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Home My WebLink AboutPermit Building 1974-7-30 (2) r,! p_'.~~:, C'_~" :,f -" '., r .. PROPERTY OWNER 11111, Robert r;. CONTRACTOR Same PROPERTY LOCATION - INCLUDE POST OFFICE 3655 Dulte PROPERTY LEGAL DESCRIPTION - METES, BOUNDS ....,..,...~- .~;r .- .'~""'./,,;.._~ ~- ~< . . LANE COUNeUILDING PERMIT OR MOBILE BUILDING 0 MH D MAILING ADDRESS B70 West Centennial. Sprlnqfleld MAILING ADDRESS Hce USE PERMIT PERMIT NO, 111376-74 PHONE 746-J~16 PHONE Lot 25 Block 2 RANGE 19 ., 3rd Add SECTION 06./.3 l1eadOrl Green TAX LOT NO. J9ZJj CODE CENSUS TRACT TWP APPl. NAME & EXISTING STRUCTURES ON PROPERTY None LEGAL ACCESS TO PROPERTY ..s 45S Duke PROPERTY SIZE - FT. MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT WIDTH DEPTH AREA Connect to Existing Sewage System D New System D TYPE CONSTRUCTION SQ. FT. +: BDRMS VALUATION Dwelllnl1 10564il 21.BO 336 @ 5.30 23,020.80 I , 780. BO 24,001.60 1~ .~ I ., j 'i ~ .~ .. ~ Garage Subdivision Approved ,SEWAGE DISPOSAL , OTHERD 112.00 50.00 22.00 FEES PLUMBING INSTAllED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER 1% surcharge TOTAL v SEPTIC TANK ~ PUBLIC .t:J o OTHER r ;! , 1.34 IllS.34 COUNTY BUILDING & SANITATION SPECIFICATIONS WITH DIST. BOX: GAL. 900 DRAIN FIELD REQUIRED UN. FT ISO TRENCH WIDTH FT. 2 OR SQ. FT. 300 MIN. SEPTIC TANK CAPACITY ,. TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIL. EASEMENT J. Shook DATE 7IE!(}l7t. d1il ~ ~ J BLDG. SETBACKS . FT. FROM eTR. OF ROAD RIGHT OF WAY FRONT 45 SIDE INT, 5 SIDE EXT, AUTHORIZED SIGNATURE - DATE s/s J.E. Boss by Chmrlie Harbaugh RA USE CLASSIFICATION REAR 7 BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK ,PlUMBING - CANARY BUilDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule 011 required inspections. All construC4 tion shall comply with Uniform Building Code, D.E.Q. stondards 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) PORM := CS5-13 (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX. 135 EAST 6th, EUGENE, OREGON 97.(01 ( ) ( ) ( ) Site Inspection E...Ho 10 3 r-~ C\ctJ · ?Uti 1376 - , r NIEA'c::t'OW .G-.€E;au T /.t6 6;:;S Ob C 'ENs'lI!" TRA CT Lt -;;S BfA. <- TAX LOT .' ~urLDING~SITE EVALUATION , . . Building Permit Appl ication No. APPLICANT:A / ' jJ NAME ff t' / fl ADDRESS ' R. Pre-Permit Investigation PHONE DATE 7- ":)..2 -7Y LANE COUNTY PLANNING DEPARTMENT NOT NO YES appl icable I. Zoning ordinance Compliance ( ) ( ) ( ) (Zone ) 2. Subdivision Ordinance Compl iance ( ) ( ) ( ) 3. Required Access ( ) ( ) 4. Building Site (Area, Width, ( ) ( Fronta~e, Setback) 5. Other (see comments ( ) ( ) NAME DATE COl1HENTS: - -- BUILDING INSPECTION SECTION NOT NO YES NAME DATE appl i cab I e - - jf 6. Plans Submitted ( ) ( ) t - 7. Soil Stabil ity (foot ings) ( ) ( ) 8. Flood Plain ~ ( ) ( ) 9. Other (see Corrvnents) ( ) ( ) e,76~~{ 'J-~&.