HomeMy WebLinkAboutPermit Building 1974-8-29 (2)
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LANE COU.NTV.ILDING PERMIT OR MOBILE
BUilDING 0 MH 0
MAILING ADDRESS
870 ~/EST C:!:tJYEIHll A ~
HOM.SE PERMIT
PERMIT NO.
PROPERTY bWNER
ROI:lEIlT N HILL
Bu I LDER
S?R I NO!' I [i.D
11;63- r:
11;103 -/(/
P",O~E ~
ORE;JOt! 7110-991.:
CONTRACTOR
~;AME
PROPERTY LOCATION - INCLUDE POST OFFICE
3656 ~KE STIEET SPRINGFIELD, OREOO~
PROPERTY LEGAL DESCRIPTION - METES. BOUNDS
LOT 4 BLOC~ 3 3RD ~DDITION TO '~ADOW G~[EN ESTATES
MAILING ADDRESS
PHONE
TWP
RANGE
18
02
SECTION
06.4. Z-
TAX LOT NO. CODE
LJ:;/{,c;o
EXISTING STRUCTURES ON PROPERTY
NDtlE
CENSUS TRACT
APPl.
NAME
&
MAILING
ROBERT'W HILL BUILDER
870 WEST CE:JTENN IAL
LEGAL ACCESS TO PROPERTY
J(t)!,p DUKE STREET
PROPERTY SIZE - FT.
ADDRESS SPR I N~1F I ELD, OREGO:!
FOR MOBilE HOME PERMITS ONLY
No. of Bedrooms
WIDTH
DEPTH
AREA
STRUCTURES TO BE BUILT THIS PERMIT
Ld/
Connect to Existing
TYPE CONSTRUCTION
Sewage System 0 New System 0
SQ. FT. :;+ BORMS VALUATION
1088 0 16.10 17,516.&>
368 (i) 5. 30 1 .9'jC..::!2- _
I>,LHJ(.CV
DWELL I NO
GA"AGE
INSTALL SE\tAGE DISPOSAL SYSTEM
SEWAGE DISPOSAL PLUMBING INSTALLED BY
PUBLIC 0 SEPTIC TANK 0
BUILDING ~
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
OTHERD PR 1011
Q2.00 FEES
'll.00
2'i.00
OWNER 0 OTHER: NAME
WATER SUPPLY
PUBLIC 0
[l OTHER
TOTAL $
1.17
, 00:i(
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAl. 900
COUNTY BUilDING & SANITATION SPECIFICATIONS
DRAIN FielD REQUIRED
tiN. FT 1~
2 TO 3'
TRENCH WIDTH FT.
OR SQ. FT.
3JO
TYPE OF STRUCTURE
5N
OCCUPANCY
I J
ZONE
PUBLIC UTIl. EASEMENT
BLDG. SETBACKS __ FT. FROM CTR. OF ROAD RIGHT OF WAY
fRONT !r5 SIDE INT. 5 SIDE EXL
AUTHORIZED SIGNATURE - DATE
/5/ J. E. Doss Dy C IIARBAWfl
USE CLASSIFlCA TION
REAR
2
J.SHOOK/SAMliARIAN
D,ATE
0/29/711 014
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX :"'PINK.
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
Call 687-4065 to schedule 011 required inspections, All canstruc,
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)
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FORM= C55-13
(POST THIS PERMIT ON MAIN BtDG. AT SITE)
LANE COUNTY, DEPT. Of ENVIRONMENTAL 'MANAGEMENT
COURTHOUSE ANNEX. 135 EAST 6th. EUGENE, OREGON 97401
..
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( )
'd.l1.J II."} '"'' 1~ I
Bu rl ding Pe rm i t
. I
Site Inspect ion
App I i Gmt il.lo._/6/3 - 7..V
~ ho ro
1'3-~-~ _
AI'PUre:3rd. io rneo.d.o<L<l~,een
Ilt\I\I: Hlff..J?,dlrlPr, "S~t-e~
ADDRESS .
Pre-Permit Investigation
;!c,~(~
PHONE
DATE 1<,-::J;).-7'/
LANE COUNTY PLANN I NG DEPARHlENT
NN1E DATE
L
Zoning Ordinance Compl iance
(Zone )
Subdivision Ordinance Compl iance
app I icab I e
() ()
3.
4.
