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Home My WebLink AboutPermit Building 1974-5-3 (4) :,' 1 ,.' 11 :l . .. ." . ..\ o "r.': . o PROPERTY OWNER 'If /'j LANE COU. BUlLOING...PERMIT OR MOBILE .aE BUILDING 10 MH 0 MAILING ADDRESS USE PERMIT PERMIT NO. ~,a,71J PHONE ,!J&'I';::)i(, PHONE lumEm ~J. HILL BIlIWID. U.:t. CONTRACTOR SA~1~ PROPERTY LOCATION - INCLUDE POST OFFICE 1210 D:lNDEA I PROPERTY LEGAL DESCRIPTION - METES, BOUNDS ';\ilO. 8m t1. C~tJ1ml'J1A'-' (jl'll H:nVlnn, lb. MAILING ADDRESS TWP AODITION ~~ADOU GREEN EDT. LOT 2~ AL~" 1 RANGE SECTION 0$,4,Z 02 TAX LOT NO. If-' '2 ZtJr) CODE CENSUS TRACT 16 ':lQ.C1OO EXISTING STRUCTURES ON PROPERTY APPl. NAME & MAILING ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms lloamT N. WILL BUIWIIt. we. ~~o~n: lEGAL ACCESS TO PROPERTY 1210 OlltlDP.A PROPERTY SIZE - FT. WIDTH 70 DEPTH 121 AREA STRUCTURES TO BE BUILT THIS PERMIT D',IIU.tll NO Connect to Existing TYPE CONSTRUCTION F'RAMlt Sewage System 0 SQ. FT. :,t BDRMS 1033 012. (3) 506 0 3. New System 0 VALUATION I!')w,. "D:U,)' GAQa~E.ATTAC"ED-~C. 1.513. ~ Sl.!,)U4. SEWAGE DISPOSAL , OTHERD "lb. 00 'jO.00 22.00 FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY JAClIDO:l PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAilER .. SEPTIC TANK 0 PUBLIC 0 o OTH ER TOTAL . 12ij.OO COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN fiELD REQUIRED 200 UN. FT TRENCH WIDTH FT. 2 OR SQ. FT. ~oo MIN. SEPTIC TANK CAPACITY WITH OISl. BOX: GAl. $00 TYPE OF STRUCTURE 5~J OCCUPANCY I &. J ZONE PUBLIC UTIL. EASEMENT BLDG. SETBACKS n FT. FROM CTR. OF ROAD RIGHT OF WAY FRONT 45' SIDE INT. 5' sIDe EXT. -- AUTHORIZED SIGNATURE - DATE /n/ J.E. Bass, OY, C. ~~Auea REAR USE CLASSIFICATION 10' Pur J. SHOO~, 5ANITAR~~ DATE 5-:;";~ In BLDG. PERMIT-WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule 011 required inspections. All construe. tion sholl 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) rORM ::= CSS-lJ (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 . ApPROVED / ~ DISAPPROVED ~ DATE REMARKS GAS PIPING GROUNDWORK ApPROVED / / DISAPPROVED ~ DATE REMARKS ROUGH PLUMB I NG .. INSPECTOR INSPECTOR ApPROVED ~ DISAPPROVED C1 REMARK~ ""oC:- '1- J y """"~r ROUGH GAS PIPING ApPROVED C1 01 SAPPROVED ~ DATE REMARK 5 FINAL PLUMBING ApPROVED .!2f;:1 REMARKS C1 DATE.J .- 2 , - 7 't , DISAPPROVED FINAL GAS PIPING ApPROVED C1 DISAPPROVED C1 DATE REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE C1 NOT READY TO ISSUE, / / DATE REMARKS I NSPE.CTOR INSPECT..." I INSPECTOR ~~ '(/ INSPECTOR . BUIL~ING SITE EVALUATION Js'/cfF: {;?g -7'/ () Building Permit Appl ication No. () Site Inspect ion () Pre-Permit Investigation ~ LANE COUNTY PLANNING DEPARTMENT NOT appl icab Ie (' ) ( ) ( ) ( ) ( ) ( ) NO I. Zoning Orqinance Compliance (Zone rR A ) Subdivision Ordinance. Compi iance ( ) ( ) ( ) ( ) (' ) ) ( ) ( ) 2. 