HomeMy WebLinkAboutPermit Building 1974-3-29 (2)
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\ PROPERTY OWNER
m II, Robert N.
CONTRACTOR
LANE COU.BUILDIN~ PE~MIT OR MOBILE HA
BUILDING @' 'MH f1
MAILING ADDRESS
USE PERMIT
PERMIT NO.
309-i'4 .
3tltj- 7'1
PHONE
7':{;_~'J1 C
PHONE
Same
PROPERTY LoeA liON - INCLUDE POST OFFICE
I
870 West Centennicl
MAILING ADDRESS
Springfield. Ol'og;1O
I..
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
1 Lot 27 Block 2 3r~ Addition Meadow
TWP RANGE SECTION
18 02 06 .I. 3
APPl.
NAME Robert N. Hi 11
&
MAILING
ADDRESS
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
Green Estates Subdivision 3605 Duke Street
~ 9Z1 ~' CODE CENSUS TRACT
EXISTING STRUCTURES ON PROPERTY
None
LEGAL ACCESS TO PROPERTY
,'l,(/Dc) Duke Street
PROPERTY SIZE - FT.
WIDTH
DEPTH
AREA
Connect to Existing Sewage System 0 New System 0
TYPE CONSTRUCTION SQ. FT. # BDRMS VALUATION
n_l J ;n9" mi>+"
Frome
1104 @ U (3)
13.24E
GarnOA. nttachad. un~lled
41+1 GJ 3
1.323
i4.571
SEWAGE DISPOSAL
PUBLIC 0
BUilDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK JO( OTHERO
. l;q.OO
~n_nn
2f:'00
FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER: NAME
WATER SUPPLY
PUBLIC 0
o OTHER
,
MIN. SEPTIC TANK CAPACITY
$-11.7. nn
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED
UN, FT 180 TRENCH WIDTH FT,
2
OR SQ. FT.
360
TOTAL
WITH DIST, BOX, GAl. 900
Roof Drains to Streot
TYPE OF STRUCTURE
OCCUPANCY
ZONE
PUBLIC UTIl. EASEMENT
l;_tIi I & J
BLDG. SETBACKS _. FT. FROM CTR. OF ROAD RIGHT OF WAY
USE ClASSIFICATION
FRONT i!.':;
SIDE INT. r:; SIDE EXT. 40
AUTHORIZED SIGNATURE - DATE
I~ I ... E. Angg hv C. Hllrbauah
REAR 5
John Shook
DATE
3-29-i'4 g H
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT:
Call 687-4065 to schedule all required inspections. All construc-
tion shall comply with Uniform Building Code, D.E.Q. standards
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 :t= CSS-13
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, t35 EAST 61h. EUGENE. OREGON 97~Ol
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PROPERTY OWNER
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CONTRACTOR
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LANE COUN.UILDIN~ PERMIT OR MOBI~E
BUilDING ;0 MH 0
MAILING ADDRESS
Hctt
USE PERMIT
PERMIT NO,
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I.. ',;3 ....~'C~ C~-.~~'.Cr..:;tD~
MAILING ADDRESS
~.,~)r :C':~){Jlcg(. C~'Cr.-"~r~
PROPERTY LOCATION - INCLUDE POST OFFICE
I
PROPERTY LEGAL DESCRIPTION - METES. BOUNDS
i ;~ ;'j' G~~1"';- .'. .(,'((i~~c_~ ~:'~::'::lt'1:~7CC;~ Cn~'t~'~. ~':.f':]ivgD~~;:J c>
TWP RANGE SECTION 1'T-AX LqT NO; U CODE
'0 ~? c:; ,j, 3 '7 Z T
APPl.
NAME
&
MAILING
~.c~~:; ,<,:.-:~ :)~r(.:: t~
CENSUS TRACT
EXISTING STRUCTURES ON PROPERTY
:,:~;';;;.<:;.;; 11
l.~t::::
LEGAL ACCESS TO PROPERTY
.3& c S CLlb Gtl":::~
PROPERTY SIZE - FT.
ADDRESS '-, WIDTH,,, DEPTH AREA
FOR MOB\LE .H9ME PERMIT~ ,ONl* '\ ~ ~ ---t, ~ .,~ ~~\.\.,('" '" ,&\\ ~~,.\lo. M~".)\-\' C'\
No. of Be~rodms " _ \ \ ~ ,. "~(;onnest....l~~E')(IstmgI'Se.'!Yoge -System; '0 .
