HomeMy WebLinkAboutPermit Building 1973-5-30 (2)
f'" ft"....,~.
<
-.....,.,....~ -. ;"~"
- ,
,,=,~.,-
-.....--.-..
_or T
...-;1
1'''
,.
':., ....-;,..... ~
t.' t,-, ~
LANE COUNTveJlLDING
BUllDING;[J MH 0
MAILING ADDRESS
2,,4' NORTH ,4 TH ST~EET.
MAILING ADDRESS
Ou'.; :~U;
~.I/
PERMIT OR MOBILE
cf
~ <' :.": -... ~
HoAsE
../~
PERMIT
PERMIT NO,
lf32. -")"':'
~
PROPERTY OWNER
TAGGARTJ OOR IAN
CONTRACTOR
SPRINGFIELO, OREGON
cn2- 7,
PHONE
747-6.24
PHONE
PROPERTY LOCATION -INCLUDE POST OFFICE
106Q OONOEA STREET
PROPERTY LEGAL DESCRIPTION - METES. BOUNDS
1 5T ADDITION MEADOW GREEN ESTATES
TWP RANGE SECTION
LOT 7 BLOCK 2
TAX LOT NO.
CODE
CENSUS TRACT
18
02
06,1.3
$ If, U?rJ
. EXISTING STRUCTURES ON
':I~-1'i2 A
PROPERTY -
APPl.
NAME
&
MAILING
ADDRESS SPRINGI!IF'J-O. QRfGON
FOR MOBilE HOME PERMITS ONLY
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
DORIAN TAGGART
NONE
LEGAL ACCESS TO PROPERTY
OOND.f~ STR~FT
PROPERTY SIZE - FT.
iR2'i':l4 NORTH .4 TH STREET
WIDTH
DEPTH
AREA
Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT. # BCRMS
New System D.
VALUATION
DwELL I NG-MA I N
0l!UItllMaXllX
GA~AGr-ATTACHrD-CrILrO
rR4M~
I':IQ:? tl I:?
II>. 704
4Rn c:il ':1.<:;0
1. ~O
~NST^LLATION OF S.O.S.
COVERED PORCH
SEWAGE DISPOSAL
flo (i) 1.00
An
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK 0:. OTHERD
. 71.00
::>0.00
<<.<:;0
FEES
PLUMBING INSTAllED BY
OWNER 0 OTHER: NAME
WATER SUPPLY
IR.4~4
PUBLIC OOX
o OTHER
MIN. SEPTIC TANK CAPACITY
, 1::>4.<:;0
COUNTY BUilDING & SANITATION SPECIFICATIONS
DRAIN fiElD REQUIRED
TOTAL
WITH DIST. BOX: GAl.
1000
UN. f1
22'1
TRENCH WIDTH FT.
::>
OR SQ, FT.
4<:;0
"
_HOI n TJH.NC:MF'~ Tn A MAXIMIlN nF'PTI-I OJ."' ::?h I Nr.u"'c;._ ~TU-'n !:'T_ ~llnM Twr unllClr AIoJD-.e.B.flDC'QTY
I IN!:' ''''ITI-I All Pll.i:'lTCl nl:' TWit" nDAINC'IIt"I n_
TYPE OF STRUCTURE
OCCUPANCY
ZONE
PUBLIC UTll. EASEMENT
s: M .1 -"fl.l'" I
BLDG. SETBACKS __ FT. FROM CTR. Of ROAD RIGHT OF WAY
USE CLASSIFICATION
FRONT
),,::
~
SIDE INT. S SIDE EXT.
AUTHORIZED SIGNATURE - DATE
REAR
1nl c- .AU'" C.
Inl I t" C^DI! I!loV rUA,.....' '" U.nn.""u
. "
G,W. GRAY, SANITARIAN
DATE
"i/,0/7,
~5
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
r
Construction to comply with uniform building code and county regulations
covering plumbing c;md sewage disposal. All buildings require a certificate
of occupa'ncy. before being occupied.
(See Statement on Reverse Side)
.~
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
. \'ORM "C;""
LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 97"01
. '.
I . r,
LANE COUNT.;I~DIN~ ,PERMIT O"RJOBILE
BUILDING:D . MH 0
MAILING ADDRESS
~: ("!.' ~>':i'~_~ \,1.. t",~J ,:~-;(.:V... !' >~lil': .1V..J..... ;':""C~"'l
"'Ill
.