Required Access
( )
( )
( )
( )
( )
() ()
r~ ) On(\ 0_
L{\) ()
2.
Building .Site (Area, Width,
Frontage, Setback)
Other (see comments)
( )
( )
5.
COHHEIHS:
SANITATION SECTION NOT NO YES i ~3'.Q DATE
apD I icab I e (V 8/27171(
10. . Sewage Disposal ( ) ( )
\ - ,
II. Us'ab 1 e Area ( ) ( ) ( )
12. Wa t e r Supply ( ) ( ) ( )
13. Ot her (see Comments) ( ) ( ) ( )
l
COHH ENTS :
TO APPLICANT:
Your Building Permit / Site Inspection:
() Can be approved.
() Cannot be approved o1t this time ilS indictltcd on item tWo above.
Quest ions and further informilt ion on i tClllS I through ~ contilct the Lal1c-
COUNTY PLANNING DEPARTHElH. Questions alld [lIrther in[onniltion on items 6
through 13 contact the Lane County O"ildin<j ,1l1d Sal1itiltion Division,
() Wi I' be held in this office unt i I you Ciln resolve the problems indicated.
() Is being returned.
() Your building permit ilppl ication fee is being ,'eturned under separate cover.
LANE COUNTY PLANNING DIVIS IClN
135 Sixth Avenue East, Eugene, Oregon 97401
Phone (503) 687-4186
LANE COUNTY ENVIRONMENTAL MANAGrrrmNT
135 Sixth Avenue East, Eugene, Oregon 97401
Phone (503) 687.4065
C55-28
.
DatF'
8/29/74'
.
.
1663- 74
CURB CUT
Permit No
-
PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
WHEREAS, the attached applicatian 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
870 WEST CENTENNIAL
or constructing the following
LOT 4 BLOCK 3
be and is hereby issued to ROBERT N. HILL Bu I LDERS
facility:
3RD ADOITION TO MEADOW GREEN ESTATES
for placing, building
DUKE STREET
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 M9B-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 WtLL BE CONSTRUCTED IN ACCORDANCE WITH THE ATTACHED SIDEWALK
SPECIFICATIONS AND DRAWING M98-49. 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
8!19.LJ'i
. 19--15-.
Expires
,19_.
Inspected and Approved
Approved by Board of County Commissioners
By /J
@/V~
Director of Public Works
Dato
By
WHITE - OFFICE FilE
GREEN - RESIDENT ENGINEER
PINK - PERMITTEE
BLUE - ROAD SUPERVISOR
ORANGE - BUILDING & SANITATION DEPT.
YELLOW - REAL ESTATE
C98-79
~
....
Dat"
-"'..
.
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
for placing, building
or constructing the following facility:
3~
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.
o j( 5 ~
o/r-
r,/SJ1'!
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-
forF'
,19_.
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
BLUE - ROAD SUPERVISOR
ORANGE - BUILDING & SANITATION DEPT.
YELLOW - REAL ESTATE
C98-79
. ~
PROPERTY OWNER
LANE COUNT4J1LDING PERMIT OR MOBILE
BUILDING [J MH n
MAILING ADDRESS
HO~SE PERMIT
PERMIT NO.
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L.
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j~HONE
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PHONE
CONTRACTOR
MAILING ADDRESS
PROPERTY lOCATJON - INCLUDE POST OFFICE
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PROPERTY LEGAL OESCRIPTlON:- METES. ~OUNDS
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"'Jr'"'
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TWP
RANGE
SECTION
TAX LOT NO.
CODE
CENSUS TRACT
,.
APPl.
NAME
&
EXISTING STRUCTURES ON PROPERTY
<.
..;. ~
LEGAL ACCESS TO PROPERTY
.,
MAILING
,
"
PROPERTY SIZE - FT.
ADDRESS
FOR MOBILE HO^:lE .PERMITS ONLY
No. of Bedrooms', . . ~~, \\'..
STRUCTURES TO BE 8UILT THIS PERMIT
WIDTH
DEPTH
AREA
,. \
, ,
,.:\ ...
',,~.'\ \~tbn~ec~ ,1& E,}iSti~;) Sewbg~ .Syste,mD
TYPE CONSTRUCTION ,SQ. FT. +; BDRMS
\ '~~ "V '.~'
New System 0
VALUATION
,
,-:+-
."
