The URL can be used to link to this page

Home My WebLink AboutPermit Building 1975-7-31 ~'-, >=-~ C'-:----'~.,-- '-rr~'~ vI '. "I~.. ,:.~ '. , ,~ , '.1 , . I' +-. I ..,f'; " LANE CaTV BUILDING PERMIT OR MOBIL&ME BUILDING 0 XX MH 0 MAILING ADDRESS 1690 SOUTH A STREET USE PERMIT PERMIT NO. 20'17-7"i PHONE OREGON 746-442Q PHONE , . :0;'/. '.." I . . PROPERTY OWNER JACKSON C KEPHART SPRlrlGf'IELD CONTRACTOR SAME PROPERTY LOCATION -INCLUDE POST OFFICE 1482 DEL ROlE AVENUE PROPERTY LEGAL DESCRIPTION - METES, BOUNDS VERA DELLE LOT 3 BLOCK 3 TWP RANGE SECTION 17 03 24,3..;' MAILING ADDRESS APPl. NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No. of Bedrooms TAX LOT NO. tt IJdt/ EXISTING STRUCTURES ON PROPERTY CODE CENSUS TRACT JACKSON C. KEPHART DELROSE AVENUE LEGAL ACCESS TO PROPERTY SAME NONE PROPERTY SIZE - FT. WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT, 1; BDRMS New System 0 VALUATION DwELLING 1466 0 16.10 , to'?3' hn'? (,'J '?1.h71.20 26. 27, . CO GARAGE '104 @ ,.,0 SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER 3%SURCHARGE SEPTIC TANK o $ OTHERD lIP. 00 , "'" ClO....- ,7.00 FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC 0 o OTHER PUBLIC TOTAL $ Il.~ 2'59.6'5 COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAl. 900 L1N. FT 1'50 TRENCH WIDTH FT. ~DE PTH OR SQ. FT. 300 ~ TYPE OF STRUCTURE OCCUPANCY ZONE fiRE 3 USE CLASSIFICATION PUBLIC UTll. EASEMENT ~ I~ BLDG. SETBACKS __ FT. FROM eTR. OF ROAD RIGHT OF WAY FRONT 61 /5/ J. E. SIDE INT. '1 SIDE EXT. AUTHORIZED SIGNATURE - DATE Boss BY HARBAUGH REAR DATE SHOOK/SANITARIAN 7/31/7'5 OLM BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687.4065 to schedule all required inspec\ians. All construe. tion shall comply with Uniform 8uilding 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= c S5.~J.!--,-,------~.~ ~~._ (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 ....-.,- _"~'_"_cc-,'.._r'_' I /,/fl. 1/ / , " . .. .J aNTY , .~ LANE , \ ~'-.... . BUILDING D XX PROPERTY OWNER , .JAC~;IlC!l C t'ltPi1AIlT CONTRACTOR SAME PROPERTY LOCATION -INCLUDE~POST OFFICE 1~~2 OtL~'E AVENUe PROPERTY LEGAL DESCRIPTION - METES, BOUNDS VUA Dt:!./"E LOT 3 !JLOCi'l 3 TWP RANGE SECTION 17 O~ ~. ;< BUILDING PERMIT OR MOB_HOME USE PERMIT MH D PERMIT NO. MAILING ADDRESS 16-JO SOUTH ~ SlntEf g~~I~G~Ir.~o MAILING ADDRESS 2f'hl-i"'i PHONE C:::lrcn:>l ',!;&l!!IP:.'i PHONE tJ-Ai Tv~ CODE CENSUS TRACT APPl. NAME & JACKSON C. KCPHART EXISTING STRUCTURES ON PROPERTY '1R:LntJ~~ A'lr!uUrl LEGAL ACCESS TO PROPERTY ~AMI! HOlIIi: PROPERTY SIZE - FT. MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT WIDTH DEPTH AREA Connect to Existing Sewage System D TYPE CONSTRUCTION SQ. FT. ;; BORMS New System D VALUATION ~r.LLING , '1466 () \".10 3 An., '-., Co> ~......,~~ till" _ "/;", CiA.IAGE 'ID4 () ". <0 :)Lh?~ .p'"l- ..