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Home My WebLink AboutPermit Building 1974-2-25 (2) c- )-/Jl ~."~ -.~.-!- . II .~' "'4.'......,.; . : :1\ ',/' .., ." .' PROPERTY OWNER (.lj 11. nc~ert, ~J. CONTRACTOR f' 50l:3 PROPERTY LOCATION -INCLUDE POST OFFICE v_......, ,. .......-...,. " .-.... ' 'LANE COUN.UILDING PERMIT OR MOBILE BUILDING E:J MH 0 MAlllNG ADDRESS Hce USE PERMIT PERMIT NO. ,I//!?' ).-:,'i 17~')'4 ". C7Q Vest C~ntcnniDI MAIliNG ADDRESS Snrlnnylnlrl. Orna~n PHONE 7!'~_Q()1:"'\ PHONE 1175 Ocndoa PROPERTY LEGAL DESCRIPTION - METES. BOUNDS 31'.d l!dd It Ion to t1occlow Greon Estlltos TWP RANGE SECTION 10 02 06,'. :3 Dlf'::!lk 2 lot:lB TAX LOT NO. $92-13 EXISTING STRUCTURES ON PROPERTY CODE CENSUS TRACT APPL. NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No. of Bedrooms ncbort tJ. 1lI11 r,'rtnf\ LEGAL ACCESS TO PROPERTY OnnrJAJ) ~"r"'("lt- PROPERTY SIZE - FT. WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewoge System 0 New System 0 TYPE CONSTRUCTION SQ. FT. # BDRMS VALUATION Ik-olllna t::rrn"n 101' !?l I' (~\ 12.3C4 Garc~o attcched uncoiled 575 G:l 3 1.72<; Covered Plltlo 1610 2 3:!? 51nstoll Sc~cr~ DlsDosnl Svst~) SEWAGE DISPOSAL 14.t:.'l1 PLUMBING INSTALLED BY PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK ill OTHERD Il;q.OO D ~O.OO ~1.00 FEES OWNER D OTHER, NAME Jock Jackson WATER SUPPLY PUBLIC ;0 o OTHER MIN. SEPTIC TANK CAPACITY WITH DIST. BOX, GAl. ~O .1:10.00 COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED UN. FT 1 GO TRENCH WIDTH FT. 2 OR SQ. FT.3CO TOTAL noof clcolns to street. TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIl. EASEMENT 5tJ I&J RA BLDG. SETBACKS.. FT. FROM CTR. OF ROAD RIGHT OFIl.WAY "oot Pub II c Ut 111.uSE,ClASSIF.ICATlON, I to-,-, .. t......ot ...u:H....I.!lIo:.ulll.. FRONT 45 SIDE INT.5 SIDE ;EXT. REAR 7 Foot Pub I i c Ut II It 105 EusET.1cnt. AUTHORIZED SIGNATURE - DATE {51 J.E. Doss by C. Harbouoh I.. 1 BLDG. PERMIT - WHITE OFFICE COpy - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD John Shook DATE 2-25-74 s11 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:::: CSS-13 r- '. -- ".... -. -"'/'~' \ / __ -...,.,-r ,_ _" _""'. '~ c ; _ :J. .'.:..~-~ d"" ~ , ., !.' :' L~NE CO~N.UILDING PE~IT- OR MOBILE Hce USE PERMIT BUILDING EJ MH 0 PERMIT NO. MAILING ADDRESS ;' (~. \. ' >. /1, .::J:.r ' PROPERTY OWNER ,.... ~ ~ 1\ '""- ~ ....,.-,.,., r"l' ,/ " -.' 0 1,. _ __'" '-. ...~O PHONE ["y,:) t.~'~.'t, C.--::-; "::;)0 "1 ~~-::~"~~(:1""~D""'", :' ....,~.~" CONTRACTOR ('. '1 " -- I' MAILING ADDRESS PHONE PROPERTY LOCATION - INCLUDE POST OffICE ~ D G ::-~~~~~~ ~~ PROPERTY LEGAL DESCRIPTION - METES, BOUNDS ~::j [:"~:'~~.c~~:1 c:> [~~:-:~::J c:;:(::::) cGee ::':0 TWP RANGE SECTION ~Q Ci (:'i , I. 3 APPl. n~C"-:::':;~ ~~~~ ~"j TAX LOT NO. .jf92/~ EXISTING STRUCTURES ON PROPERTY CODE CENSUS TRACT ~ ~~:::::7n [J. NAME & MAILING ADDRESS em..... '),J J \ ~ r' -v-~ ~\... - \\.:.