-'7# ~ '7 COMMENTS: / If' , SANITATION SECTION NOT NO YES JJ:U:,Q DATE appl icable Zh'F/~ 10. Sewage Disposal ( ) ( ) ep II. Us ab I e Area ( ) ( ) ( ) 12. Water Supply ( ) ( ) ,~ 13. Other (see Comments) ( ) ( ) COMM ENTS : TO APPLI CANT: fJifl!1q / l~.You,r /f/? /n\ ( ) ( ) ( ) Building Permit / Site Inspection: Can be app roved. Cannot be approved at this time as indicated on item NO. above. Questions and further information on items 1 through 5 contact the Lane- COUNTY PLANNING DEPARTMENT. Questions and further information on items 6 through 13 contact the Lane County Buildinq and Sanitation Division. Will 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., I LANE COUNTY PLANNING DIVISION 135 Sixth Avenue East, Eugene, Oregon 97401 Phone (503) 687-4186 LANE COUNTY ENVIRONMENTAL MANAGEMENT 135 Sixth Avenue East, Eugene, Oregon 97401 Phone (503) 687-4065 C55-28 I .. . .j' Dat;' -7-31-74 . . Permit No. n76-74 CURB CUT . . . 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 permit should be issued, now, therefore, it is hereby. ORDERED, that a permit be and is hereby issued to Robert N. Hi 11 870 West Centennial SDrinqfield. Oreqon or constructing the following facility: for placing, building Dwelling Meadow Green 3rd add Lot 25 Block 2 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. 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. 3. Sidewalks will be constructed in accordance with the attached sidewalk specifications and drawing H 98-49. The standafds curb type shall be constructed unless otherwise specified. This permit is revocable at any time, and will be strictly adhered to and no work ather than that specifically mentioned above is hereby authorized. This permit shall be void unless the work herein contemplated shall have been completed be- fore ".1 Y : 1 ~ , 19----#. Expires 19_. Inspected and Approved Approved by Board of County Commissioners By ----/2/ //!4~f-~1_ Director of Public Works Date By WHITE - OFFICE FilE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUilDING & SANITATION DEPT. YELLOW - REAL ESTATE C98-19 ~ --I ./~ ......... , . ,- . . ~.-;: . '. DatoP . .' Permit No CURB CUT 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 permit should be issued, now, therefore, it is hereby. ORDERED, that a permit be and is hereby issued to .:: ~ ~ ",: .n"" , for placing, building or constructing the following facility: " \ '~ r . , ... ~ " . 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. 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. '. ."., . .... ~ "" ~. , ,'"-,...,, ,,\.',,-,:.-. .~ 'v ':~<,; ".. ~ \''/,' J /?'~1,1q~' 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 .' 1 9---,-. Expires ,19_. Inspected and Approved Approved by Board of County Commissioners By Datp 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 -- ~ .... \. PROPERTY' OWNER tlI u D, 1::':::Cfl\ [,. CONTRACTOR Gr:-:-:l PROPERTY LOCATION - INCLUDE POST OFFICE LANE COU. BUILDING PERMIT OR MOBILE BUilDING [J n MH [I MAILING ADDRESS l~/Q t:,--oll GC';'\Cc;;:.lo!, G:whrVld<J MAILING ADDRESS }:/l1CZ I H. USE PERMIT PERMIT NO, ::.(:3/\.;~'i.'