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HomeMy WebLinkAboutPermit Building 1975-10-6 r~~ ,k:':;., ,;:'/k/1 f: J' ',", r- ~- \ _ .. .... " LANE ,8If..!TY u ~. BUilDING ,r.;] PROPERTY OWNER BUILDING PERMIT OR MOBIL_OME MH 0 MAILING ADDRESS ;J C?flo -7 S-' USE PERMIT PERMIT NO, ")1'+11 2670-75 PHONE f(op.~~:ct Rn f 1 nn~r. CO~TRACTOR 1 ~Q_n ,S{\urh flAil ~~1'*OAr MAILING ADDRESS ~r~fn~f4Al~; 01'*0_ 7h."'_h.h.?O PHONE Same as above PROPERTY LOCATION -INCLUDE POST OFFICE O.S. REG. # 1716 Ver~ Dells Subdivision PROPERTY LEGAL DESCRIPTION - METES, BOUNDS Delrose off North 14th off Hafden Bridge Road. TWP RANGE SECTION TAX LOT NO. -#-/h;t() - EXISTING STRUCTURES ON PROPERTY Lot 2 Block 3 1490 Delrose CODE CENSUS TRACT 17 03 24,3, ;J., APPl. NAME & MAILING l(ephart Builders 1690 South "A" Street None LEGAL ACCESS TO PROPERTY /l{qo Dalrose Avenue PROPERTY SIZE - FT. I ADDRESS Sprl:ngfield. Oregon FOR MOBilE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT 97477 WIDTH DEPTH AREA Connect to Existing Sewage System 0 TYPE CONSTRUCTION 50. FT. +:: BORMS New System 0 VALUATION LMe11 ing 1501 () 21.30 32.721.ao Guru -'0 563 ru 5.30 "/""""rl1 ~:nhC:lI,..fr:l"'_f01 Q~U'::ae\ tlit.:.nn~Al t::.'\7c:tt-t:lm {'n 21,7li3.':lO 35.705.70 .sit.e innuect.ion 75-751 SEWAGE DISPOSAL nevI PUBLIC 0 SEPTIC TANK IKI BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER Surcharge TOTAL . GY:ltem required OTHERD 1h.~_00 FEES ?~_OO '\1..._00 PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC D[J{ D OTHER $_ ~_'\7 ?OQ.'\7 COUNTY Plumbinfl ~2.00 - \klter Connection ~2.00 - Sawer Connection MIN. SEPTIC TANK CAPACITY WITH OIST. BOX: GAl. BUilDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED maximum depth 24 inc!:les ,,00 L1N. FT 150 TRENCH WIDTH FT. OR SQ. FT. 300 TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTll. EASEMENT 5N I and J BLDG. SETBACKS.. FT. FROM CTR. OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT SIDE INT. 5' SIDfi,,6XT. AUTHORIZED SIGNATURE - DATE fA f .In).n 1':. Bn"s f Clwrlcs lJarbaut!h DATE {,5' REAR 7' P.U.E. Zone RA John H. Shook. R.S. Igfl Oct. 6. 1\175 BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule all required inspections, All canstruc. tion shall camply 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 := C 55" q (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 BUILc1N'G-,'SITE EVALUATION. #-- '/;1;. R S ~ ~, SUBDIVISION: (-) BUILDING PERMIT APPLICATION NO. LOT: () SITE INSPECTION PLANNING DIVISION Not AE'plicable ~() ( ) ( ) ( ) ( ) 1. Zoning Ordinance Compliance: Zone 2. Subdivision Ordinance Compliance 3. Required Access 4. Building Site (Area, Width, Frontage) 5. Other (see comments) COMMENTS: _.~ PLANN I NG D I V I S I ON ACT I ON -PE'"t4D I NG: reS( } NllTJ APPLI CATI 0N# . BUILDING INSPECTION DIVISION Not Appl icable ( ) ~R (( ) 7. Plans Submitted 8. Soil Stability (footings) 9. Flood Plain 10. Other (see comments) COMMENTS: WATER POLUTION CONTROL Not Applicable ( ) ( ) II. Meets Department of Environmental Quality Standards. 