- '€ ~ 't'\ -\\- Ii: LEGAL ACCESS. TO PROPERTY r:---::-':-, Gr.,.;'-~r, PQOP~TY SIZE,,- FT.. i' " ~.""':"""",..J:-:1'}"'I...'~ WIDTH DEPTH ',- "',0 AREA FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. # BDRMS New System 0 VALUATION r::.:J 0 u eCl ., 1/,7, ~~ :"">1 n f,>1 ~\1~ C',"\ ' ( ..." (~"':}:',:;:J C'l~:-:.c;:::j c::::::JB~cj ""~'~'1 \')--,") \".".t,-,JI....-. ........1. \ -..... :: . ~;J;:) c ;) ~ W'\ - \ - ~ ~:....W\y:,,,,,~(,~,'C;"-n :)~~. ~::-t, \ ~'" w~ ~,""\'\~>:\,' . \ PLUMBING INSTALLED BY OWNER 0 OTHER: NAME ~~~~:.__:. WATER SUPPLY ~ ( '~ , \.r:/,'( ) c Cc~c( ,0 D [~,::'. '"'"::). ~) OC:<::~QU G150~:!>> SEWAGE DISPOSAL :'~~,\(/,'\l") PUBLIC D BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK i:b OTHERD ~ !);~.C:J ,) ~:J6C:J ,))U.C) r" ~ ~., ,0 FEES \ '0\'\~0 , PUBLIC itb o OTHER , ~W\.\ '-l ,I~ MIN. SEPTIC TANK CAPACITY $ Of.J.CJ COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED tiN. FT E CJ TRENCH WIDTH FT. 2" ....f',) OR SQ. FT:'/~~~ TOTAL WITH DIST. BOX: GAl. S:--..J '. \,,\ \ , ..... ....-..... ......... \ '. ~:'::;~ L:::JO:::> C:)'C8S:~1;. ". '+.' 0 ,0{ .~ ......~_ .' \ '\ '. , , .. ~,..,~~' ~'=""'~~'"K:~- -...:.'-~~,~ ~'::.,_~~_ :;.... TYPE O,~~!R~,~T!J,R\..'-'J: '.....~~.....~,~ :__~~~.'~"'" ~~ ..(?~~UPAN!=~~' ,..~:..t;~ _ '\:.~Z~E\~... ~ '':- P~BlIC UTll..EASEMENT f'" r'" . -" '''. ~'\.'~ '> f1 h -'f '-"". '\ " .J I.. ",-" t .~'t-...''-:\ ... ,...... 't. L! Y .: ", .',,'1.... ',.t........ " .... .\_ BlDG, SETBACKSh FT, FROM'CTR. OF ROAD RIGHT OF',WAYor vS1""I>~v1s,l' (""v\': "'USE"c;lASSIFICATlON. . , ' FRONT ('J ~ \Sl~~ INT.\], \' ....."SIDE1~x)~./,' '~~"*\'~"RE~-~~~"'::::~ rfSu$Gs~~1~.1~C~~~~~~~~~,:;..~o,," AUTHORIZED SIGNATURE - DATE \\ \ C~--:J tv G. [~_'J::::~:::-;) (.~~;::',: [;~- ~.-=j r,," ~ C (,' ,I{ Co ~. /,,'/' BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUilDING - GREEN SANITATION - GOLDENROD DATE II ('" {"., c:>'---_ )I/-,i Construction,to comply~wit~ uniform building code and county regulations covering~pluml?ing and ,sewage disposal. All buildings require a certificate of ~~po-"~y~fo~~li.e~n'g,q~cupied. '\ (See Sfatement on Reverse Side) _~"""'~",,'~.~ -i,: "\ \ \ ';'\~~ ~'\ ~"Z ")'~\ (POST THIS PERMIT ON MAIN BLDG. AT SITE) lANE COUNTY, BlOG, & SAN, OlV" COURT HOUSE, EUGENE, OREGON 97401 FORM ::t C55-13 J ~. c.--- . SITE INSPECTION APPROVED.Cl DISAPPROVED.Cl DATE REMARK 5 FOUNOATION INSPECTION . INSPECTOR ApPROVED .L.lLl- Dl 5APPROVED / / DATE REMARKS h f-& d/J~~t~.d.