HomeMy WebLinkAboutPermit Miscellaneous 1978-3-8
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r' .,~ LANE COUNTY BUILDING' PERMIT OR 'MOBILE HOME "
., .. MH 0 +411L 287-13'
I BUilDING I2\! PERMIT NO_
PROPERTY OWNER MAILING ADDRESS PHONE
BRUCE FIX 1001 DIXIE BRIVE 746-3072
CONTRACTOR MAILING ADDRESS PHONE
SPEC HOME
PROPERTY LOCATION - INCLUDE POST OFFICE
D
1027 ,XIE DRIVE PARAMOUNT P.O. SPRINGFIELD,
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
OREGON --ACROSS STREET FROM 1018 DIXIE URIVE.
2NO ADD. MoUNT VERNON ESTATES. BLK. 1
TWP RANGE SECTION
02
05,':?.'/
LOT 7
TAX L.OT NO.
.#- R/t?l1
CODE
CENSUS TRACT
18
35-152 A
1001 DIXIE DRIVE
EXISTING STRUCTURES ON PROPERTY
NVNE
LEGAL ACCESS TO PROPERTY
DIXIE DRIVE
PROPERTY SIZE - FT.
WIDTH 85' DEPTH 124.82AREA 10,609.7 OQ.FT.
APPL.
NAME
&
MAIliNG
ADDRESS SPR I NGF I ELD, OREGON
FOR MOBilE HOME PERMITS ONLY
No. of Bedrooms
BRUCE FIX
STRUCTURES TO BE BUILT THIS PERMIT
Connect to Existing Sewage System 0 New System 0
TYPE CONSTRUCTION SQ. FT. +: BDRMS VALUATION
DWELLING - MAIN
WOOD FRAME
1346 Q 12 (3)
48403
16,152
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(,vv't
DOUBLE GARAGE ATTACHED UNCEILED
INSTALL SEWAOK DISPOSAL SYSTEN.
SEWAGE DISPOSAL
<
OTHERO
0tl.00
20.00
qo.~
FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER: NAME
WATER SUPPLY
WALLEYS
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK Q:
PUBLIC ~
o OTHER
TOTAL
s
118.~
COUNTY
BUilDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED
I&:>
UN. FT
TRENCH WIDTH FT.
3
OR SQ. FT.
540
MIN. SEPTIC TANK CAPACITY
WITH 0151. BOX: GAl.
1000
H
HOLO TRENCH DEPTH TO 24" MAX I MUN. STAY AT LEAST 10 FT. FROM THE HOUSE AND PROPERTY LINE,
H
WITH ALL PARTS OF THE DRAINFIELO. DIVERT ROOF DRAINS TO THE STREET.
TYPE OF STRUCTURE
OCCUPANCY
I & J
fROM erR, OF ROAD RIGHT OF WAY
ZONE
RA
USE CLASSIFICATION
PUBLIC UTIl. EASEMENT
'i N
BLDG. SETBACKS.. FT.
FRONT 4'5
SIDE INT. 5 SIDE EXT.
AUTHORIZED SIGNATURE - DATE
REAR
5
/S/ J. Boss BY CHARLIE HARBAUGH
G. W. GRAY R.S.T.
DATE
3/8/73
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
Construction to comply with uniform building code and county regulations
covering plumbing and sewage disposal. All buildings require a certificate
of occupancy before being occupied.
(See Statement on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 97.401
FORM ti"CSS-13
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CENSUS ~ 'i'~.-i~~
.'BUIt'D'ING SITE EVALUATION
~ Building Permit Application No,-237-73
() Site Inspection
() Pre-Permit Investigation
APPLlC~:
N/\/1E 'LI/..P
ADORE S
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PHONE
DATE ..2-...:;;:, - 73
LANE COUNTY PLANNING DEPARTMENT NOT NO YES NAME DATE
app I icab 1 e ~ JId- 2./'2,6 h<.