- 26. ?n,,': c SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER 3~i$URCHARG~ . OTHERD 1 IS~. tV'l 1 m fV'l 'H.OO FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY SEPTIC TANK 0 PUBLIC 0 o OTHER PUI!,-.r TOTAL . 4.6') 2"q.6'i COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED UN. FT "I':iO TRENCH WIOTH FT. JOEPTK OR SQ. FT. :100 MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAl. 900 , TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTll. EASEMENT 1N 1Q,J BLDG. SETBACKS __ FT. FROM CTR. OF ROAD RIGHT OF WAY rillE '-I. USE ClASSIFICATION FRONT 61 SIDE INT. 'i SIDE EXT. AUTHORiZeD SIGNATURE - DATE REAR /a/ J. E. Boss BV HARBAUGH SIlOOll/!lANITARIAN 1/31/15 DATE moM BLDG. PERMIT-WHITE OFFICE COPY - WHlTE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD IMPORTANT: Coli 687-4065 to schedule all required inspections. All construe. 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) \ FORM =CSS7.13 , ' '" - ~. . (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 "''-...L..~~,-,:.........."~"""---;.-,l'-t".,,......_._,".'':_..J'"_'_~_'_ " ~.,::' ,- '!> " . . . SLAB FLOOR PLUMBING GROUNDWORK ApPROVED Cl DISAPPROVED Cl DATE INSPECTOR REMARKS ''; .. ," GAS PIPING GROUNDWORK ,. ApPROVED Cl DISAPPROVED LJ OATE INSPECTOR REMARKS r":l" ~' ROUGH PLUMB I NG ApPROVED w DISAPPROYED C1 .DAT/o '-/3-?-r"INSPECTOR~.# (/ REMARK 5 ROUGH GAS PI PI NG ApPROVED C1 DISAPPROVED Cl DATE INSPECTOR REMARK 5 FINAL PLUMBING ApPROVED LKJ DISAPPROVED Cl DATE.1-1tr }e. I NSPECTDR ~~ / REMARKS FINAL GAS PIPING ApPROVED C1 DISAPPROVED C1 DATE INSPECTOR REMARKS CERTIFICATE OF OCCUPANCY , \. READY TO ISSUE C1 NOT READY TO ISSUE / / DATE INSPECTOR REMARKS .J - .. , . LANE c1NTY BUILDING 0 BUILDING PERMIT OR MOBI~OME MH 0 MAILING ADDRESS USE PERMIT PERMIT NO. i . PROPERTY OWNER PHONE .' CONTRACTOR MAIliNG ADDRESS PHONE PROPERTY lOCATION - INCLUDE-POST OFFICE '_1 PROPERTY LEGAL DESCRIPTION - METES, BOUNDS ,- TWP RANGE SECTION ~' ,," TAX LOT NO. , ). V CODE CENSUS TRACT APPL. NAME 8. EXISTING STRUCTURES ON PROPERTY ',-- ,. '- LEGAL ACCESS TO PROPERTY , MAILING " \ PROPERTY SIZE - FT. ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT WIDTH DEPTH AREA Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. ;: BDRMS New System 0 VALUATION . (' ~ , . FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY SEWAGE DISPOSAL PUBLIC n BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK 0 OTHERD ., PUBLIC 0 o OTHER TOTAL . MIN. SEPTIC TANK CAPACITY COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FiElD REQUIRED ./,.\ WITH D]ST. BOX: GAl. lIN. FT .' TRENCH WIDTH FT. OR SQ. FT. 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 ..._,. "',. , '^ j' ,.v " BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUilDING - GREEN SANITATION - GOLDENROD Call 687-4065 to 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 occupied. (See Details on Reverse Side) f'O~M =C55-13 (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 ,. 