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Home My WebLink AboutPermit Building 1974-3-27 (2) r L 0"73 tv .~ bl fL LANE COUNT-_ILDING PERMIT OR MOBILE HO_SE PERMIT 37i'-74 / BUILDINGXIXJ ~ MH 0 ' PERMIT NO, '?:7 4 - 71.. MAILING ADD.RESS --~ PHO-~Ei-- ~, ." '. ..)..AI'"'..... PROPERJY.OWNER -/' l.,n"''''1.cth CONTRACTOR alnnrlnn ChArlng, Jr. 11~8 DandeD Street MAILING ADDRESS Sorlnafleld. OreClon 747-4920 PHONE ~j""!,n PROPERTY LOCATION - INCLUDE POST OFFICE 'll~'R J}n~rl<:,'" J!.trp"'r So:>.dnofiAld_ O,'coon PR6PERTY LEGAL DESCRIPTION - METES. BOUNDS lor 1'- Rlnrk 1 flrgt Additln~~padnw Green Estates Subdivision TWP RANGE SECTION TAX LOT NO. CODE ----' " CENSUS TRACT lR " 06 . / . .3 12100 ICJ-02 EXISTING STRUCTURE,S ON PROPERTY House LEGAL ACCESS TO PROPERTY DandeD Street PROPERTY SIZE - FT. APPl. NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No, of Bedrooms r,lpnrtnn r.. Innn1.!/n,.th. Jr. WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewoge System 0 TYPE CONSTRUCTION SQ. FT. # BDRMS New System 0 VALUATION B~A;.t^" ~F a~~lly Rnnm , Hdd I t Ion of Ut i I i ty room Dnd bathroom J:rAmp 4lln tW 1 2 120 (1i1 9 4_000 I,oeo 5,8Ctl SEWAGE DISPOSAL PLUMBING INSTALLED BY PUBLIC D BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER v SEPTIC TANK ['] OTHERD . U.OO FEES OWNER D OTHER, NAME WATER SUPPLY PUBLIC m D OTHER !?_nn MIN. SEPTIC TANK CAPACITY WITH OISl. BOX: GAl. s 44.00 COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED TOTAL UN. FT TRENCH WIDTH FT. OR SQ. FT. Not DDD11cab1e TYPE OF STRUCTURE OCCUPANCY lONE PUBLIC UTll. EASEMENT ~-~ BLDG. SETBACKS __ FT. FROM eTR. OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT N IA SIDE INT. Ii_ sIDe EXT. - AUTHORIZED SIGNATURE - DATE REAR 7 Is I .1. E, Bnss bv C. HarbQuah Bob Lowry DATE 3-27-74 slf BLDG. PERMIT - WHITE OffiCE COPY - WHITE COUNTY TAX - PINK , PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule 011 required inspections. All construc- tion sholl comply with Uniform Building Code, D.E.Q. standords IMPORTANT: for subsurfoce sewoge disposol ond county regulotions covering plumbing. All buildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) /' FORM :t C55-13 - ' (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, OEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 BUILDING SITE" EVALUATION ~"~ji'rd;ng Permit )' Site Inspect ion J:~_ / C. I-!