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Home My WebLink AboutPermit Building 1975-1-29 (2) '''"'';-l"'~-----...-'t.~ ".-.'1 N' '~:-,""'''i''''''I''~'!lIIliiI'''''' .~., _-__' _~"'~_,__. r~......._...~.....__,........-:-- ~,..,.;\'"_... ___';,. ........' ~r ...... .~ _.......,. '. . ....~ .' LANE CO~. BUILDING PERMIT OR MOBILE .E BUILDING 1'"')' MH 0 MAILING ADDRESS 0(0 \,'!ST Cn!TW:ll AL MAIliNG ADDRESS I 7.2 -- 7s .. .... '4 ,. USE PERMIT PERMIT NO. 172-75 PROPERTY-OWNER ,~O ;(RT d. .IILL OUILO::r1 Inc. CONTRACTOR ~;t.:~lC PROPERTY LOCATION - INCLUDE POST OFFICE DUKE ST;i:~r nJ~~- PROPERTY LEGAL DESCRIPTION - METES, BOUNDS Jno ADD I T IOU 1';::1\00'1/ GREE:l SPR I rlQr I ELO O:lEGOIJ PHONE 7"~ C'I' f L,.t)- ~.. .L PHONE E!lTATES LOT 2!~. TAX LOT NO. tt:- C) ?I 0 aLOCK 2 TWP RANGE iu 02 SECTION 06./,3 CODE CENSUS TRACT 35-152P APPl. NAME & RODEOT N. I-IILL BUILDER It~c. EXISTING STRUCTURES ON PROPERTY [JOllE LEGAL ACCESS TO PROPERTY 3669 DUKE ST~EET PROPERTY SIZE - FT. 8 fO W!:!lT CElllENtJ I AL MAILING ADDRESS SPR I NGf' I ELO FOR MOBILE HOME PERMITS No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT OnZGON ONLY WIDTH DEPTH AREA Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. :;.: BDRMS New System 0 VALUATION DwELLING 1092 G 21.80 4e4 e 5.30 3 ~" ,',,- 'c ~.l,\A""l.C ~Af:AQE ~ "I.- ..,.. C~I :;\J:;. 1"-\; e::O,310.:0.- PR I"Q~ ~PP!1nv^, SEWAGE DISPOSAL . OTHERD l1f\ nt'\ PLUMBING INSTALLED BY r'l:"w SY~TEt4 t1EQU I REDOWNER 0 OTHER: NAME FEES WATER SUPPLY PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER I;.;SURCHAOGE SEPTIC TANK 0 !:;" nn ~');Oo PUBLIC 0 o OTHER TOTAL . I.LI3 1<;11.4'<1 COUNTY BUILDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY WITH OIS1. BOX: GAl. DRAIN FielD REQUIRED 900 UN. FT lr-1O TRENCH WIDTH FT. < D~?TIPR SQ. FT. TYPE OF STRUCTURE 5N OCCUPANCY I t':. J lONE RA PUBLIC UTIl. EASEMENT FRONT BLDG. SETBACKS u FT. FROM CTR. 15' Of ROAD RIGHT OF WAY '>' SIDE INT. J SIDE EXT. AUTHORIZED SIGNATURE - DATE J. Eo Boss ElY C. HARJAUGII REAR USE CLASSIFICATION 7'rtJE /S/ JOHU SHO~'/SANITAr.IAU DATE 1/29/75 ElLl.t BLDG. PERMIT - WHITE OFfICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 ta schedule all required inspections. All construe. 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) h FORM = C55" lJ (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 9740t r! , 1..,'1.; ,'t~l~:;....r'"\ ~ t. .J:./f-t~-. <. ,.., . ,.... 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() SITE INSPECTION PLANNING DIVISION Not Applicable 1. Zoning Ordinance Compl iance: Zone~ () 2. Subd i 'I is I on 0 rd i nance Comp I i ance ( ) 3. Required Access ( ) 4. Building Site (Area, Width, Frontage) () 5. Other (see comments) ( ) COMMENTS: 1 ( f. V. e ~,Or>>l1t- T AR SUBDI~N: LOT: I I t!!,/ / [I J.7/?s CK.'D B;: ~ 6. Setbacks from cll of rlOPd: Front ':::> Side Exterior - Setbacks from interior lines: Side e; Rear ., ~U.:c:._ S TAX LOT BLOCK: APPlI CANT DATE No T) ( ) ( ) ( ) ( ) I PLANNING DIVISION ACTION PENDING: YESl } NOl } APPLICATIO~ BUILDING INSPECTION DIVISION Not Applicable ( ) (l.) ( ) ( ) 7. Plans Submitted 8. Soi 1 Stability (footings) 9. Flood Plain 10. Other (see comments) COMMENTS: WATER POLUTION CONTROL Not Applicable ( ) ( ) 11. Meets Department of Environmental Quality Standards. 