3. 4. Required Access. Building Site (Area, Width, Frontage, Setback) Other (see comments) 5. ., 1. :; T K'R02 S b6 TAX LOT " CENSUS TRACT Srd M'etlOOW &Tee", t=.71 L-2'1 ~-I APPLICANT:,') I /,1/ JI'/ NAME ~oBPrT IV. ItlJ.,I ADDRESS.. . PHONE DATE f..I-2S-7v , YES NAME DATE ~~n~ V -...:l-/--7 V / .. COMMENTS: BUILDING' INSPECTION SECTION NOT NO YES appl ic~ble (Y 6. Plans Subm i t ted ( ) ( ) r 7. Soil Stabil ity (foot i ngs) 9) ( ) ( ) 8. Flood Plain Oi) ( ) ( ) 9. Other (see Comments) !f.) ( ) ( ) , COMMENTS: NAME DATE ~,ltfJ+!kdK-2 -7(/ . ,- , SANITATION SECTION NOT NO YES J yt"Q- DATE aool icable h yI'50 flU 10. Sewage Disposal ( ) ( ) II. Usab Ie Area ( ) ( ) ( ) I 12. Water Supp 1 y ( ) ( ) () 13. Other (see Comments) ( , ( ) ( ) COMMENTS: TO APP LI CANT: 1~ Your SI ~~~ f1 Building Permit I Site Inspection: Can be approved. Cannot be approved at this time as indicated on item. NO. above. Questions and further information on items I through 5 contact the Lane- COUNTY PLANNING DEPARTMENT. Questions and further information on items 6 through 13 contact the Lane Countv BuildinQ and Sanitation Division. Wil I 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 cover. ( ) ( ) ( ) LANE COUNTY PLANNING DEPARTMENT 135 Sixth Avenue East, Eugene, Oregon 97401 PHONE: 342-1311 EXT. 231 LANE COUNTY BUILDING & SANITATION DIVISION 135 Sixth Avenue East, Eugene, Oregon 97401 PHONE: 342-1311 EXT. 411 C55-21l . L.J-25-7Y'2'5-74 I ~ . . ., . (, /Y-zV 678-74 ~ CUT ~) ~ick uJalR.::> SIDEWALK Dote Permit No. PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY WHEREAS, the attached application has been fully cansidered by the Board of County Com- missioners 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 _ROOERLN..JiJ.LLfiUl.LDER.,_LNr -870_CEN_UIIN.lAL,_SJ'.RJNG LLE L o_,--OR. or constructing the following facility: DWELL I NG jRD._AoD.._MEAD.o_\CGRE EN_E.S_T.i\US_Lo_T~BLK .__1 for placing, building 121QJ20i'ln~. upon the right.of-way of County Road No. , Mile Post . in strict conformity to the exhibits attached hereto, and subject to all terms, conditions, agreements, stipulations and provisions contained in the application and permit, the Rules and Regulations Gov- erning Facilities to be Permitted upon County Road Rights-of-Way, as set forth by the Lane Man- ual 50.190(2) any amendments thereto, and any other applicable regulations, law or ordinance. Specia I Provisions: 1. Driveway will be constructed in accordance with the attached driveway approach specifica- tions (Drawing M98-50). 