HomeMy WebLinkAboutPermit Building 1973-5-3 (2)
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LANE COUNTveILO\NG ~RMIT OR' MOBILE/HO.SE PERMIT I:-- (/'"-:: .~.'
BUILDING D' MH 0 ~ PERMIT NO. 693-73 .
MAILING ADDRESS PHONE'
870 Centenn lal, Spfd. I 746-99"6
MAILING ADDRESS t PHONE' .
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PROPERTY OWNER
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Hill, Robert-Builder
CONTRACTOR
1052 Dondea St.
PROPERTY lEGAL DESCRIPTION - METES. BOUNDS
Meadow Green Estates, Blk. I, Lot 7
TWP RANGE SECTION
18 2 611.3
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PROPERTY LOCATION -INCLUDE POST OFFICE
TAX LOT NO.
.JtOzetJ
CODE
CENSUS TRACT
APPl.
NAME
&
MAILING
AOORESS Spr Ingfleld, Or.
FOR MOBilE HOME PERMITS ONLY
No. of Bedrooms
Robert Hill Bulldee
3S-152A
EXISTING STRUCTURES ON PROPERTY
None
LEGAL ACCESS TO PROPERTY
Dondea St.
PROPERTY SIZE - FT.
,870 Centenn-I a I
WIDTH
DEPTH
AREA
STRUCTURES TO BE BUILT THIS PERMIT
Connect to Existing Sewage System D
TYPE CONSTRUCTION SQ. FT. :# BORMS
New System 0
VALUATION
Dwelling - main
I~d
1056 Q 12 3
616 @ 3
12,672
1,848
14,520
Garage - att. - unc.
S~WAGE DISPOSAL
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
.
OTHERD
59.00
20.00
21.'.;0
FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER: NAME
WATER SUPPLY
Jack Jackson
SEPTIC TANK 0
PUBLIC rn
o OTHER
.1 f t
TOTAL
s 100.1;0
COUNTY BUILDING & SANITATION SPECIFICATIONS
./
MIN. SEPTIC TANK CAPACITY
, '
DRAIN FielD REQUIRED
WITH DIST. BOX: GAl.
1000
UN. FT
150
TRENCH WIDTH FT. 3
OR SQ. FT. 450 ~
Hold dralnfleld to a 2~1 depth maximum. Hold ten feet from house and easemonts with
dralnfleld. Divert roof drains to the' street.
,
TYPE OF STRUCTURE
OCCUPANCY
lONE
RA
USE CLASSIFICATION
PUBLIC UTll. EASEMENT
5N I & J
BLDG. SETBACKS.. FT. FROM CTR. OF ROAD RIGHT OF WAY
FRONT 61 SIDE INT. 7 SlOE EXT.
AUTHORIZED SIGNATURE - DATE
/5/ Boss bv Harbau~h
REAR
10
DATE
G.W. Gray, R.S.T.
5-3-73
SLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
Construction to comply with uniform building code and county regulations
coveri.ng plumbing and sewage disposal. All buildings require a certificate
of occupancy before being occupied.
(See Statement on Reverse Side)
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(POST, THIS, PERMIT ON MAIN.BL.DG. 'AT SITE)
LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 97401
.,
FORM ::C55-13
, BU I LD'ING SITE EVALUATION
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Bu i I ding Perm i t Appl ication No.
Site Inspect ion
( ) Pre-Pe rm i t Investigation
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T /,/ R ~2s 6 ". TAX 'l()'f "
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APPL~ . .tt2/ j . ~-l
NAME_'_ ~"~g' . ~
ADDRE~~ A-7!:j1J1U' J1 tf.{ II L.,
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PHONE '
DATE 4- .?3- 7'5'
~ 93 -7'..3
LANE COUNTY PLANNING DEPARTMENT NOT NO YES NAME DATE
appl icable (v(
I. Zoning Ordinance comp]~e ( ) ( )
(Zone /'? ) (~
2. Subdivision Ordinance Compl iance ( ) ( )
, 3. Required Access ( ) ( ) (~ r-' {?
