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Home My WebLink AboutPermit Building 1973-5-23 " /' ~ _ ,'",r" -f --;--........."'........--....:"..,- \. ,'f! . . .j '\: .. ~ ~ >'11.....1 t, . ,', ) .. ~\1 ../.,--._~,..-- ,.." -;;::;;-- PROPERTY OWNER . .0" --I..~t. 'eLL",.:- / LANE COUNT, ILDING PERMIT OR"MOBILE HO SE PERMIT BUilDING 0 MH 0 PERMIT NO, MAILING ADDRESS ' 870 W. Centennial. Sofd. MAILING ADDRESS . , ~ 'V. , %;'~? /7'..3 t :' ~ " 878-73 Hi II. Bob CONTRACTOR. PHONE 746-CJ~16 PHONE " PROPERTY lOCATI9N - INCLUDE POST OFFICE i04a; Dondea PROPERTY LEGAL DESCRIPTION - METES. BOUNDS Lot 5. Blk. 21st Add. 18 2 to Meadow Green SECTION 6,). 3 T AX LOT NO. CODE 1f-.J;;t? /!/(J;p?) 35-152A . EXISTIN'G STRUCTURES ON PROPERTY CENSUS TRACT TWP RANGE APPL. NAME & MAILING Bob Hill 870 W. Centennial None LEGAL ACCESS TO PROPERTY Oondea St. PROPERTY SIZE - FT. ADDRESS Sorln9fleld. Or. FOR MOBilE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT WIDTH DEPTH AREA Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. # BDRMS . New System q VAL.UATION Olrtelllnq - main Garage - otto . unc. Covered ootlo Wood 1087 @ 12 294@3 98 @ 2 3 13 . 041. 882 196 14,122 PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK 0 $ OTHERD .;q.OO 20.00 21.1;0 FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY Jack Jackson SEW AGE DISPOSAL PUBLIC JO o OTHER TOTAL $ 100.1;0 COUNTY BUilDING & SANITATION SPECIFICATIONS DRAIN FiElD REQUIRED UN, fT 225 TRENCH WIDTH fT, 2 OR SQ, fT, 450 MIN. SEPTIC TANK CAPACITY WITH DI$1. BOX, GAl. 1000 Hold trenches to a 2~' maximum deoth. Stay 10' from the property line and house with 011 oorts of the droinfleld. Divert roof drains to the street. TYPE OF STRUCTURE OCCUPANCY ZONE RA USE CLASSIFICATION PUBLIC UTll. EASEMENT 5N '. I> J BLDG. SETBACKS __ FT. FROM CTR. OF ROAD RIGHT OF WAY FRONT 45 SIDE INT. ~ SIDE EXT. AUTHORIZ~p SIGNATURE - DATE /s/ Boss bv Harbauah REAR 7' PUE DATE G.W. Grav. R.S.T. 5-23-73 BLDG. PERMIT - WH lTE 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 97401 FORM ::C55-13 BUILDIN~ SITE EVALUATION {'\ . . ,- (j Building Permit . G,G" ~~ Appl ication No.-2L78-73-. T 1<2. R--.aLS /..... .TAX,L.Of C~S:TRACT'.{}:" - fS.21.f1 ' APPL A if: II' \\ ' NAME H I ADORES ' () Site Inspection () Pre-Permit Investigation LANE COUNTY PLANNING DEPARTMENT NOT NO aDD I icab I e I. Zoning Ordinance COmpJian~ ( ) ( ) (Zone (t.. . ) 2. Subdivision Ordinance CampI iance ( ) ( ) 3. Required Access ( ) ( ) 4. Bu i I ding Site (Area, Width, ( ) ( ) Frontage, Setback) 5. Ot he r (see comments) ( ) ( ) COMMENTS: YES ('/ ( ) I ( ) ( NAME DATE JhJ- ~-;""'I/- .7<" (, )1 BUILDING INSPECTION SECTION NOT NO YES NAME DATE aDDl i cab I e