2. Permittee will be responsible for the immediate removal of all mud, dirt and debris from the roadway and right of way caused by his operation, leaving the roadway and area in a neat, acceptable condition. 3. SIDEWALKS WILL BE CONSTRUCTED IN ACCORDANCE WITH THE Att~CHED SIDEWALK SPECIFICATIONS AND DRAWING M 98-49. THE STANDARD CURB TYPE SHALL BE CONSTRUCTED UNLESS OTHERWISE SPECIFIED. 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 be- fore MAy 'l. , 19-]5-. Expires 19_. I nspected and Approved Approved by Board of County Commissioners By Date &. /).A. ..', ....a,(...... __ _ -" v 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 .~ .. -.. . ' , . '," . e. l ~,)~::):)~,~, . "- 'e .' . Permit No. _'78 -21 CURB CUT . .. ~ .::. . ~ ' o Dato /' ..... ,) ~ if''; . PERMIT ~~,~::~:.~\" IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY WHEREAS, the attached application has been fully considered by the Board of County Com- missioners of lane County, and it is the opinion and judgment of the Board that the said application should be granted, and that a permif should be issued, now, therefore, it is hereby. ORDERED, that a permit be and is hereby issued to r~:."'_'T; [:1, eil,S" /'.... I-.?""-'" , ~ . . . , J' '" 1'-'. ' -,. ('r-"""'I I,.., ,~,_.. ~ ~'''~ ..~.,.... ......... . r;-., ..',) \..,~r. ..Ci1", '" 'd./~..n.__,JOI'.'')'" L'.....D or constructing the following facility: tl';~~;U..O\:3 ','.:'}, t-)t> C.~t..:-:~~:] C':::r\J l:CyAV[;O lov r~ C\.u... D for placing, building tL~Q fJ:-:::~~~~ upon the right-of-way of County Road No~ , Mile Post in strict conformity to the exhibits attached hereto, and subject to all terms, conditions, agreements, stipulations and provisions contained in t~~ application and permit, the Rules and Regulations Gov- erning Facilities to be Permitted upon County Road Rights-of-Way, as set forth oy the lane Man- ual 50.190(2) any amendments thereto, and any other applicable regulations, law or ordinance. Specia I Provisions: " 1. Driveway will be constructed in accordance with the attached driveway approach specifica- tions (Drawing M98-50). I 2. Permittee will be responsible for the immediate removal! of all mud, dirt and debris from the roadway and right of way caused by his operation, I.I'c,ving the roadway and area in a neat, acceptable condition. . ,\ . ,t4 , , . ~O:-::;::.Y..:~O ~::,~.~ c: C::::~:V.:0':~CJ Di) ~G:::;~:.'::::{":~~! Jt'lCj .-'......"/'~rlO'~l\ql"..,." ^"'---' C'-'"'''''/I..n ~'J ("~ t-~'1 7.....""" 1~''''''-'''''''IVv' .~- "...Y ......~'. ,<..> ._,~.-' .._';'/l,/~" (/-'-~""JlO ...,~...' v"..,;. "'0-'''''_' ,._" ...... "'r." ...., "'.., C,"..~ ""('" ('~"G'~ OLJ" : J ......-'..'~". ~h", ~.... ,...-\'ol..,-," '~'_.nl.'''' -'oJ -;.r\.:.. ':JY X ]."tI ~JCf~M iJ 1~/-'/jJ 7ij~ '.:::: flt:mC::30 c;C= ,'::::1.:' Ct.