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Home My WebLink AboutPermit Building 1975-5-15 , , - ~~ .,. ~- ~_... "/.- Cf) 0 /-,'7,) - 981-7') PHONE O,lEGOtl (116- ~429 PHONE ., . '\; PROPERTr.... OWNER JACIlSOf< C. I:CPIIART CONTRACTOR 3A":r PROPERTY LOCATION - INCLUDE POST OFFICE 111to llEL HOSE AVENUE NORTH 14TH PROPERTY LEGAL DESCRIPTION - METES, BOUNDS I:IE"A DELLE LOT 6 GLOCK 3 TWP RANGE SECTION J LANE COUNT....,ILDING PERMIT OR MOBILE BUilDING Q:X ,., MH 0 MAILING ADDRESS 1690 SOUTH A. MAILING ADDRESS HO,..USE PERMIT . . PERMIT NO. S?R HIGrt EL D OFf HAYDEN BRIDGE RoAD 17 3 24/3,3 TAX LOT NO. CODE :/!-szod CENSUS TRACT 20 ED-l')O APPL. NAME & MAILING ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT JACKSON C KEPHART EXISTING STRUCTURES ON PROPERTY :.ONE LEGAL ACCESS TO PROPERTY DEL ROSE AVENUE PROPERTY SIZE - FT. SAME WIDTH DEPTH AREA \ l);!ELL I NQ Connect to Existing TYPE CONSTRUCTION 1508 @l 21.80 506 @ 5.30 Sewage System 0 New System 0 SQ. FT. +: BDRMS VALUATION $32, 574.4u -L?L2e.!.:~~ $35,556.20 GI\I;AQZ SEWAGE DISPOSAL PUBLIC 0 BUilDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER lj50UFlCHARGE SEPTIC TANK o $ OTHERD 1~,).00 ')0.00 ~4.oo FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC 0 o OTHER TOTAL $ 1. 7Cl 2':lQ,7Q COUNTY BUilDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY WITH DIST. BOX, GAl. 1000 DRAIN FIELD REQUIRED UN, FT 180 TRENCH WIDTH FT.2FTOEPTH OR SQ. FT, 360 INSTALL IN ACCORDANCE WITH PLAN MARKEO INSTALLERS CO~.: TYPE OF STRUCTURE 5N OCCUPANCY Jew lONE PUBLIC UTIl. EASEMENT BLDG. SETBACKS". FT. FROM CTR. OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT 4')' SIDE INT. 5' SIDE EXT. 45' REAR 5' AUTHORIZED SIGNATURE - DATE /S/ J. [. Bos:! BY C. HArlSAUGH JOHN SHOOK/SANITARIAN DATE 5/15/75 OLM BLDG. PERMIT - WHITE OFFICE COpy - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GReEN SANITATION - GOLDENROD Call 6B7.-4065 to schedule all requited 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) F'ORM ::: C55-13 (POST THIS PERMIT ON MAIN BLDG, AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 ] T , , 'b "Ii , ~ .... .. C') ..... ..., l( I -y- .1 J ~ .. " .-- , L_U I u ,- L\ 'I r ~' .j \J \ ,,) "'11 L!~~~. CO,)OF\E, .' i3UiLDER-JACK KlPH/-\ RT --_. -- -- --------_.__.~ , 1.1. " \ I', \ \ \ . /, , 1- ,I.) lU1;'1..... /, ~/' ~-.;~~.o..;-.._-'-: J /, II .(t; !~ \ \.' . ': \J. G J ill ..,' -.l '. . I_j J"./c!"r tt"" /'PLAi\J -----------------.---.---. ELEV Pjr;;,OQ-'J ,\ '-' V L \\.BI1 P.L.lo.:'.53' <, ?03't-----'-.. . ...', 73:!p'.~____.._.__.____._.._._._____.____.___. 1 'I t_ U' , Y"-:' . . . . 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'.. 5) , ,'I r, 0~\~" , . ~ I i ":". /;' , ~; -' .;, P.l., ~;VI8' '. ,q',05' ...~ ~..L-""!,-,__"",,,,,,,_----...... '- , ~'I ...........,.. ,J. I. --"1L."""..... ........".''-'O.-~=r.~~..,..=,:.:..=..:..:-.-:::...::::..:..::...===.,::..::-_'" ":"=.0..::. '~'_=,~~=....:: ~., .;;'-::::,=~"'''-''_~=~...__'_ .-.--.-- 1160 DELROSE iWE, N ,~ ~I U r fJ~ ~tlV , '. I ! Col'/c. i .IlPPROI/I:II I " I I I I I I L... > <( , Ll.., (j)1 oi 0:1 I --.JI ~I . ~ " "-: " ~ Q.:. .. ~;!Sl-f- . . BUIL~ING SJTE EVALUATION ... ~ '8UllDING PERMIT APPLICATION NO. () SITE INSPECTION PLANNING DIVISION Not Applicable RA- () ( ) ( ) ( ) ( ) 1. 