12. Other (see comments) COMMENTS: TAX LOT BLOCK: APPL I CANT DATE No es () ( ) ( ( ) ( ( ) ( ( ) ( CK'D By:N~. '7-2..-3 -Th- Setbacks from ell of road: Front Side Exterior Setbacks from interior lines: Side Rear 6. No ~ () () ) ( ) ( ) ( ) ( ) CK'D Byd~.?~..Jo-~ f/ DATE No Yes () T1> ( ) (() ",,,y,~~ ~-zr'7 C DATE TO APPLI CANT: Your Building I Site Inspection: ~Can be approved. ,~ ( ) Cannot be approved at this time as indicated on item NO. above. Jer 1/'1i?~ Questions and further information on items 1 through 6 contact the LANE- f' 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 appl iC~!.t.2!' fee is bein.q..~'iltur::ned under separate cover_ DEPARTMENT OF ENVIRONMENTAL MANAuEM~NI 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4186 C55-28 "' BUILDING EVALUATION. PERMIT APPLICATION NO. T. R S SUBDIVISION: LOT: TAX LOT BU U.O'iNG~ SITE " ( .,) ( ) BLOCK: SITE I NSPECTI ON . APPL I CANT DATE PLANNING DIVISION Not App 1 icab 1 e No Yes CK'D BY: . . 1. Zoning Ordinance Compliance: Zone ,-, '.. ( ) T)TI 6. Setbacks from ell of road: 2. Subdivision Ordinance Compliance ( ) ( ) ( ) Front 3. Required Access ( ) ( ) () Side Exterior 4. Building Site (Area. Width, Fr?nt~ge) . ( ) ( ) ( ) Setbacks from inter i or lines: 5. Other (see comments) - ;. ~,~ ,,( ) ( ) ( ) Side Rear COMMENTS: ,,- /'1 I~' .. = PLANNING DIVISION ACTION PENDING: YES{ 1 NO{ 1 APPLlCATlONH BUILDING INSPECTION DIVISION Not Appl icable ( ) ( :) ( )) ( ) No Yes T)Vf ( ) '< ) ( ) ( ) ( ) ( ) CK'D' BY:: ., ,.;/ 1/ I -". " . 7. Plans Submitted 8. Soil Stability (footings) 9. Flood Plain 10. Other (see comments) DATE COMMENTS: WATER POLUTION CONTROL Not App 1 icab 1 e ( ) ( ) No Yes T)TI I ( ) (') " II. Meets Department of Environmental Quality Standards. 12. Other (see comments) CK'D l,/i i\i BY: ,II" 1- , I DATE COMMENTS: , " TO APPLICANT: Your Building I Site Inspection: {')"Can be approved. " '( ) Cannot be approved at th i s time as I nd i cated on item NO. above. .,~ , Quest ions and further i nformat i on on items I 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 aEplication fee is peinq ~~tu~~~d_under seoarat~ver. OEPARTMENT OF fNVIRONMEN1AL MANAIiEMioNI 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687~4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4186 C55-28 '~ , . LANE COUNTY BUILDING 0 . BUILDING PERMIT OR MOBILE HOME MH '0 MAILING ADDRESS /~ . " USE PERMIT PERMIT ',NO, PROPERTY OWNER PHONE CONTRACTOR MAILING ADDRESS PHONE ,~ ,J , , 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 & lEGAL ACCESS TO PROPERTY -, '. MAILING '~, ~ \ , PR~PERT~, S~ZE - FT. ~ _:.'\~_ \. WIDTH DEPTH " \'.... .\ \... ..). ADDRESS . t FOR MOBILE HOME ,EERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT \'~\ - '(. \ >- ~.:-\~~ ~)::-'~ ~ -"~. AREA " 'Z, ~, \'.. , Connect to' Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. ;: BDRMS New System 0 VALUATION \~ \.,,~~~,,~~~ ~"\, ~\- \ " ---, - ;:~-:_'.'