4. Site (Area, Width, ( ) ~ (~. ,)r q~z(;~i
\ . Bui Iding (,.)
I Frontage, Setback)
\ 5. Other (see comments) ( ) ( ) ( )
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COMMENTS: ~- tt-::Jh' / ;".A "". , . .'
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BUILDING INSPECTION SECTION
7.. Soil Stabil ity (footings)
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( )
A~
NOT
app] icable
() ( )
( )
( )
(,It)
NO YES
NAME
DATE
8.
Flood Plain
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( )
( )
( )
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~$~ f'-'Z-~-~
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6.
Plans Subm i tted
;,.,
9. Other (see Comments)
'COMMENTS: 1'f:7NT of" f.AA
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SANITATION SECTION
NOT NO YES
appl icable - .It.
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COMMENTS: 7l".,a. Lh~;'I;...;t . h.v.>.. _ f-< - ~-';',Ft.Ib
/.,,,'M..,,..~_^>& ./v..a, ~~I. a.../Lu1. y;r "j1nA..
. - ,.I . .. Cr 1/ .
[) /<!JJ/ 1 i\\ 0 u)
NAME
DATE
10.
Sewage D i spos a]
II.
Usable Area
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/'-/. 1- 'J-~ - ,.J
12.
Water Supply
13.
Other (see Comments)
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TO APP LI CANT:
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- ~o r Building Permit I Site 1~Y'flct~-ion.: .
"'-~II :t 5-2:- '4 c::;:"') I II ,n
c:l"f-', Can be approved. . . . I 0-' - ~
NO'i~e.D ~ot be approved at this time as indicated on item No.4-9- above.
L _~~_~ Questions and further information on items I through 5 contact the Lane-
~ COUNTY PLANNING DEPARTMENT, Questions and further information on items 6
j.Prough 13 contact the Lane County Buildinq and Sanitation Division. .
(...r--Will be held in this office until",You ca'7:'esolve the.problems indicated.
() Is being returned. ~ I /973
() Your building permit appl ication feelS being returned under separate cover.
li\N[ COUNTY PLANN I NG DEPARTMENT
Il~ Sixth Aven~e East, Eugene, Oregon 97401
"'hINI: t'll-I.111 rXI. 7'>1
LANE COUNTY BUILDING & SANITATION DIVISION
135 Sixth Avenue East, Eugene. Oregon 97401
PHONE: 342-1311 EXT. 411
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(;.15-7)
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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
n. r,U!.U
and constructing of the following facility:
for the placing, building
~R" JtU<JM:\'\1 [I, ,.u ;\\~~h Mt ('>'h ~''''Pb m-..,e..
ROSa ~Ot!l c~coC LJ.D. Cl.@? c~ (cu1 ~:) C2:J(
upon the right. of-way of County Road No. nn~.r:._, 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:
EJ;ll'iv\...wwY t1!l!.! bel CCl>OO~Cl\l:.cCl :l.m ac~QzQlar.:so t1i~. C!::o D~l);GcU':.:::18 ","<::11'V....:::-:
ovu",,,,,ao~ o~!aMln~= (Inn~iLtU t:1<;::O-\;O) l'
l?om::lACWo t1J1.11.! be gOO~iilD~lo f;CJX' tho ~!o~ ll'C:::rv'c! oi? cll.ll. Cr:{i. :lL.
omS tJo:!Jlg-.1l.o g3~ ~ g'OO~l1 o~ rA0b~ ell t;:)3f (:0=0:3 hy ~io o;JCll'u\';1!.c:.oo
lcmrw..g C~ rrroGt::l~ omd DECO Uil 0 ~~, oc~o~l!.a (:@:.tilM;!c:;:}. .