12. Other (see comments) COMMENTS: No Yes T)~ ( ) ( ) ( ) ( ) ( ) ( ) CK'D BY: No Yes T) TI ( ) ( ) , Ok'D "dIM / /2R/zs- DATE TO APPL.I CANT: r:::. '(our~Building I Site Inspection: 0\ '17.....(-\rCan be app roved. \/~ ~ ~ () Cannot be approved at this time as indicated on item NO. above. ~ Questions and further information on items I through 6 contact the LANE- COUNTY PLANNING DIVISION. Questions and further information on items 7 . through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION. ( ) Will be held in this office until you can resolve the problems indicated. ( ) Is being returned. ( ) Your building permit ap'pl ication fee is being ~'ltu.,:ned under seDa~ate cove~_ ,EPARTMENT OF lNVIRONMENTAL HANA~E~~~I 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4186 CSS-28 . . . . ~ Dqtp' JANUARY 2Q/7'1 . permi~. 172- 7'5 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 ROB'RT N. HILL BUILO'R R70 W~~T r~LEHHl61 ~PQING~IElD OR~nON ~~? or constructing the following facility: 3RO AOOITION MEAOOW GREEN ESTATES LOT 24 BLOCK 2 for placing, building 3669 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 appl ication 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), 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. 2, 3. SIOEWALKS WILL BE CONSTRUCTEO IN ACCORDANCE WITH THE ATTACH EO SIOEWALK SPECIFICATIONS ANO ORAWING M98-49. THE STANOARO CURB TYPE SHALL BE CONSTRUCTED UNLESS OTHERWISE SPECIFIEO. 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 JANUARY 29 , 1 9..1i... Expires ,19_, Inspected and Approved Approved by Board of County Commissioners By ~.c-?/n;-t Director of Public Works Date _& By WH ITE - OFFICE FilE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUilDING & SANITATION DEPT. YEllOW - REAL ESTATE C98-79 ~ . , Dqtf: . permi!, ., " 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 a nd 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 or constructing the following facility: for placing, building 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 appl ication 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 o j( ~ "UiJD, IV JIUJJlJ II 0, Inspected "-ndA~o'J"e'Jf1j Date J> / to . 71/ f!!Xv , ,19_. Expires ,19_. Approved by Board of County Commissioners By By Director of Public Works ~ WHITE - OFFICE FilE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUllDINC & SANITATION DEPT. YellOW - REAL ESTATE C98-79 PROPERTY OWNER LANE COU4BUILDING PERMIT OR MOBILE H. BUILDING Q: MH 0 MAILING ADDRESS USE PERMIT PERMIT NO. '/. ., PHONE ., o . _ S. ". , '-n . "" .. '. ~ CONTRACTOR MAILING ADDRESS PHONE ;,. PROPERTY lOCATION -INCLUDE POST OffiCE PROPERTY lEGAL DESCRIPTION - METES, BOUNDS TWP RANGE , ~JVf'''' SECTION '.' ..,~. '.'