The URL can be used to link to this page

Home My WebLink AboutPermit Building 1976-6-21 (2) ....;.: .--........ '" ,.~~~~~~ r CONSTRUCTION [Xl MOBILE HOME [l PLAN REVIEW [] CHANGE OF OCCUPANCY [ ] LA~COUNTY PERMIT FOR: . PERMIT NO. 121i7-7'i DOwner ,Jim J;jlvllnallGh NAME ~7'1 SHvp\" r'~::>lldn~l!: r}r;vp ADDRESS crry Flln!>n" Or,'nnn 'ZIP CODE PHONE o Contractor S'I!np NAME 70(,;(\ ADDRESS CITY ;'-1' ~~ < ~c:ection~Tax LotJ/J1.J- Code Pe6t 11 B lock ~ Acreage ZIP CODE PHONE 0.5. Reg. '" Twp 17 Range 5 b2d".d.l:\dd to Gardenway u IVISlon Census Tract Width Access to Property (Road Name)' lhl\ Diamond Street None Depth Existing Structures on Property: Directions to Property.. Address: Centennial to Andarson to Diamond 1311 Diamond Street STRUCTURE (# BEDROOMSI \'Anni-e- oF""" n..,n.ll ~ft,.. -.. -. . ...~ ~~-~~~ ~-- ~o~~~- -.....- ._r --'-;J- J:'lIgDn&:\ nt"fOgnn 07dn1 so. FT. 147; ra ?-lSm ~Rn III ~ 'In 3 Eled: VALUATION :)3~,15!j.O(l P' J.074.[)1l ~i~5 .22Cl. 00 SEWAGE DISPOSAL: PUBLIC I I SEPTIC TANK [ OTHER [ ] PLUMBING INSTALLED BY: OWNER [] OTHER I] NAMF WATER SUPPL Y: PROPOSED [ J EXISTING [] [ ] PUBLIC [ ] COMMUNITY.. NAME' [ I PRIVATE WELL [ J OTHER.. SPECIFY' BUILDING 14; nn PLUMBIN(.; 'I? nn 3% SURCHARGF <; '11 MOBILE HOMF WASTE DISPOSAl 7" nn PLAN REVIEW 'TOTAL 257.31 CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS MIN. SEPTIC TANK CAPACITY: GALS._ 900 MIN. DRAINFIELD }RO LIN. FT. MAX. TRENCH DEPTH 30' INCHES lilS"tallln W~ approvea area or tne test no1es in back yard Ke:3p C:ra1nl1ncs l\l fact '(rer,l ;..0 IlOllS, ,:n<J property Ilnes TYPE OF CONSTRUCTION "~I GROUP H..l FIREZONE STAY 100' FROM ALL WELLS USE CLASSIF. SETBACKS.. FT. FROM CTR. OF rM: FRONT 8.<; SIDE EXT. FT. FROM PROP. LINE: SIDE INT. 5 REAR 5 ZON" 11(;1" AUTHORIZED SIGNATURES: /s/. ,j r- r.ln~t" hu IJ~....h.':IllI"''''' . -- --~.. ,. ,..~.....J_~_.I"'....._-!_.~ - -. -01' .......... v..... ......,. ISSUANCE DATE: 6/21176 d1rll 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 wilh the Stale Buidling Cooe, D.E.a. standards for subsurface sewage disposal and the State Plumbing Code. All buildings require a certlllcale 01 occupancy before being occupied. (See Details on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) ;v , CSS.13 LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 \ --,- . , ~ '., , .. '. LANE COUNTY PERMIT FOR: . PERMIT NO. 12tJ7 -70 , . , \~' ;',.,. I'; i:\ __ CONSTRUCTION [Xl MOBILE HOME [l PLAN REVIEW [J CHANGE OF OCCUPANCY [ 1 ,0 Owner Jim Cnvanaullh NAME 373 Silver Mea~ Dri~e ADDRESS CITY EUOQ1I3 OmlltJl'l ZIP CODE PHONE I, , i r , i I o Contractor Samn NAME 3 ADDRESS O.S..Reg. # 7069 _"i1-/fdf / .Tw~ 17 Range 3Sectio~~~ Tax Lot //# ,2nd A1:Id to &\rdemtllY Park 11 5 Subdivision Lot Block . . 