\'.\
,
:\ :11
. .-
,
SEWAGE DISPOSAL
"
FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER: NAME
WATER SUPPLY
PUBLIC D
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK 0
OTHERO
..
, ,
, .
':\.'1' ,,~\, ~~\
PUBLIC D
o OTHER
\
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"'..
,
,
TOTAL
~
MIN. SEPTIC TANK CAPACITY \
WITH DIST. BOX: GAL
COUNTY BUILDING & SANITATiON SPECIFICATIONS
DRAIN FIEl,p REQUIRED
UN. fT
TRENCH WIDTH FT.
OR SQ. fT.
i~ ) \ -~'\ . " \
. .},t-~. ~.\~~~~
,A,.
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: \
.'
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TYPE OF STRUCTURE
OCCUPAI'/CY
ZONE
PUBLIC UTlL EASEMENT
BLDG. SETBACKS FT. FROM CTR. OF ROAD RIGHT OF WAY
USE ClASSIFICATION
FRONT
~:
SIDE INT. SIDE EXT.
AUTHORIZED SIGNA!URE - DATE
REAR
, "
,
"
~.. .
, DATE
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PlUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
Call 687.4065 to schedule all required inspections. All canstruc,
tian 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)
FORM:::: (55-13
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY, DEfT, OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
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SITE I NSPECTI ON
APPROVED.. P
REMARKS ;><-.
DISAPPROVED L::::7 DATE
INSPECTOR
.
.
FOUNDATlO~ :~ION /J /f'
ApPROV[O " DISAPPROVE~I 1 DATElfJ/7'7t(_A:PECTO(':A':
REMARKs.QJt:;J;,/f~ d,,~&H. 9'-/:2 .?~ <<. e. I
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L.W.f' . W-
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--PI( I~ j>>~'- CI' ~~ <-r.... rlf~7Y t/f, 6
I
L::::7 DATE/~~;'. 7Z/
I
INSPECTO~~
ApPROVED
REMARKS
e..)
LATH OR SHEETROCK INSPECTION
ApPROVED ~ DISAPPROVED /
/ DATE /~,/~'71( I NSPECTO{Jl/ <:Bt:.
REMARKS-
FINAL INSPECTION . ~
ApPROVEO DISAPPROVEO Cl DATEJ;2.-/0-71/ INSPECTO(~
REMARKS Ad~~ ,I., PIJi!, .ik,A (N;',lA~II-lo/-?f iJ{, J,u,h. ~~)
..4A.1ilL/ I ,. U. - " ~ f '
CERTIFICATE OF OCCUPANCY
READY TO ISSUE L::::7 NOT READY TO ISSUE / / DATE
INSPECTOR
REMARKS
/1 /J/
~~
/ {pIPJ"?, 76 ~ 3 tu&'
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LANE COU.!~lTY,.ILDIN~. PERMIT OR MOBILE
BUILDING D MH D'
MAILING ADDRESS
N Et~1. 0:111.0::-,;) CjC U:;:;;y Clm'EC::llA~
MAILING ADDRESS
HoAsE PERMIT
PERMIT NO.
,.,-'." ,
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S:'"'~ I ;c;, .~' 'EM)
C:~L:~;'):~
PHONE
'I' ,r>J..r f
(. ":>.v y ~
PHONE
AllON - INCLUDE POST OFFICE
./)6 ~~:!<t ~'i'.lrlT GpRW"l"teLP. "'ICJOl.l
.fOAl DESCRIPTION - METES, BOUNDS
Lt.... 4 Cl.ec:: :: S;:!) ('.');)1110;: TO 1<~t\GOI!I 0.1::;r;,: COTAne)
RANGE
c:>
SECTION
06
TAX LOT NO,
CODE
CENSUS TRACT
;(O:;C5l7 rJ flll.,. Ou H.:JEa
EXISTING STRUCTURES,. ON PROPERTY
C;o:;::'
&
olt> tiEBT CftnUlmtAI.
LEGAL ACCESS TO PROPERTY
~~:~~.:": n'. -:V
PROPERTY SIZE - FT.
ADDRESS ~?" HlUPlIIW, OfIroca
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms
WIDTH
DEPTH
AREA
STRUCTURES TO BE BUILT THIS PERMIT
Connect to Existing
TYPE CONSTRUCTION
Sewage System D New System 0
SQ. FT. +t BDRMS VALUATION
",:.: C 1C.18 ~1,:;1~.C:j
!)~t.l. IIlD
Cil,:AClI
';If"
,...