.,#1" ',.#\
.~ '(".:-)
",':'-"_,.r'~
"
HO~SE PERMIT
PERMIT NO,
. ~, . ''\
'J 'I ~ . "
PROPERTY OWNER
~ ~ "?.. : "."" ~ f'
CONTRACTOR
MAIL[NG ADDRESS
PHONE
?~\;\::J(;':"" ,
PHONE
PROPERTY LOCATION - INCLUDE POST OFFICE
~ "":\' - '\ \ - ~ \ ~~ \~~.}. ':- \\~~
~- '~~-...~ /'0 V~:-'''?
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
l f'~~'':'\:'(:':, r~'.^r-n.~ r~~'~:~r: (~f;'\lr'),Tr.fJ
TWP RANGE SECTION
r<-.otr 7 r~'u~:; - ~ n
TAX LOT NO.
CODE
CENSUS TRACT
APPL.
NAME
&
MAILING
('! ",-r:) 1.3 # I(,ZCI7J
'i1"~~- :~..!-=,\.-~-\ \
~ ~;t;) fl
EXISTING STRUCTURES ON PROPERTY
~ \ .. i ' fI.
._-' ^\,G -=., ;:.co T"~';'.,~o' ., .,
...... . "<, . ~.
~, ,'r ....,.........., r,:) ...., ' ''''''~-!l1'n -.,.;:;;
! .~ . .'" . ..1' ,_G ...., _' L. . ,. .tll
I.
r.....~ _ ,
. LEGAL ACCESS TO PRO~EB.!i.~.
;)""}"':1'1^nt"r.r!t"V' '~
PROPERTY SIZE - FT.
ADDRESS
,of
.~ ';~'\H'~'vt.;,~,\.j't\ {.... '_;"'~'l
~,
WIDTH
FOR MOBILE HOME. PERMITS ONLY
No. of 'Bedrooms .:\", (, . > \: t \ . \
STRUCTURES TO BE BUILT THIS PERMIT
, '\
" '4" . ~
......'-...,)
",... , tp-\\'-,~.
,,~ ~ ''"~ :.>:-' ^ ..,..,
\,....-..,
,..\..-..,:: ,
'\'\.4
"'c-
\
.
L1
I
,-
BUILDING
WASTE DISPOSAL.
"
"
'~
o OTHER
,
PLUMBING
PLAN REVIEW
PARK TRAilER
~.j
"'~
I
.
TOTAL
~ ~~ '~~..r;)
........
COUNTY BUILDING & SANITATION SPECIFIG:ATlONS
MIN. SEPTIC TANK CAPACI~\. DRAIN fiELD REQUIRED '\.. ~ ~-)J: ...,' ,
WITH DIST,)OX!~'GAL,\'t' ~~~~"'...\\IN'''~ C.~~\;T)lf'~CH'\'D'fiJ"Ft~" ",",-ORSQ, FT,
:1 '~\'-\'-;.-\" ~
't"'~ \~:''-~~:::::''''r) ib~C>. ~~~:-iJ'-::t:j ~'-:r:1:'t] ~'J r::~ ~C~:-::,:::'.. ':,VU-J 'll (:.'7. o.::e~' '~"~'i~ l;:,l~/~'I'I'~:) C;~~\")"~j7'V
l\ "'\"~\~:.\.. ' )',.i: \\'~'."'"
"., ":'~~J t!t,,~. ~I'~".:'~l r:/ ll:..~~~:!t\~t~~~~~rt~~~"t.,\ ~\."";-.'Jo. '\~'~~\:,~\\_,~\,~",~\'l,~~. _ ~
. ~~, ~~ ~~~';:~:o~-I\~,~\,"'i:'_
"~,..,"\._<i ~~ ~~~~ ~ ~ ~~~(.