11;1 \ Dtali3)nd Streat Ac~ess to Property (Road Name)' CITY ZIP CODE PHONE Code Census Tract Acreagc Width Depth Existing Structures on Property: None 'STRUCTURE (# BEDROOMS) Poroft f..... Ot.",l1 fnn Pflnnf~ 9..... r,..",ntm Contennia1 to Anderson I~II Ulooona ~tree~ Eunone Oronon 97401 , so. FT. 1475 Cil 21.00 680 0 5.30 to D1fJlI'.l>nd .Directions to Property. Address: :--.. 3 BocJ: VALUI.\TlON. 00 l)"'::.loa. J.ON.rlO .' :63a,lim.lllJ SEWAGE DISPOSAL: .,PUBLlC [J SEPTIC TANK [ OTHER [ J PLUMBING INSTALLED BY: OWNER [] OTHER [] NAM" WATER SUPPLY: PROPOSED [ ] EXISTING [I [ J PUBLIC [ ] COMMUNITY. NAME: [ J PRIVATE WELL [ ] OTHER. SPECIFY' , BUILDING PLUMBING 3% SURCHARG" MOBtLE HOMF WASTE DISPOSAl PLAN REVIEW 145.00 32.00 5.31 .\ / 1'5.00 TOTAL 257.31 CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS MIN. SEPTICTANK'CAPACITY:'" ,. .\ . .\ -ion GALS, ,_.ellUl), MIN.DRAINF.IELD . .JllO. L1N.Ft;c. 1 bMAX.TRENCHDEPHL . .. ~INCHES 451......101.' I" "Ill,;: Ui-'V'Uweu tl.'Uo. u, ....\:,I '-'11)11- uti tiS n tn:K )'lJro ~Op (j"'tllll1llt~~ It) l"C:()t, ~rc!j} ~IUl IIV.;.IwU UIIJ C"I,,",,(lKJI-4-.'" ~ ;.h;l) TYPE OF CONSTRUCTION srI GROUP IBJ FIREZONF STAY 100' FROM ALL WELLS USE CLASSIF. SETBACKS. FT. FROM CTR. OF rM: FRONT 45 SIDE EXT. FT. FROM P~OP. LINE: SIDE INT. REAR 5 ZON" MY AUTHORIZED SIGNATURES: /s/ J ri: Dosr. bv 1!IIrl:lll11oll A A..~v/ftr.nf~n~An Ci ISSUA.,~CE DATE: 1"(,1' v d10 C55.13 Call 687-4065 to schedule all required construction inspections. Call 687~4061 to schedule all requirod IMPORTANT: septic system inspections. All construction shall comply with the State Buldling Code, D.E.a. standards for subsurface sewage disposal and the State Plumbing Code All bUildings reqUire a cerUllcate 01 occupancy before being occupied \ (See Deialls on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN . SANITATION - GOlDENROD . SLAB FLOOR PLUMBING GROUNDWORK ApPROVED / / DISAPPROVED ~ DATE REMARKS GAS PIPING GROUNDWORK ApPROVED rt DI SAPPROVED ~ DATE REMARKS ROUGH PLUMB I NG ApPROVED ~ DISAPPROVED L:::7 . .- , . .. INSPECTOR INSPECTOR DATE l}-;),Q-74. INSPE~~~ REMARKS ROUGH GAS PIPING ApPROVED L:::7 DI SAPPROVED L:::7 DATE REMARK S FINAL PLUMBING ApPROVED ~ DISAPPROVED L:::7 DATE1::,,2 ?~")I': REMARKS FINAL GAS PIPING ApPROVED L:::7 DISAPPROVED L:::7 DATE REMARK 5 CERTIFICATE OF OCCUPANCY READY TO ISSUE L:::7~ NOT READY TO ISSUE ~ DATE REMARKS INSPECTOR I NSPECT~~ ~"/"_ INSPECTOR INSPECTOR "l" Blt\!.DINj SIT.E EVALUATION eGif) (1)1 p\1 'BUILDING PERMIT APPLICATION NO. \~'...::Jc... () SITE INSPECTION PLANNING DIVISION Not Applicable PI>. l) ( ) ( ) ( ) ( ) 1. Zoning Ordinance Compliance: Zone 2. Subdivision Ordinance Compliance 3. Required Access 4. Building Site (Area, Width, Frontage) 5. Other (see comments) COMMENTS: T I j R~ 34-z..4TAX LOT SUBDIVISION: LOT: 'I BLOCK: 5 APPLICANT DATE No Yes ()~ ( ) ok1 () ~ ( ) (A:. ( ) ( ) CKI~ t..