinary backfill. Well cover: 0 Concrete. 0 Wood. 0 Metal. ~nings in well cover waterti~ht: 0 Yes. 0 No. Pu....p: 0 Shallow well. 0 Deep well. Length of drop piP'" feet. Pump capacity, gallons per minute. l.ocated in: 0 B.1S~ment. 0 Pumproom off basement. 0 PumphouSC' ahove ground. 0 Pump pit. Pumproom properly drained: 0 Yes. 0 No. Pump mounting watertight: q Yes. 0 No. Type of storage: 0 Pressure. 0 Gravity. Capacity, gallons. Has bacteriolo~ical examination of water ~n made? 0 Yes. 0 No. I('answer .is "yes," give dat.. 19_ Quality of water 0 is 0 is not satisfaaory for human consumption. Installation 0 does 0 does not comply with approved exhibits. if any. Insp<<tion made by: 0 Stafe. 0 County. 0 Loul Health Authority. Inspecfed by Date of inspection 19_ (TITlE) GP 0 900.682 \ . ." t , , . . (k/I,:'- ~~k pstaller"s Name t/' No.LivingUnits IBedroomslBaths septJ.c TanK: Ft. from well Steel 0 Ins~ae Ul.IDens~ons: .tot:.. Length Width Applicant Name Kephard Builders Mailing Address 16qo S "A" .NDIVIDUAL SE~GE UISPOSAL SYS~-RECORD nstaller: Complete top part ~orm to signature and return both copies to Lane County Building Sanitation Department. '7 ~ t/-& z;, , '. ." Pr-RMIT No. 1354-73 Crui ckshank' I Property Address 1~8 Del rose Ave, I Basement I Water Supply Yes 0 No 0 Public 0 Other-List Concrete ~ I Gal. Capacity / /hP/;? Tile Disposal Field: Distribution Box :Yes Ii( No 0 Other DistributJ.on- Type No. Compartments Diameter Depth Feet from Well Foundation Lot Line , Front Side Rear ITotal SqiFt.between\Filler I IFiller deDthlFJ.ller depth I, 'I. jX above below ,_ ft. .,.~D lwes.9 Type '/L tile ~ in. tile f.P' ~ Sprinofield. Oreoon Length o~Lines - Ft. I Trench 1. 2. ~ 4. 5. 6. Width ;t Sketch (See instructions): / .~ I '~("f , , , ~()! - \ l......... ........ ~.......... .'. Date 1_ ILl - 7 .., ~_U))_ 1'1' ;f l' i '. .................~..r , 'f~--' "\ { I !/~D < < ~"""-' -"., ;'I ,. i:' ! (I .-:- ,..-. ~""";. ~ signature~~ ~~~ Fo~anitarian Use Only: ~Approved: System Installation o Disapproved: Does Not Conform Remarks: Conforms to Current Standards to Current Standards q JUlIn. , Date: '\ '" Lane County Building & Sanitation Dep . , LANE COUNT.ILDING PERMIT BUllOING 0 MH 0 MAILING ADDRESS OR MOBILE HO&SE PERMIT PERMIT NO, . PROPERTY OWNER PHONE CONTRACTOR MAILING ADDRESS PHONE PROPERTY lOCATION - INCLUDE POST OFFICE PROPERTY LEGAL DESCRIPTION - METES, BOUNDS TWP RANGE SECTION TAX LOT NO. CODE CENSUS TRACT ~ APPl. NAME & MAILING ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT EXISTING STRUCTURES ON PROPERTY LEGAL ACCESS TO PROPERTY '- \ PROPERTY SIZE - FT. WIDTH DEPTH AREA Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. :# BDRMS New System 0 VALUATION , ~ SEWAGE DISPOSAL PUBLIC 0 SEPTIC TANK 0 BUILDING It WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER OTHERD FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC 0 o OTHER TOTAL . MIN. SEPTIC TANK CAPACITY WITH OIST. BOX: GAl. COUNTY BUII.OING & SAN IT A nON SPECIFICA nONS DRAIN FIELD REQUIRED UN. FT TRENCH WIDTH FT. OR SQ. FT. " , t\' . ~ - s, \ e;-\' -"@\ .\ \ ".\ }'::t-"" ~ 1\ , ,\ \ ,,\': ,. ' ~,'\\.... '>-'\" \. " TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIl. EASEMENT BLDG. SETBACKS _ FT. FROM CTR. 