1/ -- . \/ . \. INSPECTOR SITE INSPECTION ApPROVED ~ DISAPPROVED ~ DATE REMARKS. f) .If' '6j .A /~./Y.P/ d'~--';;'-l4L.r i"J,L, ~ 'P'~.L - /- ~ I '" (L)!I - I FOUNDATION INSPECTION ApPROVED /1/--; DISAPPROV. EO L-/ dATE r:- ,:20/';6" I~ECTOR REMARKS lJ /(5 ~.u .4I.a;Jdzt:. ~:b;Z . f'~,-~,-?' / / It A/ FRAM I NG I NSPECTI ON /V; ....O;;!~~' "JPP"J'EO, = A ,,,,-/I)- ^ W ,."",/1(, REMARKS ~ ~q. ().r",,~,I)#./ I ~ ;11.../;;-(. ~(I;-'d2 , tll LATH OR SHEETROCK INSPECTION ApPROVED LJL/ 01 SAPPROVEO 1/ ~ I(};J {) 'J DAT/l- 'J -1'.) INSPECT~' c-./,_ REMARK S FINAL INSPECTION '. 'I t .--- {j ~J} DATYk-'!// y,;; INSPECTOR ._~ ...-/' , ApPROVED ~ DISAPPROVED L::::7 REMARK S CERTIFICATE OF OCCUPANCY READY TO ISSUE L::::7 NOT READY TO ISSUE L::::7 DATE INSPECTOR REMARKS A I ///j r,r,j / /...././ h{;4 #:J.IM'1-7S ~~tlfi.2 - 2J~ I .1 'I !j , I!.!i ' 'tiil ~~ - ----------- --l I I I .~ ~ ~ ~ ~ I>- ~ I.:: Q. ... , . S T- ~ /~ \ Ij If , H SCAI.E /11,', /.0. VERA LOT 3 LANE DELLE 13LOCK 3 CO) ORE. 13UiLDEP\-JACK KEPHART P.L. {gS.oo' PLAN RI4GG - 3 \j / :/ I / / I -<?~ ,0. " f.& Os ~ I' , , /' 1/ II j I / I .I / /1 I I o~ '~ ~. .' ~ . - .' . r: . .. . " . - 3 ". I I I I I . .... \,j . . . ,,),, l.:~ 1 , , . .' ~~ IE ([; E HI [ ] Efy JUL8;; 1975 L,i;Ng COUNTY ~NVjR~NMI1J14TAL MGMT. 5(OS7-7S U.Il~U:1 THAtl . . . ( )', BuLl-ding Permit ( ) Site Inspection ( ) Ap!cat inn /In, t"JF\C7 .'PLICMIT: n/U '() 'lIIII\'!:w 1-'- AlJlJI('f S 5 jS '1C~ PHONE '- (t DATE . krr/,q;f- Pre-Permi t Invest igat ion --..------ . " -"-'.. --. LANE COUNTY PLANNING DEPARTHENT 3. 4. Required Access NOT appl icable () () ( ( ) ( ) ( ) NO NAME DATE I., Zoning Ordinance Compl,iance (Zone ) 2. Subdivision Ordinance Com I' I iance Building Site (Area, Width. Frontage, Setback) Other (see comments) ( ) ( ) ( ) ( ) j( ) ( ) 5. COMMENTS: .._--~ BUILDING INSPECTION SECTION NOT IW YES ' NAME DATE a;;p I i cab I e l..\) 6. Plans Subm i t ted ( ) ( ) ,7. Soil Stabil ity (foot ings) (P ( ) ( ) 8. Flood Plain ( ) ( ) ( ) - - 9. o the r (see Convnents) ( ) ( ) ( ) tY2P;/HP./L '1-2. Cr 1.J - " = f COMMENTS: L SANITATION SECTION NOT NO YES NME ~ app I icab I e 5\~ ~<t7S- 10. Sewage Disposal ( ) ( ) () 11. Us'ab I e Area ( ) ( ) ( ) , 2. Water Supply ( ) ( ) (') '3. o the r (see Comments) ( ) ( ) ( ) ----- COMMENTS: TO'APPLICANT: (Your BuildingPermit / Site I.nspectinn: ::11 U' Can be app roved. -:::::!JSJ ~ () Cannot be .1pproved at this time .JS inuiciltcd on item UO. <1bove. ~ ~ Quest ions and further informi"ll ion on itclTls I through 5 cont<lct the Li"lnc- I. COUNTY PLANtllNG DEPAH1I1Eln. Questi"n' ,1I1d fnrther information "n items' 6 throu!lh 13 contact the Lane County OlJi Idinq iH1d SLlllit<1tion Division. () Will be held in this office until you can resolve the problems indicated. () Is being returned. () Your buildin~ pern,lt appl ication fee is being returned under separate cover. LANE COUNTY PLANNING DIVISION 135 Sixth Avenue East, Eugene, Oregon 97401 Phone (503) 687,4186 LANE COUNTY ICNVlRONHENTAL MANAGr;;r.lENT 135 Sixth Avenue East" Eugene, Oregon 97401 Phone (503) 687-406~ C55-28 , . . . ~ , '. DtItp , . :IUI,v <1. 