I. Zoning Ordinance compl~ - ( ) ( )
(Zone ) I I
2. Subdivision .Ordinance omp iance ( ) ( )
I
3. Required Access ( ) ( ) ( )
4. Building Site (Area, Width, ( ) ( ) ( )
Frontage, Setback)
5. Ot he r (see comments) ( ) ( ) q
COMMENTS:
8UILDING INSPECTION SECTION NOT NO YES NAME DATE
app I i cab I e ik>
6. Plans Subm i tted ( ) ( )
7. Soil Stabil ity (footings) >f) ( ) ( )
8, Flood Plain (l) ( ) ( )
9. Other (see Comments) ~) ( ) ( ) (ef 7t~ 3- 8''''T}
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COMMENTS:
,
SAN ITATI ON SECTION NOT NO YES NAME DATE
~pp I icab I e ( )
10. Sewage Disposal ( ) (~
II. Usab I e Area ( ) ( ) ( ) /II) j~1'
12. Water Supply ( ) ( ) ( )
13. Other (see Comments) ( , ( ) ( ) ~- ~-,$/ I
COMMENTS:
"
TO APP LI CANT:
YorBuilding Permit /~::f:-serc~
(//) Can be approved. '3~
() Cannot be approved at this time as indicated on item NO. above.
Questions and further information on items I through 5 contact the Lane-
COUNTY PLANNING DEPARTMENT. Questions and further information on items 6
through 13 contact the Lane C6untv BuildinQ and Sanitation Division.
() Will be held in this office until you can resolve the problems indicated.
() Is being returned.
(.). Your building permit appl ication fee is being returned~under separate cover.
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LANE COUNTY PLANNING DEPARTMENT
135__Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342-1311 EXT. 231
LANE COUNTY BUILDING & SANITATION DIVISION
135 Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342-131 I EXT. 411
M55-28
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PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
WHEREAS. the attached application has been fully considered by the Board of
County Commissioners 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 and is hereby issued to
1>."1","," 171.,..,
and constructing of the following facility:
for the pla,cing. building
DY"i~~f"1"-n.1 n!:"'~"'n:'t....h o~~h l"':~;t" I"T'C"
0./..:10 il..lv,~ tl.P. O.ii9 ltc1?t, aUln
upon the right-of-way of County Road No. lP~!l . in strict conformity to the exhibits
attached thereto. and subject to all terms, conditions, agreements, stipulations and pro-
visions contained in the application and permit. the Rules and Regulations Governing
Facilities to be Permitted upon County Road Rights-of-Way, dated March 31, 1960 and
any amendments thereto, and any other applicable regulation. law or ordinance.
Special Provisions:
D:-il1C'JC)1 01.11 Jl' co:.ot..-uctcrl 1~ aecozdcc:lo u~i:h ci,o C1ttcchGd 13.:1"c~y D9J..c.::C"
opcolftc.:Jt'o:oo (D:auf..l[, t19S-:iIl).
1?('"-Lllt~c(' 1:1111 ..JL' ~co~o:'oi!>lo fo= tho ic:.;~A-.Jta .c~.=! 0& oU:~, J.:... (1 .:
dc' . to .::0:1 tl;c c'O:l.;x.J)' c~ =1cbt 01< "'0)' eauoa:l t>y hie op~':oticn. lcm:!p':; t':0 .c::;~"
~~y ~D~ O~C3 i~ 0 ~c~t, aec~~:~blc cc~~ltion.
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 before
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7::'
,19_,
Expires
19
Inspected and Approved
Approved by Board of Commissioners
By
Date
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By
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Director of Public Works
WHITE - OFFICE FILE PINK. PERMITTEE ORANGE. BUILDING & SANITATION DEPT.