-~-1c... 6. Setbacks ftom ell of road: Front ~' ~J'~1:.:..~ Setbacks from Side Rear Interior lines: 5' .s.' PLANNING DIVISION ACTION PENDING: YESl ) NDl ) APPLICATIONN BUILDING INSPECTION DIVISION Not Applicable ~I~ ( ) ( ) 7. Plans Submitted 8. Soi I Stabi I ity (footings) 9. Flood Plain 10. Other (see comments) COMMENTS: WATER POLUTION CONTROL Not Applicable l ) ( ) 11. Meets Department of Environmental Quality Standards. 12. Other (see comments) COMMENTS: No W () ~! ( ) ( ) ( ) ( ) ( ) ( ) No Yes () "@" ( ) ( ) CK'D BY~-/tI'1(p DATE CK'D BY:.,AlU ~_ tyr('7l (J DATE TO APPLICANT: ~o~r Building I Site Inspection: I ~ Can be approved. :/>C& ( ) Cannot be approved at this time as Indicated on item NO. above. \~y Questions and further information on items 1 through 6 contact the LANE- \i. 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 application fee is being .~~turn~d under separate cover. DEPARTMENT OF ~NVtRONMENTAL MAMliEMEN. 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4186 C55-28 "I~..,..." . . Btr~~:I'~G~ S I~.E EVALUATION . { . . A~f~~~:DiNG PERMIT APPLICATION NO. \dA~I-I(.... v. \.\ , ( )., SITE INSPECTION " T Ii R~ 34.z..4TAX LOT SUBDIVISION: LOT: II BLOCK: 5 APPLI CANT DATE PLANNING DIVISION Not Applicable No Yes 1. Zon I ng Ord i nance Camp Ii ance: Zone g A. l) () (:..-)~ 6. 2. Subdivision Ordinance Complllar,'c~( ;) () ( ) (<) 3. Required Access ~;~ ( )//1/( ) (><l 4. Building Site (Area, Width."'Frontage) (j,)t! () c>):. 5. Other (see comments) () () vI') / I COMMENTS: . I II J~' ' , CK I D-BVJ .b, '(.., -~. 7 "" Setbacks from c/l of road: Front 4s ' 'S'i"de.Exte"j or Setbacks f rom Inter.! or- \.I.nes: 0'1.. jl9.e " I d :"-'i! t.-~ Rear .!::' f J "'\ I BUILDING INSPECTION DIVISION PLANNING DIVISION ACTION PENDING: YESl ) NOl ) APPlICATION# 7. Plans Submitted 8. Soil Stability (footings) 9. Flood Plain 10. Other (see comments) \ \ , i Not Appl icable l ) ( ) ( ) <.> I COMMENTS: WATER POLUTION CONTROL . Not ADDl icable l ) ( ) II. Meets Department of Environmental Quality Standards. 12. Other (see comments) COMMENTS: " " No Yes ()"W ( ) ( ) ( ) ( ) , ( ) ( ) CK'D I~/t/ I I" .,.. .". BY l~/ I, J /1' W' f U DATE / No Yes () "RY ( ) ( ) CK'D By:At.u ~ fo-r(7L (I DATE TO APPLICANT: Your Building,,'1 Site Inspection: .,' i -(>;') Can be '~pproved. ,. _ (JJ ../1' '-'ie fjJ( ) Cannot be approved at this time as indicated on ite~;,NO.I,;' above. . '0. ,f Quest Ions and further i nformat I on on I terns 1 through 61 contact the LANE- \:;-.' ::-;", COUNTY PLANNING DIVISION. Questions ana'f.ur.the~ .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 buildi'ng 1?ermlt ap'pllcatlon fee is being retu~fl.~d under seDan.te cover. vEPARTMENT OF tNVIRONMENTAL MANAGEMcNI 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4186 C55-28 ~ '. . .';';'" '" . Dotp I June 21 1976. Permit No . 