-::' "J'~:?,:: r:::\:,0 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 be- forE' ;:.ov 3) 19 'j~l. Expires ,19_. Inspected and Approved Approved by Board of County Commissioners By Date By Director of Public Works WHITE - OFFICE FilE GREEN - RESIDENT ENGINEER PINK - PERMITTEE SLUE - ROAD SUPERVISOR ORANGE - BUILDING & SANITATION DEPT. YEllOW - REAL ESTATE c98-79 ~ ~ ." . PR 0 SEWAGE 0 I SPDSAL SYSTEM RECD . . top part o_rm to signature and submit bot_Pies with app atio~.",j PERMIT NO. (;;7R-- /'7 PROPERTY ADDRESS . INSTALLER: Complete INSTALLER'S NAME No~ Livi~)~~ed~~s I 'J, Septic Tank: Ft. from well ..) Basement Yes No I~o ,O~~ Water Supply Public ~ Other-List Concrete r.l _No. Compartments Gal. Capacity ~ 1 ()<9-0 Tile Disposal field: v' Distribution Box: Yes No Other Distribution-Type 3i , 1\ I III I " G2b I , I 135' 36 - -I I Inside Length OWNER NAME Steel 0 Ft. Diameter DeDth Dimensions: Width &n-lu-.f Ai. J.kd ~ ~ MAILING Y7() 4),~ ADDRESS ~/ cfl-t. 97(? '} Lengt~9f Li~~t. lT~encr I Total Sq. 1. 2.)',3. 4/':)5. 6. Width;;) Ft.39o Plot Pian (see instructions): RECE\VED - By - 4 J\JN25197 f>.NE. CQUN1'l t.NV~ONMt.N1AL MGMT. f 1,0 I I , _L/D_ Feet from WEll Lot Li ne Front 1Ft. Between Lines 10 / foundation Side Rear IFi Iler% IFi Iler Depth IFilley_Below TVDe , ~ Above Ti 1 e.;;>-i nJTi Ie I.CJ in. - -.- -. - -' / .../ Si9nature . 1~0J' . r~ (1-" CERTIFICATE OF SATISFACTD\Y COMPLET N - / /, ///.. For Sanitarian Use Only: Date:~1' ~;fl I7C~ 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 loca~i 0 Approved: System Installation conforms to current standards Disapproved: Does not conform to current standards Remarks: Date (0 - oJ-/ -~ ltl~~ ( "'n i tar i an r s Signature lAANE COUNTY STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY C55 -11 . PROP[4HY OWNER LANE COU. BUILDING PERMIT OR MOBILE BUILDING ill MH ,n MAILING ADDRESS aE ., . ~\ . ~ USE PERMIT PERMIT NO, )(J\G PHONE "...~ . . ~ . :,J. (:~:.t ;'-Uf ;Zi~~ " ,.~----. . '.,,~,. ~~'~~, tJ. c::: ..i'~ :. t~~'1I ~ . ~-::;.je:~:'~a:'~,,~).., (;..\. . ~,.... -.' t ." PHONE 1.1 CONTRACTOR ~X:t; PROPERTY LOCATION - INCLUDE POST OFFICE MAILING ADDRESS , .. n~t) ~':':::.1:'''6 PROPERTY LEGAL DESCRIPTION - METES, BOUNDS ',:~!::. ....1..::)110(..:; r.....'"::)" 1 (':::';C:J \:'-',7. RANGE SECTION TWP .... { ~ ~" '0',' ,,:, r.....' 'J f. c...'-.J)~ ,,'.. 'I TAX LOT NO. CODE CENSUS TRACT c'? (~/' I..., '.~a :~, EXISTING STRUCTURES ON PROPERTY APPl. NAME & MAILING ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms {'c:m1 P. :au ::ur..cu, V:C. "t.........,. \...~-;... LEGAL ACCESS TO PROPERTY 1 :;~o u:::;~,,:.o.., PROPERTY SIZE - FT. ":-' , . '. v:,IDTH tv DEPTH: 1.1.