HomeMy WebLinkAboutPermit Building 1975-10-6
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.. .... " 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
,
......