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Home My WebLink AboutPermit Building 1975-12-24 . , .; ," . LANE COUNTY PERMIT F. PERMIT NO. 3268-7] 0.'. , . ,. CONSTRUCTION [yJ MOBILE HOME [J PLAN REVIEW [] CHANGE OF OCCUPANCY [ ] DOwner :',f."?t1A'1T Ru I LnJ:'RS NAME lGQo SOUTH 'A' ST. ADDRESS Spn'NGflELO, OnEGO~ 74G-4~20 CITY ZIP COOE PHONE o Contractor NAME O.S. Reg. # l?lh AOORESS CITY ZIP COOE PHONE Twp ': Range n':l Section .. :;>11. ~,-ax Lot /0 7~tJ-() Codp Census Tract Subdivision \I~""A '::':'_' ': 1Cl'l'Lot 1:;> Block Acreage Width Access to Property (R oad Name I: 1~'S- nr-. nnr.ro ^,,~ C::oo I "_H'l~ I ~I n nDlt"~"1\,1 Depth Existing Structures on Property: ",,'H,.. Directions to Property. Address: STRUCTURE 1# BEDROOMS) 3 SO. FT. lllRl1 ('?1 An hP.n ~ ':In - ;;. VALUATION .:::,':It:;l :;>n - :;>')U,h nn :HI. KO" ?n - -.. - f"'It....... ....... ~II.........,. BUILDING PLUMBING 3% SURCHARGF MOBILE HOM" WASTE DISPOSAL PLAN REVIEW SEWAGE DISPOSAL: 75-242 PUBLIC [] SEPTIC TANK [>II 142.00 j(.w ,.j( OTHER [ 1 PLUMBING INSTALLED BY: OWNER [J OTHER [J NAM" WATER SUPPLY: PROPOSED [ ] EXISTING [J [ J PUBLIC [ ] COMMUNITY. NAME: [ ] PRIVATE WELL [ ] OTHER. SPECIFY: (').00 TOTAL c5y.j( CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS MIN. SEPTIC TANK CAPACITY: GALS. ann MIN. DRAINFIELD l"n L1N. FT. MAX. TRENCH DEPTH ":lr- INCHES It-O<:lIA.' It, APDpnurn 'l2.r:'A C11"...V 1n J:'rf."'I" f."DnU unlt~1! AMn DDnO~DTV IlaJe-c::t r.?r.-~e-f)\l1:' t\ 01:'01 A("r"'t1.-tlT An-" I\:P....O no.. IMI:'II:."I n TYPE OF CONSTRUCTION '''' GROUP I p, I FIRE ZON" STAY 100' FROM ALL WELLS USE CLASSIF. SETBACKS. FT. FROM CTR. OF r!W: FRONT SO -' SIDE EXT. FT. FROM PROP. LINE: SIDE INT. 'i REAR ') ZON" RA AUTHORIZED SIGNATURES: /s/ _ _ I unL\Of Ult"'lf"'~''''' I"''' ''''''1 ISSUANCE DATE: , - v _""'_ .... ~ ,. ~ 0' LJ"'~-.1 LJI ...."#'I'~...;..... ,~"........v...... ..... ....." .~-- .- --. I..' U' BLDG. PERMIT - WHITE . OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUiLDING - GREEN SANITATION - GOLDENROD IMPORTANT: Call 687-4065 10 schedule all required construction inspections. Call 687-4061 to schedule all required ';2"--' septic system inspections. All construction shall comply with the State Buidling Code. D.E.Q. standards r-.../ lor subsurface sewage disposal and the State Plumbing Code, All buildings require a certificate 01 ~ occupancy before being occupied. (See Details on Reverse Side) (POST THIS PERMIT ON MAIN BLDG, AT SITE) C55.13 LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX. 135 EAST 6th, EUGENE, OREGON 97401 . . . . r -r- . 1 I , .... '" i- n 1- A,,- o 1'). ,. p " >/) .. t: S T:: P _A \j -'-_.'-~--- . _ .1,. " ltt SCALE 'It.._";.I-C ., VERA DELLE ISTADDITION LOTI2 BLOCK I. L/~NE CO,} ORE. 13 UI LDE R -- JACK __> __,,___ __ ,..