- . (I , App I i cat ion No.J;7l./- 7'1 () Pre-Permit Investigation T I5['"R ~S t;,1,3TAX LOT CENSikS RAcT - , ..L 1st . ""e~ GTee~ u,. APPL T: . NAME ',La"auJ^rfl... ADDRESS r:r- PHONE DATE ~-~,O-'7Y DinE l/\NE COUNTY PLANN I NG DEPARTMENT NOT app I icab Ie () () ( ) ( ) ( ) ( ) I'. Zoning Ordinance Compl iance (Zone d??1 ) Subdivision Ordinance Compiiance ( ) ( ) ( ) ( ) 2. , ". Required Access 4. Building Site (Area, Width, Frontage, Setback) Other (5ee comments) 5. NO YES NAM E (/ ( ...y-' ( ..y' (y ~ ;?$-~ ( ) , -. ..:3 -,..2/- ., v' / COMMENTS: -= BUILDING INSPECTION SECTION NOT NO YES NAME DATE app I i cab I e h 6. Plans Subm i tted ( ) ( ) 7. Soi I Stabi I ity (foot i ng5) * ( ) ( ) 8. Flood Plain ( ) ( ) 9. Other (see Comment s) }f1_ ( ) ( ) O:Jf~ ""J 'J' - ?L,/ ~ COMMENTS: y YES re.r TE - SANITATION SECTION 10. Sewage Di5posal II. Usable Area 12. Water Supply 13. Other (see Comments) NOT NO aDD I ~ cab I e (~ () ( ( ) ( ) q () I COMMENTS: \N \\ TO APPLICANT: ( ) ( ) ( ) ( ) ~ Building Permit I Site In5pect ion: Can be approved. Cannot be approved at this time as indicated on iten. NO. above. Questions and further information on items I through 5 contact the Lane- COUNTY PLANN ING DEPARTMENT. Ques I. ions and further in format ion on items 6 through 13 contact the Lane County Buildinq i,,,d Sanitation Division. Wi II ue held in this office unt i I you can resolve the problem5 indicated. Is ueing returned. Your buildin~ permit applic.Jt.iun fee is ueing ret'urned under separate eu/er. Your 3/26~f ~ ( ) ( ) ( ) ( ) LMI' (l1l1N'1 Y I'I.tINN ING OEI'/IRTMENT I :1."> ~ i.x fI, Avellue E~, I. EU\jene, Cl"~9,)n 9740 I "',,>Nt: 31'1..1311 EXI,211 1\ I.ANE COUNTY IlU I LO I NG [. SI\N IT/IT ION D I V I S ION 13') Sixth ~vC1,ue Edst. E'''lell''. O"C'<Jnn 97401 l'IlL1NI.: 31;2-1311 fliT. Ifll "'i15s=2'if"- --,-- r " ,. ... ........ - I r 1;\_ " LANE COUNTvelLDING PERMIT OR MOBILE BUILDINGtA:iJ MH 0 MAILING ADDRESS i , "-'\ HO.SE PERMIT PERMIT NP, :;7~-7'j , .J 'i PHONE PROPERTY OWNER .n.'1..-..~~.,th r,:',...."'A.,':'\ rt-.""'I.........n CONTRACTOR M I. II~n nnQ~~n ~~~~~~ MAILING ADDRESS G~p'o~OI~ln nr~~n ~r\?-.lf'll)r' PHONE q,~ . PROPERTY lOCATION -INCLUDE POST OFFICE n n ()f\ f'~1"'~I""" r,.~p-'~..,....& ~,.t"~ IpnO Intl1 (\oo()r'1'Ion PROPERTY LEGAL DESCRIPTION - METES. BOUNDS .... f..:,,",Co 1~ Olt"\......:\. "1..01> !\i"A8~1^.,.. f.\"""A-:--1 n.f"~ l1'!_c-nt""n QtI~rllu.l('\lnn TWP RANGE SECTION TAX LOT NO. CODE CENSUS TRACT nn I~ 0<1. 171M ~I llC'-,I)?, 'EXI.STING STRUCTURES ON PROPERTY APPL. NAME & MAILING ADDRESS FOR MOBI~.\ HOME 'RER,~'TS ONLY No. of B~arooms ""--..: ,l '\ ,t. \ ' ~ , '": \\ " " "- ~,-\.\ ~ ~,. t:f...,...u'V'\ LEGAL ACCESS-- TO PROPERTY . ,,-' " ' ~"~.......n ~C>&"'I'"'-"')to ,\ ~ PROPERTY SIZE - FT. nl,...