r:iJ 6. Plans Submitted ( ) ( ) 7. Soil Stability (foot i ngs) ~'I> ( ) ( ) 8. Flood Plain (1) ( ) ( ) 9. Other (see Comments) (I) ( ) ( ) {,u iD~ oj'. ~ ~ -'I'] 1- COMMENTS: SANITATION SECTION NOT NO YES NAME DATE aDDl i cab I e 10. Sewage Disposal ( ) ( ) (~ II. Usable Area ( ) ( ) ( ) , /~r 12. Water Supply ( ) ( ) ( ) ;// (;j. ~ . P' ~ 1.1'-' I .J 13. Other (see Comments) ( , ( ) U ~/ COMMENTS: TO APP LI CANT: Your P1 Building Permit / Site Inspec~~: Can be app roved. ,y c:... /,.)-.5 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 County BuildinQ 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 returned under separate cover. ( ) ( ) ( ) U\NE COUNTY PLANN I NG DEPARTMENT 1'\'; Sixth Avenue East, Eugene, Oregon 97401 "tI'tNI' :\1,1-1'\ 11 rx 1'. 7'; 1 LANE COUNTY BUILDING & SANITATION DIVISION 135 Sixth Avenue East, Eugene, Oregon 97401 PHONE: 342-1311 EXT. 411 ~~, , ~.. ((., , , .. Date -, t ','" ''0 . ~ . :1. It: 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 r".....t... t-.."~~ and constructing of the following facility: for the placing, building F/'\~ f\ M.;, >1 JU'\~ r.r'1r1. t~..,,(l,.w r,'''0''fI \\1 i? n n.7 f'p ". l\~/.'l ('-," , Pill- ~y) f ~ .....) I'.: '- r:" ;',,' upon the right-of-way of County Road No. 1\110) , in strict cOliformity"tei'tlle'e'xhibits 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. J)or'l"r.:~ ". 0".,'j,.....,;-'r~ ,,"'t~ ~~I1.h .....1?~ .,. }.3~ e:--~'~::; r.z~cct SpeCial Provisions: ~J~''v;:r''~.~ \'~?":r-t~ t:':\l !)o cnr;::}t~1::~od '~n !;Cc,"~1:Jea t;1~h t~tO :'.';:~cr.("~:'] (Of. C "; 1):1'." ;:;c', U.2ci :-lc:th::J (lh'cdr:r:; 1~'J0-n')). Eb:'"':ifi"tc:? l,"ll (x) tcc~~:1$f.blo rot? l'lo ~~1Jt'l1oto ro-:::vol,1)f oU !J~e:l. t'f"f.C" f~r:'7 ("'(') ~:....f[l "!',J "10 S"'~{;:)y o':1d 11'1r~t o~ t.:"JY f;'O\!cdl by i~o 'j:lCFnu(':1, lclV."o:; ~:c ' ,,::17 ,m] lYC:) in n r:::1'i:, 'lccop'i:ob10 1!l'l:d1tf.,n. 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 complet.ed befor" ~:'Y m, , 19~. Expires , 19 Inspect.ed and Approved Approved by Board of Commissioners By Date By Director of Public Works WHITE. OFFICE FILE PINK. PERMITTEE ORANGE - BUILDING & SANITATION DEPT. GREEN. RESIDENT ENGINEER BLUE. ROAD SUPERVISOR YELLOw. SURVEYOR C~I-52 '~ . -".'~. ,[ " , - , ""..--., '", -," ^,'-- ,--.. ',.. ",' . .' r~.~' -h.' DatA --." ;/ (- --.~ ". ,.J . -- '/ . I.:... \ '.- '" APPLICATION FOR FACILITY PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY ~ " Your applicant. " /' '. ./~;,/"/ hereby makes application under Rules al)d Regulations Governing Facilities to be Per- , mitted Upon County Road Rights-of-Way, to construct the following facility: , ... . . /" .../1 ,', ..~~.I~' . r ,. ,. ,.. " _ /,.,;00 .'