~ / "3-'.::z/. "141 INSPECTOR r2 _ '3 ~/'- ';'1 to../.. (!3 I FRAMING INSPECTI ~ ApPROVEO DI SAPPROVEO .Cl DATE ..)': r. 7 t/ I NSPECTO{ ;::II--- REMARKS /fflI!lt,;.."Y,Ht/?-u.-V V-J ~ '{ll,e. ~u.. /./.-1 (- 7 If -:Ji?t4fU t- /w"/l.r-"'~' ,I...t!.>.I!""~' ",-; 2 ,7VfV' . LATH OR S~~~K INSPECTION ApPROVED ' / .DI SAP'11tED 1--..-/ RE MARK S..2.J;,n; f1J1J JIII DATEt.--I" 1 J f FINAL INSPECTION ApPROVED ~ DISAPPROVED ~ DATEY/[f"7t/ ( REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE ~ DATE REMARKS hi /74 ..,It /~' ~ '/ /./.' . ...\...,...0" Uo"C ,. /7tJ-7Y 11f-c.:e:e //76- ~~- ~ ~J '""",,( ~(!3 ~ INSPECTOR d ~ ) INSPECTOR 1 ... " . .~ , I I BUILDI~G SITE EVALUATION . ~~~ .\t~ c.. "~TAX LOT . I~;r;~~ ~:~N6p#:/;dd, .rs-;z .L-:<?" ADDRESS ~""~ ....i k\Bu~lding Perm i t App I i cat ion No. ( )\ Site Inspect ion . .;, ( ) ~Pre-Permit Investigation L/\NE ""COllNTY PLANN I NG DEPARTMENT \.. '\ I. '(Loning j PHONE DATE I ~-6 - /'1 - Ordinance Compl iance (Zone ~ I>-- ) Subdivision Ordinance Compl iance NOT a.;pl icable () () ( ) ( ) ( ) ( ) NO YES NAME DiHE ~ 2.. -..., - 7 t./ / > .... Required Access ( ) ( ) ( ) ( ) ( \, ( . (/~ ( ) ( ) 2. 4. Building Site (Area, Width, Frontage, Setback) Other (see comments) 5. .COMMENTS: BUILDING INSPECTION SECTION 6. NOT aDDl icable ~ () () /l) vlf () () I ~) () () Other (see Comments) () )1) () (3..~L ,.l-I6--7f ....'r~../Jf~~_/'V'~.....~..At.,,&~~ . . ......- .' --- /J JJ /1 -A ,/I ~. ~ r, ./fI~./~-y_ r:r-,./.A~ r/l J./ ,-(/ 1/ f / 1\ ( ..A'A , ~ - ~ NO YES NAME DATE Plans Subm i tted 7. 8. So i I Stab i 1 i ty (foot ings) Flood Plain 9. COMMENTS: SANITATION SECTION NOT NO YES NAI1E DATE , app I icab I e ~ a\'U.Q 4lS'/1"L 10. Sewage o i sposa 1 ( ) ( ) 11. Us ab 1 e Area ( ) ( ) ;/ 12. Water Supply ( ) ( ) 13. Other (see Comments) ( ) ( ) ( ) COMMENTS: TO APPLICANT: C),)J-~~ l>< ~ Building Permit / Site Inspect ion: ~ Can be approved. ~ Cannot be approved at this time as indicated on item NO. ~ above. Quest ions and further informat ion on items 1 through 5 contact the Lane- COUNTY PLANNING DEPARTMENT. Questions and further information on itcms 6 through 13 contact thc Lanc Counlv Buildinq ;,,,d Sanitation Division. Will be held in this office until you can resolvc I'he problems indicat"d. Is being returned. Your bllildin~ permit appliccJtiun fee is being returned under separate (.u<ler. ~"6~r ~ ( ) ( ) LANE COIIN'IY I'I.i\NN ING DEI'/IRTMENT I],') Si)<tll AvcrIl'" [^'t, [uyelle, (l'''9uIl 97401 ,'Il,)Nr:: 34l..UII 01.211 LANE COUNTY BUILDING & SANITATION DIVISION IJIJ Sixth I'lV(;lIl'" tdst, E"'1elH'. O""'1nn 97401 - . PllllNL: JLJ2-1311 fliT. 1f.1 ~\ --'M5S: 28- -----.- ,. . "\-,--;,i ;," .~,: .~~ -: . ; -' - ,,.....t: . "V" -:\1~,\ I t t. LJ'CJte _.. '~";,.' ~".