~""'lI'" n 'r,r,.~_"'''r-" , ' ~ " , .~" ,I. , ,,\ . ~ ~ ,. - WIDTH DEPTH AREA '7\ ~ ~~'~~Connec!\ t~...~Existing>, S:.~age ~SY5;e.m" 0 . New System 0 TYPE CONSTRUCTION SQ. FT, # BORMS VALUATION , ' STRUCTURES TO BE BUILT TH]S PERM]T "!:''';{).In...... ".,4 fTr-.....llu n.~ ~,.jit Ie;! of '\l~'H I~V~ crod o;:thr=:\.o.'~. ';'C ".~ I.~n n I? --J hIp^) .\ ,\-~(J 9 1,r:::J_, ,. .j , " ., ~OC~~:: WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER \~ '\~ J'. ","'....~,,> 1:':.' "~W\~""'\"-5>~"~~~"~\~~ ~~,\ ~l": "_~"t..._ '"'- ~, "i '" \ \ PLU~B.ING INSTALLED BY OTHERD '\' OWNER D' ',OTHER, NAME lI::!.no FEES '\ \1\"(\ .W,ATERSUPPlY :', PUBLIC m \ '.0 OTHER ,~ ,,~ ,.,fln ';\\:.~\-"~ \' ~\ ~ ~\.-\, SEWAGE DISPOSAL PUBLIC 0 BUILDING " SEPTIC TANK ['J MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL. . l.t\, on COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED TOTAL L1N. FT TRENCH WIDTH FT. OR SQ, FT, C1t ,::01 ic:tlle' . , ~'-: TYPE OF STRUCTURE ~ Sa:J \ BLDG. SETBACKS __ FT. FROM CTR. OF ROAD RIGHT OF WAY \9C,CUPANCY"~ ,..... ZONE PUBLIC UTIL. EASEMENT USE CLASSIFICATION FRONT,JI" SIDE INT,',; SIDE EXT, a AUTHORIZED SIGNATURE - DATE /0/ J.il. CeOl! bv G. 1~i'bCll'1h REAR 'j Oob b~rll DATE 3-2"1-70 0 I '{ BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK,' ~;.:; >... PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD , '-- \ ....\ ' \. , . "iMPORTANT: ' . ~.. <;all'6B7-4065 to schedule all required inspections. All construc- tion shall .comply with U~iform Bui)ding Code, D.E.Q. standards for :s~bs~rface sewage dispgsal an~'.'county regulations covering plumbing. All buildings require a certificate of occupancy before being occupied. ' (See' Details on .J~:everse \Si4e) '.' \ .... '.. .J ,~l..~":. , . , ' .,,' " " ,...' FORM:: C55-]) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT I COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 . . , (, .~~... ." .~..; \". SITE INSPECTION ApPROVED C1 DISAPPROVED C1 DATE INSPECTOR REMARKS FOUNDATION INSPECTION ApPROVEO ~ DISAPPROVEO 1--/ 1/-; ~ -7L!INSPECTOfi)/ DATE . REMARK S FRAMING INSPECTION ApPROVED / V'/--DI SAPPROVED C1 DATE 1/'- 3tl-7<; I NSPECTOR~ ~ / REMARKS LATH OR SHEETROCK INSPECTION -- ApPROVED ~/ 01 SAPPROVED / , DATE/j'-IJ-7ti' INSPECTO"~ ~/ / REMARKS FINAL INSP~C~~' ApPROVED DISAPPROVED C1 DATE Ij, f, 71/ INSP[CTO~ REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE C1 DATE INSPECTOR .3 71/- 11( - ~ ~ ,. ;/ ./Ij .<l./ tJ . '('. ~.U/ q /f'1U.:A1 ~ ,I'l 1) ~ , 1/ 8., /)".",j/a. REMARK S ',;-"', :tlT i..'Y tL LANE COUNTAtJlLDING PERMIT OR MOBILE HOaSE PERMIT BUllDINGLD MH 0 PERMIT NO, MAILING ADDRESS ". '0" ...