STRUCTURES TO BE BUILT THIS PERMIT TYPE.CONSTRUCTION SQ. FT., :t: BCRMS
r.'\'.,t\54.~~- J~'\ ... rr>I . ~Q ~.~
,;:'::'0 ~~: n... ( '~.a:n vh. ~~ - ~~;;,r' ..l\....~'!"" J :J\/:,) \. ~ ",:;J)
\.
'!}i :' :0
_~ 'r."-- ~ ('...~?crJ;--:J. c:~~~)ic::j
SEWAGE DISPOSAL
PUBLIC 0
,
PLUMBING INSTALLED BY
BUILDING
WASTE DISPOSA'l. ~
PlUMBING \ -
PLAN REVIEW
SEPTIC TANK .:0: OTHERD
\' """
.. '\1 ;'1.,,,)
~'\ ("\ "
S"':;;';::
--'''- (.",'"
-.,j
PARK TRAILER
TOTAL
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAl.
FEES
OWNER 0 OTHER, NAME
WATER SUPPLY
,
~y't\~~
PUBLIC 0
o OTHER
t ~~/.C')
COUNTY BUilDING & SANITATION SPECIFICATIONS
DRAIN FIElD REQUIRED
S::d
'u:J
OR SQ. FT.
"
TRENCH WIDTH FT. t...
UN. FT
'::,~~/V l'r\I~)1 ~:O Scrc:..-~.
TYPE OF STRUCTURE
.J~
OCCUPANCY
G G J
lONE
PUBLIC UTll. EASEMENT
BLDG. SETBACKS _ FT. FROM CTR. OF ROAD RIGHT OF WAY
FRONT (:,:j SIDE INT. SIDE EXT. t...:"
AUTHORIZED SIGNATURE - DATE
iel J... D:;C:!l
BLDG. PERMIT - WH ITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
~ CS5-l]
Call 6B7-4065 ta schedule all required inspectians. All construc-
tion shall comply' with Uniform Building Code, D.E.a. 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) ,,',
,
USE CLASSIFICATION
REAR ~j
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(POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
PHONE
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PHONE
New System 0
VALUATION
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DATE
,~:;;)2:>J:;:j
,
.
.
SITE I NSPECT I ON
ApPROVED ~ DISAPPROVED ~ DATE
INSPECTOR
REMARKS
I NSPECTOR ~
FOUNOATION INSPECTION
ApPROVEO rT:7 D'SAPPROVEOL-I DATEtj-II:,?!1
~' . r(}#
REMARKS (9/( to -;'J~ 1../- /-'71/ u{,
{) l{l~ :'di!tJ~~0 !:Jul-ll~/,~/" r--,~ f~5L
f'~c.", t,b-
FRAMING INSPECTION ~"V 1i!-'1
ApPROVED / t-r/'DISAPPROVEO ~ DATE 5~2./ 711' INSPECTO;V
REMARKS -i-A.,-1'/HJ!J~ l/ -J ..):}
I I /
LATH OR SHEETROCK INSPECTION
ApPROVEO L6 DI SAPPROVEO
!F'lvrt( ,""",l~.:
L-! DATE
REMARKS
FINAL INSPECTION ~
ApPROVEO ~DISAPPROVEO ~ DATE $ ,/f!- 71 INSPECTOR ~ t!!..L
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE ~ NOT READY TO ISSUE ~ DATE
INSPECTOR
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.:J1)?~71(' 14 # "3 (,()f p~
REMARKS
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SUPP.wENT TO BUILDING PE~MIT NO. ~ 9- ~~
Lane Caunty, Oregan
"1 /' ..L. \, L / I ~ ,->
OWNER I _J" ~ ,f.,. 1_/ 1 J. ';1.(", I /
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CONTRACTOR 5 /"', ,o>'.A_
n< -7 '7,) /J -~ ,/ J
MAILING ADDRESS )'; / 'LJ CA: ' r r ;/ I./', . /.!Lr!.(.~f;, " ,
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MAILING ADDR"c:e, _,~, ,,," .-r..... .
PROPERTY ADDRES~
Jt ADDITION:
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D CORRECTION:
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,_IA ':/-1/ u/'//",...'" l' ",Ii.".. /J~t'/~
, - "'.' /.,.- ,. ';'" -/r,;;/
", " "./"f' "'1'" ",Ap..-;.-/r~
- ,- .." ~ -',-' . ", ,,, ,
CHANGE RESULTS IN: 0 REFUND OF FEE, OR
J
BUILDING 0;:
SEPTIC TANK
SANITARY CONNECTIONS
_0J)./.,)
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/ / ~../.,A!:-":? L"/-:::'. .