~~.._____....4 _.___ ..... .__ . KEPHART PLAN R1424-1 151 9 DEL R.Q"J . .}'.~P.~.iJC_._. 'IJ!!i'I~!~ I. . ..:;,J~"il ! :,' -- 'lfl'I'ld'.I' -- . :1') '.'--~..: ~ll~lfM HI'-' '. . _ __'-:;;':.Jf:i, ' Il..' ,j -\ I ,\,j Ii j: , "p., '".", " .1: )11'1 ::ti:;)':{ill :;,: ;_:,': ,; II . 'Jl.i~ ~ t..;. ( ,., :'ii " ~ ." III ' . \. I K,,~I:! ;:',:::::1.": ! Ili!!!,i!,. I~ :'-L-:- ,.' .' . J. ~:',;l ;J . ,!i'-i>l"':':.' : ;1:,"'," i: 7' . ,,, . ..",,1 !.. ,. t";,, .':1':' '! ~ '" .j',. ';.i. .. " . " '., . f.,! ,1.,,__ ~:'. . ,':, :;:;' j 1;,1' 1,. , . j '_ .; . 1:,,' I!, ,r:;.J' :'.,'I~;j 'I! ':_' :'j . "''''''1' ,'!'I"','1(1,'. . I I. ", -::, i,',,'; t'l: :"Ii l'~'" . , ; . ,."I~ -"'11:' '!'Il, "_' r i 'W: .; ,"'j',,<.1 "i. .j~ . Y"-'''--- .' ... .-"" ' .' .. " ' . ~q'.O'~ ~'~~-~O"~'-~ /~O .;!IL su,;{ ~/ ' 'TMI-, 1 ~ ' / . " ... \.~. ~ I , " CONt OP.WE ,> ,; " " .; t!'. "" . I I - I "'....I:~'..'.".:'~,.,..,..,. :.ill.:f. fill 'l 'I. 'II J l,' \" L ,P,' ~ ' . !.I ':::iH' ~ ...; :J, !"I f~>:1 ;,; . :!~ 1'; . ,{;,~';:: -i.~.;.~, ;>.;~:,:: n Ii . ,:. ' - , ';'\'.1 " - ,,-' .,,..,,, -,~'~'~'-""':t-' 'r-:-.:-'. . l.__2' I .", . ,',' . . 1lI <) C , ... 'l. r;1to~5~~ '- --- P.l. "'t'>. P>S' I .. " 'l L' I , I !I .1 1 'I . f'L. 'eC~'Ost " ~lAeLI<" u.1ll't'i \:.!\;>CMCiIIT \ I l! {~ , t.:. ~ ci ;, .,. ~ . . RECEIVED By DEC191975 LANE COUNTY ENVIRONMENTAL MGMT. 3:2? S"- 70- . . BUILDING'SITE y~ eft NO. ~"Z. Go8...1S EVALUATION. PERMIT APPLICATION ( >" 'PUILDING () SITE INSPECTION PLANNING DIVISION Not . ~~Iicab'e 1. Zoning Ordinance Compliance: Zone~l ) 2. Subdivision Ordinance Compliance ( ) 3. Requi red Access ( ) 4. Building Site (Area, Width, Frontage) ( ) 5. Other (see comments) ( ) COMMENTS: T.' Ro3 S?J.J TAX LOT S.VISION: Ye.",,\~ /Sf Ai,,] LOT: I'l..- BLOCK: I APPLlCANT~.j... ~IIJf/r~ DATE No Yes () (i) 6. ( ) (IC) ( ) (JQ () ~ ( ) ( ) PLANNING DIVISION ACTION PENDING: YES\ ) NOl ) APPLICATIONH BUILDING INSPECTION DIVISION Not Appl icable l ) ~t> 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 Yes () 17r ( ) ( ) ( ) ( ) ( ) ( ) No Yes ()W- ( ) ( ) CK'D BY: ~ Setbacks from ell of road: Front ~' Side Exterior Setbacks from interior lines: Side ~ Rear ."5 ' CK'D BY&Z~~ ATE / .;2-,29-'?J - CK'D B~) d.cr /;)-2J..7r- U DATE TO APPLICANT: Your Building I Site Inspection: ~an be approved. ~ ~() Cannot be approved at this time as indicated on item NO. above. ~Ll:1:; 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 appl ica!.i.E!!..Jeus._~einq.x~t\l.r:!:l~d undM,. separate cover. OEPARTMENT OF ENVIRONMEUIAL MANAuc~cN' 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4186 C55-28 . " 'I . '.. , . ..(-1"'/'1 .' . BU.IL.~I,N.G:S,.ITE.E_VALUATION. 