- ../',/ :/s ....-:.t. ft#'"~~.c:A.-' )1 .~. ",~..?-,(,.~.;"/('.,.1 , 1\ ,- 0.(",,. ., I. . , 1/ Upon the right-of-way of County Road No. ,If" I/~ . at the following location: ': ';", ~. " ' / ,'- ,/" _.- '; .1 ',' p 7-- (-- .L /'./ '"'" . '1/" ..: r" .J... -', .... . ," 'I. ." '. ') or . ""... ~ .' .. n ~ it' __ I ,I ~, , ',' . - .. ~ ~ i,. as shown on the exhibits which are attached hereto. in strict conformity to the state- "", 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 tenns. conditions. agreements. stipulations and provisions. in 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. ,'l({:" '... , f I \.... ...,:'1 L, ';'r, ., -<- .... -- .... "./ 'r ,(;'2- /.' /.... /.) 1;-," ",;l, n',. /- I' ~ Signature '/ /[, " /"', ,/" _ JT' "'. - I Address WHITE.. OFFICE FilE GREEN. RESIDENT ENGINEER PINK.. PERMITTEE BLUE.. ROAD SUPERVISOR ORANGE.. BUILDING AND SANITATION DEPT. . YELLOW. SURVEYOR ,,' / ...."~I'.;,,I" .I"~ ..:' ./" ,:': /" _ "';"r..,/./ , ,v I ... /,/ C~ Phone, No, " "..,-,. ",' ~.-...- -:' ~ . " , .-'I ._;. ~. '1\', \ LANE COUNT~ILDINGi' pmAlrO~' MOBILE BUilDING 0 MH [j'~~, .\: ,,''''! ' MAILING ADDRESS " 0;0 tJ. Ccn~GJc:llli. [')':L. MAILING ADDRESS '.... HOeUSE PERMIT PERMIT NO, '. 'u'i:'''f/i~; PROPERTY OWNER :; ill C;;) \ CONTRACTOR I' PHONE 7t..~;...~~: 11 () PHONE .: ' PROPERTY LOCATION - INCLUDE POST OFFICE W~:; b~;:l2Ll PROPERTY LEGAL DESCRIPTION - METES, BOUNDS L;Jt ~. DDh. a In& "':'d. to C:CC::D\1 Greon TWP RANGE SECTION I', i' u, j, ~ TAX LOT NO. ~; --'lG~> CODE CENSUS TRACT ::I / ,",/ 5l:.~ I ~2{\ EXISTING STRUCTURES ON PROPERTY tC3r:J LEGAL ACCESS TO PROPERTY iJo~:!co lit. PROPERTY SIZE - FT. APPl. NAME & MAILING C;D Hill GiO U. Cc~tcnalol ADDRESS S:Jrlrl;]fI6Ucl. Gr. FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT WIDTH DEPTH AREA Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. ;; BDRMS New System 0 VALUATION L~;::J1 11",) - Clio G~'?~~CJ - a~t. Q ~n:;. " 03V~7cll ..,.JClo ~d ICJ7 () III c';I}'~,; j !::O (; a ;; I ;l.G.!:'~ l::2 IC") 14.W_, " , SEWAGE DISPOSAL . OTHERD 50.Cl) r~.oo 21.r;O FEES PLUMBING INSTAllED BY OWNER 0 OTHER: NAME WATER SUPPLY J,'":~"1 t~CC::.r.3:: puallc 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK 0 PUBLIC :EJ o OTHER TOTAL . lCJD.r;O COUNTY BUilDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED lIN, FT 225 TRENCH WIDTH FT, 2 OR SQ. FT. ~:;o MIN. SEPTIC TANK CAPACITY WITH DIST, BOX, GAl. I C:JD '~:jld trcn;;:'2J eo Q 2/;''' r.:o:t~r.:1.Cl dc,th. Scey 10' frC!:l ~tl:) Drlll;)ortv Ilno end [~I.JCO L11th 011 DC7CD of t~ droln?lold. DI~~re roof 'rclno eo c~ ntrcc~. TYPE OF STRUCTURE OCCUPANCY SfJ I l> J BLDG. SETBACKS __ fT, FROM CTR. OF ROAD RIGHT OF