1/ Lr~~ ?7?.-/ , Date /j- 4- 79
D ADDITIONAL FEE:
TOTAL !l: ..~J /; _ .',;
DATE FEE PAID /1. .I'. ;/.~{
1
LANE COUNTY DEPT. OF HEALTH & SANITATION
D G/
Cash Check
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Supplement N2
.1679
5 By f,., ?
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BUILD1~~ SITE EVALUATION
I
'J7;)~4,
Appl icat ion -No. 309-7/
'~
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X"Building Permit
( )
( )
Site Inspection
Pre-Permit Investigation
L/INE COUNTY PLANNING DEPARTMENT NOT NO (~
app I i cab I e
I. Zon i ng Ordinance Compl iance ( ) ( )
(Zone ~ ~ ) (~
2. Subdivision Ordinance Compl iance ( ) ( )
1 Requ ired Access ( ) ( ) (~
> .
4. Bu i I ding Site (Area. Width. ( ) ( ) V(
Frontage. Setback)
5. Other (see comments) ( ) ( ) ( )
COMMENTS:
BUILDING INSPECTION SECTION
NOT NO YES
apP~i)able(~ ~
~ ::::
01 () ()
6. Plans Submitted
7. Soil Stabil ity (footings)
8. Flood Plain
9. Other (see Comments)
COMMENTS:
SANITATION SECTION
10. Sewage Oisposal
II. Usable Area
12. Water Supply
13. Ot he r (see Comments)
COMMENTS:
NOT
app I icab I e
() ()
() ()
() ()
() ()
T"""7gR Z S .t
CENSUS TRACT -
Ntlldow67ff'l'l. Es+
APPLICANT: ~ '
NilME 1/
ADDRESS
TAX LOT
t>;? 7 tS- z..
PHONE
DATE
?~7-7Y
NiV1E
DATE
/i/
()
~- 'j{-7d-
NAME DATE
- -.
/1:1 It~ :J. ).//J " /l6
- - I
"' E::~\L~D-
(V'
( )
DATE
'3/2d7r
TO APPLICANT:
Building Permit / Site Inspection:
Can be approved.
Cannot be approved at this time as indicated on item NO. above.
Quest ions and further informat ion on items I through 5 contact the Lane-
COUNTY PLANNING DEPARTMENT. Questions and further information on items 6
through 13 contact the Lane CoulllV Buildinq dad Sanitation Division.
Will be held in this office until you can resolve the problems indicated.
Is being returned.
Your building pernlit appl iCutiun fee is being returned under separate culler.
Your
'5-21ff f\r
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LANE CI1I1N'IY I'IJINN ING DEP/IRTMENT
/3, Si,xllo Avell"" E^st, Euyelle, Oregon 97401
,'I'ON!:: ,Ill.. 1:111 0 I. 2]1
I.ANE COUNTY BlIlLlllNG & S/\NIT/ITION DIVISION
lJ5' Sixth I'lve'llue East, ['''Ie",., Oreqnn 97401
J'lll1IJL: Ji,2-1J1I DT. tt/I
MSS=ZS- - --.--
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Permit No
.....,
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CURB CUT
PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
WHEREAS, the attached applicatian has been fully considered by the Board of County Cam-
missioners of lane County, and it is the opinion and judgment of the Boord 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
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, l~ ,
for placing, building
or constructing the following facility:
-, ,,- -" . __,.. ..-., .r
.._.~' "'..' 1....., ".".' ~ ~.~
'~<-:~ ~,~"~i,' .',
\;~ ,~:..:: ( . ~:..'
(,:;;0
upon the right-of-way of County Road No. ,-- .'" 0.. , 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.
Special 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.
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
, "
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,19--=':':".
Expires
,19_.
Inspected and Approved
Approved by Board of County Commissioners
By
Dato
By
.".
Director of Public Works
WHITE - OFFICE FILE
GREEN - RESIDENT ENGINEER
PINK - PERMITTEE
BLUE - ROAD SUPERVISOR
ORANGE - BUILDING & SANITATION OEPT.
YEllOW - REAL ESTATE
C98-79
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Oat.. . . Building Permit #
APPLICATION FOR FACILITY PERMIT
I,
(Applicant's Nome)
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-way of County Road No. , at mile post on the
I No. I So. I E. IW. I side of the road, or
(mark with X) .