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 , Construction to comply with uniform building code and county regulations covering plumbing and sewage disposal. All buildings require a certificate of occupancy before being occupied. (See Statement on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 97401 FORM ::::C55-13 r' . . SITE I NSPECT ION ApPROVED Cl DISAPPROVED Cl DATE INSPECTOR REMARK S FOUNOATION INSPECTION ApPROVED ~I DI SAPPROVED L-I DATE fj- 2Z.-'77 INSPE{,(; REMARKS FRAMING INSPECTION ApPROVED I-nDISAPPROVED Cl DATE 9'~/2-~:T INSPECTOR REMARKS LATH OR SHEETROCK INSPECTION ApPROVED L-/ DISAPPROVED ~ DATE INSPECTOR REMARKS , --- FINAL INSPECTIO~ ApPROVED ill DISAPPROVED ~ DATE /~""?"7j INSPECTOR REMARK S 4 ~ / () -If) --'>1 M,.-m p, 11- ,f{- ,7-:; CERTIFICATE OF OCCUPANCY READY TO ISSUE ;---? NOT READY TO ISSUE Cl DATE INSPECTOR REMARKS ..rl //d. d / -(IJ-t' V .f/~ f- ~..... A II / 36't.{-13 /tIjW~7 /LI'I8' V~ .... 62 a ;l. 0- J6-0 . . LANE COUNTY B.ING PERMIT OR MOBILE HOME. APPLICATION PERMIT TYPE - BUILDING K;( MOBILE HOME Dose REG. # PERMIT # / 3S~- 73 PROPERTY OWNER -"""\ MAILING ADDRESS PHONE r , C7t~ ~ ~~J pi /A:;;)G AOD/S~ CJ 0 PROPERFY LOCATION - INCLUDE POST OFFICE ' /44(f /iJ"Ph ~1- ~U~ PROPERTY LEGAL DESCRIPTION /1 I~ A /:I ",./I , A ..f A /7 -::?.../' ~ /eTES & BOUNDS 0 YES LOT - BLOCK - SUBOIV, /1/ i'// lL /f 1#..J::..Ge- ~ - '-" "'" - / .......-'"'. ATTACHED 0 NO T/WP1 R/)~NG~ ;:,C, / TAX LOT # CODE CENSUS TRACT . ...J c.-<- ~ $/l -r-r;? /5<:::> APPLICANT I DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY ~ LEGAL ACCESS TO PROPERT"f - ROAD NAME OR # q(.f~ ~h-/~-'_..R PROPERTY SIZE-WIDTH DEPTH -AREA ..... .. , NAME ~ AND / I /J _ f.4?1../' CLd /./_ f..lA'---?/,-""",, MAILING ....- ADDRESS FOR MOBILE HOME PERMIT ONLY Number of Bedrooms STRUCTURES TO BE BUlLT THIS PERMIT -z/,.~~./../h' ~~?' c7 add //-Pf.t2- -t9~ - ..'7.....~/. ~ V /tH4Y'~ a /, ~ PHONE '7~6 - L/f/:29 Connect to Existing Sewage TYPE CONSTRUCTION ~ -;1/.1~~_ System D or New System Req. D SQ,. FT, #.J. EDRoa. MS /VAl,TION / /9~76@t2( .~/ /~~4-8 '<5t:ly. ff /lfZ3 /5~~ .Jh,"-??1",,/L'vh.~ d-/d.dJvP. SEWAGE DISPOSAL t' PUBLIC 0 SEPTIC T ANK ~ OTHER 0 BLDG. $ h..<. t9.:.o FEES WATER SUPPLY WASTE DIS. ~ ?/l. 00 PUBLIC 'g' Q.THER PLUMBING 33.:50 PLU~ING 'fEES fP'd, <<-</ PLAN REVIEW tJ FIXTURES .1~U PARK TRLR. CASH ~ER CHECK CONNECTION FEE ,..:). tL..<J II s..c.,-V PUBLIC WATER / s.d TOTAL CONNECTION FEE / /5. 05.2- , PLUMBING INSTALLED BY QQ OWNER 0 OTHER 0 NAME -'l~c--J PLANS FURNISHED I' tp'AciLITY PERMIT YES ~ NO D YEsK NO 0 Sly71;;P'!J~ ~i:j./jJ ;~)rt BY '/ - ?~;T~_; ~ITI 3 ,/ I 5'4-7-3 MIN. SEPTIC TANK CAPACITY COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED UN. FT..2....C5() TRENCH WIDTH FT. .."';>-"'OR SQUARE FEET q'Cb ~7~ s,<6t_m b ('"J~5 ib S~~L 4bo 1~,c;l-0/kI fY'-r Y'e.P'J~ T'J/rS"t b~. Y 1/. WITH OISl. BOX: GAl. TYPE OF STRUCTURE 0 "'-11 OCCU7~ BLDG. SETBACKS - FT. FROM ClR. OF ROAD RIGHT OF WAY FRONT II..~" SIDE INT. ~ SIDE EXl. ffllT~AN ~ . .[0.\1. ~LANNIP"'I!'. 7_''''_7.&'''. ~~ 7;trf/'8 ~ ,,~ I Directions to Find Property: ~ I REAR ,4.. BtoG.INSP. COPY 1 - OFFICE COpy 2 - JOURNAL COPY 3 - AUDIT Form # C55.12 ZONE / REAR YARD PUBLIC U<ll. EASEMENT USE CLASSIFICATION ) iki~~~~;J.3:~:1 (( , -, --/