'p'~.', '----'I, ~ ' "~");' /,3 d'J= ( )"'ilUILDING P'ERMIT APPLICATION NO. ';.} e;~VO'.!~ () SITE INSPECTION I PLANNING DIVISION Not Applicable II ,i}"o l ) ,. () ( ) ( ) ( ) 1. 2. 3. 4. 5. Zoning Ordinance Compliance: Zone Subdivision Ordinance Compliance- Required Access Building Site (Area, Width, Frontage) Other (see comments) COMMENTS: Te' '/ R c2j S -;~!-! TAX LOT S. VISION: l/p..,." ,;"11c. h+ A LOT: J '... BLOCK: I APPLICANT :"<(1\;' ,("'7'~' t~L1! . {,~ DATE No Yes () (Ji) 6. ( ) (!() ( ) ()() ( ) (<) ( ) ( ) PLANNING DIVISION ACTION PENDING: YES\ ). NO\ ) APPLICATION# , / Not / Appl icable/No Yes l) ()"Gtr. ,,:;r' //1/. f,L /fr,/ ,;.:-. Cf,) . '( ) ( ) -' / BUILDING INSPECTION DIVISION Not Appl icable l ) ( ,) (!~ ( ) 7. Plans Submitted 8. Soil Stability (footings) 9. Flood Plain 10. Other (see comments) COMMENTS: WATER POLUTION CONTROL 11. Meets Department of Eriv,l~onmental fv v Quelj;y, Standards. , .O~~er/ts,ee, commentJ'~Go">.I/"".0. f'k,.'a. f 12. /.; . COMMENTS':. , / / No Yes () 1ff ( ) ( ) ( ) ( ) ( ) ( ) /' .. CK'D BY: <;;.~,.)\j~ Setbacks from cll of road: Front ~o Side Exterior -"-' Setbacks from interior lines: Side t; Rear :"5 . /"? c'J!f1 4: ~ CK'D By,:___.,p&-M~.,.,.~ -' /DATE ./ / ,7- 2..rQU), / / ". If () ,; (:....- 'C{;:ay:~) i:e;"'-;j:JJ' 7\ /- U DATE TO APPLI CANT: Your Building / Site inspection: ~ ,.- ,(~) Can be approved. ( ) Cannot be approved at this time as indicated on item NO. above. Questions and further~fnformation 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. l ) Your buildinq ~ermit application fee Is being retu~ned under seDarat~ rnvpr vc~ARTMENT OF ENVIRONMENTAL HANA~EMENT 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4186 . -'~~ , '. ).', ~.., . J. I' . . : t"" 1';'/ ~ ')' 'tf...:::~ . I C55-2B . LANE COUNTY PERMIT .: PERMIT NO. j2C';G7:) CONSTRUCTION [AI MOBILE HOME [J PLAN REVIEW [] CHANGE OF OCCUPANCY [ ] DOwner KI':~nAnY r;UIL[;ZQO NAME 16~ SWTil 'Ji' nT. ADDRESS "" r 0 7"/: 4"r-n .,!;-:I HlaF !In.D. ,,;;(:Q lJ '{:;)oo '." J CITY ZIP CODE PHONE o Contractor O.S. Reg. # 17 NAME i7\(, ADDRESS CITY ZIP CODE PHONE Twp Range (,:l Section rh Tax Lot Codp Census Tract Subdivision '1~"^ n~I'" V'lr Lot !? Block Acreage Width Access to Property (Road Name): 1c;,;(; '~-:->I C1~'lr,> Au~_ n1'l~H'f'tf?II'. no. O:-lll'nn"1 Depth Existing Structures on Property: p":null" Directions to Property. Address: STRUCTURE (# BEDROOMS) r:'-1U. Q:':(~ CA~A~J! :I sa. FT. ,b::h c::>I.l:'n [,;):) c<;.lIn VALUATION 'a!'. "l';~ .n-I - r . ,';IilJ. r.n ~'!l. i~v~,""r r'- SEWAGE DISPOSAL: 73.