. TAX LOT NO. .,."'" ._!.." ,} CODE CENSUS TRACT " APPl. NAME & MAIliNG ADDRESS EXISTING STRUCTURES ON PROPERTY . .' , . ; : ;, (;", ~ e't;. to'"':', lEGAL, ACCESS TO PROPERTY ,.. " . PROPERTY SIZE - fT. /. . .' .~ J WIDTH DEPTH AREA FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. :,! BDRMS New System 0 VALUATION l:.O >. , ( '" 'II' , , SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAllE~ , FEES PLUMBING INSTAllED BY OWNER 0 OTHER: NAME WATER SUPPLY SEPTIC TANK 0 OTHERO PUBLIC 0 o OTHER . ~,,: TOTAL , , MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAl. COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED lIN. FT TRENCH WIDTH fT. 'OR SQ, FT. TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTll. EASEMENT BLDG. SETBACKS._ FT, FROM CTR. OF ROAD RIGHT OF WAY . . USE CLASSIFICATION o SIDE INT. SIDE EXT. AUTHORIZED SIGNATURE - DATE ; ,.ll . " REAR I '. fRONT ! DATE ., ~:- /~. ...... f ': I . . 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: fl?f subsurface sewage disposal and county regulations covering plumbing. All buildings require a certificate of occupancy before being occupied. (See Details an Reverse Side) f"ORM == CSS-13 (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 . . . SITE INSPECTION ApPROVED W DISAPPROVED Cl DATE REMARK s I INSPECTOR FOUNDATION INSPECTION ~ ApPROVED f'i"/ DISAPPR;VED / / DATE 2.-/J.' 7/j' I NSPECTO~ ,\:) 1t"7, j f.'. ,y' ,: or; , ~ _ '7 _ ~1 {" (,~ , REMARKS 0'/1 <.; "'I1,{i>AI),-fL<-"..I.~';'i.ril,' ,_.,' 1'1 ..', Ii , ,.- / I ' , _A-/,.' r;;' /J, /1 /1j L. . ___.,~-.a.. J -VI' "':f' F~~.th-lUWA. ~~.t~41Y~., FRAMING INsle:CTION V / ---K 0 ApPROVED ~D;SAPPROVED Cl DA,TE L(.j (/ ~ 7 bIN~PECTL L__~/ (!'/ J: REMARKS1/!4'..~duiu4f &:.2441' AWtt, ~~7c't-;gt.{J . /; / _:- Y II ..-7 ~.u~ tJ/~/tI-'7tH/ / . / . ~ /' LATH OR SHEETROCK INSPECTION ~ ApPROVED ~ISAPPROVED rt DATE s:.,2~-16 INSPEC~ R~MARKS ~ j--~ _~ 14 t.f#~.11~" 75~ A {);(~~1--,~N .#{~~. '')--.L-;r.5~ FINAL INSPilCTIO /}// ' ApPROVED DISAPPROVE~ D~TE~-fl'7t INSPECTO(1t.e I....- ~ ~7 _~tY'J(~~-/~.71S~ ~~rlj'N . ~ - :J ~. __ _I ~:.r./j'.t'D pe-1Jrn.b .,(. >/.l , __:r~~:)Uj/ - , / CERTIFICATE OF OCCUPANCY READY TO ISSUE ~ NOT READY TO ISSUE ~ DATE INSPECTOR REMARKS _. 'J ') . tl:2td:!:q~ /72 -76'-7i.i.U .? ere: 7' .0 ~ ~ . 6D~ LANE CO':l~ BUILDING PERMIT OR MOBILE .E USE PERMIT BUILDING rw MH 0 PERMIT NO. MAILING ADDRESS ;a!...~ l~:'Ht.s:rJ L::. 7,..,.;) t::;07 CC~'i.~~i'.:;:a:'~ ~;r:"~:~7.::LO MAILING ADDRESS ~ (, . .' PROPERTY OWNER .:0-:~:'~./ ~J. PHONE \:~~::', ; t', .- PHONE CONTRACTOR ~;t~~:: PROPERTY LOCATION - INCLUDE POST OFFICE ~!:.Itl '}'.Q::GY3~_0- PROPERTY lEGAL DESCRIPTION - METES, BOUNDS ~:;o ~:,t)~Y OC:; 1'.~~C::1 C~ll~St~ Cc)T^V~() Lor ::~l CI.C:;,I;: I,' \J RANGE ";':) SECTION TAX LOT NO. CODE CENSUS TRACT TWP oS ",. "")r ;J-:o.~.