,
as shown on the exhibits which are attached hereto, in strict conform ity to the statements of the
exact nature and amount of work to be done, and to the description of the facilities contained
in said exhibits. The applicant will be the principle owner of the facility as constructed, or other-
wise primarily liable and responsible to members of the public for its proper maintenance, repair,
operation and use. The applicant accepts all terms, conditions, agreements, stipulations and pro-
visions, in Rules and Regulations Governing Facilities to be Permitted Upon County Road Rights-
of-Way, as set forth by the Lane Manual 50.190(2), any amendments thereto, and any other ap-
plicable regulation, law or ordinance.
I To Date
Permits Processing Noted Noted
I Director
I Principal Engineer
I Subdivision Engineer
I Permit Engineer
I Weighmaster
I Zone No.
Signature
Address
WHITE
GREEN
PINK
-OFFICE FILE
- RESIDENT ENGINEER
- PERMITTEE
BLUE - ROAD SUPV.
ORANGE - BLDG. & SANJT.
YELLOW - REAL ESTATE
Phone No.
C98-78
.IVIDUAL SEWAGE DISPOSAL 'SYSTEM RECORD (1
staller: Complete top part o~ to ~
signature and return both copies~ Lane
County Building Sanitation Department.
"IIIl
Pr'RMIT Nn_
30 <;--7<1'
1 L r"
Ins/iller's Name
,J(Jg{1 /c;;(JFf==;r/
No.LivrngUn~ts jiearoomslBatns
J _ :? /
SeptJ.ct TanK:
Ft. from well Steel 0
InS1de D~enS10ns: ~t.
Length Width
Applicant"
Name Robert N. Hill
I gr~e~y Address
-='b~-fe Street
I Basement I Water Supply
Yes 0 No % Public jzj' Other-List
-
John Shook
Concrete Jii
Diameter
Depth
I Gal. Capacity, ,1~
Tile Disposal Field:
Distribution BOX:YeS~ No 0
Other Distr~butJ.on- Type
NO. Compartments
ITotal
ft.
Feet from
W"ll -
Lot Line
. Front
SqjFt.betweenlFiller IF~ller
lines Type a.ove
tIle
Foundation /0
Mailing
Address
R7n u~~. r~ntpnj~l
Length
1. 2.
C:nr i"nnf '-"',.1 rl
of Lines - Ft.
3. 4. 5. 6.
n rp<l1t1
Trench
Width
Side Rear
deothIFJ.J.J.er depth
below
in~ tilp. in
Sketch (See instructions):
\ I
S-
,
ID\
--
I
I
d-
1-
foo'
\
101
1__-~.iO-
I
10'
I
--
--
I
I
;)0'- \-\cl-
\
I
L(~I I l
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SS-' \
-
-
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2:0'
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Rf~rr.P?[D
MAY 06 1974
Env;;;.m;rlamaJ
/1J'anag(~rnwnt
J
-
Date ,)'-L,.- '14
Signature ~~ OD _
U-
For Sanitarian Use Only:
~Approved: System Installation
tJ'Disapproved: Does Not Conform
Remarks:
Conforms to Current Standards
to Current Standards
Date: 6/;'1/7'(
Lane County Building & Sanitation Dept.
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LAN~ COUNeUILDING PERMIT OR MOBILE
BUilDING @ MH 0
MAILING ADDRESS
G~~ \ ',,~~ (i>,-r."C-'''' I ') I
Iv ..........1.,0 0_.t. ~.L L
MAIliNG ADDRESS
Hctt USE PERMIT
PERMIT NO.
.,--..",'"
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PROPERTY OWNER
:.~1:9 ::"~~\:-'~ t..
CONTRACTOR
PHONE
S~7:,:f/l.!(1. Ci',~~;::
f(~~"";::,,~ :
PHONE
,;~ ":.:-:
PROPERTY LOCATION -INCLUDE POST OffICE
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
~'.o~ L? [J'OC~l i! :;V-U 4\~:;~\;ion t:0C;~C~ '07Cv...:n Gntc~:::o ~U?xJ~v~o'cn .,
TWP RANGE SECTION TAX LOT NO. CODE
~(~;; Ctl::O S~YC(;~
CENSUS TRACT
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CG
APPL.
NAME
&
MAILING
ADDRESS
FOR MOBilE HOME PERMITS ONLY
No. of Bedrooms
.~jcr\; D. :a II
EXISTING STRUCTURES ON PROPERTY
L:~~
LEGAL ACCESS TO PROPERTY
L'll:,:; SI:7CCt
PROPERTY SIZE - FT.