~2t2 PUBLIC [J SEPTIC TANK [i,1 1<:;: .lJ'J OTHER [ PLUMBING INSTALLED BY: OWNER [J OTHER [J NAM" WATER SUPPLY: PROPOSED [ ) EXISTING [] [ ] PUBLIC [ ] COMMUNITY. NAME: [ ] PRIVATE WELL [ J OTHER. SPECIFY: BUILDING PLUMBIW' 3% SURCHARGE MOBILE HOM" WASTE DISPOSAl PLAN REVIEW j.r..::~ ;;..;f U.lN TOTAL ':;-~.JH CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS MIN.SEPTICTANKCAPACITY: '.> GALS. '\ MIN. DRAINFIELD 1~ L1N. FT. MAX. TRENCH DEPTH 11!::'''1l'. '. HI Ai"l'ROIIl:V .~R"A. F,T(,\I 10 FllltT I7fllm ~IOUS~ AND e>roPFRTY L.INF:f\. A:<,,^ .0;1 DfInWTI!::I..... :;6 INCHES ~r:r.n\11T ^ :1;'Pl..At.:~~r:r;:~ TYPE OF CONSTRUCTION SU GROUP I A ~ FIRE ZONF STAY 100' FROM ALL WELLS USE CLASSIF. SETBACKS. FJ; FROM CTR. OF r/W: FRONT .r' SIDE EXT. FT. FROM PROP. LINE: SIDE INT. 5 REAR 5 ZON" (\!.\ : AUTHORIZED SIGNATURES: Isl c:"":~ ':.?_"'_~/~_",""~~.~~~~_._~~ ISSUANCE DATE: , " n,.,,"'... n_ f'1dJ'r-.. C'''' _::10;;._ _. _.._..,_.._ ~::.~~:.~:.:': to ""J, 7:' .::;-1;;:". .~ J~ BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD IMPORTANT: Call 687-4065 to schedule all required construction inspections. Call 687-4061 to schedule all required .... seplic system inspections. All construction shall comply with the State Buidling Code, D.E.C. standards \" ( for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate 01 'J- occupancy before being occupied. (See Details on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) C55.13 LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX. 135 EAST 6th, EUGENE, OREGON 97401 SLAB FLOOR PLUMBING GROUNOWORK . . ApPROVED / / DISAPPROVED Cl DATE INSPECTOR REMARKS GAS PIPING GROUNOWORK ApPROVED Cl DISAPPROVED Cl DATE INSPECTOR REMARKS ROUGH PLUMBING ApPROVED ~PPROVED L::::7 REMARKS DATE?l-/~-?~ INSP~_~{,..,. ,/ PjlG7/\;", lpp ROUGH GAS PI PI NG ApPROVED L::::7 DISAPPROVED L::::7 DATE INSPECTOR REMARKS FINAL PLUMBING ApPROVED /~ DISAPPROVED L::::7 DATE~-9'-?~ INSPE~~~ REMARK S FINAL GAS PIPING ApPROVED L::::7 0 I $APPROVED L::::7 DATE INSPECTOR REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE L::::7 NOT READY TO ISSUE / / DATE INSPECTOR REMARKS .~ .. PROPOS~EWAGE DISPOSAL SYSTEM RECORD . . INSTALLER: Complete top part of forWo signature and submit both co with applicador;1.:',. 1i'~C.L If /(A-h> PERMIT NO. ? 1-/',,<;1..,7.('- INSTALLER S NAME . PROPERTY AUIlRESS v ~ Inside Len.']th OWNER NAME Dimensions: Width Steel 0 Ft. Diameter Id/tf Baths Basement Water Supp~ Yes No Public ~Other-List Concrete ~. Compartments ~ Gal. Capacity Tile Disposal Field: J ~ Depth Distribution Box: Yes ~ No Other Distribution-Type /e?t7t? No. Living Units Bedrooms Septic Tank: Ft. from well HAILING ADDRESS ~E~ IrA~ r )~91fJ ,rnA~ tJu../L//EIfC, ',4.' sr Feet from WEll Lot Li ne Front 1Ft. Between Lines /tf Foundation Length of Llnes-Ft.~g I Trench I Total Sq. I. dJ. 3. 4. 5. 6. Width Ft. ,?