~' PHONE it::::~(,,;~() PHONE :~s~r; r;:~~:l PROPERTY LEGAL DESCRIPTION - METES, BOUNDS k:(;J\) Dice 2 3rd ~CJ TWP RANGE SECTION r-:cc~CJ GrC'0:~ TAX LOT NO. CODE CENSUS TRACT 11 <;) c~ APPl. NAME & MAILING ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT EXISTING STRUCTURES ON PROPERTY [:Ono LEGAL ACCESS TO PROPERTY D:.:::() PROPERTY SIZE - fT. WIDTH DEPTH AREA C:-;,)Ul k:1 Connect to Existing Sewage System D TYPE CONSTRUCTION SQ. FT. ;t BDRMS UC;;5 () 21.L'3 :J]{) () 5. llJ New System 0 VALUATION #) fl ~ 4" (\ ~\ ..:idlo' ;e,I.\,~) eel C:::l i,/,:J.,::J ...::::=-="--......oL.=-_.""""-~. 2~)~~;~~ .C:) St;::jl\/io~c:l ~;::~..c"cd SEWAGE DISPOSAL . OTHERD 182.1:3 ::O.C3 ,ilI.UJ FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PU BUC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER ~~~) G~?G~7CO TOTAL " SEPTIC TANK 0 PUBLIC B o OTHER . u .~[) ILJ~.b<J MIN. SEPTIC TANK CAPACITY WITH 015T. BOX: GAL. ScJ COUNTY BUilDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED UN, FT U!)() TRENCH WIDTH FT, 2 OR SQ. FT. ~~" JI~V TYPE OF STRUCTURE [" OCCUPANCY ,! ZONE M USE CLASSIFICATION PUBLIC UTIl. EASEMENT BLDG. SETBACKS _. FT. FROM CTR. OF ROAD RIGHT OF WAY FRONT 1;,:; SIDE INT, J SIDE EXT, AUTHORIZED SIGNATURE - DATE 010 .I.':. 0000 ~lJ G,;c,!lo r:C...:':CiJ:;, Q REAR 7 J. S~:, DATE 1I'd':ff!.; (-1 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. stondards IMPORTANT: for subsurface sewage disposal and county regulations covering plumbing. All buildings require a certificote 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 97.401 r SLAB FLOOR PLUMBING GROUNDWORK . ApPROVED rt DISAPPROVED rt DATE REMARKS GAS PIPING GROUNDWORK ApPROVED / / DISAPPROVED C1 DATE REMARKS . INSPECTOR INSPECTOR ROUGH PLUMBING ApPROVED .(}!f;J DISAPPROVED C1 DATE 9-J-?~ REMARKS ROUGH GAS PIPING ApPROVED C1 01 SAPPROVEO C1 DATE REMARKS FINAL PLUMBING ApPROVED ~ REMARKS DATE/- DISAPPROVED C1 FINAL GAS PIPING ApPROVED C1 DISAPPROVED C1 DATE REMARK S CERTIFICATE OF OCCUPANCY INSPECTOR INSPECTOR 4# ?/ .... -s--.)~ INSPEf:'V~ -I/O INSPECTOR READY TO ISSUE rt NOT READY TO ISSUE ~ DATE REMARK S INSPECTOR ~ ---::00 ~ '" . ; ........- LANE eOua, BUILDING PERMIT OR MOBILE BUILDING [J,..0~ Qp MAILING ADDRESS " ' ~', .,.., ,,,,-, '-'. ''''V''','' '-'1 ,...,J:l., rl 1.:\' ;t.} ..~,-... \; h...,......u<--ho ,5.:7u;~.>'c..;~(, 'I"" ( 'j HE "'= ~ lI'- " , " USE PERMIT PERMIT NO, / "........ .'I~~!~~ 'i-, PROPERTY OWNER J~ J:I ~,:/c CONTRACTOR PHONE ~ c_, ,~ ." ~ p~, .;_J. .,' ~ MAILING ADDRESS PHONE :c : PROPERTY LOCATION - INCLUDE POST OFFICE ',"., " '."'". v~, -/ ....'-,~.-J PROPERTY LEGAL DESCRIPTION - METES, BOUNDS /,. .- C' ,J ,~r . J"'u,-,-~ ') " " , iJ~'iJ h:':~ .. ::::~_:::; ~~:'C~':) TWP RANGE SECTION TAX LOT NO. CODE CENSUS TRACT " " c:> APPl. EXISTING STRUCTURES ON PROPERTY C::::,) NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT LEGAL ACCESS TO PROPERTY ~;':::J PROP:..RTY 5)lE - FT, WIDTIi . DEPTH. , AREA (l~,:: ~ C. Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. .l.; BDRMS ~C:~) C (]~ o,:~ New System D VALUATION )' H ') :; _ ~ ' e ~Z=~':' ::' ~Z:;'-' ~)o~~a .