WAY FRONT ~~ SIDE INT, 5 SIDE EXT. REAR AUTHORIZED SIGNATURE - DATE /0/ Dono by H:)r~c~D~ lONE M USE CLASSIFICATION PUBLIC UTIl. EASEMENT 7' PU;Z G.U. Orcv. n.S.7. DATE 5-2!lo1~ 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 0 certificate of occupancy before being occupied. (See Statement on Reverse Side) (POST THIS PERMIT ON MAIN BLDG, AT SITE) LANE COUNTY. SLoG. & SAN. DIV., COURT HOUSE. EUGENE, OREGON 97401 fORM =C55.1] . .' ... SLAB FLOOR PLUMBING GROUNDWORK ApPROVED ;---? DISAPPROVED ~ DATE REMARKS GAS PIPING GROUNDWORK ApPROVED ~ DISAPPROVED ;---? DATE REMARKS ROUGH PLUMBING ApPROVED .;x;:; 01 SA,PPRQVED ~ REMARKS Dm?/. 'J - 71 , ROUGH GAS PIPING ApPROVED ~ DISAPPROVED ~ DATE REMARK 5 FINAL PLUMBING ApPROVED ~ DISAPPROVED ~ DATE REMARKS FINAL GAS PIPING ApPROVED ~ DISAPPROVED / / DATE REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE ~ NOT READY TO ISSUE ;---? DATE REMARKS . INSPECTOR INSPECTOR INSPECTO~ ~ C/ INSPECTOR INSPECTOR INSPECTOR INSPECTOR . ' , . InstaL\.ef's Name / IVtJ.,W\ (J/tJ..ccU No.LiVing?nits IBed~6msIBat~s septJ.c TanK: Ft. fr9m well Steel 0 Insl.Oe Ul.InenSl.ons: l'..t.. Length width Applicant Name Bob Hi II Mailing Address 870 W. Centennial .INDIVIDUAL SE~ll DISPOSAL SY. RECORD Installer: Complete top part form to signature and return both copies to Lane County Building Sanitation Department. 878-73 GG Pr-RMIT Nn_ I Property Address 1045 Dondea I Basement I Water Supply Yes 0 No ~ Public fsi Other-List Concrete ell::: No. Compartments I Gal. Capacity, [00 0 Tile Disposal Field: Depth Distribution Box :Yes.~ No 0 Other Distribution- Type Diameter Feet from 1'1,,11 Foundation ) 0 Lot Line . Front - Side /0 Rear /0 ITotal Sq1Ft.between\Filler IF~ller deothlFJ.LLer depth A "" ' I 0 'J above below I ft.,...>O IJ.nes Type 1 'L. ,,:,,1<=:10 ?_ ~_~, ,,:;1~ -'<~. of,... SerinQfield. Or. Length of Lines - Ft. I Trench 1.7~Z70 3.j()4. 5. 6. Width:z. Sketch (See instructions): I -10 - , , iO' I ,- -- \ -- i 10' , I L_:!..6' -- , .' 10 I ---- I \ , 130' 1-10'_ I +S' 5' -- :s.s' I ItS' I -_l ~ ~ --- - --, ( \U' \ ---;-.....-. -- __ 4S' I - - -_I ~~;~ - ~ I '<-, ' :) ,;,< ...~ ~ ~... , ~... }J \ \.~: ii'" ~ ", c#~. · -V '\~ ~~ \$/ ~*' Date 7- 28 -73 Signature ~ :1- _ __ Conforms to Current sLdards ~a:~: <2' ~/- 23?})1 to Current Standards ~ c For ~itarian Use Only: 0rApproved: System Installation o Disapproved: Does Not Conform Remarks: -AN. ~ Sani tarian I s Lane County Building & Sanitation Dept. \' \ PROPERTY OWNER ':'i1..C:;~) CONTRACTOR ~.:< LANE COUN_ILDI~l(7\~PE~~I~. OR MOBILE BUilDING D' MH [l , \ MAILING ADDRESS'll ,- 8'liJ \1. ~t;cipI9B. l')I'J. MAILING ADDRESS: t;-C .,""'~ H.SE lERMIT PERMIT NO. ~/i;:~'j;; 'l PHONE 71,~:"~-)iG PHONE , . .' ~<1~ ; ;::).:::!C~ PROPERTY LOCATION - INCLUDE POST OFFICE .. , PROPERTY LEGAL DESCRIPTION - METES, BOUNDS k'l: 13. CH:. 