&70 Plot Plan (see instructionsl: I ~ - jF.t f?t1.fe I Side IFiller~Filler Depth Tvoe 12lAbove T i 1 e 7 Rear IFille~Jlelow inki Ie 111. in. 51- ~ I ( /It 1 (4:-/P ff' .::::, ~ ft() c,.&->t:- -:r " ~19~'l' /19 rr [ -JI - /fP t<,-}I - ~( " 1-... ~I ( I Ii; _ /,,p T 1/ f,/ If' ~I!,nature OJ..., u~~ CERTIFICATE OF SATISFACTORY COMPLETION ./? I 71 For Sanitarian Use Only: -- Date:...) -/ - '" In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certificate is issued as e~l~ satisfactory completion of a subsurface sewage disposal system at the above locatl Approved: System Installation conforms to current standards c==J Disapproved: Does not conform to current standards Remarks: '.... ~ .'\j "- ~ t '" /6 fi Jt I' fl Date C55-11 y~~ S1!inltarlan's Si~dture LANE COUNTY V STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY . . / , ~ '/ LANE COUNTY PERMIT F. PERMIT NO. CONSTRUCTION [:J MOBILE HOME [J PLAN REVIEW [J CHANGE OF OCCUPANCY [ ] DOwner ','. .C NAME ADDRESS CITY ZIP CODE PHONE o Contractor NAME ADDRESS CITY ZIP CODE PHONE O.S. Reg, # Twn Range Section Tax Lot Code . Census Tract Subdivision' .n Lot Bloc~ Acreagp Width Access to Property (Road Name)' " Depth Existing Structures on Property: Directions to Property, Address: STRUCTURE 1# BEDROOMS) SQ. FT. VALUATION SEWAGE DISPOSAL: PUBLIC I] SEPTIC TANK [. ] OTHER I ] BUILDINC' PLUMBIN(; 3% SURCHARGF MOBILE HOMC WASTE DISPOSAl PLAN REVIEW , " ,..... , - , PLUMBING INSTALLED BY: OWNER (] OTHER [] NAMC WATER SUPPLY: PROPOSED [ I EXISTING [] [ ] PUBLIC [ ] COMMUNITY, NAME: [ ] PRIVATE WELL . [ ] OTHER, SPECIFY' '-...\ ..,,-.. ,\-.",\'\ .. ~l " TOTAL , - \ -';).~ t '''t " CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS MIN. SEPTIC TANK CAPACITY: GALS. . . MIN.DRAINFIELD r .:".::,' L1N. FT. MAX. TRENCH DEPTH INCHES , ~" .. ' >I . " TYPE OF CONSTRUCTION GROUP FIRE ZONC STAY 100' FROM ALL WELLS USE CLASSIF. SETBACKS. FT,FROM CTR. OF rfW: FRONT :.. SIDE EXT. FT. FROM PROP. LINE: SIDE INT. '~REAR ZONC AUTHORIZED SIGNATURES: /s/ ISSUANCE DATE: BLDG. PERMIT - WHITE OFFICE COpy - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD IMPORTANT: '. Call 687-4065 to schedule all required construction inspections. Call 687-4061 to sChedule all required septic system inspections. All construction shall comply with the State Buidling Code, D.E.a. standards for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of. occupancy before being occupied. (See Details on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) CS~.13 LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 . . SITE I NSPECTI ON ApPROVED L::::l DISAPPROVED L::::l DATE INSPECTOR REMARKS FOUNDATION INSPECTION ApPROVED L-/ 0 I SAP PROVED c=; DATE INSPECTOR /-, REMARKS () /{ 1i A"/U ~/ ~({~a'k / - z t ~ i7t:- U &~- / If' ~~ 4'/' FRAMING INSPECTION '. : Lf(: j(/ /'J . /., ,~ 9 V. l- ApPROVED J,n ~1APPROVEO I;;J 19m 1 ~ 7 7ft ,1'SPECTE-,..