~-\-;.I '\).'f, ,-, :p~f "It'' j ~OPERTY OWNER ) 1 'I ,- tj PHONE ~~t/JoC, ---;;:;1 PHONE Dr. ,-----"'~.~.~L (Hrr:~';,':1 f~l~l('n_ /". l~~;-J r:::~~~i: S-~~rc~c CONTRACTOR MAILING ADDRESS r')rir.ivloICl. C,C::::lrJ 0;"~'''''''' PROPERTY LOCATION - INCLUDE POST OFFICE il"" i' ,,",'Ai: n'~{'{'~ !.-"wk...,Qlnlc1. UI'Gttl'::! PROPERTY LEGAL DESCRIPTION - METES. BOUNDS "-">. If, i)ln-c', tlirnp i,C!(H;,!n:', ['0rc:r., r,rr.{':) fi!lt;!;OCl GulldIVIOIC:l TWP RANGE SECTION TAX LOT NO. CODE \ \ CENSUS TRACT '''1 I' C:'l Iml.W 19-02 EXISTING STRUCTURES ON PROPERTY tC'!!Jil LEGAL ACCESS TO PROPERTY !k:".r.CO IL ~CG e PROPERTY SIZE - FT, APPL. NAME & MAILlNG ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms rHn''''t'ln r.. 1.0:1f"""".C:l_ J... WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT, :;t BDRMS New System 0 VALUATION ./1"11('>1",") (1; fJ:"l'hJ' ;"-....."'"' fir..:) 1:f::-l " 12 (.~ .'] :):~JUCi8;l ()("u~n icy ~ Lr.::l bJthr= lro () D .. I ~- '~ .... , __:;;'..Z: -z-_'" I: 'J" SEWAGE DISPOSAL . OTHERD ();1.Cfi FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER " SEPTIC TANK 0 PUBLIC G D OTH ER I~.n MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL. $_ t:~.C() COUNTY BUilDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED TOTAL L1N. FT TRENCH WIDTH FT. OR SQ. FT. [)~ C'~'1; i C,; 10 TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIL. EASEMENT $le~l BLDG. SETBACKS _. FT. FROM CTR. OF ROAD RIGHT OF WAY FRONT nr.'1 SIDE INT. 5 SIDE EXT. Q AUTHORIZED SIGNATURE - DATE Inl J.C. C:J:J~ ~" c. t:J~bct.!'l~' USE CLASSIFICATION REAR f c("~ !,r.~?)1 DATE o ~'i 7< .' vOt'; 0 ,) ~). '/ BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule all required inspections. All construe. tion shall comply with Uniform Building Code, D.E.Q. standards IMPORTANT: for subsurface sewage disposal and county regulations covering plumbing. All buildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) FORM::: C55-13 (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 SLAB FLOOR PLUMBING GROUNDWORK . . "../' 'eo .. -' . ApPROVED / / OISAPPRQVEO .0 DATE INSPECTOR REMARKS GAS PIPING GROUNDWORK ApPROVED / / DISAPPROVEO C1 DATE INSPECTOR REMARKS ROUGH PLUMB I N9 INSPECTOR 44 ApPROVEO /Xl D'SAPPROVED C1 DATE5- to -J'-/ /'J ' V REMARKS t1-r try U-.'M, t>11 ~y.:;:1x> ~/d... Df 5"''''~''''''V''''l -'Yr,> v'/","" DJIJ ,.e;",.,~eyL I Jd./ P/.It::. (...<.J::7-1-<!!or.g:IJ?.... '7p!:~/n ,Zd{./ D};Z./y, 'rH~:J~-7'/?"{r CO'.L1qI fd.J2..