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 t"...cl.11;:)
Inspected and Approved
, 19 7.(\. Expires
, 19
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
C91-S2
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/;'" 'Date ./... - ~~
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APPLICATION FOR FACILITY PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
Your applicant. I' //>'/ . .,.f:
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-of-way of County Road No. 10 I (~ . ~t the following location:
I ...... .'/~ ,,/'I'.<_'} J ('."':......-, ...~,-?2.. t' ,~:;. /
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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
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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 Regulations
Governing Faci Iities 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
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WHITE. OFFICE FilE
GREEN ~ RESIDENT ENGINEER
PINK. PERMITTEE
BLUE.. ROAD SUPERVISOR
ORANGE. BUILDING AND SANITATION DEPT.
YELLOW - SURVEYOR
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Phone No,
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LANE COUNneILdi'NG ~ERMIT. OR MO'B;LE HO.SE PERMI/
BUILDING 0 MH 0 PERMIT NO.
MAILING ADDRESS
C70 Ccn~cmilol. ~!)I'I1.
MAILING ADDRESS
GrJ,-,3
--------
PHONE
j'!.:c;..S::;IC
PHONE
PROPERTY OWNER
Di II, Q::l::ort-C:t I lcior
CONTRACTOR
,
PROPERTY lOCATION -INCLUDE POST OFFICE
IOJ2 ~m1co St.
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
t~c~~ Orcc~ ~s~ctoo, Ol~. I, Lot 7.
TWP RANGE SECTION
?
T AX LOT NO.
t ' J ..
;:" ("
CODE
CENSUS TRACT
10
:I
G,
35-I!.i2J\
EXISTING STRUCTURES ON PROPERTY
t::.no
LEGAL ACCESS TO PROPERTY
Cort~;)O St.
PROPERTY SIZE - FT.
APPl.
NAME
&
MAILING
ADDRESS g,'lrllllJl'lold, Or.
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
[;o~er~ IlII1 D:J Ii<:C<I
070 Centennial
WIDTH
DEPTH
AREA
Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT. :# BDRMS
t)~:o 1.11 n1) - mo In
\:.':md
lOS(j Q 12 II
GIG 0 :ll
New System 0
VALUATION
12,0'12
n~7~C~ - O~~. a une.
n ('I,f)
v t_ ~~..:
~{}.:.,~\;
SEWAGE DISPOSAL
PLUMBING INSTALLED BY
.
OTHERO
5!.1.IlU
20.00
21.~O
FEES
OWNER 0 OTHER: NAME
WATER SUPPLY
J~ct: JC~~:gCfl
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK 0
PUBLIC GJ
o OTHER
TOTAL
. 100.50
COUNTY BUILDING & SANITATION SPECIFICATIONS
WITH DIST. BOX: GAL
MIN. SEPTIC TANK CAPACITY
1000
I~I" drolng'old 1:0 c 24" d:,th r.m:lcu:n.
DRAIN FielD REQUIRED
IliO
\
Ibhl ton
L1N. FT
TRENCH WIDTH FT.
~
OR SQ. FT.
4;;0
feot ~roo houno end coc~~~to ~Ith
dr0lnfloUd. DI~rt roof drclno 1:0 t~ ol:rcct.
TYPE OF STRUCTURE
5(J
OCCUPANCY
I ~ J
ZONE
l1A
PUBLIC UTll. EASEMENT
BLDG. SETBACKS __ FT. FROM CTR. OF ROAD RIGHT OF WAY
USE CLASSIFICATION
FRONT
61
SlOE INT. "I SlOE EXT.
AUTHORIZED SIGNATURE - DATE
'~rbal!gh
REAR
I"
/0/ Cooo by
G.U. Grev, n.n.v.