~ APPl. NAME & .J:::iJii:flY CJ. 11ILL I3UlLC:\fl I.::. EXISTING STRUCTURES ON PROPERTY r~OI::: lEGAL ACCESS TO PROPERTY 3~9 Or:!(: ~)Yn::::'l PROPERTY SIZE - FT. Gl0 ~,CY C~~Ytl~~I~~ MAILING ADDRESS r:r~O;:'''C7~ClD O:Jt!r:O:J FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT l;,:~ ~~l~ . r::J WIDTH DEPTH AREA Connect to Existing TYPE CONSTRUCTION In~: 0 CI.Be Sewage System D sa, FT. # BDRMS New System 0 VALUATION 3 #...... I,,, /'" (:~,j]t .....u Gr..Jt.C'.1 L:t',!:, 0 5.jO ,) ,''':: j..:',..., ..,.".__)., I ~..--....:,~, t.l..:,;J;n" ., P-llno tC.?'::"l\"If\1 SEWAGE DISPOSAL . PLUMBING INSTALLED BY ~',... OVOV(;t1 C1liCOlrlEDoWNER D OTHER, NAME FEES WATER SUPPLY PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAilER .~ :~.;2C:~'Ar.:J-l SEPTIC TANK 0 OTHERD u 'iI~ nn 4i\ (';~ <;j.:::) PUBLIC 0 o OTHER TOTAL $ I.L}] ~~~).l~_~ COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED MIN. 'SEPTlC TANK CAPACITY WITH DIST. BOX: GAl. SGD UN. FT I'm TRENCH WIDTH FT. ~ n::?";~OR SQ, FT. TYPE OF STRUCTURE ,;J OCCUPANCY : 2~ J ZONE ;U\ PUBLIC UTll. EASEMENT BlDG, SETBACKS n FT. FROM CTR. OF lj' ROAD RIGHT OF WAY ,;. SIDE INT, .; SIDE EXT. AUTHORIZED SIGNATURE - DATE J. t::. .~~~ i.jV c. t\~~:J~~O~J REAR USE CLASSIFICATION 7'RJ::: FRONT 101 .Ie:::.: ~:J(x:::/Dtl:JjYc\Qli'--J DATE 1/e:.'9/7j ,-~ ,.' ........ 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 on Reverse Side) \ \ fORM::t C55" 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 II DI SAPPROVED C1 DATE INSPECTOR REMARKS GAS PIPING GROUNDWORK ApPROVED II OISAPPROVED C1 DATE INSPECTOR REMARKS ROUGH PLUMB I NG ApPROVED ~ DISAPPROVED C1 DATE~~Jl-? <"' REMARK 5 INSPECTOR ~ ROUGH GAS PIPING ApPROVED Cl OISAPPROVED Cl DATE INSPECTOR REMARKS FINAL PLUMBING ApPROVED fXJ DISAPPROVED Cl DATf("- ,":;? ~NSPECTD"_ --- /U REMARKS ~"e>....~.~.,.-. r?An_,. ~..f?, I~/t") ./;" ~P~~'Ii~./ c:r-t;=7-r FINAL GAS PIPING ApPROVED Cl DISAPPROVED / / DATE INSPECTOR REMARK 5 CERTIFICATE OF OCCUPANCY READY TO ISSUE C1 NOT READY TO ISSUE Cl DATE INSPECTOR REMARKS \ <. PR. SEWAGE DISPOSAL SYSTEM RECO~ Complete top part 0 to signature and submit bot~es with application: PERM IT NO. 172-7-'5 JS INSTALLER: INSTALLER'S NAME PROPERTY AUDRESS /)etYr::t?JotI dd~~_DUKE STREET No. Living Units Bedrooms Baths Basement ~A ? ':2.. Yes No ';" . '3~M Water Supply Publ ic YOther-list t Septic Tank: Ft. from well Steel 0 Concrete ~ tf/n /~/G LtI Inside Dimensions: Ft. Length Width Diameter Depth OWNER NAME ROl1ERT i'J HILL '1UILDER No. Compartments ~ Tile Disposal Field: Distribution Box: Yes\! Other Distribution-Typi' No Ga I. Capad ty l' o-t.J1O Feet f r.qn] 'PL,t3 LlC, HAILING 310 ':!EST CEI!TEllNIAL WEll /II$Wet..{.1 Foundation ADDRESS Lot Li ne '_I SPRINGFIELO OREGO"1' Front J;t;'"' Side 6 Len!J.!.h of L I nes-Ft. I Trench Tota I Sq. I 't. Betwee'} IFi 11 er IF ill er Depth (1,){2? 3.4.5.6. Width Ft.~ Lines 10 TVD~AboveTile(A 'lot Plan (see instructions): <ft:::'7J {j).., 16>0' n 1~ .::] -- iOJ.'.> .