;'~""~'\"4'" "\,\ ~.~ ,QC~iiPA!-iC' ~~\~ZO~E~'- '\ \\ "';'.) ":!\PUBlI~Ut'.l.' EASEMENT
..... .."'- ""~ """'~ ~\ _t\ " ,,," ,', ~" ,...." "\,
" ~. ~'-,,'~~~~1-:r'- -. ~:",,\..~_~~~\'i" '~:"~,,,,...,...~1~ .. ~"""~'\I~ '\"~
BLDG. SETBACKS --i.No.' FROM\.GT~..."OF}'lRQAD"RIGl1,T"9FZWA~ ~......~.:t1N\~"USE Cl'~SSIFIGATiON....~ \-..)~ \.......,,~
FRONT ;:'; YsfD~\Nf. r\ -\ \ SIDE EXT. \. "I '. .REAR ~\ .. r-. 0 , ~ ^"'.!l\ .~~ '\ . .;
. AUTHORIZED SIGNATURE-DATE' \ -....:,....--\\\'1..... ~ ,'~ \1 .... , ~
l-l ..Lr.. !"'.........') ,.."v OJlN'-',l'J r~^""'--'Nr"'''' \~ '\ ~,e~. \::.~t1, 'CW~~4.~'^~:
f;: "
DATE
t,;!: 'f'l'> ,
A. _ ~,J
BLDG. PERMIT - WHITE
'OFFICE COpy - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
,
Construction;fo comply with uniform building' code and county re'gulations
covering plumbing and sewage disposal. All buildings require a certificate
of occupancy.. before being ~ccupied.
.. . "'lo . ....... -. ~
~
(See Statement on
, \
'k t.., '~ ., ~ ~
BLDG. AT'.,SIT,E)
... '
R::-'erse ~e)
.", ~.. \
" '\:....., .
,
>.
;'\' ...." - ....-
(POST THIS PERMIT ON MAIN
LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 97401
~ F'ORM = C55-1)
~
~
....... <':' ~
.
.
..
,'--'.
SITE INSPECTION
ApPROVED Cl DISAPPROVED Cl DATE
REMARKS ~~ ~ / /J - t.~ -7-sL
INSPECTOR
FOUNDATION INSPECTION
~
APPROVE~~--1)ISAPPROVED ~/
11-0' '1~
~_/~
./J
k. .LJ
-%""
:;.. . J~- -.
I N.SPEcTOFF'/\....1
DATE
REMARKS
.<II /l /~
FRAMING INSP~~ ./ ' I;:J!J-ctt{_~
APPRO~_ I ~APPROVED Cl-;;J:! ~ ~NSPECTO~
~~~ ~/I-f.fO" _ /I,
..uc ~,..i~ I 1-2 r- '11 '''-/.I''t' /2. '...~ 71f~ '''_I (hI;."/]
j, Ii' ~ 7P //Ii .4&'~';/ I - ;,'.,)t/ i"
F i
(
~
,,~, "?! ~&/~1' 7/.~7'I-7(e(
ApPROVEO . ~p~!:::] DATE '/-/~ ~J'f I NSPECTORQ
RE S' 'iI-Il-1lff4dt10 ,,-f-14
- - --...w'UJ-tcl-
READY TO ISSUE ;---? NOT READY TO ISSUE !:::] DATE
INSPECTOR
REMAR"K 5
.r\ " /~p
L/-u'-~-
II
9J2"7J ~/()(;" j1)J~
3r-/J-1.. ~
~
;j
~U~;LD~~NG. SITE EVALUAT ION .
(./ Building Permit Appl ication
() Site Inspection
() Pre-Permit Investigation
.CO.CD, ~~
N'c), Q?;)'-73
T /LR ~ S t., TA}; "LO;
C. TRACT:'!<,_p n .
APPLI~ ,\\,'
NAME~F\F\MT;j .1 )(\kll A\.l
ADDRESS ~~ .
PHONE
DATE
-'_ I
f~ /0(11 I~
" I
-
LANE COUNTY PLANNING DEPARTMENT
I.
Zoning Ordinance Compl i~'i.
(Zone~. )
Subdivision Ordinance C~mplTance
NOT
a;;;'licable
() ()
( )
( )
( )
( )
NO
YES
NAME
DATE
3.
4.
Required Access
( )
( )
( )
( )
( y-- /J1~5Z-
(~
( -r----
u---
( )
5=-22.-7.$
2.
Building Site (Area, Width,
Frontage, Setback)
Other (see comments)
5.
COHM ENTS :
BUILDING INSPECTION SECTION NOT NO YES NAME DATE
a;;;'1 i cab 1 e
6, Plans Subm i tted ( ) ( ) 0
~; 7. Soil Stabi] ity (foot i ngs) ()1 ( ) ( )
8. Flood Plain (j1 ( ) ( ) {~~~~~~V~~
9, Other (see COIMlents) fJ ( ) ( )
COMMENTS: r
-.