DATE
53-:;-f~:J
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. ,i
(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 == C55 -13
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SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED ~ DISAPPROVED ~ DATE
INSPECTOR
REMARKS
GAS PIPING GROUNDWORK
ApPROVED / / 01 $APPROvED ~ DATE
INSPECTOR
REMARKS
ROUGH PLUMBING
ApPROVEO .t;?J D,SAPPROVEO C1 DATEt -fl...''3
REMARKS
INSPECTOR~,f~
(/
ROUGH GAS PIPING
ApPROVED C1 DISAPPROVED C1 DATE
I NSPEC.:rO~
REMARKS
FINAL PLUMBING
ApPROVED ~ DISAPPROVED C1
REMARKS
DATE!j- ')-2.2. INSPECTo"4:/
FINAL GAS PIPING
ApPROVED C1 DISAPPROVED / / DATE
INSPECTOR
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE C1 NOT READY TO ISSUE r---? DATE
INSPECTOR
REMARKS
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LANE COUNT&11I5;NG 'PERMIT OR MOBILE
BUilDING 0 - MH 0
MAILING ADDRESS
GN ec;)llcr.nl~. L:;>~c1.
HOeuSE' PERMI~
- PERMIT NO.
(VI" ,-
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PHONE
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PROPERTY OWNER
[l! 10. r.c~~a-2:.li1c::!r
CONTRACTOR \
MAILING ADDRESS
PHONE
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PROPERTY LOCATION - INCLUDE POST OFFICE
iG:;2 l~;;~::;::l SC.
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
i:::;.:6:m Crc:::n ::H!ctC:J. all.;. O. ~(l "j
TWP RANGE SECTION
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TAX LOT NO.
CODE
CENSUS TRACT
~~:OH,&~
PROPERTY
,.
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II
G
APPl.
NAME
&
MAILING
ADORESS [;?rlr..Qnol::J. 01.
FOR MOBilE HOME PERMITS ONLY
No. of Bedrooms
C::;~:;r(l MOl ~Cul1~;:o
C/0 cC:JeC:ln~
,\
EXISTING STRUCTURES ON
t:J~:)
LEGAL ACCESS TO PROPERTY
c;};:::J;D Ga.
PROPERTY SIZE - FT.
WIDTH
DEPTH
AREA
G:;7~:? - cen. .. tJ41C.
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C~0 C II
New System D.
VALUATION
o 2.C;/}
n ['I,'~
"...,--~~....
QL';:p:)( .0
STRUCTURES TO BE BUILT THIS PERMIT
Connect to Existing
TYPE CONSTRUCTION
l~j
Sewage System 0
SQ. FT. # BORMS
oc0G Q Utl, ;J
c::;:'lll'1;] - C:J Un
. ~-'
SEWAGE DISPOSAL
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
PLUMBING INSTALLED BY
.
OTHERO
~~.~
2U.CD
m.!ill
FEES
OWNER 0 OTHER, NAME
WATER SUPPLY
J:'ct! J::~I:~:J
SEPTIC TANK 0
PUBLIC B
o OTHER
TOTAL
. gl..'J.~U
COUNTY
BUilDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED
V!:O
lIN. FT
TRENCH WIDTH FT.
)}
OR SQ. FT.
C;2<J
'MIN. SEPTIC TANK CAPACITY
tGCJ
WITH DIST. BOX: GAl.
,
.;:,~c1 CrolnQloid \1:0 l\Z~1 C:::pcl'l ccnCr;:>p., ~t::)l(] &C:J ~c::t 1'i"C) beo cr.J'<;;::&.......;;Jeo ~GctJ
(;:?..-llo{'loid. DI\,-;Jr~ t"C){' drc:lno eo tb oeJfcol:~' n .. . ~. ',,~ } , \. .,
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OCCUPANCY
I C. J
ZONE
Ct.')
PUBLIC UTIL. EASEMENT
TYPE OF STRUCTURE
BLDG. SETBACKS u FT. FROM CTR. OF ROAD RIGHT OF WAY
FRONT ()! SIDE INT. 'i SIDE EXT.