\ -S..s - ~ \ ~";:''1~\~\~\) , '~.::.. - ~..l: - '\ - \ ~ ,\,,-,.C ~~C\':: "t-- "'-I'l-" , PLUMBING INSTALLED BY SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAilER SEPTIC TANK 0 OTHERO , FEES OWNER 0 OTHER: NAME WATER SUPPLY \'. --J .r ,\. 'j\ - '\&::),\ PUBLIC [J o OTHER '~ TOTAL , MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FiElD REQUIRED tiN. FT TRENCH WIDTH FT. OR SQ. FT. ~'-' " ~, \ ,,, \,\~ '~'l\,,( - '(''\~~~~ "Y\~\ ~ '-'~~~~ ~~;\~'~~", \" '\. \ '\ 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 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) , Il I'nAM == rtt. 11 (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE eOUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX. 135 EAST 6th. EUGENE. OREGON 97401 r . . " . SITE I NSPECTI ON ApPROVED Cl DISAPPROVED Cl DATE INSPECTOR REMARKS FOUNDATION INSPECTION d: /- 11'-' H ~ APPROVED.LE7. DISAPPROVED / / DATE, j;/lL, INSPECT '" REMARKS/jI4~f{, If);/~"'/~O:(~/_ A 02,1 f?J /'l n 1'.7 AU" ? /'~.,./ / n.. / t.1 ~Y'~ tc-Z', c'" ~1- - " , :' //1 .E') ~ ,1./)11 (f; A f/J "'!.' d'ct.t..t<-(;jC'o-f I i,~ :7 , 7 (j f(.~/_ ('-';; (- FRAMING INSP~ION ');,/L,..",/ ApPROVED .ct; DISAPP;~OVE/ 0 '~ATE t ,-~ '1v lHr..!tJ!f".~~ fJ ( REMARKS dlhilll -:: r:f!/;?A '1/ t7tV~1 / 2 . Z '2, - 7<3 t,:?/~ /A-r.~r'.d fi.b/R.u-:r r-iLu. i-I - ?J.... " ::::.:.( LATH OR SHEETROCK INSPECTION U .d ApPROVED ~ISAPPROVED 1/ DATE//C)2/--7&INSPECTO{L/,f.' r!? I REMARK S ;; FINAL INSPECTION f1:?~ ~ / ~/ V -0 I.. ApPROVED ~iJISAPPR9VED C1 OATE3-,/' /~J INSPECT / C::::-, . REMARKS A ~?'~ltiJ t<J.IHIlLiJ~, J ~~:J. r"?1df' (ij..l , I n p . I;' r . . .. I 0/( 4/.eU.' "':\ "/1 . -)", CERTIFICATE OF OCCUPANCY READY TO ISSUE Cl NOT READY TO ISSUE C1 DATE INSPECTOR REMARK S /) // /'l / (// , " / ,A" P ~P'/A".AI ~V ....r...-~ 7/ 02~'}(}-7.s- IrL../W / fro - I)~~ j - ~~;~,........,qi!"~' , J(" ,~.f} " ".'~ LANEclNT;"B~ILDING PERMIT OR MOBI'HOME BUILDING ,r:;] MH 0 MAILING ADDRESS 7 , PROPERTY OWNER USE PERMIT PERMIT ,NO, ',,/41.+11 L2,;}H)'J PHONE :"'0 ":;",'2 ~.r1"'-_~(:I 11;"~:\ "':,r'a~""'~l. n' II Po' .tr'1-~1P. MAILING ADDRESS ,~"....{j'~.,.C.~~1r1..,. """':........ 7t'.'~....(~b..?\~ PHONE CONTRACTOR J!'T..D C:) c.~~l.ro PROPERTY LOCATION - INCLUDE POST OffICE Octt). 2..::~J~ ,) :i71.6 Va~'.., llelt.J ':~'j~......:~~: i:':'r:~ L~!. 2 n~cc~;, ~ PROPERTY LEGAL DESCRIPTION - METES, BOUNDS 4".''-1:!-.:0':3 O~:.: &.:cr~.t",,:# l/;"~~ tJ::: ~ ""Jall [:;i.(~:;\, L~")':'U. TWP RANGE SECTION TAX LOT NO. l(.;';:) !!..J;\f;C:.:':"l CODE CENSUS TRACT ~ 17 " V.l t.,~ APPl. NAME & MAILING ADDRESS l.~ ~)44':'i:t l.:~j.~t(:';:;J EXISTING STRUCTURES ON PROPERTY Ua~; LEGAL ACCESS TO PROPERTY ~~':() ~~~.L~:~ li:~'.P ~;t;J~~:1~ ~~~!;~:l~ l_4~:'X:::_'O PROPERTY SIZE - FT. 0...... .~. : .~, 'h~t L:~' .:.;tr.:. 'J'~v'i . 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 sa. FT. 1; BDRMS New System q VALUATION d,.~~.t.L'..:..~- . ~:'-;~;. "": .,..... ........ &~ ~.' , .J' ~ ,.c,,~ f I,..~~ , ~ :"4\~" : .,~~ 3.:1) :;~le ~--.;. ~ '.::-"::::'_;~~.l '~'~1'~"'f"';:":'~ ~"'. 1."~-~ (>,1 'o:<".'r.,:k. ~'''~1'!,~~.n~:'\ ("',' ~- ...,..,.,," '," ., . ..:..ao. v.i..., H.' t~,~ ;:'1::~"'. ,. SEWAGE DISPOSAL ".:u.J I , OTHERO ::,t ~__"I.;~' ; FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBliC 0 BUILDING 'WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER ,,:,) SEPTIC TANK 0 ::~^ ;~',j :-:::.:.i~;:;d :' ~~.,""'~ PUBLIC D:..'} o OTHER .,' ,....-, . \.. L ~, J >.~~.... ",.t .;.,_, ~..--~ ......i..:.:......_l.L,2 ~_",'JI t)2va) t_ ::::~ JJ::.:."~ J.~~ii.C1 oJ: 0 e3 "" ~.:.~::' -: ?::-~~. -:3~~<:~~ TOTAL , 'l \".::rj,' COUNTY BUILDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL. " .....~' " L1N. FT " , '~v--J " r ~'--:, J-i..::.. _: ,":".J ..:"":, TRENCH WIDTH FT. :... :~,). '--"~) DRAIN FIELD REQUIRED OR SQ'. FT. :'::0 TYPE OF STRUCTURE c-' OCCUPANCY ZONE PUBLIC UTIL. EASEMENT l: I--:-':,"v J BLDG. SETBACKS _. FT. FROM CTR. OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT (.;;;' SIDE INT, .:.i 3 SIDEc'EXT. AUTHORIZED SIGNATURE - DATE REAR ';" r .U.J.-;. 604~ oA (.:1 t'~'f'0:) .~o J"-::~;l'~ i ~~"'l.'~';/1 j " . .L .,:.: 47" . '1 Jc.=. tl. :;>::t~~:D LLel1. 1:/-1 4:::;1;'. C~ DATE ;'~7.. 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 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) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY. DEPT. OF ENVIRONMENTAL MANAGEMENT \ COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97-401 F'ORM ::: CSS"13 /, . SLAB FLOOR PLUMBING GROUNDWORK ApPROVED /7 DISAPPROVED Cl DATE REMARKS GAS PIPING GROUNDWORK ApPROVED Cl DISAPPROVED / / DATE REMARKS ROUGH PLUMB I NG ApPROVED LK1 DISAPPROVED Cl DATE '2 ~J'c-')G. REMARKS ROUGH GAS PIPING ApPROVED Cl DISAPPROVED Cl DATE REMARKS FINAL PLUMBING ApPROVED ~ISAPPROVEO Cl DATE~-~-'I'~ J 4(0 _?" REMARKS FINAL GAS PIPING ApPROVED ~ DISAPPROVED ~ DATE REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE ~ NOT READY TO ISSUE I / DATE REMARKS . INSPECTOR INSP.ECTOR INSPECTOR~r INSPECTOR INSPE~c..~ ~~~.4~;} INSPECTOR INSPECTOR , ... . INSTALLER: Complete top INSTALLER'S NAME "'Jif'/\ No. Living Units ~ (.(4:0 V Bedr60ms Septic Tank: Ft. from well Steel 0 Ft. Diameter Inside Len~th OWNER NAME Dimensions: Width Kephart Builders .' PROPOSE.WAGE DISPOSAL SYSTEM RECORD .. . ~\ part of form to signature and submit both copltP'with appl ication. '. PERMIT NO. 2670-75 . John Shook . PROPERTY ADDRESS 1490 Delrose Basement \ Water Supp~ Yes No Publ ic ,V-Other-List Concrete ~ Compartments ,I' Gal. Capacity Ti Ie Disposal Field: ,~ Depth Distribution Box: Yes ~ No Other Distribution-Type Baths /OCPCJ 97477 Total Sg. Ft. '?I?