2. 3. 4. 5. Zoning Ordinance Compliance: Zone Subdivision Ordinance Compliance Required Access Building Site (Area, Width, Frontage) Other (see comments) COMMENTS: T~ 03 S ;;e.4 TAX LOT. S~: LOT: BLOCK: kPr~aY' ; CK I 0 BYdJ&.:r <f ~ Ix::;- Setbacks from cll of road: Front ~' Side Exterior ~ Setbacks from interior lines: Side 5' Rear e APPLICANT DATE No Yes () :p:, 6. ( ) t""_ ( ) r ( ) t1" ( ) ( ) PLANNING DIVISION ACTION PENDING: YES\ ) NO( ) APPLICATIONH BUILOING INSPECTION DIVISION Not ADDlicable ~~l ( ) ) 7. Plans Submitted 8. Soil Stability (footings) 9. Flood Plain 10. Other (see comments) COMMENTS: WATER POLUTION CONTROL Not Applicable ( ) ( ) 11. Meets Department of Environmental Quality Standards. 12. Other (see comments) COMMENTS: NO~ () ( ) ( ) ( ) ( ) ( ) ( ) CK'D By:lfr16~"1-"J2"~ , - .fArE" No () ( ) tVt (~) CK'D BY: ~'3J...tI.e, Jz!?'})1.., 7;- U (/ DATE ' TO APPLI CANT: ~ You~ Building I Site Inspection: /1~)~) Can be approved. rl~ I~') Cannot be approved at this time as indicated on item NO. above. ~~ \\;1r.JC{ Questions and further information on items 1 through 6 contact the LANE- ~ ;(~~ COUNTY PLANNING DIVISION. Questions and further information on items 7 through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION. ( ) Will be held in this office until you can resolve the problems indicated. ( ) Is being returned. ( ) Your building permit ap'pl ication fee is bein9~~t!-J1:'~,~d_unde~ seDa~ate CDver_ LJ"~r"\' MENT OF ~NV I RONMENTAL HANAliEM~NI 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4186 C55-28 ,~ , Dat~ . MAY 1'i, 1Q7'i ~ermitl Q81-7" CURB CUT 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.IUK~O" 1690 SOUTH A STREET SPRINGrlELO OREGON 97477 or constructing the following facility: VERRA DELLE LOT 6 BLOCK 3 I(~DIJAPT for placing, building 1460 DEL ROSE AVENUE 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 appl ication 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. 3. SID6 WALKS WILL BE CONSTRUCTED IN ACCORDANCE WITH THE ATTACHED SIDEWALK SPEClrlCATloNS AND DRAWING ~&8-49. THE STANDARD CURB TYPE SHALL BE CONSTRUCTED UNLESS OTHERWISE SPEClrIED. 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 MAY 1'i. lQ76 ,19_. Expires 19_, Inspected and Approved Approved by Board of County Commissioners By @ /IJ~ Date By Director of Public Works WHITE - OFFICE FilE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUilDING & SANITATION DEPT. YEllOW - REAL ESTATE C98-79 '~ , . " . . Permit t Dcit~ CURB CUT PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY WHEREAS, the attached applicatian 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' "1' for placing, building or constructing the following facility: 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 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. o () jr !t:. 1!