AUTHORIZED SIGNATURE - DATE
lo! Coso bV l::.lrtcllJ"
USE CLASSIFICATION
REAR
iO
a.u. OrGy. .Cl.D.i'.
DATE
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BLDG. PERMIT - WH ITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
Construction to comply with uniforryl building code and' county regulations
covering plumbing and sewage disposal. All buildings require a certificate
of occupancy before being occ.;'pied.
(See Statement on Reverse Side)
'.
(POST THIS PERMIT ON MAIN BLDG, AT SITE)
LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 97401
FO~M := C55-13
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SITE INSPECTION
ApPROVEO ~ DISAPPROVEO ~ DATE
REMARKS
FOUNDATIO;; NSPECTION
ApPROVEO 6D'SAPPROVED L..:..-! DATE';: /7~ 1 J
REMARKS
INSPECTOR
INSPECTOR
~
FRAMING INSPECTION
ApPROVED ~ D'SAPPROVEO Cl DATE ~-I.Y" '73 I NSPEC~
REMARKS
LATH OR SHEETROCK INSPECTION
ApPROVED L..:..-! D'SAPPROVEO r----? DATE
REMARKS
FINAL INSP;~~
ApPROVEO 0' SAPPROVEO c:J DATE1..::..?J-.?1J
REMARKS ~~~~-~'i'~~ntl!
.
CERTIFICATE OF OCCUPANCY
READY TO ISSUE Cl NOT READY TO ISSUE Cl DATE
REMARK 5
(p 9,) ~73
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INSPECTOR
J
INSPECT~
INSPECTOR
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INDIVIDUAL SEWAGE DISPOSAL S~ RECORD
Installer: complet~' top pa~f form to
signature and return both copies to Lane
County Building Sanitation Department.
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P~Q""IT No
693-73
GG
Insta~l,er' S Name
IV "VfVl ~.J:Z7t/.
No.LivinyUnJ.ts IBe;oomslsains
sept:J.c TallJ{:
Ft. from well - Steel 0
.lnSl.oe UJ.InenSl.ons: r't:..
Length Width
Applicant
Name
I Property
I Basement
Yes 0 NO.:l2l
Address
1052 Oondea St.
I Water Supply
Public ~ Other-List
Diameter
Depth
\ Gal. Capacity. 1000
. Tile Disposal Field:
Distribution Box:YeS~ No 0
Other Distribution- Type
Concrete J;ir
No. Compartments
Robert Hill Builder
Mailing 870 Cent""";" 1
Address
Sprinqfield. Or.
Length of Lines - Ft. I Trench
l:]2.2.71?3. 4. 5. 6. Width:S
Sketch (See instructions):
Feet from I
Well Foundation/O
Lot Line .
Front Side 10 Rear /0 f
IT otal SqjFt.between\Filler IF~ller dePthlF~ !!er depth
f "-' 1 . l/ (j. abOve be low I
t.~::>O ~nes7/) Type I, tile 2--ln. t.n" F 114
~
D, IH!'1 ~ " ~ ~ U)
~n JUN 05 1913 ..
d~\\lE CUUl'1Y HEI\LTH lmtt
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- --1} -
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Signatur~
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For ~itarian Use Only:
~ Approved: System Installation
o Disapproved: Does Not Conform
Remarks:
I'
Conforms to Current Standards
to Current Standards
Date: {;-~-;"'7
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Lane County Building & Sanitation Dept.