GREEN - RESIDENT ENGINEER BLUE. ROAD SUPERvISOR YELLOW. SURVEYOR
e\1a-52
Date
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'. APPLICATION FOR FACILITY PERMIT
IN THE, BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
'-
Your applicant, ,,{ .,,' /
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hereby makes application under Rules and Regulations Governing Facilities to be Per-
mitted Upon County Road Rights-of-Way, to construct the following facility:
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Upon the right~o{f-Way of County Road No. J f. ;OP. ,at the. following location:
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as shown on the exhibits which '~r'(attached hereto, in strict conformity to the st<!te-
ments of the exact nature and amount of work to be done, and to the description of the
facilities contained in said exhibits. Your applicant will be the beneficial owner of the
facility as constructed, or otherwise primarily liable and responsible to members of the
public for its proper maintenance, repair, operation and use, Your applicant accepts all
terms, conditions, agreements, stipulations and provisions, in Rules and Regulatipns
Governing Facilities to be Permitted Upon County Road Rights-of-Way, dated March 31,
1960, and any amendments thereto, and any other applicable regulation, law or ordinance,
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Signature
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Address
WHITE. OFFICE FilE
GREEN. RESIDENT ENGINEER
PINK. PERMlnEE
BLUE.. ROAD SUPERVISOR
ORANGE - BUILDING AND SANITATION DEPT.
YELLOW .. SURVEYOR . #
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PROPERTY OWNER
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LANE COUNTY BUILDING PERMIT OR MOBILE
BUILDING [;] MH 0 ~d I ,.,_
MAILING' ADDRESS
. HOME. U~4t~~;T"
.' PERMIT NO.
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MAILING ADDR~SS'
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CONTRACTOR
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PHONE
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PROPERTY LOCATION - INCLUDE POST OFFICE
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PROPERTY LEGAL DESCRIPTION - METES. BOUNDS
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TWP
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RANGE SECTION
i.c: 7
TAX LOT NO.
CODE
CENSUS TRACT
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PROPERTY
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APPl.
NAME
&
MAILING
ADDRESS ~:~.~ I ~~'~::'I CLOQ c:'1CG::J
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
.[:l:::C: FOB
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EXISTING STRUCTURES ON
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lEGAL ACCESS TO PROPERTY
D.OBIC (;;llliC:
PROPERTY SIZE - FT.
C~l
WIDTH /)
'-.J
DEPTH
."C," 1'')
h,......l.:.. AREA
tti,Ct;;;;. .~
C~~. [ ).
Connect to Existing Sewage System 0
T.VPE CONSTRUCTION SQ. FT. # BDRMS
New System 0
VALUATION
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SEWAGE DISPOSAL
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$
OTHERO
ru.W
c-o.oo
\9.'.10
FEES
PLUMSING INSTALLED BY
OWNER 0 OTHER: NAME
WATER SUPPLY
t~~~":;vu
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAilER
SEPTIC TANK riI,
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PUBLIC CJ
o OTHER
TOTAL
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COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAL.
~ooo
DRAIN FiElD REQUIRED
ll:li>
lIN. FT
TRENCH WIDTH FT.
:3
OR SQ. FT.
( .r."
;y.oi
10' -......
W:.I.) ,,:~:::~tl C:;:)';t) <;(l t;~)" c:~nit:::n. s~., ~\\ L~OT 10 ~'l. V'~G:1 1'1:::: tlCCJC;~~ ",lC?Co.":'i1V !.OC;:.
'7.....'90 C7 7['~ C '^I"-I~L~ "IV"','V ::~'.-(~P O:iAIC:3 to Yt'."~,, r..,-:!,~::!0,",'it'1'....\, ,\. ....,.,.,~
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TYPE OF STRUCTURE
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BLDG. SETBACKS _ FT. FROM eTR.
FRONT t;5
OCCUPANCY
I C, ,I
ZONE
tll\
PUBLIC UTIl. EASEMENT
OF ROAD RIGHT OF WAY
SIDE INT. ;J SIDE EXT.
AUTHORIZED SIGNATURE - DATE
C::D:) GV U.~;U~'lZ "::~~~:.!f:~
USE CLASSIFICATION
REAR
:i
1:"1 J.
a. tJ. (::)AV R.n.y.