~ . ",' '/\ ,'~:.J '., ~: . '. Permit No. ,,',I CURB CUT , PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY WHEREAS, the attoched application has been fully considered by the Boord of County Com. missioners of Lane County, and it is the opinion 0 nd judgment of the Board thaf the said application should be gronted, ond that 0 permit should be issued, now, therefore, it is hereby. ORDERED, that a permif be and is hereby issued to L~ ?;~;;-;t; Do fJ;\~n. .) ~JJi1.?c{':-:ITO or conl~t~~j,~..::.~eO!~~JE~:i?~ f~j'l~tZ' G\H?l.!l Gt.iCo ;~r-,~y~ ~~2:) for plocing, building upon the right.of-way of County Road No. ll.Gll,(j , Mile Post Co~2: i'~.:,')::(,:' in strict conformity to the exhibits attached hereto, and subject to all terms, conditions, agreements, stipulations and provisions contained in the applicafion ond permit, the Rules and Regulations Gov- erning Facilities to be Permitted upon County Rood Rights-of-Way, as set forfh by the Lane Man. ual 50.190(2) any amendments thereto, and any other opplicable regulations, low or ordinance. Special Provisions: 1. Drivewoy will be constructed in accordance with the attached driveway approach specifica- tions (Drawing M98-50). 2, Permittee will be responsible for the immediote removal of all mud, dirt ond debris from the roodway ond right of way caused by his operation, leaving the roodway and area in 0 neat, acceptoble condition. This permit is revocoble at ony time, and will be strictly adhered to ond no work of her thon that specifically mentioned above is hereby aufhorized. This permit sholl be void unless fhe work herein contemplated [lC;:~,X:JJ,'l H, 78 19_. Expires shall have been completed be- forp ,19_. Inspected ond Approved Approved by Boord of County Commissioners By Dote < ' By Director of Public Works WHITE - OFFICE FILE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUILDING & SANITATION DEPT. YELLOW - REAL ESTATE C98-79 "" ~. .' ,,~ <'. Dqte _' . Building . Permit # . . . APPLICATION FOR FACILITY PERMIT I, (Applicant's Name) hereby make application under Rules and Regulations Governing Facilities to be Permitted Upon County Rights-of-Way, to construct the following facility: Upon the right-of-woy of County Rood No. ! ." I ~ , at mile post on the I No. I So. I E. ! W. I side of the rood, or (mark with X) os shown on the exhibits which ore ottached hereto, in strict conformity to the statements of the exoct nature and amount of work to be done, and to the description of the focilities contained in said exhibits. The applicant will be the principle owner of the focilify os consfructed, or other. wise primarily liable and responsible to members of the public for its