-+- ~~... !J'ud".... hAV'-;'" ) , ~ ~::1"J.. " to- (f.~J.. 0 /)11 J...,...1 .;-.\ ~.o.... e,,'" ,-r-.2. "f' A. ~ . I ROUGH GAS PIPING ApPROVED .0 DISAPPR,OXED .0 DATE INSPECTOR REMARKS FINAL PLUMBING , -. . /~ .?? DmP-J'.cr-;l) INSPECTO~iiIt 0 (/ ApPROVED ~ DISAPPROVED C1 REMARKS FINAL GAS PIPING APPROVED..C1 DISAPPROVED C1 DATE INSPECTOR REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE .C1 NOT READY TO ISSUE C1 DATE INSPECTOR ,. REMARKS LANE COUNTY"OREGON. . DEPT, OF ENVIRONMENTAL MANAGEMENT . .. ..,.J t.r-- JOB ADDRESS / / :.;> X' II . / '; ,I' /."T"1..,., A",--- I TO: NOTE: "./ It 17 / 1"( I -; {-~ :' I'/.A ~ ../ ~ d J/ ,'i -1;//..,_tI'n.: e~_ // C74-184 Phone 687-4065 INSPECTOR'S MEMO /1 ] ,j 1'./ ..( V--'"l....,.. .-t- J?'7 \.):-. 1/ --+-' i.-f.-r..- .1.., _ _ ,~; t , '/'/J ,H;>) . ~ /AA /J j) p /' f~ """' I , /..~-r / , INSPECTOR CONSTRUCTION PERMITS & INSPECTION DIV, DATE ,~,. -' '.I . I~ ' .o.li ,.:~ J . <.J I I If!:, .- , / : (/ __--.._,... ~, /\ I I .. .I 1 I j:;" , \..-/ I (J : /c;//!o'11 11-- .....~.. .~ " .L&'iE..--LQillUY__-1N_SEEtII 0 N _,B.[Cillill TRS#_~-~-Q~-\ ,(\ \~:~\)~_-==:.= DATE ISSUED:L\}~~\?-:-J.. ::~~8~:~~-- - -~----- --- S8~~QtI~M~N9s pn~ --.--.------ ----- CLt FRONT CL. SIDE INTERIOR REAR WORK AUTHORIZED_BY PE~T ' ' , ,. ~~S}\J 1 ,Cl~______.__.______._______'n_____'____ DI-J~S,T~~~_c:.&.,~~ -\K) ,~\~\ ~~V) \;\~VW (O.~~i'f)-L , _ \ ~ 5Y>\~Qf'I~~ (\{:)~ ~~ t.yp~ ~~ ~{) -<:::0'" SITE ADDRESS i' -, .. FOO\\~~/ ~t'~i&r~~Y~nfOM( PLACEMER'(cr--TNSPECTION-" Approved Date }Correction__,___Date ______Inspector PERMIT # 5BJc.- 5',;::l. PHON~NUMBER PHONE NUMBER 7fPLUM~~;~fIWli~ts 'PLUMBING GROUNDWORK [NspCi~TION---- Approved Date_____/Correction Date Inspector_ UNDERSLAB PLBG. 0 /UNDERFLR PLBii. 0 I NSPECTI ON Approved Date /Correction Date ,_,_Inspector SLAB INSPECTION App ro ved Da te jCorrection Da te _________ Inspector ROUGH PLUMBING (TOP OUT) INSPECT raN Approved Date /Correction Date Inspector FRAMING INSPECTION Approved Date /Correction Date Inspector ROUGH MECHANICAL ' Approved O~ Date~%3,'il3/correction INSULATION / VAPOR BARRIER INSPECTION Approved Date /Correc ti on Date Inspecto~ Date . Inspector LATH / GYPSUM BOARD INSPECTION Approved Date_:-____jCorrection Date Inspector FINAL MECHANICALJ--}\oIOOI5-STOVE[l---:- .-------- '" .fl ^pproved~_Date,~3~1/correction______Date_ u_.Inspector ~~ FINAL PLUMBING INSPECr'lorj'--- ------ .---- Approved,__Date ..__/Correction _Date________Inspector 'FINAL INSPECTION BUI'LoTNCntJ7M-O,IIlTlibi.fCtr7A-GPCACEMENTj]- AfJproved Da te... ..___. .._....j':orrecti on___ __.,Date..