1247=76 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, ORDE'RED, that a permit be and 373 Silver Meadows Drive is hereby issued to Jim Cavanaugh Eugene ORegon 97401 for placing, building or constructing the following facility: 2nd Add Gardenway Park Lot 11 BLock 5 1311 Diamond Street Eugene 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 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. 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. 3. Sidewalks will be constructed in accordance with the attached sidewalk specifications'and drawing M98-49. The Standard Curb Type 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 June 21 19IL. Expires 19_, WHITE - OFFICE FILE YELLOW - REAL ESTATE PINK - PERMlnEE ORANGE - BUILDING & SANITATION DEPT, Approved by Board of County Commissioners By _ } . .' , (ff! L./vA,L(~V ~-C-lxI! JJ:b-t/ Director of Public w~ C74-129 Inspected and Approved Dat" By ~ . PROPOS EO SEWAGE DISPOSAL SYST'RECORD . . Complete top part of form to signature and submit both copies with appl icatio(l:'> .' " PERM IT NO J 247-76 GG ~, .. INSTALLER: . . INSTALLER'S NAME 1? A- ~ D I} U. \.s 1S' 'AU<' tl-oE No. Living Units Bedrooms Baths l ~ 2- Septic Tank: Ft. from well Steel 0 Inside Dj,mensions: Ft. Len'1th IrS Width ~ Diameter OWNER NAME PROPERTY ADDRESS Di amond Street Baseme~ Yes INQ} Water SlJP.P I Y Public ~ Other-List Jim Cavanaugh Concrete ~ No. Compartments l Gal. Capacity Tile Disposal Fiel~ Depth'8 Distribution Box::-~sl No Other Distribution-Type \000 HAILING ADDRESS 373 Si 1 ver Meadows Dri ve Feet from WEll Lot Li ne , Front fao Side /0 Rear 12 I Ft. Betwee'l IFi ller, IFi Iler Depth IFi 1 'e~ Below Lines fO Tvpe Ih-Above Tile '2..in.lTile \a in. -I Foundation ,~ Eugene Oreqon Length of Li nes-Ft. t Trench I Total Sq. . WI Ho 3fo4. 5. 6. Width"2.. Ft..'~~O :'Iot Plan (see instructions): '01 MYIO"O, s-r. " lHZ,\II"E I f f I l .. ~ ' r ' HI CEIVED iJY~ 'JUL 0 2 1976 LANE COUNTY ENVIRONMENTAL MGMT. "'0 ScALE Date '7/ fD / '7 b , ~O )- ; \ ~' -+- ,30. pvc. 411 , " f\ .~o0SE For Sanitarian Use Only: Date: 7-Y-?,t:' In accordance with 1973 Dregon Laws Chapter 835. Section 214 this certificate is issued as evidence of satisfactory completion of a subsurface sewage disposal system at the above location. ct(lApproved: System Installation conforms to current standards c::J Disapproved: Does not conform to current standards Remarks: ] 107" ~ - -4',. - - '-l--~" -:k1Y t:I" ... - . lo'..Hl --;.r ......... .." r--." (}',] S i~qnature~.v Jt' f'V!rt..l\l~ 1/ ~ CERTIFICATE OF SATISFACTORY COMPLETION ( ": " C55-11 '----- 4 ~-- - sanltarian,sri re LANE COUNTY STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALIT r . . LANE COUNTY PERMIT FOR: . / '~ PERMIT NO. ~,;.