DATE
2NN:j
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
Construction to comply with uniform building code end county regulations
covering plum.bing" and sewage .disposal. All buildings require a certificate
of occupa'1~y ~~tore being occupied.
. -, .',
(See Statement on Reverse Side)
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(POST THIS PERMIT ON MAIN BLDG. AT SiTE)
LANE COUNTY, BLDG. & SAN. DIY., COURT HOUSE, EUGENE. OREGON 97-401
FORM :t cSS.lJ
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SITE INSPECTION
ApPROVED ~ D'SAPPROVEO ~ DATE
REMARKS G--wJ..Jr.-.n "!,.. ~ q ;";1<,
INSPECTOR
FOUNDATION INSPECTION
ApPROVED / \..... /
DISAPPROVED / /
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DATE -..~) :-.J.i -,
INSPECTOR
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REMARKS
FRAMING INSPECTION
ApPROVED /~D'SAPPROVED / /
1-/ - "t! '7~
DATE 7' ..A .' .1
/
I NSPECTO,!;:
REMARKS
LATH OR SHEETROCK INSPECTION
ApPROVED 1---/ D'SAPPROVEO 1---/ DATE
INSPECTOR
REMARKS
FINAL INSPECTION __ /'/
ApPROVED ~DISAPPROVED L::J DATE t-/.7' '73 INSPECTOR ~
REMARKS~ ~ tIJ-'-/'7-'tJ
CERTIFICATE OF OCCUPANCY
READY TO ISSUE L::::l NOT READY TO ISSUE L::::l DATE
INSPECTOR
REMARK S
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U /PERMI~
PERMIT NO.
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LANE COUNTY BUILDING PERMIT OR MOBILE HOME
BUILDING ID MH 0 4P41/7
MAILING ADDRESS
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PROPERTY OWNER
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CONTRACTOR
PHONE
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MAILING ADDRESS
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PROPERTY LOCATION - INCLUDE POST OFFICE
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PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
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SECTION
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TAX LOT NO.
CODE
CENSUS TRACT
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RANGE
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APPL.
NAME
&
MAILING
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EXISTING STRUCTURES ON PROPERTY
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LEGAL ACCESS TO PROPERTY
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PROPERTY SIZE - FT.
n-.
WIDTH U:)
DEPTH
1 tpo~. l ',')
(~~"".l '~AREA
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1::::I'i :) ll: ,': '-;;,0111:
ADDRESS ;':"~~::~~s~t~}~ :~"l{:'1"::~J
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT. # BORMS
New Syslem 0
VALUATION"
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SEWAGE DISPOSAL
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OTHERD
Ul.<m
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FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER: NAME ~,:~~~ ~'.:1~
WATER SUPPLY
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING,
PLAN REVIEW
PARK TRAILER
SEPTIC TANK Q:
PUBLIC 0
o OTHER
..,
TOTAL
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COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN, SEPTIC TANK,CAPACITY
"\. ,,',
WITH DIST. BOX, GAL,. '.. ~.cu!)
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DRAIN FiElD REQUIRED
UN. FT >I, '&.!,
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GW.V A<J "Cll!>" 10 P"i'. C'il~l 71;[;
TRENCH WIDTH FT.
3
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OR SQ. FT, J'~d
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TYPE OF STRUCTURE
FRONT
BLDG, SETBACKS.. FT. FROM CTR.
'.-.
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OCCUPANCY
I {', J
OF ROAD RIGHT OF WAY
ZONE
['1,\
USE CLASSIFICATION
PUBLIC UTIl. EASEMENT
\.: rJ
SIDE INT. '. SIDE EXT.
AUTHORIZED SIGNATURE - DATE
REAR
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DATE
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BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GO~DENROD
Construction to comply with uniform building code and county regulations
covering plumbing and sewage disposal. All buildings require a certificate
.... of occupancy before being occupied,
(See Statement on Reverse Side) ......