1Q7'i Permit No. ~?~ 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 ond is hereby issued to JACKSON C. KEPIlIART ,6QO SOUTH A STREET or constructing the following SPR I NGf I ELD facility: OREGON 97477 for placing, building VERA DELLE LOT 3 BLOCK 3 1482 DEL ROSE AVENUE SPRINGflELO OREGON 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). 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. SIDEWALKS WILL BE CONSTRUCTED IN ACCORDANCE WITH THE ATTACHED SIDEWALK SPECifiCATIONS AND ORAWING M9B-49. THE STANOARO CURe TVPES 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 JULva1, 1976 ,19_. Expires 19_. Inspected and Approved Approved by Board of County Commissioners By O.-k!. A1A.~--':~-'-A J Director of Public Works DatI" By WHITE - OFFICE FILE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUILDING & SANITATION DEPT. YellOW - REAL ESTATE C98-79 . ~J . . .' . Date Permit No. 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 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 ", or constructing the following facility: for placing, building 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, ogreements, sfipulations 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. , ", , ,,~ ~ , ",: i ~ " 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. ~~ ) :?~ ~ z /JJ-d(' This permit shall be void unless the work herein contemplated sholl have been completed be- for,. J. 19_. Expires 19_. ,Inspected and Approved Date ,f.pproved by Board of County Commissioners By By Director of Public Works WHITE - OFFICE FILE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUILDINC & SANITATION DEPT. YELLOW - REAL ESTATE C98-79 r PROPOSED.AGE DISPOSAL SYSTEM RECORD . .... ~\.:Y~7F7~ part of form to si9nature and submit both copies with application. . . PERMIT NO......,'...... .'~iIioo- I NSTALtER: ~omplete top INSTALLER'S NAME Not 1 isted 1 /'1/L/_ /? /< /,f/JY No. Living Units 8edrooms 8aths PROPERTY ADDRESS ,'. , / /."", .:;H+S- ( DFL. I) /v,". t-':./M to" i- ill",,}.' is }fP$' k Watl!?' Supply / " Publ ic ~Other-List 8asement Yes No Septic Tank: Ft. from well Inside Lenqth OWNER NAME Steel D Ft. Diameter Depth . )~}('KC:'''''N I' K'FP,t~~lk~r -1."'6""; <-:I: ~.~."': , -'- } Dimensions: Width Concrete [Z]~. Compartments ~ . Tile Disposal Fjeld: Distribution 80x: Yes Vllo Other Distribution-Type ~\~~\) .~~~ o\CjlS . . ,?'V' ~)-{l ;,.> sS ~~~ r:.~i.. ~ c.~'\I'\" ~ D cL R. &f E\.~~~ Si~ature 'l?" _.....