SANITATION SECTION NOT NO YES NAMIi DATE
a;;;' I icab I e
10, Sewage Disposal ( ) ( ) Of.)
II. Usable Area ( ) ( ) ( ) . t1^~
( ) ( ) ( ) LA (J. .~
12. Water Supply . "'-.:
(see Comments) ( , ( ) ( ) r 5JJ-T '
13. Other
COMMENTS:
TO APPLICANT:
Your Building Permit / Site In~,ction:
()<j Can be approved, K (!,- /"JI
() Cannot be approved at this time as indicated on item NO, above.
Questions and further information on items 1 through 5 contact the Lane-
COUNTY PLANNING DEPARTMENT. Questions and further information on itemS 6
through 13 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 appl ication fee is being returned under separate cuver.
U\NE COUNTY PLANN ING DEPARTMENT
Il~ Sixth Aven~e East, Eugene, Oregun 97401
1'lhlNI: \',1-1.111 rXL 711
LANE COUNTY BUILDING & SANITATION DIVISION
135 Sixth Avenue East. Eugene, Oregon 97401
PHONE: 342-1311 EXT, 411
... .-- -'.. . ...
n___.....
--:'.--:;'" ", ..~~
-"~
","4~','.! ~:-s"';~'-': ....-.:!:- ~'.,.. ':'''''-''"T '~:.~.
~-
.......,.
l- '
LANE COUN.UILDING PERMIT OR MOBILE
BUILDING D MH D '
MAILING ADDRESS
Hce USE PERMIT
PERMIT NO,
,......
',..
PROPERTY OWNER
PHONE
'~'.~~ ~IlDY.. :>~r(~".':l
CONTRACTOR
, t,
:':0~:1) r~r~~"'j ',~tj \7;1
MAILING ADDRESS
\' ~r.'r~<;", q9:11~'n7~r'"I,"" C'r ('~;~:
",., /'
t .1_,1
. PHONE
," ,'"
PROPERTY LOCATION - INCLUDE POST OFFICE
n' , ;'~""~"l ^ ~~Jn~.P'1
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
" ^",,'It"If.)'" r.~"l\n~.l nf'l"'~r'" f.'!"l.?^-7rrl
TWP RANGE SECTION
Irw 7 rt roC''' r>
. TAX LOT NO,
CENSUS, TRACT
';',~6~r:{") (\
EXISTING STRUCTURES ON PROPERTY'.
CODE
fP
0(')
APPl.
NAME
&
MAILING
~~) I ^'" 7^r':^P1'
1:""'7
LEGAL ACCESS TO PROPERTY
~~ ':'\'~!1 t'n;:,VM '2h T~.t ~,..np(l"T
f"t"l-...n,:" ^ '1.?Q,'""rv
PROPERTY SIZE - FT.
ADDRESS "u:.,t:..~~....~ f"'. (',....."07"
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 D
VAl.UATION
'- ':-;' I I '~:---.,."I^ ~ r'
5"nM''!'"
1 \::'....., /' )~)
1(.
,.
~':::::;::S;:G~~nn
!'~'~"'i":.rn,..,"'':1'"e.~:""r.,=>,(''r?' I' !'()
P'1 r ~ [;0
I (
i(.".'7II.;N7t::"' .""~ ~~_O.~._
r, .\1;'{j'''n L\~v,::::,
SEWAGE DISPOSAL
[;('1 n ~,~
FEES
PLUMBING INSTALLED 'BY
OWNER 0 OTHER: NAME
WATER SUPPLY
____-.."'.t'..
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK O'
$
OTHERD
~n~m
~~. ':. f:.r.l
fJ,;!...";O
~, .'/'
".l .
PUBLIC ITH
o OTHER
TOTAL
t 1~"~. r:"--'
COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
DRAIN FIELD REQUIRED
...
WITH DIST. BOX: GAl.
1\'1.;0
L1N. FT
P'f--:',
TRENCH WIDTH FT.
r-
OR SQ. FT.
I;' :()
:~":'\"I \--'ilr'r~r.r';,n 'Tn ^ r-/'\J11L'T'j r':"1'DY&' C7 ~h
t r'r.:~~r:"!"',_
9.V^t' .~ v7 _ C"r:-~'l 'i1rt"t m"'lt----.n ^"\f' ():'1()'),~.':-'V.'V
1t'1~ "lit'" Mt ;?I\~?:, r7 \'~'" n"')^ln:OIf1'.n.