2 ioe;;~.' CJ r::::c(..':J O;'C:;;l TWP RANGE SECTION APPl. NAME & MAIliNG ADDRESS "17" "Cl" I'" '1 C~ .....~ "-J} ~ "- 'I.... 0 ... FOR MOBilE HOME PERMITS ONLY No. of Bedrooms J:: ,.' ~;"'\\ , , .\ " " TAX LOT NO. CODE CENSUS TRACT n (i "" lr'" JI:.>-.,...-:...l EXISTING STRUCTURES ON PROPERTY C!::;n:3 .\ LEGAL ACCESS TO PROPERr.t~ [Q:t:':co G~. ~- -.!R9~E.RTY_SlZ.E - F\ ','. ,I, n:'.. ~ ''', '\.. .... .'~" I, .... WIDTH DEPTH AREA C-." ....'.11 ._"""-..;;' c":" =2-~~, ' ,,:,oJ~' . '-. --::...~~_. ~ \ ~~- ~ - " ~ ".--..--,..;;,..... ~ ()7C 0. Gcntc:1l1lol ('\ - C\" ~ Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. # BDRMS New System 0 VAL.UATION ODDC~jJ STRUCTURES TO BE BUIL.T THIS PERMIT :.i'::;:Jlllr." 0 r-:jl[l ,.J..;,(~:)': 00 r~~. Q ('.:\,:::;,,:;1 [>:;\: 10 ~\.~ SEWAGE DISPOSAL PUBLIC 0 BUilDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER , C:1C.--=-~ ::':'__";":;._'- ~ t:.'J'.)::l 1O~7 (. lil ;l , , L~'.. :; ~51! II ~~~~ '-"'~> \ I "A, ~f'~.~ F~.12" . <.' ~,~-., , ~._.~ ~-'? ~~~ ~""" ~:~~~ I ,)~ PLUMBING INSTALLED BY SEPTIC TANK 0 , OTHERD :..J.OO ffi. GO m.~o L..:~t\ J,:C:~~:;~~. WJ.~;~ COUNTY BUilDING & SANITATION SPECIFICATIONS MIN, SEPTIC TANK CAPACITY DRAIN FielD REQUIRED WITH DIST. BOX, GAl. .Jet!) UN. FT 225 TRENCH WIDTH FT 2 OR SQ. FT. tJo ::Ud ~rcIlC::~::J' cO ~'. r:;l1ic:;:c; ~!:;~~.-~\~~~~,' f~ tt::J t'{\!;):)~y ~~n~,,::::;;J!::) tluCtl ~ . ')..'\._. .\.,.~.~~~";'\l\'-~\'"~~~\'~..:t'';;;-\''''''' il ;'eLl c'7 ~r:o (k<l~~~ Q...1:...~r~\'~.J _ ~I:i'.s~o.i:\ \<~~~-, 2'\ . ,~ ~"-o'X-~ ~~ ~'" ~ OCCUPANCY I C. J FROM CTR. OF ROAD RIGHT OF WAY SIDE INT~ ~ . SIDE EXT. AUTHORIZED SIGNATURE - DATE t)V tl.:w:L:Jl}:J TOTAL TYPE OF STRUCTURE ,'l BLDG. SETBACKS.. FT. FRO'NT !::) 1<;.;1 C:;:1() BLDG. PERMIT - WHITE OffiCE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD FORM = C55.13 FEES OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC ':EJ o OTHER . II ZONE PUBLIC UTIl. E'ASEMENT ;:"\ USE CLASSIFICATION REAR 7'. \>iJ:l DATE o.t!. (Jr,~. D.G.Y. ;00', ;o~' Construction to.. comply with uniform building code and county regulations covering plumbrng and sewage disposal. All buildings require a certificate of oc~upancy 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 97401 '-_.0, ..... .. ... - tIP SITE I NSPECT I ON ApPROVED C1 DISAPPROVED C1 DATE INSPECTOR REMARKS FOUNDATION INSPECTION ApPROVED LjL...f DISAPPROVED L-f DATE L ;,/') ..1} REMARKS~./.. b -:2ff.""