"
{~ ry"<. 1 l)li}.l:c
,.j-.;J-I ~-..J._ -....-~.
.~r,'~~, :.. "j
1:::l7M.~ SEWI1.0(t Dtn"'C~~!' OVIl.!::;
,
,
SEWAGE DISPOSAL
,
OTHERD
\:~~.ro
PRIO:;
FEES
PLUMBING INSTALLED BY
OWNER 0 OTHER; NAME
WATER SUPPLY
PUBLIC 0
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK 0
'iC . C)
PUBLIC 0
o OTHER
2ii.00
TOTAL
,
~~, I f
,;)0.1 (
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED
1l:n <! VO '1.>'
UN. FT,;J TRENCH WIDTH FT. J OR SQ. FT.
3jD
MIN. SEPTIC TANK CAPACITY
t-.r,-.-"
WITH OISl. BOX: GAl. ,-.-
TYPE OF STRUCTURE
t.~ ~ \
-..'
OCCUPANCY
I J
ZONE
PUBLIC UTll. EASEMENT
BLDG. SETBACKS __ FT. FROM eTR.
FRONT I.,)
OF ROAD RIGHT OF WAY
"
SIDE INT. ., SIDE EXT.
AUTHORIZED SIGNATURE - DATE
1:. C;;::;3 C: C Ha';r.\~:ll
REAR
2
USE ClASSIFICA lION
hI J.
J S:~':.1J:!/ftJHTArJ i^tJ
DATE
f #., (. ".
"t ' ~ ,,) ,. ~.
,. ,
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
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 ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
,.
.
SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED / / 01 SAPPROVED J::::l DATE
REMARKS
GAS PIPING GROUNDWORK
ApPROVED J::::l DISAPPROVED J::::l DATE
REMARK S
ROUGH PLUMB I NG
ApPROVED lXJ DI SAPPROVED C1 DATE '1-2 1- /~J
REMARKS
ROUGH GAS PIPING
ApPROVED J::::l DISAPPROVED J::::l DATE
REMARKS
FINAL PLUMBING
ApPROVED fXJ DISAPPROVED C1 DAT~//-.f-'-'7't
REMARK S
FINAL GAS PIPING
ApPROVED C1 DISAPPROVED C1 DATE
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE ;---y NOT READY TO ISSUE ;---y DATE
REMARKS
.,..,.
INSPECTOR
INSPECTOR
INSPECT~j/
INSPECTOR
INSPECT~~
INSPECTOR
INSPECTOR
'POSED SEWAGE DISPOSAL SYSTEM R~D '
INSTAllER: Complete top part form to signature and submit b . copies with applicatio;. .
PERMIT NO. J(.!J,"'-7<-1
NAME;{) PROPERTY ADDRESS
-hr"v f1J.~~ A ~ 'l G: /)a ~ S /J r r d!pjd
ng Uni ts Bedrooms,'? Baths Basement Water Supply - ,-.- v
") Yes No c- Public ~ther-List
Septic Tank:
Ft. from well Steel 0 Concrete ~No. Compartments Gal. Capacity
PO{fJ.p tl / tJ ~
Inside Dimensions: F;" / Tile Disposal Field:
len~th Width ~ Diameter DePth~ Distribution Box: Yes ~No
:~~R .Jj,hr-:rf)J..# // / Other Distribution-Type
o Feet from. J.. .....,.0
MAILlNG.n7d W. C€;.J IUWiC"ff WEll 1Vd-Vv"'-Foundation
ADDRESS "'" ' ..1 """11- lot Line'
I.JP/I r_q V \ Front Side Rear
length of Lines-Ft. Trench/ Total Sq. I Ft. Betweep IFi lle~j-IFlller Depth IFiller Below
'/M.~. 4. 5. 6. Widtfl).: Ft. Lines /C) TvpeJd-. Above Tile 6inJrile (;, in.
:'lot Plan (see instructions):
't
10/
4~
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IA-.:~./'7-' 74'
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CERTIFICATE OF SATISFACTORY !OMPlETION . ...