(,;lor " CONSTRUCTION [uJ MOBILE HOME [J PLAN REVIEW [J CHANGE OF OCCUPANCY [ J o Contractor t~~C c.jrLt::"'::'~ NAME Sc,~ NAME S?J ;.~11i2r r-J'2~~,n 'l?S\,";' ADDRESS CITY Ct.:~ :~~:' '-:~;r .~;) ZIP CODE PHONE DOwner ADDRESS CITY ZIP CODE PHONE 0.5. Reg, # 'i~:;0 Twn n Range :::Section ':) ~ Tax Lot Code ,,'.) ..~ f f::lfl Co ~, L?"'~~--:W r27:: \...... ,-_'.1.1-.....:\ n I) Subdivision Lot Block Acreagc Census Tract Width Access to Property (Road Name)' fJ~c~.J"d S~~::;\: Depth Existing Stru~tures on Property;' ,,- ~.. 1..3..(~,,\. '\ '.'_" 1)..." '. ',,,;, \ " Directions to Property, Address: C:::1Cci::11a1 ~O ,~~C:::fUG?1 . tJ [~c;-:~:; I !J 8 i )1 CL,"HIJ :".,\,;:.l\: [::71::8 nK:c;:~ ')11l11 SQ. FT. :; l:~:~f.. 14 rJ f' 2~.r:l ' VALU.;'<}I()N, f" ,'. . ~ I' " "'" STRUCTURE (# BEDROOMSI ""'^i0;: (;'7 "r ::1H ~;"I ",,- -.0~ ~>~p ~"rr,:r" . .... ,... 'oj....... '- Cl():~ ';.,,(( t' ,.1 ,,' SEWAGE DISPOSAL: PUBLIC [I SEPTIC TANK [ OTHER [ ] PLUMBING INSTALLED BY: OWNER r 1 OTHER I I NAMF - '_n'n BUILDING PLUMBING 3% SURCHARGF MOBILE HOMF WASTE DISPOSAl PLAN REVIEW ": ~ . ".I,. ~,,:.H ".:' - \ WATER SUPPLY: PROPOSED [ ] EXISTING [] [ ] PUBLIC _. [ ] COMMUNITY, NAME: -,\ [ ] PRIVATE WELL [ J OTHER, SPECIFY' J. #',,\ ..:.,'.. -q,_,. ~l;! TOTAL :.;~'I. :J', CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS MIN. SEPTIC TANK CAPACITY: i]"<' GAtS"~"I)"^>',:,~ MIN..DRAINFIELD -~ ^ I":'_'-".~IN"FT,~ "0 . MAX. TRENCH,DEPTH ." '.!.I -INCHES ....v '-"'0'" "... ".... \....'~'''' o:-Jloi.... "h .....1..1 V. -.H0 v;....:uv "''''lh..;U II u....\~.. YUIi" .s.........) 1.......; \I .. :,;:.....::J B I, I-..;."v ,.~~.... ","~.I\ .,.~..>.._.,.-",-.. 'fI,.,.___ v:,.... ..;Wo..l~. ...........1 ~ ~'rv,.~ "J w UI~~v r-1"1. ,'~." TYPE OF CONSTRUCTION :J" GROUP lie:::! FIRE ZON<= STAY 100' FROM ALL WELLS USE CLASSIF. SETBACKS. FT. f"ROM CTR. OF rM: FRONT .." SIDE EXT. FT, FROM PROP. LINE: SIDE INT." REAR (' * ZON" rei' AUTHORIZED SIGNATURES: / / (; L ~"'nn "''J I'~"''''rt'r''' S ",.J,)~) '--'. .~\.. 'J...~ ~. ..J G ~7\I','/Brl~\'<l!?\!{,") ~-ISSUANCE DATE: ," ,: II : c':~:,1 (POST THIS PERMIT ON MAIN BLDG, AT SITE) Call 687-4065 to.scheduleall required construction inspections. Cat! 687.4061 to schedule all requlrod septic system'inspections. All construction shall comply with the Slate Buidllng Code, D.E.a. standards for subsurface sewa.ge dispO~1 a nd the State PI~mbing Code. All buildings require a certlficate\o,. occupancy before being OCCUpied. 'j :;\ .' .\,., (See Details on Reverse Side) .. ' , \. BLDG. PERMIT - WHITE OFFICE COpy - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN .. SANITATION - GOLDENROD IMPORTANT: .; 'l', C55.13 LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 ~ . . , 'T " \, . SITE I NSPECTI ON ApPROVEO Cl D'SAPPROVEO Cl DATE INSPECTOR REMARKS FOUNDATION INSPECTION APPROVEO,LX1 DISAPPROVEO,~/YATE /i, INSPECTOR REMARKS ~/(7~ ~~L~~Z;;;ir:2;?