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LANE COUNTY 61NG PERMIT OR MOBILE HOME. APPLICATION
. PERMIT TYPE - BUILDING M MOBILE HOME Dose REG. ~ .?" / PERMIT #
PR~Y ~ER d J /'A // '~}1l';lJ ADDRESS /7 --' ,
.fi~/t..T ~ /~/ 97cJ ..-t"~/~...-./
CONTRA~ ~ MAILING ADDRESS ~./
PROPERTy;oCATlON -,,qClIjDE POST OF:CE /O..s .;2 ~_ -1/ '" ~
PROPERTY lEGAL DESCRIPTION J..../7 L? 4.#/ ~....."._./ "'/ r A?~ METES & BOUNDS 0 YES
lOT - BLOCK - SUBDIV. ;;7&-7 ~I //~~~~_ /rl'';;'''~.ATTACHED 0 NO
RANGE SEC. TAX lOT # CODE CENSUS TRACT
6' 3-.5-:" /~-...1A
DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY
~<
CESS TO PROPER:PD NAME OR #
.._ _ _ 'A .
ROPERTY SIZE-WIDTH DEPTH
PLUMBING INSTALLED BY ~_ ./ /!/ _ ./
OTHER 0 OWNER 0 OTHE~NAME~~ ~
WATER SUPPLY PLANS FURNISHEb / FAClll\!YPERMIT
FEES ~
PUBLIC V OTHER YES NO 0 YES ~ NO 0
PLUMBING \lEES ~NATU~R ]>F jPPll NT . .~ ' 1/ DATE
-k~XTURES /f;('J('JL\..fL,@fJ ~~ Udo r-~::?~
CASH 0 sFw4 ' ~ , FEE RECE VED DATE
CHECK rtA,i;:;ECTlON FEE ~/ /) IJ ~ -'/ ~d..3 -7.:/
PERMrf '# -'
PUBtlC WATER /
CONNECTION FEE L'. ~-Z; f'2. 7> _ 7 J
COUNTY BUILDING & SANITATION SPECIFLCATmNS
DRAIN FIELD REQUIRED I
lIN. FT. l.lO TRENCH WIDTH FT. 3 OR SQUARE FEET t.{,f"O
/;tJr
_ REAR / t). .
~_/:~~ BLDG. INjp{jr.rlA/m,{di S-/-/73 D.t.
;,. r I -
h..:{--;,/iI ~,.,
~____ 40"- o..j
'~ ~ x:W.;;f
~PE OF STRUCTURE S AJ occu7'q 1
BLDG. SETBACKS - FT. FROM eTR. OF ROAD RIGHT OF WAY
FRONT 'I SIDE INT. "9 SIDE EXT.
SANITARIAN Cafe '1--7 ~AUA
AtiJ. ~d '/-;1.'-' -=-=-tJ"---(
Directions to Find Property: (J
7?
d<
4/~
APPLICANT
NAME
AND
MAILING
ADDRESS
FOR MOBILE HOME PERMIT ONLY
Number of Bedrooms
SYRU ES TO BE ~ll~IS PERMIT ...
//~ ~--j - pI~
;..-#' ../..M~Ai' .
~-4--7'<('/ JAfl.-f
SEWAGE DISPOSAL -
PUBLIC 0 SEPTIC TANK X
.'OG. $' ~ 'Gf "~N:J'
,:;:u:1 , .& C/
...:J / ..S'll
WASTE OIS.
PLUMBING
PLAN REVIEW
PARK TRLR.
TOTAL
..42./J, c:(L
MIN. SEPTIC TANK CAPACITY
WITH olSl. BOX: GAl.
~()O
t<t.--t ~9
COpy 1 - OFFICE
COPY 2 - JOURNAL
COPY 3 - AUDIT
Form # C5S*lZ
h93-7\.?
7~:ff/b"
PHONE
AREA
Connect to Existing Sewoge System D or New System Req. D
TYPE CO~CTlON SQ. FT. ~!-B~OMS VALUATION
,?' ../ ~ .- e.. ./ ;?~-( ~ I....::. -::u J,J" t 7:J.-
-?p,x'.1.~ bib (0.3 I,' R.t/8"
Ii Sc?CJ
REAR YARD
PUBLIC UTll. EASEMENT
USE CLASSIFICATION