______......__ Inspector CERTIFICi\TE OF-ocCUpANCY 0------ - IEMVdRMT-CERTlrrCATE OF OCCUPANCY [) Approved_____Date._,_____ .,_ ,_. Ins\, . ",. __ _ _u___,_..Approved_..__....Date Insp. .___+.....__. _.._.._ ___ .._._.u.__._.._.. _ ______.._ ._.._ _._. _._ ___._ ___.__ .._ .__ _.._ ~._ ...__ -- . 1\ " . LANE COUNTY .DING PERMIT OR MOBILE HOM.E APPLICATION '. ( j ,- PERMIT TYPE - BUilDING E! MOBilE HOME OOSC REG,# PERMIT:#: 37l./- 7'-1 ~ROP RTY OWNER ,I. MAILING ADDRESS (4 PHONE PJndf)n C'f/Qr/es / tJ.~uJo,..+h :-tv. Il~fr ,J)t'JndP/1.5t.Q-.,I";~t-,e!d '1(7-~ C R (TOR J I U MAILING ADDRESS - V('1 _ n / PHONE n Cn_a..ne5 L 0 no u ?oc1..b..J:.L/ /d? umd& Sf L"XJ r/(!J.:tWd 79" 7- ~ PR, J R~ ~CATIOD~c~Dd;: OFFlCSt V Sp r; ?J.c. e /d OVrJlJ Y1 9~ SI' 7 7 PROPERTY LEGAL DESCRIPTION I AI ( fl.1 II I J' >t t ('f "'" ~. / f1..'"ESAASMETES & BOUNDS 0 YES lOT - BLOCK - SUBDIV, (..!(:y_ lP ')..l rt'../<. ~f'''' , II/&d.i.(j) Uf.€fln ATTACH EO 0 NO T\~ jGE Sf;; I ')X, ~(f C?9 -O~ CENSUS TRACT AP:'~~:NT G..l.ebd.ofl C Lon woY-!--\-" Sr DESCRIBE~~~~UCTURES ON PROPERTY IF ANY 1("'\ JrL LEGAL AC(ESS TO PROPERTY - 'jPAD NAME OR # AND 111,~ ,\ j(Jnrlllll Yr ,f)tJl7det< S+-- :::';;S: S,or', t)~ Ci j~ OYf9)IJh PROPERTY SIjdt1H ;3H3 FOR MOBilE HOME PERlfIT ONLY J Number of Bedrooms STRUCTURES TO BE .AUI~T IT~IS ~ERMIT Hr.lr:11 hon U+-l Lt~ AREA jJ() ~ Sc.~ V .~ of ram;!; 9 Ra A-h Connect to Existing Sewage TYPE CONSTRUCTION I?tlflm "FYrum-e System 0 SQ. FT. S"-:JO or New System Req. 0 yd(n@~I-2:UALtbbo l.;{o@."1 \0'60' 5?>6D. SEWAGE DISPOSAL PUBLIC 0 BLDG. $ WASTE olS. PLUMBING PLAN REVIEW PARK TRlR. SEPTIC TANK ~ <'J.- FEES OTHER 0 WATER SUPPLY PUBLIC ~ Pl~~BING FEES ~ FIXTURES PLUMBING INSTALLED BY OWNER ~ OTHER 0 NAME PLANS FURNISHED FACILITY PEHMIT TOTAL PUBLIC WATER CONNECTION FEE OTHER YES 0 NO 0 \1C3NATURE Of APPLICANT @-':<.\ L.--::X ~4- r FEE RECEIV~ BY :x l<; PERMIT # YES 0 NO 0 l?- CASH 0 SEWER CHECK (l CONNECTION FEE DATE ~--<........A-~, . -- ~ DAlE ?mH~~e..... 3-jQ,iV \.l.lj, - /" ,/ MIN. SEPTIC TANK CAPACITY WITH DISl. BOX: GAL. COUNTY BUilDING & SANITATION DRAIN FiElD REQUIRED UN. FT. TRENCH WIDTH FT. SPECIFICATIONS # J .OR SQUARE FEET V \\~ TYPE OF STRUCTURE .s-t/ OCCUPANCY / ZONE REAR Y ARC PUBLIC UTIl. EASEMENT BLDG. SETBACKS - FT. FROM erR. OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT 4' A SANITARIAN (&-L SIDE INT. ~ SIDE EXT. - pale PL~.k 'MIJ.-JI1J ~.J-..v-.?f/ > I / Date REAR? _ BLDG. INS~ (I 4& Datu '3. ;U~ .?j/ Directions to Find Property: COpy 1 - OFFICE COpy 2 - JOURNAL COPY 3 - AUDIT Form # C55-1Z