~ft& ~~-~EwAf/ K .U.-vr: /=".."...~, -;Ii? /~8/:::> '" FRAMING IN~~C~ ApPROVED DISAPPROVED Cl Om 1- 30 -1~ &/' ~ INSPECTO~ &/ , , REMARKS ~. " LATH OR SHEETROCK INSPECTION ApPROVEO L4.../ DI SAPPROVEO REMARKS ~/"\ RB E<1B~ - - 1--/ DATE ?' / ..:z~b(-. INSPECTOR "7v< 4........ / ~ ~ /'I. 15 f 19 h> (. '-c..... c:::;( '" -,' FINAL INSPECTION ApPROVED ~ DISAPPROVED CJ DATE/t)-IS-1~ INSPECTOR u>>n t/ REMARK S CERTIFICATE OF OCCUPANCY READY TO ISSUE CJ NOT READY TO ISSUE L:::7 DATE INSPECTOR REMARK S - ./f/ ////. JV / .//t.P V t4///P /.:I,I17-7t- {~ I 1{/4<:"'</u!~ /~J "",.r.1 < I] O~OTE: . . 101'/7 - 7 6 .. PERMIT II BE.PPROVED ,- -, NO PERMIT WILL BE ISSUED UNTIL THIS APPLICATION HAS APPLICATION FOR: CONSTRUCTION I >c::1 MOBILE HOME c=J PLAN REVIEW c=J CHANGE OF OCCUPANCY [=:J ~J--;m. C ;?PAA'/-UMh 37:t1wA.. /1I~tJ:Jd~ Cw. E<<{;EA.i6- ()~ Name ; Address City <lff6 y Phone c:z:f CONTRACTOR ,.____ ~' 6y/;vd.:J./ 7 A j;;me Address / / City Zip Phone O.S. REG, Dr/If?7 V ei?) Twp. J 7 Range () 3 Section, ~ ~' Code Census Tract "31 -~ Subdivision2AJO /itt/ a.o,r?a&r""':.k~Lot .....<:"" Property Acreage Width2l...:'Pth~ , ~/lL;<'- ACCESS TO PROPERTY (Road Name) ,i,) j /.J /]7" $-1- ; Existing Structures on Property: dCJd..3i?' / Property Location - Address/Directions: t';:;4.J T:!?AiAJ/)4" / ~) _.#" '7"/,d-- - ./) / /C)M..d All? IL e' rl- .x I Below r Office Use OnlvXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I /C/-? _ ~ OlI.K 0 OB~oms) . ~ ~ .va,I'S-5-: 0 0 I . <;:-- PrJ .s. 30 \... -, ./ 3~ () 7 Y. 00 I .3 . <-. ..j"~ 9, t' 0 . ~NER -'l.,)~".<!t5o'" L.rJ A?_/;;. ~""("'. /.3/1 n~~~~ rt'J ~~ v SEWAGE DISPOSAL: Site Inspection U Existing S ge Disposal System Public [=:J Community [=:J c=J or New System Required c=J WATER SUPPLY: Well Spring Other Name of Community or Public System TOTAL PLUMBING: Installed by er c=J Other [=:J Name FEES: Bldg, Plumbing 3 % Surcharge Waste Disp. Plan Review Mobile Home 3 of Fixtures Sewage 2-- Water Connection Connection <--- PLANS FURNISHED FACILITY PERMIT ~ c=J NO [=:J YES 0 .Iv - CASH Type of Constructiop ._~/ <.!; Iv Group ~H"J:'" ,Q. Signature of APhant: ~flu Fee Received BY~ ~t Required - Lineal Feet J f'U Maximum Depth ...m 14 . n;lJ,- _' p:..&u -rW'~LL;I -:. ~a ~ 'r- hL L.-...___...-?_,'p ~ -Z-J /. >od- - - , ,. - ......- I~ Fire Zone Use Classification Date: {; -fl- '7 b P SFI. :51 ",~' ~~"'" 'I'M> .J~~r, , A 11'/ _ (-<;;:,,,U) ;y""....., ., , - BIdg Setbacks - from Center of Road Right of Way: Front A...:; I Side Int.~' ~..:.__ _..~_~___ r=' Rear ~ Zone .As.T(RA"\ P~G: \~Ub-g.~ ~;. CSS.ll DATE: ~I,TATION: DATE: /?~ING'. . /? /I>fTE: .~ .L.7uJ. ~A h..--II. 7( r1TJ~e:I'i: Id-/4/...7/-........... COUNTY <.. D;PARlMENT 61;NVIRONMEN~A~ tNAGEME-~T / ,/.......... LANE