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HomeMy WebLinkAboutPermit Building 1974-3-29 (2) r ~..j./ , I. ., , :, ~ \ 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 ., .- - '. - - ,'. .',f/l "'# . i - PROPERTY OWNER ,"'" ". .. . I ~_ ~.' ;,}C~ " '.' CONTRACTOR ;(- -8 LANE COUN.UILDIN~ PERMIT OR MOBI~E BUilDING ;0 MH 0 MAILING ADDRESS Hctt USE PERMIT PERMIT NO, ~!::::> 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 l. " ~-'~~:Jt~.~ , J):,~ g.~~~t ."" '. " (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 PHONE 't:'()O' ~!~?~: PHONE New System 0 VALUATION . " .,,"i,I.' . .... .p... .r~.:)i . ~(~:) 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 ~/&. ;~t ~ .~ .., ~ " ,/ 'I .:J1)?~71(' 14 # "3 (,()f p~ REMARKS " " . I t9/. ~1. 6) c,l ~ 'I ,~"" . '; . . I SUPP.wENT TO BUILDING PE~MIT NO. ~ 9- ~~ Lane Caunty, Oregan "1 /' ..L. \, L / I ~ ,-> OWNER I _J" ~ ,f.,. 1_/ 1 J. ';1.(", I / I' / CONTRACTOR 5 /"', ,o>'.A_ n< -7 '7,) /J -~ ,/ J MAILING ADDRESS )'; / 'LJ CA: ' r r ;/ I./', . /.!Lr!.(.~f;, " , j, - , " MAILING ADDR"c:e, _,~, ,,," .-r..... . PROPERTY ADDRES~ Jt ADDITION: j,? _ l"-'I-I>/JJI____""/"f...(/'.- ,j ,:, I r-'" '\.."; (rf(').8 r I' ..\--". ;;:',' I , ,I.(} j....; ..., ,I -.--1__:'1" ,J ~ .f IJi . , ,.-,. I . ~, \.~.L--:'.~ / U 1..1, D CORRECTION: \ "'j' . "..... ~~ :JA'?~/J I mL, . r 'J!-_/'J-;-.~,~ " 'V C.n A -,' ~7C} ,_ . ./ d . ~ -1,' 4<;("4 ..'A....:;-. ." //;, ~.l.~ , ) ) n ~ L 1 (.-' 1!'i ", ~) "" (,. ..' /i^/uu , ../ ~_/- .. / ,_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)./.,) ~ r' , /.?/ y~ /~ / / ~../.,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 , \~Q ~C~\ ~ Supplement N2 .1679 5 By f,., ? J BUILD1~~ SITE EVALUATION I 'J7;)~4, Appl icat ion -No. 309-7/ '~ ., 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 '"'" . " .I ) ( ) / () ( ) 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- - --.-- I \ It " -~. ".... . . Permit No ....., . .. , ,Dot.. 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 '".. - "" . v () , 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 , " -~.~ ~~, , ..".) l) ,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 t . Ii .-' . . . . 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 I iCJ ( SS-' \ - - \ 2:0' \ ~~c 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. ~fL.- ,..~~ -"' ,.. . .. 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. .,--..",'" .' .' 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 iJ c? 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 (- ~ ;; ___ _1,3~;;:;~_. ~ t~ ,,'," . ~c.Jr ' 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): / CJOO Foundation /0 , -.. ""-L '" ./ , .'.T:"~ .'J'. 13-0. - ~ . f)8. ~ ~ I \..@;;0~9 , ~ ,~ \ I , 1'\.\ ~ ' 1 ~ ~;';j\ \ I "" ~ <~ - - - -- . ;1.1 ". . <-1.1" . 0 .:> C:l ~ 0/-& ~ , ~ >J , ~ 1\ L f \ I' I , ~ ..2f / ;1.:1. 7" 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