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HomeMy WebLinkAboutPermit Building 1973-5-3 (2) /J ."'fl' . ." . ... . . .\~ . .'~~R/4 .,'j."~" 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' . .' T"".'"""", ....-..-.. ~-".....,--/~ --'..oJ~. ; '."'\ .> t ,\ PROPERTY OWNER .~ (,'. .:.. 1r, .~ , !, 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 ,. ~ 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) .'" (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 . .f . " t Bu i I ding Perm i t Appl ication No. Site Inspect ion ( ) Pre-Pe rm i t Investigation -~AA "' - T /,/ R ~2s 6 ". TAX 'l()'f " ;m~~~~.~ APPL~ . .tt2/ j . ~-l NAME_'_ ~"~g' . ~ ADDRE~~ A-7!:j1J1U' J1 tf.{ II L., "', J-e.. 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) ( ) ( ) ( ) ~ COMMENTS: ~- tt-::Jh' / ;".A "". , . .' ..... . -~ ' - "'" I //f" 1.../ - ~ BUILDING INSPECTION SECTION 7.. Soil Stabil ity (footings) ~ jr) ( ) A~ NOT app] icable () ( ) ( ) ( ) (,It) NO YES NAME DATE 8. Flood Plain M ( ) ( ) ( ) . ~$~ f'-'Z-~-~ I 6. Plans Subm i tted ;,., 9. Other (see Comments) 'COMMENTS: 1'f:7NT of" f.AA --. . I , l' /G~j~ -'7j-ll~ -4J-r~~ , / .- /"'~.~.. .J'~- LJ ... ~.. . '~'.L~;;a'_~ _,I I .~ ,-'./'-r .. ..:.U I o -/-- '/.1 ~ / . SANITATION SECTION NOT NO YES appl icable - .It. () <:i? -(:-.( () ~;) () () P (I ( , cJ:5 (" 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 ./JuJ. )~ /'-/. 1- 'J-~ - ,.J 12. Water Supply 13. Other (see Comments) f.2/b/.-rI ) I.Jd'.c-. . ,",.J:.. TO APP LI CANT: '" - ~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 r . " '. Date em ~. Jl.0?:) . -"'.~'~"?"" ~ . (;.15-7) , / 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 .' -.' -'. ~ .........'..... .,......., l'-...,,-.'-. .,.-.........-....'.. ~ ". r-.,.......~-.rl.v.... ..--.... . ~..,~~--~.-"._, f'- '--...-....-.... .-'," r . .~ 7 ~. , /;'" 'Date ./... - ~~ ,.~ ~."-- ,---.'v'" -.......-.---.,.......--...,... ..,........._,~ .. . . ' . 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: A' [r' ...~. , " ,.' .; " . .... r; .... ,.., I'. '.;{ .-'f Upon the right-of-way of County Road No. 10 I (~ . ~t the following location: I ...... .'/~ ,,/'I'.<_'} J ('."':......-, ...~,-?2.. t' ,~:;. / '. ""(" . " 1")'(7 I', .,' ",., ...J 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 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. (v . (.... (t,(.(. v.. ,,/({" 6 d .13 '..1 _ .. . " I .' , )) Signature ./1.. . 4' " /'7.1 , . . , Address ;/.' .r' f'~ ;:.,."1,._,. . .; .~. WHITE. OFFICE FilE GREEN ~ RESIDENT ENGINEER PINK. PERMITTEE BLUE.. ROAD SUPERVISOR ORANGE. BUILDING AND SANITATION DEPT. YELLOW - SURVEYOR , ,.// .,/ 7(. .. //// Phone No, " . .' ...~" ..... ~t7I 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 e .,e '. ,. 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 ..... -.-- ~-"~J k , . " LANE COUNT&11I5;NG 'PERMIT OR MOBILE BUilDING 0 - MH 0 MAILING ADDRESS GN ec;)llcr.nl~. L:;>~c1. HOeuSE' PERMI~ - PERMIT NO. (VI" ,- ..-v;,i-j PHONE ,:v,'" II'. U..........o. ~I V ,,' ,/ PROPERTY OWNER [l! 10. r.c~~a-2:.li1c::!r CONTRACTOR \ MAILING ADDRESS PHONE . '" ...... 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 . . , . , . TAX LOT NO. CODE CENSUS TRACT ~~:OH,&~ PROPERTY ,. w 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. ~\', ~_\\ -J ~ ............. " 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 .. . ~. ',,~ } , \. ., , \ ~.. ;..-.J 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 rQI',,'O.] ..... v QI/ 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 .~ ~F I I I --.- . " . 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 fj - /) 4//' / . ij" e-! t:J:r:06r ,(J~A~ INSPECTOR J INSPECT~ INSPECTOR ~~~./~':;1 . . . . INDIVIDUAL SEWAGE DISPOSAL S~ RECORD Installer: complet~' top pa~f form to signature and return both copies to Lane County Building Sanitation Department. . 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 - - -. - --1} - 1 I ~l .- . --' 1/ -___ ___. I':.. \I'!-,/t; I 1tJ' - II ID } I. 10 I ---.. 12 ' "-. ". ~,," \ , -10:'" ~~ >J3 Signatur~ 7L~__ For ~itarian Use Only: ~ Approved: System Installation o Disapproved: Does Not Conform Remarks: I' Conforms to Current Standards to Current Standards Date: {;-~-;"'7 q;~ _At/:!.~i4'" Lane County Building & Sanitation Dept. rll:c.l1 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