~ 7- / ()J 7 6 ~ If-lil tr (l --- that This permit is revocable at any time, and will be strictly adhered specifically mentioned above is hereby authorized. to and no work other than This permit shall be void unless the work herein contemplated shall have been completed be- forp 19_. Expires ,19_. Inspected and Approved Approved by Board of County Commissioners By DatE' By Director of Public Works WHITE - OFFICE FilE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUllDINQ & SANITATION DEPT. YELLOW - REAL ESTATE C98-79 . LANE COUN1:eUILDlNG PERMIT OR MOBI~E BUilDING 0 MH 0 MAILING ADDRESS HOe USE, PERMIT PERMIT NO, ~ ~ . ' . PROPER'I t OWNER PHONE CONTRACTOR MAILING ADDRESS PHONE PROPERTY LOCATION -INCLUDE POST OFFICE , \ PRVERTY LEGAL DESCRIPTION - METES, BOUNDS TWP RANGE SECTION TAX LOT NO. CODE CENSUS TRACT APPl. NAME & MAILING ADDRESS EXISTING STRUCTURES ON PROPERTY LEGAL ACCESS TO PROPERTY \ .~ ,\~~ PROPERTY, SIZE -;- FT: WIDTH DEPTH AREA FOR MOBilE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. S; BDRMS New System 0 VALUATION '. . '\ S SEPTIC TANK 0 ....: h ' I' ~ -..\" \~ - ~ ~\;~ ~~- - "..., ~'("' . ,~~..:.. \~~....... ,', f' I....... ",.... ;:.'PLUMBING'INSTALLED~BY .. OWNElf'G] 'OTHER: NAME " WATER SUPP,LY . ," '.\- V ,-t~_~... \.. .-\, <--:-"'":' . '\ -t, ..... , " \,. ....\ '.\ J '< ..... '. ,~' '. " {.,.' ',. \ 'i:iTHERO :-;"',.;,,'r: FEES ", \~ ' SEWAGE DISPOSAL PUBLIC 0 . BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER , -, , . PUBLIC 0 o OTHER TOTAL . MIN. SEPTIC TANK CAPACITY WITH 0151. BOX: GAl. COUNTY BUilDING & SANITATION SPECIFICATIONS DRAIN FiElD REQUIRED UN. FT TRENCH WIDTH FT. ~ OR SQ. FT. ---:; TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTll. 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 Call 6B7.4065 to schedule all required inspections. All construe. tion shall comply with Uniform Building Code, D.E,Q. standards IMPORTANT: for subsurface sewage disposal an,d county regulations covering plumbing. All buildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) FORM::: C55-1) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th. EUGENE, OREGON 97401 r. . ) . . . SITE INSPECTION It .,. ApPROVED Cl DISAPPROVED Cl DATE INSPECTOR REMARKS FOUNDATION INS~ION _ _ /') ApPROVED L.!::::.j 01 SA~:ROVED ~/ DATE ~ - }./)~, 75 I NSPECTOR&....... REMARKS O/(,' -4 t 1;1"..1, 4/(~~~ ~ --12 - 7,5- ~/ '" ., t' FRAMING INSPECTION DATE !;-J,{;,-7r' INSPEC~j ad, (?t-~ () ...1r/K 12 1 ,,/ / 1'jW.uU4 ~~/""7Jf~' , - - '11 -~1___ - (1.1 : (.\ '// ~ ' ~ ....J'74~! ,/.f . -I-A#eL.- A'I~: ~ I ~SPECtON /' LATH OR SHEETROCK .' ApPROVED I:L1 DISAPPROVED REMARKS C:OJ&?V~r~ ,pl/;..,rr--"/ lu'A<;' L-/ DATE'?' -2>0-7"'- INSPECTOR "-u. ~ .I ~ ~,,!,GE /fl-,_c J'!;'. W)\-::;. ~; r-i> 1$.' " -r ..lI t<'l R...... <2-.fL d!? __ -..,.oc", p ;P~ '- FINAL INSPECTION --- r;r;::-J.?-1J/ /J;/ ApPROVEO 6DISAPP')fVED Cl DATE n INSPECTOR ~ e. /. REMARKS.~4-I"~ 8"--Y-f.5"f/:, '1l , CERTIFICATE OF OCCUPANCY READY TO ISSUE Cl NOT READY TO ISSUE ~ DATE INSPECTOR REMARKS O~ ~~t.\::;r~<J~! So ------, LANE COUNeUILDIN,G PERMIT OR MOBILE BUILDING 0., MH 0 MAlllNG ,ADDRESS ,'1&~:(I ,Oll'l',J tJ. MAILING ADDRESS I I ' I . . I H'- USE PERMIT . PERMIT NO. (,"1 '.. ,'~ 0:') PHONE PROPER'ry OWNER Set'a"'!?T ~:~nOtzCf! : t ."'';'" r- -'" ~ v....... 0...... -f!'(~ J~~',~n _ ,-..r- . ~........ CONTRACTOR ~, At'" PROPERTY LOCATION - INCLUDE POST OFFICE J!j(i) : _';~. ~2j,~,.