proper mointenance, repoir, operation ond use. The opplicont occepts 011 terms, conditions, ogreemenfs, stipulotions and pro- visions, in Rules and Regulations Governing Facilifies to be Permitted Upon Counfy Rood Rights. of-Way, os set forth by the Lone Manual 50.190(2), ony omendments thereto, and any other ap' plicable regulation, low or ordinance. .; I '*,' '...,' .' To Permits Processing Noted Date Noted Director Principal Engineer Subdivision Engineer Signature Permit Engineer , .' r r . ' "", Address Weighmaster Zone No. WHITE GREEN PINK - OFFICE FilE - RESIDENT ENGINEER - PERMITTEE BLUE - ROAD SUPV. ORANGE - BLDG. & SAN IT. YEllOW - REAL ESTATE Phone No. C98-78 ~.. ~,.' , P~SED SUBSURFACE SEWAGE DISPOS.S\ tIIIaller: Complete top part of form to signature and submit both copies with application. , ; " .. ./' , . Installer's N:rl'e " ---n ~ ;:t./ln~ No. LiVi~9 units I Bedrooms 3 (Exhibit No.1) Permit No. 1'7D-7L/ I Property Address /J J . /1 II?.. .cJ/1'YJhJ - ~J~OL- I Baths Basemen""t Water Supply () / 1/ / ~2- Yes_ No~ Community Public~Other-List_ Septic Tank: Ft. from well Inside Dimensions: Length Width Applicant Name Diameter Depth Gal. Cap_aei t'{ ITile Disposal Field: Distribution Box: Yes _ No_ Other Distribution - Type Steel_ Ft. Concrete _ No. Compartments " J/L f-77. .).u 13~~;,?L., 4~) /lI f Feet from JI?O 7,,) (' """,T ~:""A'~' Well Address V ' . i:c - /J,('), J Lot Line o? ~ ~V ~ ~ Front side Rear Length of Lines - Ft} '~';I r" ch 1 'l'otai se;.( Ft. betweenlFilter rg~~r DePthlf:q~r Depth 1. 2. 3. 4. 5. 6. Width ft. . lines Type ~e in. t~te in. __"O':';'~~~'~~~:~1} _ ~__I= __~_ =f _ __ =-=--=~_~ = I --~-- --1-"- _~ ___ _..~ _~ I "- _ ______.~~__._ ..._~ _ _____ _____ .__. _.'__ __,_ _~I_=I~':= -:~ :.... '~': ~5 i~ ==':==:= =~ I::, =: _:-~ - ~_ :==: h._.'--t.:4~l-. ~~-- -~~ ~~,~ =i~:==- -.- ---. ~-.-.-.~~~~ -~- ~~~ ~:= ~= :.::: ~~ ~= =.:~~~ ~=:,~~ ~~~~~ ~~-.- .-------..+.rt:+.:~ .'= ~~ --)1 ~ := :=~.:=: =~ -~~.~ ::< _ : J~. _::~ .:. -"- .. . I '_~ '_'.'~::' . i I '-- ." '" , ... -l-,-, ..__ - .'.-..,. . - -,-- -..., '..... ~ ,-- ....- ---- .~ -~. ,- ,_,"'h__, .--' 1__.__ -_::-'- ~ ~, ----~~- ----- I I!, - - '~~. - I' ---.--.....--i.-. ~-.-._.,'.... --.-----..---;-.-,.-- ~ ~..,.-._. ....-.-..- ..-..-._.. , ! I .....(;0 __.. I, / I == =~ ---j --T~--'~~T- .--. .-- = == -= .--- -- - -- ==:~ == ~I--~ = ~;~ -- = ~ (d.: -~-- ;~~;~ :-~::. , - -1--- ------- .