(POST THIS PERMIT. ON MAIN BLDG. AT SITE)
LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 97-401
FORM:: CSS.lJ
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SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED L::::7 DISAPPROVED L::::7 DATE
REMARKS
GAS PIPING GROUNDWORK
ApPROVED / / DISAPPROVED L::::7 DATE
REMARKS
INSPECTOR
INSPECTOR
ROUGH PLUMB I NG
APPROVED.PI DISAPPROVED L::::7 DATE 11-19-7) INSPECTOR ~
REMARKS
-n-T
,
ROUGH GAS PIPING
ApPROVED. L::::7 01 $APPROVED L::::7 DATE
REMARKS
FINAL PLUMB I NG
ApPROVED /Xl DISAPPROVED L::::7 DATE')'- Y-. 7,>
/
REMARKS
FINAL GAS PIPING
ApPROVED Cl DISAPPROVED Cl DATE
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE Cl NOT READY TO ISSUE / / DATE
REMARKS
I NSP,ECTOR
I NSPECTORd~/'
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INSPECTOR
INSPECTOR
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INDIVIDUAL SEWAGE DISPOS~YSTEM RECORD
Installer: Complete top part of form to
signature and return both copies to Lane
County Building Sanitation Department,
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Pr'RMIT Nn.
287-7a
GRAY
Installer'~ame~
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No. Livini Units IBedr~olnsl Bat~
SeptJ.c TaM:
Ft. from well Steel 0
InSJ.ae DunenSJ.ons: Irt;!/,
Length & Width If/Yv
Applicant
Name BRUCE FIX
I Property Aaaress
DIXIE ORIVE
I Basement J..Water Supply
Yes 0 No ~I Public Il:V" Other-List
Diameter
Depth
:r
I Gal. Capacity. / Olnl
'Tile Disposal Field:
Distribution Box:Yes ~ No 0
Other DistributJ.on- Type
Concrete [];j../
No. Compartments
Mailing
Address
1001 DIXIE DRIVE
Feet from
w'i!..l Foundation I 0
Lot Line
, Front Side I () Rear
ITotal Sq~Ft.betw.eenIFiller I~~ler deothlFJ.ller depth
ft. V6'o llines b Typelf1--~n:e..L in ~~~~w C, in
SPRINGrlELO, OREGON
Length of Lines - Ft. I Trench
l.b02-bo3. (;G4. 5. 6. Width :3
Sketch (See instructions) :
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" sani tarian' s Sigure
For S~arian Use Only:
~ ~pproved: System Installation
o Disapproved: Does Not Conform
Remarks:
Conforms to Current Standards
to Current Standards
Lane County Building & Sanitation Dept.
I"'''i.~. Il
..,/' LANE COUNTY BUILDIN:-:ERMIT OR MOBILE HOME USE A_CATION ~
PERMIT TYPE - BUilDING ~ MOBilE HOME Dose REG. # (/1.-2- PERMIT # ~i' 7-;z.;>
PROPERTY OWNER MAILING ADDRESS PHONE
~~ot:;~g-or' r,' x
13'''4.r_ (7. J:::,' ~
PROPERTY lOCATION - INCLUDE POST OFFICE
/ fJ <<7 D! X.'a: 121-.,
1/)1')/ QL'X.'.? IJI-
MAILING ADDRESS
74-/. -~t172...
PHONE
1/110/
[h- 74-,",-~??
S,or/nfrh'rz-IJ u J';/
---./,:, , ~. - ~ ~~ "7 METES & BOUNDS i:J Y~
/-:::~ ~ Z--r!':"'" ~ ~~ / ATTACHED 0 NO
TAX lOT # CODE CENSUS TRACT A
2 t{' .,. 15" tL
DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY
/J/ 1'.' cl.
p""r-u,ni>unT P. (J,
PROPERTY LEGAL DES T
LOT - BLOCK - SUBDIV.
TWP RANGE
/K'" .P-.