~;: A"lCf!Uf. 'I.D.1TH ~lfi;i ");,'~~ (.AV:-CN 2n~ C'~: R~::;~ PROPERTY LEGAL DESCRIPTION - METES, BOUNDS r, ~ , ..~, "OT ,l ,;LOt~:i SECTION" PHONE " ::C!2~ ,.;'(,!.e /. TWP RANGE TAX LOT NO, CODE CENSUS TRACT 'I ( ., .'J 24 20 CG-o> . ';;) EXISTING STRUCTURES ON PROPERTY ',2l:1C LEGAL ACCESS TO PROPERTY O:!f, ':CJC twm:mi: PROPERTY SIZE - FT. APPL. NAME & MAILING ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms JACB~~l C Knp~~QT ::lr,,~E WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT I. :1r.L~.I:~~, Connect to Existing TYPE CONSTRUCTION 1;!'J8 ( 21.Gu Sewage System 0 New System 0 SQ. FT. 1: BDRMS VALUATION C32br(0.t~) Ct\~t-c:~.: ,\)6 ~i 5).30 o ,?Ji.(: .-----..........-.-_~4.=->O"~.--.-.,_____ , '--~-'r--:-;:.:~-;:..';7~- - = ) lJ~'::';;Il'Ji").c.',; SEWAGE DISPOSAL PUBLIC D BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER J: ,;;unC~t:.Rr.2 . OTHERD i 1;1; .GO q~.G(J ~r}..!j FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY SEPTIC TANK 0 PUBLIC 0 D OTHER TOTAL . 1.7') 2':\V.Y'0 COUNTY BUilDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED ,r" "" L1N. FT')\ijl:)\...:' " TRENCH WIDTH FT.2VTC::PTi1 OR'sb. FT. ..../'''' .),;..-' MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAl. 'i()(:'~ 1:;::;'!1\!.I. Ii, "(;eC~VANel: til~ll F1.<'>" meaCD 1I.3T~I.CW!::l ec..l , TYPE OF STRUCTURE ;..~, ..-'/:. OCCUPANCY 1&'; ZONE PUBLIC UTIL. EASEMENT BLDG. SETBACKS __ FT. FROM CTR, OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT SIDE INT. 5' SIDE EXT. tJ;.3~ REAR 5' AUTHORIZED SIGNATURE - DATE /oj 0. r::. ,;;;;:;0 iJ'J C. t1~;m"ooc) JOlw SHooa/Oc.t,t'i''',UI\IJ 5/Fj/F'J DATE C""...w BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 ta schedule all required inspections. All construe, 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 accupied. (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 97-401 { SLAB FLOOR . PLUMBING GROUNDWORK ApPROVED / / DISAPPROVED ~ DATE REMARKS GAS PIPING GROUNDWORK ApPROVED / / DISAPPROVED ~ DATE REMARK 5 ROUGH PLUMBING . INSPECTOR INSPECTOR .. ApPROVED /),(' / DISAPPROVED C1 DATE,c~.J ')-75 INSPECTO~.:I..-(" (/ REMARKS ROUGH GAS PIPING ApPROVED ~ DISAPPROVED ~ DATE REMARK S FINAL PLUMBING ApPROVED [Q- DISAPPROVED ~ DATE~/..;?..9t:. REMARK 5 FINAL GAS PIPING ApPROVED ~ DISAPPROVED / / DATE REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE C1 NOT READY TO ISSUE ;---? DATE REMARKS INSPECTOR I NSPEC~/h-;) INSPECTOR INSPECTOR ,~ I NSTA"LLER: Complete top P.SED SEWAGE DISPOSAL SYSTEM RECa part orm to signature and submit bo opies with applic~~lon~. PERMIT NO. 981-75 . : " INSTALLER'S NAME PROPERTY ADDRESS 1j~,(J.f)Y Bedrooms Baths /'/60 JS Art,--t No. Living Units DEL ROSE AVENUE Inside Lenqth OWNER NAME Dimensions: Width Steel 0 Ft. Diameter Basement Water Su~p'~ Yes No Public ~ther-List Concrete ~. Compartments I Gal. Capacity Tile Disposal Field: Distribution Box: Yes Other Distribution-Type /t!ldO Septic Tank: Ft. from well Depth No JACKSON KEPHART Tot~ Sq. Ft..~IJO Feet from WEll Lot Li ne Front 1Ft. Between Li nes J Jf1 Foundation HAILING ADDRESS S 1690 A SPRINGFIELD OREGON L~~th of Lines-Ft. lTrenc~ I 1f.P z(~~3. 4. 5. 