TYPE OF STRUCTURE
OCCUPANCY
ZONE
PUBLIC UTIL. EASEMENT
q :'1
BLDG. SETBACKS_~
FRONT 11:;:
I
FT. FROM CTR. OF ROAD RIGHT OF WAY
SIDE INT. c: SIDE EXT.
AUTHORIZED SIGNATURE - DATE
^!"',.." .1
USE CLASSIFICATION
REAR
'af\' r M1t'\ n
.'f'1.-/' _. t" ~nnr"\ nt1' ~U1\.I....t (\ '..fI(">.'II-U.......
(j.H. Cl'lAV~ SarHVc.:HCl:;
DATE
lj/':;'.QI r':' .
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 97401
FORM == C55 .13
SLAB FLOOR
PLUMBING GROUNDWORK
':')
.
.
ApPROVEO Cl DISAPPROVED Cl DATE
REMARKS
GAS PIPING GROUNDWORK
INSPECTOR
ApPROVEO Cl DISAPPROVED rt DATE
REMARK 5
ROUGH PLUMBING
ApPROVED ~
REMARKS
ROUGH GAS PIPING
INSPECTOR
.
0''''''0''0 CJ om/- j J.J,/ ,.",?".-::f'/
ApPROVED Cl DISAPPROVED Cl DATE
REMARK S
INSPECTOR
FINAL PLUMBING
ApPROVEO KJ DISAPPROVED Cl DAT~-J.J'') 7 INSPECT."
REMARKS
FINAL GAS PIPING
REMARKS
ApPROVED Cl DISAPPROVED / / DATE
INSPECTOR
CERTIFICATE OF OCCUPANCY
READY TO ISSUE Cl NOT READY TO ISSUE rt DATE
ReMARKS
/V
t?
INSPECTOR
-,
....,
. :...
.
.INDIVIDUAL SEWAGE DISPOSAL SY~ RECORD ~
Installer: compiete :eop part..,form to
signature and return both copies to Lane
County Building Sanitation Department.
. .
. ':"
Inst~~ler's Name
--r/? .?:;C-<J~
No,LiVini Un:>,ts IBear;:t'sl B~?.~S
septJ.c 'ranK:
Ft. from well Steel 0
!ns~ae DJ.InenSJ.ons: ,t"t:..
Length B Width'; -1'....
Applicant
Name DORIAN TAGGART
I Property Address
r'\t}M.'li:' A ~TQ~r~
I Basement I Water Supply
Yes 0 No ~ Public g}./ Other-List
P'OM'T No. Q,2-7,
GRAY
Diameter
No, Compartments
Depth S
/ Gal. Capacity- /~
- Tile Disposal Field:
Distribution Box :Yes IZ).... No 0
Other DistributJ.on- Type
Concrete [!j/'
Mailing
Address
?SSh NnoT~ :h T~ STR"T
Feet from
~ell Foundation /0
Lot Line
Front Side Iv Rear /0
ITotal Sq~Ft.betweenIFiller IF~ller deothlFJ.ller depth
ft.sf(o llines /0 Type /~'''J'-j-~IT~e ~_:~__~E~w 0 :~
~*~n~~rl~I:i~
Length of Lines - Ft, Trench
1./0'42.1/13, 4, 5, 6, Width 2-
Sketch (See instructions):
,
\
Ii -- \
~ .
\ ,
D \
q \
\
\..;
,j \~
~
!'," h !/IW (f;-)
AN 31 1974 -I c
:.. LANE UUU
'\ ~ HEALTH u
,
N
, ,
\~'
\
\
,
\
I
,
"" I ~
/
Date I - 2. 7 - 7 'I
Signature ~h &1~fj
I
For ~itarian Use Only:
uarApproved: System Installation
o Disapproved: Does Not Conform
Remarks:
Conforms to Current Standards
to Current Standards
Date:
.2. -//-71
Lane County Building & Sanitation Dept,
dtJ. ~~.
'!fanftarian's Sigtiture
"
-' - LANE COUNT.ILDING PERMIT OR MOBILE HOaSE APPLICATION
PERMIT TYPE - BUILDING h( MOBILE HOME DOSC REG, # PERMIT # 1 J ,2-?J
P~RTY OWNER / // .' MAILING ADDRESS . J '--, __ , J PHONE
'i/ld.4<d1/2Af AP~ .:t53~ #1, 34UL. 1.11/-. . ,4/J4r.