-, , L .0 ('" ~\" ,,'1 ~ "" -,- I SEWAGE DISPOSAL PUBLIC n BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PA~~. .TR,,\U.,E~ ._, ",-. ~--.. . 4' ..: 0._'.1 , ',0 "./ FEES PLUMBING INSTAllED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC D 0 OTHER :1 SEPTIC TANK 0 OTHERD /' (. . '-'~' , ." 0 , ~ : j TOT AL ~ MIN. SEPTIC TANK CAPAC'I~ .... f\\, ' \ ~I!~ DIST. BOX, G~l. l\'~. \ '" f '-\ J , . j".......' ~ " < ~ 0. 0...- COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED " " TRENCH WIDTH FT. (, ..OR SQ. FT. "', ~, lIN. FT \ \.\ '-"oJ )\-\\\ , , "' ~ " " ", , - '0... . TYPE OF STRUCTURE ULLUPANCY , v ZONE ('." PUBLIC UTll. EASEMENT BLDG. SETBACKS i FT. FROM CTR. OF ROAD RIGHT OF WAY ,) SIDE INT. AUT/:lORIZEP ,. '~,,~ ,) 'if """. SIDE EXT. SIGNATURE - DATE () . - REAR ;I USE CLASSIFICATION FRONT fl/(' . , ,,/) \-0 0 ,---"....)) . v, '" oJ~~. .. .,,,.j w ;f.~' ' I?ATE 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 on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT, OF ENYIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 ~~ . . SITE I NSPECTI ON APPROVO /-./ OISAPPROVED Q DPE ""' 'NSPECTOR REM'~~~~-' ~Cd.t'g;~rM"C-;?G V---',2/ ",,?yd!a/ FOUNDATION INSPECTION -:/-'~ DI SAPPROVEO 1----/ DATE 'ifv 7---! -1(/ INSPECTO&(~ ,J/ ;1 J 2 ~ OJ;f J-h.'; ff- .I/:iJ..l4,,-lL</;;/-i.J, l:{/..,J4J.:. 'U!J'{f.t.!...;.~.K~--t~. /(:'MJ.f l'J t< ~(.<.(IJt;1 ~L rd', :.:! l...~i, ,.. H - '" - . 'vHJ1(; fr.. 7..1 .., lJ. t?L ~ FRAMING INSPECTION ~/~ ApPROVED / Y{ DI SAPPROVED Cl DATE r. / / . 'Ii I NSPECTORd -" REMARKs~~.;A~~(AiP~~ t(-U -?yli ~U/-1't /M7M'J ~ <:7-(;.. ;t!Lrr,7. _" ~-L / ~Mii(~9"""'Jrfl' @/, LATH OR S~E::~INSPECTION ~~ ApPROVED DI SAPPROVED /I DATE 1".;tff. ?t/ I NSPECTO,(5::;F(' t!!../ REMARKS /l n"" '~'';1 ,1/; ~ ApPROVEO DISA\,PRO~fD Cl DATEJ/!-IS" J'II.NSPECTo{;7t t--; t ~/r5:-4. ~~4"1U];tl4tf:-r . /. ._" 1.-(.. ,;' -c - 'yAm ~ rLJ~:;' ~~ ~.- e r ~ '7' "'''7U/D ""-7"'~t' CERTIFICATE OF OCCUPANCY READY TO ISSUE Cl NOT READY TO ISSUE Cl DATE INSPECTOR ~ ."1 /./ ----- k'~ "!~~'- /3 7~. '11( ~ df 3 /,6- S- vuk. REMARKS -~ ~. -. " INSTALLER: ~ PR.ED SEWAGE 0 I SPOSAL SYSTEM RECO. UdI. , :" .:: Complete top part of form to signature and submit both copies wr'~ application. _ PERM IT NO. 1-;7G- 7l, JS INS~LLER'S NA~~ H,A;a-e l";O/lJ IlrfVL')~ ' No. L~ng Units Bedrooms Baths PROPERTY ADDRESS f)Ui{E Septic Tank: Ft. from well Basement Water Supply Yes No? _ Pub 1 i c ~ther-Li st Inside Lenljth OWNER NAME MAILING ADDRESS Dimensions: Width Steel 0 Ft. Diameter Concrete ~.o. Compartments Gal. Capacity ~ //\Cc} Ti Ie Disposal Fieldf Depth Distribution Box: Yes ~No Other Distribution-Type :.:1o;lrRT i'~. Ii I'~L 8"(0 ':/. Cr;; TE;.;r:i A L Feet from WEll Lot Li ne Front 1Ft. Betwee~ Lines !u Side Rear IFiller IFiller Depth IFiller Below Tvpel~ Above Tile21lnJrile c.. in. Foundation :,q, ';,:;rlf.I_:J, O'~EGO: L~9th.~f Lines-Ft;.. tT~ench1 ~ ../J. 4:'t35~~-;6. Wldt~ prot Plan (see instructionsl: - I CERTIFICATE OF SATISFACTORY COMPLETION -- \ "" For SanItarian Use Only: Dat~_,5f-/~.