-1 (.. l ~/J REMARKS,gJ:j.r .11tIUJU ./Lfltgjlj p.,. "r1o~ 11!/ U-. r ( I I LATH OR SHEETROCK INSPECTION /' ApPROVED L!::::...../ 01 $APPROVED h' - Y& ~ J~h . .....' 0 ~}/:. tj ~ j fI ~ t;.NSPECTORL~ (_0--,,5 j r-r DATE REMARKS FINAL I NSP;C;I: to. /J ApPROVED DISAPPROVED L::::l DATE& - r, 7~ I NSPECTORl ~ REMARK 5 CERTIFICATE OF OCCUPANCY READY TO ISSUE L::::7 NOT READY TO ISSUE L::::l DATE INSPECTOR REMARKS .A /") J/.)\ /// /. ~-' J < A ////. :4-;; II /v.r.4~ f /' A/od;tJ/ 3J6ft-7J-jF ;;"';1 ;o~ril-"LL @,)l . ., , . . , \ -, NOTE: NO PERM~LL BE ISSUED UNTIL THIS APPL~ON HAS APPLICATION FOR: PERMIT 113;;).'8"-70 BEEN APPROVED CONSTRUCTION ~ MOBILE HOME c:J /" r$J-OWNER~1) i~&f I?UI'll- <;"""'.-. - /(,90 Address PLAN REVIEW c:J ~Ol.J-( /1 City WA CHANGE OF OCCUPANCY C:=J ?1'1~17 Zip /7<16-VC/2.j' Phone ~ CONTRACTOR Name Address City Zip Phone O.S. REG. n /7/(, Twp. /7 Range ".~ Section Tax Lo t Code Census Trae t .,:)if SUbdiVisionVe.~ -'f)~ g ~ I U 44Lot ACCESS TO PROPERTY (Road Nsme)])"f)'<.I^ '" /-, Block Property Acreage Width eo DapthJi.Jl 4~ Existing Structures on Property: ~~ Property Location - Address/Direct:ons:_/':; /'7_/1.-{!~ - JI~ }# L- k.. r /' X?. '/ .I IV r Below fa r Of f ice Use OnI vXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX f1 . /7/1 ' Sq. Ft.~/.80 I'l)l'dr~ms Valuation ~ /'/fFl/ /}' ~ ~1'1 \....;3.,,) r-' ':>J..r/. ..2n ~fl. J '1?O _Cj,rut./. /}i) (J ,- .', - L' Jpri-..J. ~.3 SEWAGE DISPOSAL: r-- Site Inspection #.~) - :;JV..::J.-- Existing Sewage Disposal System ~ 0 New System Required r:::><i / - Public CJ / ~ \ Community ~ N70f Community or Public SystOln\J\ - 40 ~ / Nam.y.__~ WATER SUPPLY: Well Spring _ Other FEES: Bldg. /'1,,), () 0 7.. '\.I? 0 _'l ?" (") PLUMBING: Installed by Owner CJ Sewage Connection @- Water Connection ~-I Waste Disp. Plumbing Plan Review Mobile Home :}% Surcharge -# PLUMBING FEES: II of Fixtures TOTAL ,s .J.L ~S"9'.3 7 o CASH ~ PLANS FURNISHEO FACILITY PERMIT ~YES c::=J Signature of Applicant" Fee Received By. _ 0 ~~iC Tank Capacity :l Drainfiald Required - Lineal Feet /S-O MaXim. um DePth. Jk ,.if) ~ , . rPtLtL..;P;L;u /rJ#-.Aa.... A.4J..U.h q-d /l'<~~' '). ~~ 0..... A o~lI. .A! A'J;/-~ _. ".~ ./~f'..i?,) , . '~~ ....-..... V - - Type of Construction .'7 AI/Group / <-f;::::; ~ Fire Zone Use Classification BIdg Setbacks - from Center of Ro,d Right of Way: Front S C I Side Int. S Side Exterior _ Rear ~' Zone JZ /J- C55-12 DATE' ~~TATI9lj: DATE: .d'JWflDING:. ./ /J~ATE' ,zJllJ7s; >6f.J. x'Pi.kv /;;J..-J..:l-7S- f/'n~(p/2-".:zJ-7'.r WE COUNTY - DEPARTMENi%F ENV~RONMENTAL jIN~GEMENT / ~ PIANNING", I ~'12..~