CONTRt9'Tttf I MAILING ADDRESS . / 1 &Y PHO~y
17i.J7- 6J2v-
oM,;;:'"
, ~ / ~ METES & BOUNDS 0 YES
/'J"lJp. Nt:7fZJtJt() t$1!!El3^1 ~-s LOT, ATlACHED 0 NO
SEC, TAX LOT # CODE /I CENSUS TRACT
~~ ... 3.>--/~-2H
~7iuRES ON PROPERTY IF ANY
LEG~t::2:;/ERT~~OR #
cfoPERTvlSil WIDTH DEPTH AREA
Connect to Ex~ti 9 Sewage System 0 or New System Req. 0
TYPE CO/.3~~ t'IfJ /' -.a.. SQ(3) # BEDR/Z :;~Ar;;N
4% 0 ~ . -?_",>v It, S t.?
~~~~~".;pP7~
(;ox") Po tp. L. d-.l fa _
:~::~N~ INST;~~:: ~ NAME /J; l~-~-- ~
PLANS FURNISHeD FACILITY PERMIT
YES ~ NO 0 YES i'l( NO 0
SIGN\\TURE OF APPLICANT DATE
t;'~. ~r,J S""-/'7'-'73
FEE RECEIVED ~ J 00 \ DATE
~ (~:Y5~2./) ~~
/.50 I'ERMITjl.3'2_?"'? /
COUNTY BUILDING & SANITATION SPECIFICATIONS /
DRAIN FielD REQUIRED /
I (j() 0 L1N, FT, ~ TRENCH WIDTH FT,;2. OR SQUARE FEET/ "f,:; (')
11- /J/J. ,,tM:.~A) f..c.- ~ ct.P1Jv ~ .2~ "itt.... ~
~ ','.T~ (j.
/'oi- L ~- .:::11t.2 ),~ ,J /L./Jo,T:: ~ J' "tI!/ ~ M
---v-- ~ ,~~~li /.
..fA;s r.~~'
TYPE OF STRUCTURE J A/ OC/~~ ZON~E //J ~RD Er ~. PUBLIC UTIL. EASEMENT
BLDG. SETBACKS - FT. fROM CTR. Of ROAD RIGHT Of WAY USE CLASSifICATION
FRONT +s SIDE INT. S- ~ REAR' /t"? ' . ",-S. _ A
SA~IY./~.'A_N.A.<U Date PLA~~9 /1 Dote BLDG". INSP. ~ A _ ~ Data
aJ,tJh'__j~4o.(.'13 "/O'I...?'J :.s-z:Z-:r=-... yj ~(~ r"2 '?"'? ~
Directions to Find Property: V I
OTHER 0
FEES WATER SUPPLY
PUBLIC V OTHER
PLUMBINbFE~ a... d>-iJ
-L4?FIXTURES .3 I) _ tI.-i)
CASH 0 flWER '
CHECK l7" CONNECTION FEE c:l... i4-U
PROPERTY LOCATION -INCLUDE POST OFFICE ~ _
/ tJ ~ <} .I /J If-11 d, /J 0' Vt.b.:r
PROPERTY LEGAL DESCRIPTION J
LOT - BLOCK - SUBDIV, /..:>/
TWP RANGE
/f2J &2-
,
APPLICANT
NAME ~
AND
MAILING ,
ADDRESS
FOR MOBILE HOME PERMIT ONLY
Number of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
"/-U....u.M.-->> /. - >>1&-'~
"" a..", A .a..a/ _ - 4..7'7. -I'h/ ~L
p ~ ..4'-D-4.
. ::-H..ey.;""';~,,,~ -,,-.pjJ.;J,.,c-,,:,...,:~
'~~t--"
SEWAGE DISPOSAL
PUBLIC 0
SEPTIC TANK 0
'7/. A-O
..:20. (:) 0
,"3 -3.60
BLDG.
WASTE 015.
t
PLUMBING
PLAN REVIEW
PARK TRLR.
TOTAL
/~...60
PUBLIC WATER
CONNECTION feE
MIN. SEPTIC TANK CAPACITY
WITH OIST. BOX: GAL
COpy I - OFfiCE
COPY 2 - JOURNAL
COPY 3 - AUDIT
Form # C55-12