WIDTH
DEPTH
AREA
STRUCTURES TO BE BUILT THIS PERMIT
Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT. # BDRMS
r:~::l8R in;!.. [':::1./
I"rw.:,:
II~ C llll ~3)
New System 0
VALUATION
tl"'l c....
O~o"~''';
G::V'C-eJ. QHtctx:::':. n;wDlk:J
t;.Iol (-
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___ _1,3~;;:;~_.
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SEWAGE DISPOSAL
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK ol OTHERD
. r:'1.r~
.:O.r.~
>.\J.r.tl
FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER: NAME
WATER SUPPLY
PU BlIC 0
o OTHER
TOTAL
$
01 7. r:::
COUNTY
BUilDING & SANITATION SPECIFICATIONS
DRAIN FielD REQUIRED
109
UN, FT
TRENCH WIDTH FT.
2
OR SQ, FT,
;.',f'.
; ,-,v
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAL.
!),;;~
>Oy Or;llfOU Co S~i'CO~
TYPE OF STRUCTURE OCCUPANCY
:)C>~) n 0 J
BLDG. SETBACKS __ FT. FROM CTR. OF ROAD RIGHT OF WAY
FRONT I;:' SIDE INT. r: SIDE EKT. I;J REAR!.i
AUTHORIZED SIGNATURE - DATE
1;/ J.t:. O!l:)"; bll C. i:;rtl,'lJC'~
lONE
PUBLIC UTIl. EASEMENT
USE CLASSIFICATION
",,!:'-~;1 G!~~
DATE
.~..-)2?~' \~"
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUilDING - GREEN
SANITATION - GOLDENROD
Call 6B7-4065 to schedule all required inspections. All construc-
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 an Reverse Side)
FORM:: CSS.13
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY. DEPT. OF ENV'RONMENTAl MANAGEMENT
COURTHOUSE ANNEX. 135 EAST 6th. EUGENE. OREGON 97401
SLAB FLOOR
PLUMBING GROUNDWORK
.
ApPROVED / / OISAPPROV(D Cl DATE
REMARKS
GAS PIPING GROUNDWORK
ApPROVED ;---? DISAPPROVED Cl DATE
REMARK S
ROUGH PLUMB I NG
ApPROVED /~--/
DISAPPROVED ~
REMARKS
ROUGH GAS PIPING
DATEfl-/,). '~L
ApPROVED Cl 01 SAPPROVED Cl DATE
REMARKS
FINAL PLUMBING
ApPROVED ~ DISAPPROVED Cl
REMARK 5
FINAL GAS PIPING
.
INSPECTOR
INSPECTOR
INSPECT~/-./
{/
INSPECTOR
DAT-~J5 ,/'tINSPECT~"I~~fl /7
~I-, tI~
ApPROVED ~ DISAPPROVED / / DATE
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE ~ NOT READY TO ISSUE I / DATE
REMARKS
INSPECTOR
INSPECTOR
~
"
.
INSTAllER:
Complete top
pAs ED SEWAGE DISPOSAL SYSTEM RECa ~J. ... .
part ~orm to signature and sub~it bo oPies~ith applicatio~; .', .1
. PERMIT NO. 30 0/-7'1'
PROPERTY ADDRE~~ U .:L 7 ~ .:<.- '
3?os- j)~--:, iI:ud- 31'// Clcl/.-i 7nhrf4,~~
Baths Basement Water Supply ~~~~
I Yes No)( Public)( Other-list
INSTAllER'S
NAME
It,,,AoJ/
Units Bedrooms
=?
JJtJr7YJ.
No. Living
I
Septic Tank:
Ft. from well SteelD Concrete ~ No. Compartments J Gal. Capacity
Inside Dimensions: Ft. Tile Disposal Field:
len'i)th 76 Width ~o Diameter Depth.(;l. Distribution Box: Yes )( No
OWNER t? / J-. ; / t?~ / Other Distribution-Type
NAME ~ 71 dLL/ roOuddh) .:4c.)
/.J .If Feet from
HAILING J'?O 2/), (':w,~b".e., WEll/jIllJr'J
ADDRESS (?, , . /7 lot line
cY.~ -I..uLdP ~f~ Front 11-/ Side (0 Rear 10
length of r.ines-'F~ I Trench I 'Total Sq. I Ft. Between /Filj,er IFi ller Depth IFi ller Below
'.712.'7'13. 4. 5. 6. Width Ft. 30 Linesln.J,,1n TVDW~AboveTilel.2.ln.lri1eI2in.