-', AREA STRUCTURES TO BE BUILT THIS PERMIT ~n. 0 ~:'~I Connect to Existing TYPE CONSTRUCTION ."UlI::": Sewage System 0 SQ. FT. ;: BQRMS to;,) J:'. n New System 0 ; VALUATION J. C'J~" )~. ((H';:::"~~~;::. \ .n ..'-'" ". " ~'. w' " SEWAGE DISPOSAL BUILDING WASTE DISPOSAL \J.... PLUMBING ~.. ~ PLAN REVIEW PARK TRAILER , PLUMBING INSTALLED BY D 01:HERO OWNER 0 OTHER: NAME ~ ,,~'.O.r~ . \fEES ", ~...... " W~TER SUPPLY "~'\.~\f.~;~..j '~\~;'~~iS~'\ ,~UBlIC 0 0 OTHER '0' .,-", \ \ .. (',' ~ -,' ". PUBLIC 0 SEPTIC TANK \.... TOTAL $ 'k, '.( .J COUNTY BUILDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY WITH DISl. BOX: GAl. I ,\~~~\-'~ , '\ :,\ f' - "a" \' "ll';:', "\",\'-<;".\ ~.l\.~,,~~~ "''''_'M~\'- " '._ ,>,...' . .,t>. ". ~ \;'\'-~^_\' ~~~ TYPE O~ ~T.ROP'TtjRE ~,-:. \~ .. ~,~,,\-- '',-.;}dCC'u~~~~ fi -. ,izb~ES";,..;\~ /~~t ..i..~~upJc : UTIl'~ EA,SEMENT l,' ,I ~~\'-~".~,,?\ ~ ~,~'~J- , BLDG. SETBACKS. FT. fROM CTR. Of ROAD RIGHT Of WAY USE CLASSifiCATION ~ .,0 :~;" H.!l REAR ,.:"\ ',: j\ X. \ DRAIN fiELD REQUIRED ,]2J UN. FT TRENCH WIDTH fT, ') ,. OR SQ. fT. l..\'1"" . , r, ~ fRONT I,.t . r . ~ . ~ '. SIDE INT. SIDE EXT. AUTHORIZED SIGNATURE - DATE i"~' . t~I'\~'".F"''' .'l.__.J,'l....!J......-vt..~ DATE J. S:--;:;n;CO !'A~HT~ .'/jAr, .' BLDG. PERMIT - WHITE OFfiCE COpy - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687.4065 to schedule all required inspections. All construc- tion shall comply with Uniform Building Code, D.E.Q. standards IMPORJ~NT:~ for subsurface sewage disposal and county regulations covering '.. plumbing. All buildings require a certificate of occupancy before' being occupied. (See Details an Reverse Side) \ , , , , ...... rORM ::: C55-13 (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY. DEPT. OF EN.VIRONMENTAl MANAGEMEN.T COURTHOUSE ANNEX. t35 EAST 61h. EUGENE. OREGOt'l 9740t /~ F ~ i ,. . 1 . , S ! TE .1 NSPECTI ON ApPROVED Cl DISAPPROVED Cl DATE INSPECTOR REMARK S FOUNDATION IN70N ~ ApPROV(O 1 .. 1 DI SAPPROVEO L-I DATE?-.3 -'7l/ I NSPECTO,( ~ REMARKS.., /) I( ~l/~ ! ~,.~ .06 ~ /)1. 7 r fJt - e I, ~ ..tIIt1j/lrp ~ 4tdT ~.... ~ /IQI( _ &-f J ' '? "" /v/~ . I . - Ii FRAMING INSPECTION ~/, ...."" I V; '''....'''0 ~::2i- / <<. 7:L '"""'t!! Ai REMARKSf'~~"~ ~ 8;; LATH OR SHEETROCK INSPE~ ApPROVEO ~ DISAPP~J"O &~ ~-7d /Jd . I NSPEcrtR ~.k C!!.t REMARKS FINAL INSPECTION INSPECTOR~~ CERTI F I CATE OF READY TO ISSUE / / NOT READY TO ISSUE L::::l DATE INSPECTOR REMARK S &; 17~1~ !f(l~~&~ 'hr- .///7 I I{)~ /;;./0 v~ ~~,s.; ,em. . /)./0 IJ.J/~1' f.r I'~ 'n Ikdj ~~ (?PI ~I.,e~ ~ ~R?' ?