~~ In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certificate is ~ed as evidence of satisfactory completion of a subsurface sewage disposal system at the above location ~Approved: System Installation conforms to current standards c::J Disapproved: Does not conform to current standards Remarks: C55-11 Total Sq. Ft. / \ ( - 'I!, !~I (.11 ::t- t:~ \ ~ J~ .; '\ '..r /72>/ \'9 (....J;- ~-'--..f?) l~ ry ~~+ \~ /..... ; /L; e 'Sert;C &QJK L./cx. / '. Bra". 3'L ,)v. e 3~-/ - '7'- {} (' 0.. ;, v L--.,' 1\.J e /\ , ........- . ,_ ,; .oJl, , '" ..~ SIJUiIlTY ~:;:'J.,..:";: I',....,... ,"'.t... il1GiVIT. fJou. <S ~ s~~. ~ r~~~re L COUNTY STATE OF OREGON DEPARTMENT OF ENVIRONME AL QUALITY lANE COUNTY .DING PERMIT 0 R MOBilE HOMeE APPLICATION. " / PERMIT TYPE - BUilDING i 1 MOBilE HOME j !OSC REG, /I . PERMIT # /37' ..?y -P~'pJ~TY'-OIWNER--' ~._---<--_.__. MAiiiNG ADDREss.... .. -.-'-- ~ #-..-- .-------...~PHONE -~------~---~-. - 2!?a__td___~d _. . ~---Z~ 99/tb CONTRACTOR I'" . MAltiNG ADDRESS . PHONE eilar:rr?clf..r;,N ~lNaUDE posTOr,icE - --- -------- 6fo05 f1~ PROPERTY LEGAL DESCRIPTION ~,....1 .... -121)_, _ /J _...., LOT - BLOCK - SU'DIV, hL-t!-'-r -cxS Qk'ut!.C """ TWP RANGE see. /f 0:2- 06 .3-M 0 cI c/ C-IJ;@~) U--I1L.hU TAX Lcn # CODE CENSUS TRACT METES & BOUNDS 0 YES ATTACHED 0 NO APPLICANT NAME AND MAILING ADDRESS FOR MOBilE HOME PERMIT ONLY Number of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT ---Llt, I" ~&7' -?a/u"-1/ DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY vf7.AJt --L/ LEGAL .ftESS T~ PROPERTY - ROAD NAME OR # ~~-,> PROPERTY SIZE-WIDTH DEPTH AREA Connect to 'Existing TYPE CONSTRUCTION Sewoge System 0 or New System Req, 0 . SQ. F@ # BEDROOMS VALUATION / t!.')& ;:;/.gl)(~).;:J:.3, D;:J/), g!) -~-~ -- -- " 3a&, 5'~O_j) 7frj.jJJ eX 7"; tol. W ..J~-Ad</~n.-,/ '.n-./ /.7~-","-"ud. SEWAGE DISPOSAL , 7' . PUBLIC 0 SEPTIC TANK _?< OTHER 0 . BLDG. j-,/ :J.. 1 ~_Q_ FEES WATER SUPPLY WASTE 015. .6./)., /)~ PUBLIC ~ OTHER: PlUMBING I' ~ . on PlU~BlNG FEES ~4. 0 0 ,- PlAN REVIEW ~_ FIXTURES / ?OZJ PARK TRLR. I- CASH 0 S~~ (% S.C. / J! ~ . CHECK ~NNECTlON FEE .::L. 0 1) !g,~L___..i K ~3!L , ~~'~~E~:g~R FEE d' () 0 ____ PLUMBING INSTALLED BY COUNTY BUilDING OWNER 0 OTHER n NAME PLANS FURNISHED FACILlT~~MIT ;ES ~O 0 YES ~ NO 0 r~'-;;Pl/~ 6-JD-~-7Ji / 'FEE)"'CEIVED BY ..? DATE /f .,I/~- ;);;1-7'/ PERMIT # . / .. 17, 7/... .7'-1 & SANITATION SPECIFICATIONS MIN. ~EPHC TANK CAPACITY WITH DIST_ 'OX, GAl. Cloo DRAIN FIELD REQUIRED lIN, FT, I DO TRENCH WIDTH FT, 2 OR SQUARE FEET .1 0 0 TYPEOFsTR:~UR'-__~_6:j(- ~C7~4:;' .~~_ .;--~-=-'REAR YARD ___ BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGttT OF -My .-' USE CLASSifICATION &~~~l~~"~/L~;'~'~?~-!ftJt1-~~-~~ _~~ PUBLIC UTll. EASEMENT --------- ----- - ----.----------.----------. COPY 1 - OFFICE COPY 2 - JOURNAL COPY 3 - AUDIT ._----. --~---- ---- --- --- --- ._-.-.------ ----------. --.._- ------------- ----_. form == r:~~-12