~\~~ ""-~L'C., CERTIFICATE OF SATISFACTORY COMPCETION ~ For Sanitarian Use Only: Date:CJ-/1-15 In accordance with 1973 Ore90n Laws Chapter 835. Section 214 this certificate is issued 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: MAILING ADDRESS . "",',. PI }'"'LP ~tnKa Length of Lines-Ft. Trench I Total Sq. I ,~t<2(t3. 4. 5. 6. Width 2 Ft~"',' 'lot Plan (see instructions): ' r !} t ) ... V <it ~ :J~ '<: I ~ I I Date --;'", /.€., /L..... Ga 1. Capaci ty / /0' (:7 (/ Feet from WEll Lot Li ne Front 1Ft. 8etween Li nes /4 Foundation Side Rear 1Ft ller IIFi ller Depth IFi Iter 8elow Tvpelrr, Above Ti Ie 21nJTi I e/..?in. 1~r ....;,;r <c;> t?rl /" r -Ai' - L CI ~ !-I('I-' 1: -1' ! ,gt'T '/' -' :... tv :(- h --) F'r-- / ~jLr-- ~ '" '" 'i n Jr !Ct:r')( I:I"'T L ",' ';"'1' ,,"".... ' -~~-!::!' '!- .( t' \ 'J S '\~ia)r's Signature L~~~UNTY STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY C55-11 PERMIT l;t?()~!;-J. '/5 ,-NOTE: NO PERMerLL BE ISSUED UN~L THIS APPLeION HAS BEEN APPROVED . ~LICAj1'ION FOR: ~ CONSTRUCTION ~ MOBILE HOME r::::=J V PLMI REVIEW r::::=J CHANGE OF OCCUPANCY C=:I \(" (!""r,~ ~~ r, \ {,,<)OS. "A" Sd.tO. \Name I Address City ( U. Zip ',~ " CONTRACTOR ~lr'-"^... rJ . Name -\. , ,. f6 r::::=J OWNER Address City O.S. REG. 0 \l \ Lo ) 7 Range 6~ Section SubdiVi.ion~ror. ,="., ~ Q 0 ' ACCESS TO PROPERTY (Road Name)"lJ, Twp. Qc/ I Lot Block ':2., \l\1)P~ Tax Lot QiY17 7 '/b-lJl/2.~ n Phone Zip Phone Code Census Tract Property Acreage Width______Depth ''3 \ 'e..Oc....e ~)~D \Y$<;) Existing Structures on Property: Property Location - Address/Directions: for Office Use Onlv~ DIl ,.e / It (, ('1 hrl~ l"Y ~7 Below SEWAGE DISPOSAL: Site Inspection # WATER SUPPLY: Well FEES: Bldg. Waste Olap. Plumbing Plan Review Mobile Home 1% Surcharge TOTAL Ue..II'f"><:'R P-ue~)~ 0 ) xxxxxxxxxxxxxxxxxxxxxx,.,r,.,rXJ:~"XXXXXXXXXXXXXu~uUuu\XXXXX 11gb f:J./blo t"?7s :'Yl</ ~ fC</) ........-' I --=-- Q vaZ(t~,hO ,?T.b7/. .2V /''''/ ~~ 0<..../ I..J Existing Sewage Disposal System ~ u;:a---- Q t.. '2. 7:S: 'tQ or New System Required ~ Spring Public Community c=J Name of Community or Public System Other If <j;--- /(X) - ~7_- PLUMBING: Installed by Owner Other [==:J Name c:::J ~3 II of Fixtures PLUMBING FEES: II .. / Sewage Connection r2 //:: FU~ o CASH ~<' L ~ECK / Signature of Applican \ Fee Received By: &if 00 'Drainf1<1<1 Required - Lineal Feet / iST) -Ov.... I"<'p'1~,~+- O'f'PA , 4. be:; ~- O!.:fJ~.l5 Maximum Depth ~ ;;;~. 65 Min. .Septic Tank Capacitv .J, eQv{> ("Ot:>_... Type of Construction / 6.1t/ Group - /GfF.;J Fire Zone Use Classification Bldg Setbacks - from Center of Road Right of Way: Front tJ Side Int. c;--- Side Exterior P:::0t ( CSS.IZ - / Rear Water Connection '1- FACILITY PERMIT Zone J<. -j DATE: 1"'-~2-7C;- LANE COUNTY ~~A1lrON: 7/'" a NE..v-;J .ftUILDING:h' X:J/f'DATE: " . II\.. ~..../ /0 ffl(J-i7-t'..('l--yfj){ ~1'::>'~~~.J v / / DE R'IMENT OF ENVIRONMENTAL MANAGEMENT