~ I1:C5;-frfre Tr-'() tr.1fMtIJ$' !'O& t-' " .. . ; lOJ'l6 HO'D3lIO '3N30n3 B3lHS )lVO It'6 SM.mI)S3 3JNV~nSNI 31111 ANVdWOJ 3JNV}JflSNI 3'lJ.Il AlNflOJ 3NV'l .. . :<) ~ ., . .. . , ROSBORO LUMBER COMPANY P. O. BOX 1098 . SPRINGFIELD. OREGON 97477 PHONE: 503.746-8411 CERTIFICATE OF INSPECTION '. Issued at: Springfield, Oregon Inspected on Date:' "Lumber herein' listed has been inspected and .tallied under Grading and Dressing Rule 1116 '.at Rosboro Lwnber. Company plant by bureau inspector." Shipment made via: " f".....--. --, /;! [. /....e..A. Certified Grader , I I I . . .~. LANE COU_BUILDING PERMIT OR MOBILE HIE USE APPLICATION . PERMIT TYPE - BUILDING ~ MOBILE HOME Dose REG, # ~ ( PERMIT :#: ~TY OWNER / / ,,~<;::< y;'-"""AILlNG ADDRESS _Y;;ok~~ AI HlfLVu/Ki..-Jitc:.. g?,&> u-" (?e)?,/I P/JI J4L ~ CONTRACTOR MAILING ADDRESS ~.,.~ ,. ~ " /' PROPERTY LOCATION -INCLUDE POST OFFICE /2 I 0 Drw"\d ee<- '3. c:L M ecd&w SEC. -TAX lOT # ")~ 2. {,., AP:l~~:"'~Jj,)jdl ~~,Ur.L_ cki-,;/<; . PLUMBING INSTALLED BY /' OWNER 0 OTHER t(NAME ':V:lC.~~/ PLANS FURNISHED - FACILITY PERMIT / ~ES '-' NO 0 YESh! /NO 0 i'ir' . ~~ ,,/'" DATE -_ 'F~ECEIV~BY 0 . f> ((~ DATE .2.. 10 ~....... ,+-'2.S~( Y PERMIT # / / -?- COUNTY BUILDING & SANITATION SPECIFICATIONS / DRAIN FIELD REQUIRED / UN, FT.;1 b f\ TRENCH WIDTH FT. 2 .6R SQUARE FEET <.L (\ d / / / '..f-II! OCCU,?$-Jr ZONE / BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY r ( f IFRO"lL Y'~ SIDE INT. 5"" SIDE EXT. - REAR I Q' PUE \IS~TA r:~~ /... ~ PlANNING I Date BlDG, IN'SP, J7 td ;{) d'/# Date A. I.f / '}) <:> j' r t( t:?:;;;- y - .b. 6 . ;> </ / ~'f/\(j CYi:1- {? j j)J {z;!.. ~:t<~ b (.() 41 . . . . I / V f . G.- :ections to Find Property: I I / Vi PROPERTY LEGAL DESCRIPTION lOT - BLOCK - SUBDIV. TWP RANGE AND ?7 t!? tQes~ Cc.l-l 7L YI ..... I .a '-- MAILING / / ADDRESS ~~~_ Ie:! FOR MOBilE IiOME PE~~ ONLY Number of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT (:fa "/1 tm.mo.Q.-- U L\~ \\ ~\"\.<:- ~\\ \;,;-"0 --h\/'i'clG(Q. "-:l ~ SEWAGE DISPOSAL PUBLIC 0 SEPTIC TANK ~ $ ~~:= -':;2 - OTHER PLAN REVIEW OTHER 0 WATER SUPPLY PUBLIC ~ PLUMBING FHS -10.. FIXTURES ~-' :s FEES BLDG. WASTE 015. PLUMBING PARK TRLR. CASH 0 SE~ CHECK ~NECTlON FEE TOTAL 12<6.- PUBLIC WATER CONNECTION FEE MIN. SEPTIC TANK CAPACITY CftlD WITH DIST. BOX: GAL. TYPE OF STRUCTURE COPY I - OFFICE COPY 2 - JOURNAL COPY 3 - AUDIT Form # C55-12 67'8-7'1 PHONE '7ft:,-'?<F/t PHONE 61een &+. L -2 l j D ) METES & BOUNDS 0 YES -, \::>-' ATTACHED 0 NO CODE CENS:3 Zf~T 9 C/O DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY J1l'n1 .t2- LEGAL ACCESS TO PROPERTY - ROAD NAME OR # 12./0 DohdeQ PROPERTY SIZE-WIDTH DEPTH /2/ AREA 70 Connect to Existing Sewage System [] or New System Req" n TYPE CONSTRUCTION SQ. FT. # BEDROOMS VALUATION I h 31.. Gi:) I 'L (.3) I'?. 3q-h - f 50b (Q),~ I 5'1 ~ - \~CfIL/ , , " REAR YARD PUBLIC UTll, EASEMENT USE CLASSIFICATION