-..... ::.:.:: 1~1 ::-- it, () jl~o fV-:--c r-z ~:;;! Gl ~ :-1 -- \ ~ '\ :.> ;;:J [,~ C= , ,-J ~ - 'J ~. , -' (J' -..... e. r. 8 - ,/ .... . ~.(O7 .!AD 'fiId ';?P'-i I~~~- ate , /l - Rear 7 rlJt:; IFi ller Below in.ITile ~ in. ---- .' ~I I /0' I ) { , - 6~'6 '7 ; ~ " "- ~ ~ ~ ~ ~~ """'---.... "\ .... . -------- ' -~ ' : ! IU- - ---b-"~-.~ ~ o IO'} I ------@..- II>' &-0 , . "- 'i::l , J J . ,~ " .~ to \) ~ ~ ---- t?v~ VJ ~'t- ~ t7U{l~ -.;. SI~ature CERTIFICATE OF SATISFACTORY COMPLETION For Sanitarian Use Only: Date:5. 2-. -7S 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 locag}o . Approved: System Installation conforms to current standards Disapproved: Does not conform to current standards Remarks: C55-11 S~~~'s Signature LAt!Jl"COUNTY STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY r I NO~: . .. PERMIT iF I 7;2 - Z5 NO PERMIT WI E ISSUED UNTIL THIS APPLICATI~S BEEN APPROVED APPLICATION FOR: CONSTRUCTION ~ tXJ . O'WNER~'~ 77. Name c=J CONTRACTOR --J 17.." 0 . - Name f7/ Twp, I'f{'" Range (};;l Section () (;, <hu"/:r.ifn/i;.R/-1 r/..ul d~/&~br.ot ACCESS TO PROPERTY (Road Name) ;0 ,~.. /~ ~ MOBILE HOME c::::J JidL A~L J~I' , , Address - PLAN REVIEW c::::J J7?rJ CIUU;GE OF OCCUPANCY CJ '2tL~_i- BoH~'q/....,Q,// - -?</6'Y 7 It, City Zip i/ / Phone Address City Zip Phone O.S, REG, II Tax Lot Code Census Tract.J .5--/..s7:2-11- Widtb/.6.~;DePth I-Z.:l. ;;u./ k,~ Block .-2 ~ Property Acreage Existing Structures on Property: /} /J/Y7..P../ Property Location . AddreS5/Direc;i~n5: 3L t?'.f' _M./~~ ~~pf ~r~':"d d-od Jt! j)l.~ A--a~dL Below for Of f ice Us e Onl vXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX:XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Sq. Fti':Q I 80 ilBedrooms Valuation /(/ 9.;!.l5':;' . C3) d 3 <j-o,s:t rJ '/9:(/0 s,.JO ~a.r. ol d ,::) L ") ......,. YI) ~ - . t/ - SEWAGE DISPOSAL:. t:') J_ '_T"'l J Site Inspection # Itr~v -- Existing Sewage Disposal System c=J or New System Required ~ WATER SUPPLY: Well Spring ______ Public CJ Name of Community or Public System ~~~ Other Community CXJ FEES: PLUMBING: 11f?, U 0 Installed by Owner [=:J Bldg, Waste Disp. --07J ' 0 0 PLUMBING FEES: Plumbing 01,(";00 7' D of Fixtures Plan Review Mobile Home 1% Surcharge I. '/.:3 0 CASH TOTAL / 9 '/, '1.:3 ~K Other C2S1 Nam~~:Ja-<'~ Sewage Connection .g). Water Connection ~ ~, PLANS FURNISHED FACILITY PERMIT !:;ZJ YES c=J NO~ ~ YES c::::J NO Signature of APPlicant~L-t- !/1d Fee Received BYr~ Date: ~.2. )/~ ,\ Min. Septic Tank Capacity q Dh Drainfield Required - Lineal Feet JQf\ , Maximum Depth 3 Type of Construction ,- .t:JN 1...J..,cr Group ~. ~'J p.J \,Fire Zoile ~ Use Classification BIdg Setbacks - from Center of Road Right of Way: Front. f~ Side Int. _~ Side Exterior , Rear 7 j7t(~ Zone ~ .... C55-12 ~TE: ~IT\TION: / I DATE:, ) ~ "BUILDINy,: /' - DATE: l/~ IS ~'JL,I. 19:r16=:J/r I.:l:rr/..{k/(;.'!: /~()Oc cU' I LAN COUNTY DE TMENT OF ENVIRONMENtiL MANAGEMENt IN/lWp,,, .' Jt'(,l~ r;,'> ' 1u'-'1.... ,",---