Date: fO-2-'1-7Y
is issued
at the above
Date
For Sanitarian Use Only:
In accordance with 1973 Oregon laws Chapter 835. Section 214 this certificate
as evidence of satisfactory completion of a subsurface sewage disposal system
1 ocap<: ,
Approved: System Installation conforms to current standards
Disapproved: Does not conform to current standards
Remarks:
STATE OF OREGON DEPARTMENT OF
;~!'b~
'ff::i COUNTY
ENVIRONMENTAL QUALITY
Signature
C55-11
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/ 'Y
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. . FFJMITff/??3-Jf ~
lANE CXXJNIY Building 7-
DEPAR1MENT OF ENVIRON1ENIAL MANAGEMENl' Mobile lIoIre
APPLICATION FOR BUILDIN:; PERMIT OR MOBIlE H<W: USE
No pennit will be issued until this application has been approved.
PLEASE PRINT
PROPERTI LOCATION :iJC,rt
+,;.; l:~~
TWP I g RAN;E b:zl. SEe. t!:J C TAX wr l CODE CENSUS TRACT
LOT NO. U BLOCK "':? SUBDIVISION" l...a#,A, ~ 71-1,....-1(Y.d df,.~~ E..J.,.L
I (].!fJ~ l'KLftJ&!r ::> '
ACCESS TO PROPERlY j -'~", "A-i;;;i- WIDIH 7/). C} ? DEP'lli /...1/. 9lJ OR ACRElGE
DESCRIBE EXISTJ:N:; STRUClURES ON TIlE PRun.ttif_ _ ,./J~ / '
APPLICANT ~ / L ,1tuLlJ.'l:;
NAME ~~r 7;. jfdl4~.. ADDRESS R?lJ kJ. ~~~d PHrnE 7r4'-ift?Jt
C:)NI'RACIDR ' 0 MAILIl'l; P J
NAME -{pAt tz.---, ADDRESS --e:k2;n.L.-,..- . PHONE ~ ~ IT- _
, ,
B~ FOR OFFICE USE ONLY:.:,:. I. :,:. :.:.:,:.:.:.:.:. :.:.:.:.:.:.:.:.:.:. :.:.:. :.:.:.I.I.I.:..\J.I.:.I.I.:.:.I.;.~'. :.:.:.:,:.1. :.1.1.:.:.1. :.1. :.:. :.:.J, A A;.,:,
~trRCtures to be built/Mobile lIoIre sq. ft~/?,fO ffbedrooms valuation
jlh.~..k!A~ /~'Ji-:P. .ff.J^ 3 /;~F:"ro
, ~-rt. A -Aj--LY-- ~ c;. ~ / lJ' <;'7}. If ~
/ a-u( r'I ., I')
~ _~ <<:;:'-05 r ,/t '
::>=wage Disposal: /J _ ,'...... ) ,
Site Inspection if ;r./V<.V ~ Existing sewage disposal system 0 or new system'required a..
/'
W~ter ~l~ /
P Jblic . strict Name Well 0 Spring 0' Other
--
Fees // ~
Plumbing Installed by CMner /Other Name:
Plumbing Fees Sewer' cormection ater cormection
7 if of fixtures U;sPection fee.:J. inspection fee,2.
-0 ~sh Plan! furnished Fa~il' ty Pennit
IB'Check Ye~ No 0 Yes No 0
Signature of/Applicant ~ RM date~;a.;;f
fee receiv~ by fl~-",,- '..) date
Drainfield recwi"red . ,
Lin7'1 Feet /I-;)D Trench Depth 2h>3 or Sq. Ft. J 6b
I
/ /
, i /
~rpe of Structure !!!J'tv Occupancy J'0f';[ lhe Zone
Blgd. setbacks-it. trOlll center ot r'gad right ot way
F:~ont l./ .r Side Int. ~ Side Exterior
PLanning
.~/?'
/'v '
NaTE :
BLdg.
Waste Dis.
PLumbing
Plan Review
T.railer
1'7. surcharge
9J,00
.<ZJ. 00
;:',\":00
LL/ 7.
1(,9'-/7
Min. Septic tank capacity
with dist. box: Gallons ((Db
TJI'AL
jJ//~.. fjf~~d-
(2.., Il---
Use Classification
R_/M-:} J'S.Q-
Rear ~ Zone cJ?--71
I. da~ Builcj:j.ng . ,/ c'. date
If),> - /,/ .
7512.Z 71;,,(/.'; ::'2' :lL:':,,' r.~:r'; 'j
(/';1 /
C55-12
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