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Home My WebLink AboutPermit Building 1975-4-28 (2) . -/- ':., L~ ~-........ ' "-~~. t<f \ ..._ ----qq 10-.'15" ~\n:'C~T ~: IILl LANE COUNT.UILDING PERMIT OR MOBILE BUILDING [](X MH D MAlllNG ADDRESS 870 VES7 CaNTE~NIAL MAIllNG ADDRESS HO.USE PERMIT PERMIT NO. OUILDER SPilltlGr IE LD <)46-7'1 PHONE 7"(-....S ~ { PROPERTY pWNER C"EGON CONTRACTOR S1!ItE PROPERTY LOCATION -INCLUDE POST OFFICE PHONE i}Ol DUI1C: STREE1' SPR I NGrI no OREGON PROPERTY LEGAL DESCRIPTION - METES, BOUNDS Iln1 AI)DITIO~l .0 t-1EADOW GREEN ESTATES TWP RANGE SECTION LOT 22 BLOCK 2 18 2 6J3 TAX LOT NO. ::jJ 9 ZIt! CODE CENSUS TRACT APPL. NAME & MAlllNG ADDRESS SPR ItIGF I EL 0 OREGON FOR MOBILE HOME PERMITS ONLY "l'i-l'i2A EXISTING STRUCTURES ON PROPERTY ROBERT N I-IILL BUILDER NON, LEGAL ACCESS TO PROPERTY 3701 DUXE STREET PROPERTY SIZE - FT. 870 (-lEST COITEtlN I AL WIDTH DEPTH AREA No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System D TYPE CONSTRUCTION SQ. FT # BDRMS New System D VALUATION f}..Jr:U.Ii'](,~ 10~< g 59<H) 16.10 5.30 lt16. ('11. ':ll' $ 3. J27.CO I~At1AGfr l'j,~ . OTHERD 92.00 2'}.OO 2'1.00 fEES PLUMBING INSTALLED BY OWNER D OTHER: NAME WATER SUPPLY SEW AGE DISPOSAL PUBllC D BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER 1~~SUnC-IARGZ TOTAL SEPTIC TANK 0 PUBLIC D o OTHER $ 1 17 11::\ 1'7 COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN fiElD REQUIRED MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAL. C'A>O tiN. FT 1<;0 TRENCH WIDTH fT:'U: PTN ~ OR SQ. FT. TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UT1L. EASEMENT '1~'1 BLDG. SETBACKS __ fT. FRONT I)')' IP.J FROM CTR. OF ROAD RIGHT OF WAY SIDE INT.,' SIDE EXT. AUTHORIZED SIGNATURE - DATE USE CLASSIFICATION REAR 7'Pllr DATE /S/ J. Eo Boss C. HARBAUQI1 JOKN SHOOK/SANITARIAN 4/;>817'\ nl r~ BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Coli 687-4065 to schedule 011 required inspections. All construe. ticn 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:::!: C55- 1J (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EA.ST 6th, EUGENE, OREGON 97401 'Bui~It-lG~SIJE EVALUATION . 'jS/C ft . ~ x--r- BUILDING PERMIT APPLICATION NO.,~46-7~ () SITE INSPECTION 1. 2. 1/ 3. '/ 4. 5. Not Applicable Zoning Ordinance Compliance: Zone~~ () Subdivision Ordinance Compliance ( ) Required Access ( ) Building Site (Area, Width, Frontage) () Other (see comments) ( ) PLANNING DIVISION COMMENTS: T Ir"'A O'e. S ~11. TAX LOT SUBD I It itPI!'N: LOT: Q, i-h/J APPL I CANT DATE No Yes ()~ 6. ( ) n ( ) V1 ()v-r ( ) ( ) PLANNING DIVISION ACTION PENDING: YESl ) NOl ) APPLICATIDNH BUILDING INSPECTION DIVISION Not Aool icable ( ) \~ 7. Plans Submitted 8. Soil Stability (footings) 9. Flood Plain 10. Other (see comments) COMMENTS: WATER POLUTION CONTROL Not Aoolicable ( ) ( ) II. Meets Department of Environmental Quality Standards. 12. Other (see comments) COMMENTS: No Yes ()~ ( ) ( ) ( ) ( ) ( ,) ( ) No Yes ()Tr ( ) ( A.. BLOCK: CK'D By:cJ..h.TW-z.'f0- Setbacks from cll of r~~d: Front i'~;-f Si~8 l!)(tflri2r~ Setbacks from interior lines: Side _"(' Rear -7' Pell:. CK'D BY:~ ~m CK'D By.\\t~ If/M7(: Cjj\J---- DATE TO APPLI CANT: Your Building I Site Inspection: ~ Can be approved. ~L ~ ( ) Cannot be approved at this time as Indicated on item NO. above. ~I_'~- 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 offJce until you can resolve the problems indicated. ( ) Is being returned. , ( ) Your building ~ermit ap'plication fee is beinR return~d under seoarate cover. LI~rARTMENT OF ENVIRONMENTAL HANAGEMEN'f 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4i86 C55-28 Dat" APR I L 28, 1975 . . 946-7') 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 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 870 WEST CENTENNIAL SPRINGFIELD OREGON or constructing the following facility: ROBFRT N. HILI for placing, building 4TH ADDITION TO MEADOW GREEN ESTATES LOT 22 BLOCK 2 3 70! ~--"--.J 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), 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. SIDEWALKS WILL BE CONSTRUCTED IN ACCORDANCE WITH THE ATTACHED SIDEWALK SPECIFICATIONS AND DRAWING M98-75 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- forF' APR I L 28, 1975 ,19_. Expires ,19_. Inspected and Approved Approved by Board of County Commissioners By 4/ b/':-L/ - ~ - Director of Public Works Date By WHITE - OFFICE FilE GREEN - RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUILDING & SANITATION DEPT. YelLOW - REAL ESTATE C98-79 CURB CUT ".