--- - ---- -----~_ _L ------- I j I ! I Date ;2,.,t, ~ I<;? C/ Sicmature ~ ~.../~ //. ~ , Mailing Foundation , Remarks: Sanitarian Use Only: Approved: System Installation Conforms to DEQ Rules for Subsurface Sewage Disposal Disapproved: Does not Conform to DEQ Rules for Subsurface Sewage Disposal Date: 6/IL//7t{ s~~an~Qr&re Quality -...... Stati!' of Oregon Department of Environmental ~r Interim Form #2 ...:' \.,) ". . . PLOT PLAN GUIDE " For Preparation of Exhibit *1 J PLOT PLAN MUST INCLUDE: 1. Legal description (Bottom of page) 2. Property dimensions 3. Direction of North 4. All roads (existing and proposed), 5. Driveways (existing and proposed) 6. Location of structure(s) on,property 7. Location of water source 8. Direction o~ slope 9. Location of trees 10. Proposed location of septic tank and drain field and replacement area 11. Dimensions and spacing of leach lines. i2. Distance from system to property lines 13. . Location of test holes 14. Draw to scale 15. . Location of wells on adjacent lots I I I -- jPIL~ 2./9' ". ,- ~ -J . plL r" "-J I ., \, f- ill 1lJ"" l!::~ ....~ IJ)~ IJ) 't - f-I:~ <1'1":- I fill 1li It (l .... c" ----~,s-~c)"" , -<$' .. '-~ III ~ _J ....:I~CJRAINFI litO !, RE'PLACEI<1J;..,'" A~EA r~_.L - - ----, ~___~_____J , TEST PI, _/) .. eo' LONG. . ,,;, -~ll' 80' ~~_. " \ -~ - "0' r--..... ,.,// ~,"': r- .- . --............. 11.,gl' , \o~/../ .0IS7'''''..'81.1'7"'ON _.!!."-~~ "000 GAL. /'/ . -Tf?tCE;;L ~ .__ s/:p ~/C -rANI<. <;WELL t f f ~ r~~;~~tSj( ")j .. lj ~ I '~' I .: WeLL ON S p/t. -7 N'""o. . -'~~~ACeN'T LOT '. C>RIVEW"'''' iJ1 ('Of N ./ \... .' II.. LINDEN t.ANE/') (PROPOS e.O) _p t- A t;j , SCALe I ~ "0 Section 2. T. T3S R. 2. W, W. ~A . Tax Lot or Account No. 2./00 Interim Form #5 :'!I~~: ~, , ": ~ -~-" :~~D. ~ MAILING ADDRESS ".' ~ ~-,' .,ft" -' ,'I, ~ -~ . , '\i -r- ~_ "- ,. ,I ,_. .' LANE COer BUILDING 0 BUILDING MH 0 MA[L1NG ADDRESS PERMIT OR MOBILE IME USE PERMIT PERMIT NO. -'" PROPERTY OWNER ::r r ~ J) r '. - '""j '; CONTRACTOR PHONE PHONE (' " PROPERTY LOCATION -INCLUDE POST OFFICE 0:>; . PROPERTY LEGAL DESCRIPTION - METES, BOUNDS ::>j l~':~~~r .:~ C'\ c::." ,.., "') ~r:::- '"'~ 1 TWP RANGE SECTION ~:~~:,~A" ~~ r,.f' TAX LOT NO. r" CODE CENSUS TRACT , " :1') "~ t,,) APPl. NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No. of Bedrooms ",,,> ;.:. ~-~~a EXISTING STRUCTURES ON PROPERTY , "') LEGAL ACCESS TO PROPERTY ,"'. ,---'V~-, , ,~(),... ',0 PROPERTY SIZE - FT, WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System D TYPE CONSTRUCTION SQ. FT, # BDRMS New System 0 VALUATION ,-,,~.... "'" . ... , , u:::,'3t:". n/~;; ~) C' 1';"1 ~ . ('" ( )/(, I"l'''''' ( .. ,_,;v '< ., , '~ 'oJ '.n .-.\> ~ " , " ~ . "0 f,~~--~,' :: ~,~ 41 .--v, c:c -:::::: , ....~..," ~)-' ,;; ..' -,' -' JI SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK 'dJ OTHERD It' \C,J FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME t: WATER SUPPLY '~:\-':~) PUBLIC ,0 o OTHER . n (~'" ,u. ,,' TOTAL rr"~ '-") t,":, ,'.'