'lot Plan (see instructions):
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Foundation
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Date ~ 7 I rt7t1 SIQnature"h-'1..J ~J~_ ~ 4>I./LP.'
. . . . CERTIFICATE OF SATlSFAcip?&~ . ~I ,/.
For Sanitarian Use Only: Date:(;f'(Lf/7Y
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
location.
~ Approved: System Installation conforms to current standards
1::] Disapproved: Does not conform to current standards
Remarks:
C55-11
~~ ~\},R.
Sa' rian's Signature
lA COUNTY
STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY
r'
LANE COUNTY ~ING PERMIT OR MOBILE HOME. APPLICATION ,/
PERMIT TYPE - BUILDING _ MOBILE HOME Dose REG. # PERMIT # <;5D<1- 7y
PROPERR~WCRI+ ;0. t-h'II' AIlINi70sS Wed C9h~V\I\QI ~IJ~L 14hO:~q II,
CONTRACTOR MAILlN-G ADDRESS f PHONE
I,
1\
II
PROPERTY LOCATION - INCLUDE POST OffiCE
TW/~
PROPERTY LEGAL DESCRIPTION
LOT - BLOCK - SUBDIV.
RANGE
2-
(] h'fTh4?--
L-;<7
%'
R2-
srJ..~
TAX LOT #
l'1tudAt,D
CODe
C .d ;-1I<E1ES & BOUNDS 0 YES
\)yf>L 11 CI'TATTACHED n NO
CENsus TRACT ., ,
APPLICANT
DESCRIBE EXISTING STRUCTURES ON PROPERTY If ANY
I1lJh e-
LEGAL ACCESS TO PROPERTY - ROAD NAME o~ r!..
,5 ~Of) D() /lp S;,.
PROPERTY SIZE-WIDTH DEPTH AREA
63 1;;(0
L NA::E
MAILING
ADDRESS
FOR MOBILE HOME PERMIT ONLY
Number of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
DHf 111~j 'tY\C\ ,'V\
(~oOnrnGP a1\-. \)(\L.
Connect to Existing
_ rT'!..PE CONSTRUCTION
"ti 7llN'o €-
Sewage
II n4
4l/1
System D or New System Req, D
SQ. FT. # BEDROOMS VALUATION
( ;~ \6), I) 1<, ') 4 T
, I .
(CU. 3
l~'d<
,
~IJ f S
ILj,<7/
PLUMBING INSTALLED BY
OWNER 0 OTHER iVNAME -:lack3:~
PLANS FURNISHED I FACILITY PERMIT
YES Q( NO 0 YES\,( NO 0
{ / S(GN~TURE OF APPLlCA~ ". '-. jfl~<'" ~TE
<lV..rS :< '1 -)( '-'?l?---<" ~.L:r'YJ' RlJtV
12 - FEE'R~'PD "Ftn~Je12f2 _ / 2-7~~ V
;(, _ PERMIT # / /
COUNTY BUILDING & SANITATION SPECIFICATIONS I' .
DRAIN FiElD REQUIRED /
UN. FT./'3 0 TRENCH WIDTH FT, ~ OR SQUA"FEET,~ b 0
I
I
/ ) YARD
OTHER
SEWAGE DISPOSAL
PUBLIC 0 SEPTIC TANK ~ OTHER 0
BLDG. $ sq.~ FEES WATER SUPPLY
WASTE 015. ~IL.- PUBLIC 0
PLUMBING 2 'i<.- PLUMBING FEES
PLAN REVIEW ~FIXTURES
PARK TRLR. CASH 0 ~
CHECK /2 NECTlON FEE
11,.- PUBLIC WATER
TOTAL CONNECTION FEE
MIN. SEPTIC TANK CAPACITY
9()O
WITH 0151. BOX: GAL
~~PE OF STRUCTURE -5 tv' OCCUPA7'kl
DG. SETBACKS - FT. FROM erR Of -ROAD RIGHT OF WAY -
n- 4:~/ SIDE INT S- I SIDE EXT, 40 I
~~ JA IA / / Dot! YNNING Date
CJ- ~, 2(. 7 <.{ 'l;?' F. 74-
Directions to Find Property:
ZONE
PUBLIC UTll. EASEMENT
REAR 5"/
BLDG. INSP.
!/ USE CLASSIFICATION
;m ~&''3-
V
Date
f
''3.& ~?y
COPY I - OFFICE
COPY 2 - JOURNAL
COPY 3 - AUDIT
Form # C5S-12