HomeMy WebLinkAboutPermit Building 1973-7-24
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LANE COUNT&ILDING PERMIT OR MOBILE
BUllOING IW MH 0
MAILING ADDRESS
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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
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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
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10 PI~~lnJ FI~tur~s
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. "'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
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IRST ADDITION TO SWANK ESTATES
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(BOOK 46. PAGE 131
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BUILDING SITE EVALUATION .
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()( 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
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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
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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
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for placing, building
or constructing the following facility:
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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
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.
.
, "
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.
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Signature
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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
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LANE COU~T_~ILDING
BUILOING 0 MH 0
MAILING ADDRESS
( ',- " : ~ ! ~
PERMIT OR MOBILE Hctt USE PERMIT
PERMIT NO,
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PHONE
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CONTRACTOR
MAILING ADDRESS
PHONE
PROPERTY LOCATION -INCLUDE POST OFFICE
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PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
'n:~ ~:J ~:) :;u~, :-
TWP
RANGE
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SECTION
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TAX LOT NO.
CODE
CENSUS TRACT
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APPL.
NAME
&
MAILING
ADDRESS
EXISTING STRUCTURES ON PROPERTY
~:~'>~:~~;>~: l;~~B D(:-:)~j
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. 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
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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
.
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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
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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
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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
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. 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 ,
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Form .Approved
Budget Bureau No. 63-R0296
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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
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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_ _ _ _ _
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1-
1- _ _ _ _ _
111
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C~
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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
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(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.
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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):
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Date 1_ ILl - 7 ..,
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signature~~ ~~~
Fo~anitarian Use Only:
~Approved: System Installation
o Disapproved: Does Not Conform
Remarks:
Conforms to Current Standards
to Current Standards
q JUlIn.
,
Date:
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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.
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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
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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.
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f- ~..... A II
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....
62
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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
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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
/
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,
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 ~ ,,~
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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 )
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