_" MIN, SEPTIC TANK CAPACITY COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED L1N. FT C:~'-:; TRENCH WIDTH FT, " (, ... -~'~ OR SQ. FTc' ' ". WITH D[S1, BOX: GAl. /"" .'-'~~' (~ ~;:,; C) ~~~',\:::::o TYPE OF STRUCTURE , " OCCUPANCY r f> J ZONE PUBLIC UTll. EASEMENT " BLDG. SETBACKS __ FT, FROM CTR. OF ROAD RIGHT 9t~-'t'AloC;>~:. ., FRONT \.., I SIDE INT. ' SIOEIEXT, AUTHORIZED SIGNATURE - DATE ("d~'J ~,~7 '~. :~.' c;~ ',~:,J ~::~) n :(: ,""':; CY~~5L,,\~SI~ICATIO~. REAR~} :','::1 ~','."'2~,': ~:,;C"::;::::", ..~ -~". DATE /' fl , r ,,:)11:.1._'. '(1 'BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD ~ -~, '\ ,,, .._J ~-;;: "'~~ ~ ,- '_.....1 J.-" (' ~ 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::: C55-1] . . " , SLAB FLOOR PLUMBING GROUNDWORK ApPROVED Cl 01 SAPPROVED /I DATE INSPECTOR REMARK S ;),':;C; . GAS PIPING GROUNDWORK ApPROVED Cl DISAPPROVED L / DATE INSPECTOR REMARKS ROUGH PLUMBING ApPROVED fSZ:1 DISAPPROVED Cl 'DATEQ-/?-7r INSPECTOR~ U REMARKS ROUGH GAS PIPING ApPROVED Cl DISAPPROVED Cl DATE I N5PECTQR, REMARKS FINAL PLUMBING DISAPPROVED Cl OATE$-/1-I,'(. I NSPECk" u # {),,?? ApPROVED ~ REMARKS FINAL GAS PIPING ApPROVED Cl DiSAPPROVED /I DATE INSPECTOR REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE / / DAT~ INSPECTOR REMARKS I- ,. . INSTALLER: INSTALLER'S PROP~ SEWAGE DISPOSAL SYSTEM RECOR-~J ,.' - Complete top part of form to signature and submit both~es with applicatiQn. '.~ PERMIT NO. I?tt)-?'J'f" NAME PROPERTY ADDRESS 6kJEc7ll Bedrooms ....;;' 1/f)I(N:1 No. Livi~ Units Septic Tank: Ft. from well Dimensions: Width Ro~r\ 11. RIO \-<<.I&'.\ C'Q:II.kV\~lO ADDRESS ' I 00 (' .....t::1.f;a C..\ ?-:\tg.'1 rr.~ Length of Liribs-Ft. '''[TrenCh J To~1 Sq. . 802:7a. 4. 5. 6. Width21 Ft..~ "lot Pian (see instructions): I 10' , ,.-1_-74- Inside Leng.!:h OWNER NAME MAILING \ _10 I I ,I 40( I I I I I t ~ Baths / Wl~ Basement Yes / NJ< '~-'M.'\"n Water Supply Publ icX Other-List Steel 0 Ft. Diameter Concrete ~o. Compartments I' Gal. Capacity Tile Disposal Field: Distribution Box: Yes)( No Other Distribution-Type /a-m':) Depth ,Jill Feet from WEll Lot Li ne Front 1Ft. Between Li nes 10 Foundation /t'; Side 1/9 Rear /6 IFiller;; IFiller Depth IFiller Below Type 17.zJAbove Ti Ie 2....inJrile ~ in. I 1\_--:- MW)t:', I __-10- I io' I 4{)1 \'. - -- I 10' I /-- - 10' t. ( I 1_ .J... ..30' - -- -'- --- ...3D I :3' ':'. '"to.;! ,9 i'" B " ~ n I;, \;, " i' "'\" &J.I L' . kJ MAY u 6 1974 t", .. .....1l.-c!J unt Si~ature d ,.~,.. C:;L ~ o?