6. Widt~ Plot Plan (see instructions): f1ri /1 'I ~/(J1f''t~ Side Rea r IF! llerklFi ller Depth (Filler Below Tvpe/' Above Tile2.inJrile6 in. tl"'''- ~ ,~o~' 1)-, t-- I ~ '<I ~ ~ "- ~ " t a ~ 'v ::,. / Ht)cJo "J t:.- ..~CEIYErJ MAY3 01~sQ F;\ ENV/~Z~t~~~I.N 'Y \lJGMT. 4,1 ~ " 'I' #-!, o \I -7 Iv" J /'or-7 J I I~ - J1';t:a~'rl'll Nt'fo I/'- 10 fT }O (-I ~ \II "",\- 2. 9'- 7~ Si~nature ,z,~,,-- ~ ~~.. ~,? CERTIFICATE OF SATISFACTORY COMPLETION ~ 77~ For Sanitarian Use Only: Oafu: (p -2. - r../ In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certificate is issued as evidence of satisfactory completion of a subsurface sewage disposal system at the above I ocat!..2. ~ Approved: System Installation conforms to current standards c::J Disapproved: Does not conform to current standards Remarks: I Date C55-11 ~'~~~s Signature ~ COUNTY STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY NOTE: ___ .A._. PERMIT IF NO PERMIT W~BE ISSUED UNTIL THIS APPLlCAT~HAS BEEN APPROVED crg-/-7{" ~ CONSTRUCTION (:2::J t7J OWNER '3 ~ C. Name APPLICATION FOR: MOBILE HOME CJ CJ ~~ lei, City CHANGE OF OCCUPANCY CJ .,'/ r., - L{l/.2 9 Phone PLAN REVIEW \'(' e p \..,," -\- , \1,9o S' A(' Address Cfl\[ll Zip c===J CONTRACTOR S a. "'-R..-- Name Phone 0.5. REG. 0 /7/ (~ Twp. j (,Range '5 Section:::) L{ SubdiV!S!On--.J.)D.A -'" _ 0.., f !l (, _ Lot ACCESS TO PROPERTY (Road Name) "lJe I\> n , " Address City Zip Tax Lot Census Tract ;:;) ()-FO/ 5D Code to Block '<' Property Acreage Width______Depth ~uo '-'\~0 Existing Structures on Property: "~r:>. Property Location - Address/Directions: I 't" () ~Q I ~ f? <:. ~ .A U-t' ........, p ~ _ W "" , J .\ ,,- 'l?,,, ~ c-l c. <' <j:;> ~ ...d N , I -.jU o.f-f- Below fa r Of f ice Us e On1 vxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxxxXXXXXXXXXXXXXXXXXXXXXXXXXJOC1rY~r~nr~rV,rxxxxxxxxxxxxxxxxxxxxxxx () _ /7/7, '- ..., Sq. F:...~ .:)1, (('D i}Bedrooms Valuation ~ /:stJ~.fO .... "=':J (3) .3 .:tf 7'?', va A"A~s.l~ ,rz;>C;-<el." .tJ6r;./. ~ \;r-' t? .., :3 ~-.s-,J G' .:L () SEWAGE DISPOSAL: Site Inspection U WATER SUPPLY: Well Spring FEES: Bldg. Waste Dlsp. Plumbing Plan Reviel" Itls-' vO ,<((),/J() ;? '-'.aO Mobile Home 1% Surcharge 1.79 TOTAL .;) 30' 7 'L Min. Septic Tank Capacity .J:.", I~/I 'n r Type of Construction ,.,5' AI Existing Sewage Disposal System C=:l or New System Required ,~ Other Public C=:J Community (1'5<(1 Name of Community or Public system~~~ .-,' Other C=:J Name~ Sewage 7 Water Connect16n &') Connection C) / 0.'. C<I , PLANS FURNISHED FACILITY PERMIT ~ y( c:J NO ..M YES c===J NO Signature of APPlican~:,v, kL.:J~^-r:- th,~ Feyeceived BY:-.p..e.A- _ Date: 4/-;;19'- ?,- , Dralnfield Required - Lineal Feet J P( 0 Maximum Depth uNDr,,^cp r..J;;.t fj" ""'drj.~f) /7:'nAI../k,,,. "- .. PLUMBING: Installed by Owner C=:J PLUMBING FEES: /0 II of Fixtures o CASH /' ~ CHECK /0 () 0 Group !~ Fire Zone Use Classification BIdg Setbacks - from Center of Road Right of Way: Front 45" Side Int. 5' Side Exterior 4!:;;' ;m,r 4.//ZQh5 DATE: I CS5.12 LANE Rear. 5' Zone RA 2Pi SANITATIJlN: .19/.., DATE: A.JI BUIl~ING.0;,1 _ DATE: V' hf S/-4-0.J~t['M....7~nrlJ44.d1/lt:&. \5 . /).. -?'d rJ 'f11 ;- COUNTY DEPARTMENT OF ENVIRONMENlIIAL MANAGEME&T