SEC.
-
...:;
APPLICANT
NAME
AND
MAILING
ADDRESS
FOR MOBILE HOME PERMIT ONLY
Number of Bedrooms
STR~URES TO JJ ~LT THIS PERMIT ~
~./~ ~~
"1~~LA- (/ ~K.- ~/~ .
A(!1 /
~a6 // /RJ
A 1~/"'r.fZ.
r-l )(
---yz~
LEGAL AcCess TO PROPERTY - ROAD NAME OR #
1)/ ! ':"~. D ,-
PROPERTY SIZE-WIDTH
R.'j"
DEPTH
1"-.4-. $;2. I
a'
I') Loq. 7
AREA
1t!J1?1 O,'XIrz. 01-.
c::/"_.I,.,_..tJ,,i:..l .....,__?/)~
( / - / /
Connect to Existing
TYPE CONSTRUCTION
\J~,,/ Fro"",,,
Sewage System D or New System Req. D
SQ. FT. <;S)A BEDROOMS VALUATION
1?'4-/' >-(3) /~.~.;;>.-
..y.p./d ,;;;.. /J ~S;).-.~
/7/ bOY
SEWAGE DISPOSAL
PLUMBING INSTALLED BY
OWNER fJ OTHER ~ NAME \.r"'II~,Y.s P/"I'" t.'/7Y
PLANS FURNISHED FAa1 TY PERMIT
YE~r;I' NO D YES .V N'"
~ATURE OF APPLICANT , ,. DATE
o/7,~ M.~. ~-vv ~I 2.{,/7'3
. FEE RECEIVED BY ''/ o'ATE
c?/OO ~__ /'
PE~MIT #/ /'
PUBLIC WATER
CONNECTION FEE /. ,7) -.:> R '7 - 7,:;>
COUNTY BUILDING & SANITATION SPECIFICATIONS .7
MIN. SEPTIC TANK CAPACITY DRAIN FIELD REQUIRED /'
WITH DIST. BOX, GAl. / (') O'f) UN. FT. I r!O TRENCH WIDTH FT. :]./ OR SQUARE FEET S- c.f '0
~ -hWA'l../ JqJ1i/,;Z; d-tll'~LA--..J, ,Add ~r /rJff ~ z(v
-'hUM/ ~J ,~~. h;'O 7~ 4 ;vv.~~#.v ;/hAMfi1/~. f}~~.L
~ ~~~~ ;6' A.v dvA.
TYPE OF S1'RUCTUStV . occu7;;,,~ 2>>- REAR YARD
BLDG. SETBACKS - FT. FROM eJR. OF ROAD RIGHT OF WAY ",--- USE CLASSIFICATION
FRONT l/ .:;- SIDE INT. S- SIDE EXT. - REAR.5 /l
S~}~.iN Dale rt'1JNIN'h ~'IIJ" _I D"J" BlDG.INS;/J:(fl .' ~ i;. /1 p ~
~ 4iJ 3'S-?3tT~irl./'A~O. '!2.I./J7.. r y NJ-''l,', 4/>7'<'4i' .JI, f/' I'J;S
Directions 10 Find Property: .11e-1-"'''''' <; ff'tI_a.f PI-t91n (Cliff /:)),(,'a. DI.....
./ /J.J..-7 /tf/_~
/I
PUBLIC D
BLDG.
WASTE 015.
PLUMBING
SEPTIC TANK ~
$ h,j'dJO
~ /7 ,1'}0
-< /9 r_ czl
OTHER D
FEES WATER SUPPLY
PLAN REVIEW
PUBLIC I(]
PLUMBING FEES
-9FIXTURES
CASH D ~R
CHECK ~CONNECTlON FEE
OTHER
PARK TRLR.
TOTAL
//q, .2-
PUBLIC UTIl. EASEMENT
Dato
COPY 1 - OFFICE
COPY 2 - JOURNAL
COPY 3 - AUDIT
Form # C55-1Z