() Feet from WEll Lot Li ne Front 1Ft. Between Lines /d Rear IFllle'j Below inlTlle/~ln. HAILING ADDRESS 1690 South "A" Street Foundation /hEI/?OU Sianature -(L~ ?t'~1..........e.4 CERTIFICATE OF SATISFACJ.aRY COMPLETION '-I'" For Sanitarian Use Only: ~ In accordance with 1973 Oregon Laws Chapter 835. Seetion 214 this certificate as evidence of satisfactory eompletion of a subsurface sewage disposal system locat Ion. ~Approved: System Installation conforms to current standards c::J Disapproved: Does not confonn to current standards Remarks: ' Sorin\,fi'A ld. Ore~on Length~f Lines-Ft. ITrenc~1 ''.3~Z:1 3. 4. 5. 6. Width.L.! :'Iot Plan (see instructions): l'rJ ~1 If ~ IE ~ V ~ J l$, , tv' ""fWW 1 '-: 1975 VINE COUNTY eNV,lllONMENTAL MGMT. Date C55 -11 Side IFi lleLk-IFi ller Depth TVDe r2. Above T i 1 e..:) 1 -~ .- -------- / / ! \ / ; I' ~ S~ jV pi IV \)t " ~ ~-4 .-" "- '0 '1'1' ~ - - ~.._~ TI'T t.'lff <:'7 Date: 11-11.(-7)' is issued at the above ~~ Sanitarian's Signat~ LANE COUNTY f/ STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY . NOTE: NO peT WILL BE ;;?C, 70, Zr-~ ld&- 7 S'~ . PEIMit If ISSUED UNTIL THIS A CATION HAS BEEN APPROVED APPLICATION FOR: v/ p6 C=:J CONSTRUCTION ~ MOBILE HOME c====J OWNER \<Ce "\,.,, yo +- ~..' \~" ",s. \(.,qr) , Name Address PLAN REVIEW c====J .)~/J, Cit~ CHANGE OF OCCUPANCY c::=J S "A" Cf7\f17 Zip 7lf t., - L/ i.f 21 Phone CONTRACTOR I, C;-iA.h-..L. Name ,.,r L \, n ~,.." Address City Zip Phone I O,S. REG. n I, I ~ / I Twp, n Range b =) Section d I , I Subdivision \)p .v-~ '\'\D Q 12 " Lot ACCESS TO PROPERTY (Road N':::> "D'!.I r"'O's-P Tax Lot Code Census Tract ~ Block ~ Y-l oJ 0 Property Acreage Width_Depth Existing Structures on Property: VI O~~ Property Location - Address/Directions: ~ f trn.s ...f? ~y~J,..._,,- 1200 rl, , ' r ",-C,{:' IV IVti o{:.(2 d-L . ~ rI , J /LfC{O ~~ Below fo r Of fIe e Use Onl vXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXlOOCXXXJCXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX ~ \ t. Sq, Ft. '7/ D~ ) Valuation I l 'AJ-Q IAQ I ~I (6)~. l~ '=<. g-::;,7:l . go ~ ~w; -A ,...1 t~ @ ,<~ ...:;fqK'<:m r-.---Y-n ~ ~ J '"=""U..:s 5 f") '7n<'7C SEWAiE-'DIsfciS-AL: - - r-----:.-:.-- Site Inspection fJ7~-!<1 Existing Sewage Disposal System C=:J or New System Required ~ WATER SUPPLY: Public ~ Well Spring ______ Other Community c====J Name of Community or Public System FEES: Bldg. Waste Disp. Plumbing Plan Review /Lj< - f) ~. an 3'-/ - PLUMBING: Installed by Owner c====J @3 /I of Fixtures Other c====J Name TOTAL f)'.7 , I...r'~ . . /_. I PLUMBING FEES: =~\ Sewage Connec tion Q Water Connection L Mobile Home 1% Surcharge PLANS FURNISHED FACILITY PERMIT ~c====J c2D~3-1 ~ Signature of c====J YES ~ ~ fL~. '" "'l'h '~~"D' ~-::q4-;7~-/ ' -. - .'1 "I Maximum Depth I Min. Septic Tank Capacity q Dh Drainfiald Required - Li7'';t / $'-r) Type of Construction - . , b If/ Group .1 '7t:..7 Fire Zone Use Classification Bldg Setbacks - from Center of Road Right of Way: Front.4-~ Side Int. :5 S'l11o:: E..t~d.g,r Rear J ( PI/I;: , I"=.A. C55.12 LANE COUNTY ~'Y-~: DATE: ~ING: _ A ~~f, ~ ~ ~ -2'1-7.... '3O~<-bV",.,(~Zfj'-:t'f)'-~/.,;'. DE ENT OF ENVIRONMENTAL ~G~ENT / PIANNITt~ DATE: q...?_<!"'-15 , ......