-"-. CERTIFICATE OF SATISFACT COMPLEft0K7 -I .J For Sanitarian Use Only: Date:5/1'I17L/ In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certificate is issued as evidence of satisfactory completion of a subsurface sewage disposal system at the above I oca,.p2' Approved: System Installation conforms to current standards c::J Disapproved: Does not conform to current standards Remarks: Date C55 -11 ~~ ~~. r S' Itarlan sIgnature E COUNTY STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY 11":\ ItJ LANE COU. BUILDING PERMIT OR MOBILE ~OME USE APPLICATION PERMIT TYPE - BUilDING i\I MOBilE HOME Dose REG. # PERMIT:# /. 70 -.7~ PROPERTY OW~ER / '\ MAILlNG ADDlJSS A ,I _/J _ PHONE ~.t:.?/ ~ ';1{. 6'1 tJ 1/./ ~ LbvtA./..-....-../ .i Y ~eI CONTRACi3: _ MAILING ADDRESS / . / ~ONE ,-..:; --: < ~ ~ ? 4/4; - 99/ t, PR~v_lnr:lo.TIOtJ\.-INCLUDE POST OffiCE --l1L7 .;-~) ./ J /J-x d1 JX../ PROPERTY lEGA. DESCRIPTION .... . / j /, -rJ_ / . L/ lOT - BLOCK - SUBDIV. ~a'? pr,o<.-- //1./-<1-.<< AA.4 X-1/../~_ TWP RANGE SEe. TAX lOT :# (ODE- i! 6U111 -I')' ~PPLlCANT , - NAME ~~-L- - A -d_~ t' ." /. / / --t:' ..L .g. -.2.-." METES & BOUNDS 0 YES r~. ,pi -.?? ,'7 ATTACHED 0 NO CENSUS TRACT - AND MAILING ADDRESS DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY '77 ~~ LEGAL ACCESS TO PROPERTY - ROAD NAME OR # li!.v-.,u;(-L-d.--- ___d--I-. PROPERTY SIZE-WIDTH DEPTH AREA FOR MOBilE HOME PERMIT ONLY Number of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT ~A./YJ:t. /" /::J /~ - tf..d - U...?7.A9... d.. r./ "f.-n)./.Ad fU./i oil --a~d-I d,(./!..1. SEWAGE DISPOSAL PUBLIC 0 BLDG. WASTE OIS. PLUMBING PLAN REVIEW PARK TRLR. , SEPTIC TANK if .;:;>;t 00' .3?J, () 0 :-3/. 00 OTHER 0 FEES WATER SUPPLY PUBLIC ~. PLU~ING FEES FIXTURES CASH 0 S9"ER CHECK ~ONNECTION FEE PUBLIC WATER CONNECTION FEE :>, '''Jl ==-- /#3/ I PLUMBING INSTAllED BY n OWNER n OTHERJ'{NAME I./../f/,t (l/,U"~ J. PLANS FURNISHED' C' FACIQ}f PERM"rr~~ YES i'X NO 0 YES p( ..I'O"'El SIG~~OF AP~~T---L.- /~";;A DATE )( /)'/& r~JJ~.:f/;b/74/ '~V:D BY' / >>'t1?/?'~ PERiM/#//?/-?-/ /' . COUNTY BUilDING & SANITATION SPECIFIC,6.TlO~ DRAIN FIELD REQUIRED L./ lIN. FT. 1%0 TRENCH WIDTH FT. z: OR SQUARE FEET ~ (, 6 Connect to Existing Sewage System 0 or New System Req. n TYPE CONSTRUCTION SQ. FT. G1MDROOMS VALUATION ''/1 '---;?~--<- ~~x4_---; "':f";:2 ("...3 )/~?>g'7 tf/ <? (f?:?) , .:;23 )( tb e.::j' / 7:1. '7 '7X~ MJ ?'. OTHER e'd,,I.,A) ~ 7, I!hJ ,;(, tJlAf TOTAL L,;;; ~- ,.,..... ,:{,u MIN. SEPTIC TANK CAPACITY WITH 0151. BOX: GAL. 1DO frY 01'5. TYPE OF STRUCTURE S N OCCUPA;CY ZO~ REAR YARD BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT .QF WAY' ~ USE CLASSIFICATION ;/ Sr-I,) i I 7 I FRONT o-rS SIDE INT.;::o, SIDE -.1 UT ~R P'U1e.-- ,. 1'1 _ ~~CWl 8/;8/;; ~ 2.-7-0;1 BLDG. INSP. ffJ tri-d1 ~71..~:I7'f Qections to Find Property' PUBLIC UTlL. EASEMENT COpy 1 - OFFICE COpy 2 - JOURNAL COPY 3 - AUDIT Form # (55-12 ~