# INSPECTOR. {Iv. FRAMING INSPECTION ApPROVED ~f DI SAPPROVEO Cl DATE - ~N7"9TJr REMARKS ~ ~ ~ ?to/ ~ C;---;Z 2..n~ / LATH OR SHEETROCK INSPECTION ApPROVED L-f DISAPPROVED / f DATE INSPECTOR REMARKS FINAL INSPECTION ~ ApPROVEO ~ISAPPROVEO ~ DAHl"tJiP~7J INSPECTOR Y-;J REMARKS,~ r.~ (J~,~~ ~ ~ ~ ~'.67um ~e,--2"-"13 V_ CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE L:::7 DATE INSPECTOR REMARKS _/'7 /j I ////. L / .A'/LPJ--" ~ '8'7'S--7J 71-d:t' /I)#J"L)~ 3s-/r2A " . , j LANE COUNTY .ING PERMIT OR MOBILE HOME. APPLICATION TYPE - BUilDING W' MOBilE HOME Dose REG, # ? / PERMIT # 5?' 7rf -7.....-?, MAILING ADDRESS A J --4 ~ - PHONE ~ R7tJ U/d~~~~.;_o/ 7#-:-~/? , MAILING ADDRESS ../.. // / . /PHONE ' , - .~, -1' - / ~J J ,I /~ C7 Zt' .dETES & BOUNDS 0 YES --;p7/-?",", ..I ~JTACHED 0 NO CODE CENSUS TRACT :3 S--/002A DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY ~- LEGAL A~S TO PROPER: ROADIJ"7 .OR # ~ 6- 4:/ PROPERTY SIZE-wrOTH DEPTH " PERMIT ~ROPERT .P7~ - -~-1 ONTRACTOR / PROPERTY LOCATION-INCLUDE/~Off ~ ,~ 5 LlLL.:L SEC, TAX LOT # c... PROPERTY LEGAL DESCRIPTION lOT - BLOCK - SUBDIV. TWP RANGE /X' APPLICANT NAME AND MAILING ADDRESS ~ ~~ FOR MOBilE HOME PERMIT ONLY Number of Bedrooms STRUCTI~?~?~O BE BU~ ~ PE~IT '" ~/U/.b~ ~.-.A. ~A'_~--r~ .....~.A'.fl~ /4/'1<::1-/ ~---/.L:~~~</~7 , ~--o;'~ ~ LJfi SE~E DISPOSAL PUBLIC 0 BLDG. WASTE OIS. PLUMBING PLAN REVIEW PARK TRlR. TOTAL Connect to Existing Sewage System 0 or New System Req. 0 TYPE ~O~ /~Q;~@}.J!- t30j V/3:1t17"~ -~9y~d ?l &'..2.- 'R(g~ I '1~ 7- - /1f/:<,;L _~_ ~~../iU?J FACILITY PER~ YES b!(" NO 0 ..." DAlE 1/..iI/ ..:j:-,,<J -7 ~ DATE .,6--/S--73 PLUMBING INSTALLED BY OWNER D OTHER~AME./. PLANS FURNISHEI5 / YES)(" NO 0 /,R. t!r7J C:~--frl:;;E 7JZT-7J . F~ ~Y ; PE....nz# 7'" ~ P7 k--;:?7 COUNTY BUILDING & SANITATION SPEIZ'IFICATIONS DRAIN FIELD REQUIRED / LON, FT, ;l:Z~ TRENCH WIDTH;'T, ..2-._ OR SQUARE FEET Z' a.. -2 t/ "'1... ~-----J/.l..td~ ~ '~j I ' -?,).<' f .~/.f aD-,;{", I SEPTIC TANK 't.J('" $ 4J:~1"3 .f!:J ,.CJ 0 ~/ "C7/ /1/0,050 OTHER 0 FEES WATER SUPPLY PUBLIC )c( PLU,.rI'I~EES ~XTURES CASH 0 se<eR CHECK }?"CONNECTION FEE PUBLIC WATER CONNECTION FEE /. ..::.-zJ, OTHER ~/J/1 MIN. SEPTIC TANK CAPACITY jAil f) WITH 0151. BOX: GAl. ~ %.;;:,,1t.U -r~ ,7ZU, r~ -'J,,;;'u,-yf.., /S-,uL ,..f,.AA":'..- ~ /ltc, TYPE OF'STRUCTURE 's AI OCCUP/~ 1 ;''/:f REAR YARD BLDG. SETBACKS - FT. fROM eTR. OF ROAD RIGHT OF WAY ~ USE CLASSIFICATION FRONT '-1 ~ SIDE INT, ~ SIDE EXT, - REAR? !f?(//t::, ~ SA~'J~RIf'N DatflfA~~INGA 11 Date SLOG'. IN/SP.,4 .. _/1.,/J /i) .. ..cz.tAJ ~v .5-.21''''1 ~, ~-j'}~7~ f.) ~ f.A'Z oS -.2 3 -?'J , - ~ /1 1 () I ~ Directions to Fiikt Property: //J~~~---" COPY 1 - OFFICE COpy 2 - JOURNAL COPY 3 - AUDIT Form # (55-12 AREA ~ ~~o .4.u ~p~ o V ~~u dt'H+L,.f. PUBLIC UTIl. EASEMENT Data