- ,> . . Dcit& . Permit No. PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY \. WHEREAS, the oltached 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 70/ ~ 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). 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. ~Kkl J) WJ\l~ 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- for" ,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 .. { 1../ , , .:1 ~- . LANE COUNTAuILDING PERMIT OR MOBILE BUILDING O:x'" MH 0 MAILING ADDRESS fl~~'."-;l ~'70 ~~":fY? ~~::J1r::::.:t/". MAILING ADDRESS HO.USE PERMIT PERMIT NO. .' ~,(~ -, . .:-' . PROPERTY PWNER t :':, ': ~ ' I ~.' CONTRACTOR ~Di1I:'C!V(~&..~ . J~~~~~,:' PHONE ,'t'./'. ". , ~. ,., 'J', I PHONE 5&,: PROPERTY LOCATION - INCLUDE POST OFFICE -;,;1: :"'" --'C C'f..::-'~':.~ fi~c'~~~"-'7~'"'r~) C\.,'.:r:r:~, PROPERTY LEGAL DESCRIPTION - METES, BOUNDS .~V:' i'\'~r);...,c., Vi; e'"f:l\:"!:'::'t TWP RANGE 'r.:r: -} f'~;;7A~n.;:"\ U n'j ;.p ',_(!~t'I r SECTION TAX LOT NO. CODE CENSUS TRACT I" . ~ (, 'l.~~ 1:;:,~, EXISTING STRUCTURES ON PROPERTY APPl. NAME & MAIliNG ADDRESS 2:::::; :t;{~V"f.:Lf) C~ 'CO?) FOR MOBILE HOME PERMITS ONLY No. of Bedrooms ","OJ;:::'': ;~ ,,1'.~. "~:'u.T1f~r~ tt;-o.W? ; ']c ~;r.!lT Cr.Cl'i',:U: 'At LEGAL ACCESS TO PROPERTY ~)70'1 ;~j)-'''' >:TRt"''' .J "- '-~...... 100' PROPERTY SIZE - FT. WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. :t: BDRMS New System 0 VALUATION .,,\j~. ~'r . ';;1' "',;~' . i~'!'" 1O\:;<i rt 1(".10 '(, l~~ 5}J( ;i.jO '" ',} ""I t.e, V .)~ ~ ~.. 'I ----.,.-.--.., -'- ,.-- -'" '/'~ ";/.) .> 0;>. I~ . OTHERD S2.W 2=5 .aD ~~eW FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER 1::3:;::~:!"'~(n TOTAL SEPTIC TANK 0 PU BlIC 0 o OTHER , ~ _ 27 !In 17 COUNTY BUILDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY DRAIN FIELD REQUIRED WITH DIS1. BOX: GAl. sa.'J UN. FT ~',)f\ .'-In.1 TRENCH WIDTH FT.f"::')~~"'.' ~ OR SQ. FT. TYPE OF STRUCTURE OCCUPANCY i,^,\ FROM ClR. OF ROAD RIGHT OF WAY lONE PUBLIC UTll. EASEMENT ."', ) BLDG. SETBACKS __ FT. FRONT Ltf'j' USE CLASSIFICATION SIDE INT. fi' SIDE EX1. AUTHORIZED SIGNATURE - DATE REAR 'j"f'lll': /-:/,1. ':'.. r:"JO c. ~(\:1i'tUCH ,lO';-: S,:nOll/'lM"?~-II\:; 1;/2817'1 DATE ("1. ,~. BLDG. PERMIT - WH ITE OffICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule all required inspections. All construc- tion sholl comply with Uniform Building Code, D.E.Q. standards IMPORTANT, for subsurfoce sewoge disposol ond county regulotions covering plumbing. All buildings require a' certificate of occupancy before being occupied. (See Detoils on Reverse Side) FORM == CSS-lJ (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 / / DISAPPROVED ~ DATE REMARKS GAS PIPING GROUNDWORK INSPECTOR ApPRO~ED / / 01 SAPPRQVED ~ DATE REMARKS ROUGH PLUMBING ApPROVED ~ DISAPPROVED L:::7 REMARKS ROUGH GAS PIPING INSPECTOR DATr& ---/?- JJINSPECTO~ r ApPROVED ~ DISAPPROVED ~ DATE REMARK 5 FINAL PLUMBING ApPROVED JX1 01 SAPPRDVED ~ REMARKS FINAL GAS PIPING INSPECTOR DATE?-2I' /~ - I NSPECT~ .M (/ ApPROVED ~ DISAPPROVEO ;---y DATE REMARKS CERTIFICATE OF OCCUPANCY INSPECTOR READY TO ISSUE / / NOT READY TO ISSUE / / DATE REMARK 5 INSPECTOR . . . ,. APOSEO SEWAGE OISPOSAL SYSTEH RrAD :.. .'.. INSTALLER:' Complete top part""form to signature and submit blll'copies with application. /7 PERHIT NO. .~-75. I NST.tJF~R' S NAHE /./ .! PROPERTY ADDRESS 9~~ 7.S rIP_'ll III ~- 170t DUKE S1. No~ Livi,g Units \B~d~oms Baths Basement Water S~IY ftf / Yes No ~ Public Other-List Septic Tank: Ft. from well Steel 0 Concrete rn No. Compartments / Gal. Capacity /(ltf})'?J Inside Dim~ions: F;- ~I ~ile Disposal Field: ,~ Lenqth ~J Width4'~j Diameter Depth 7tJ1 Distribution Box: Yes I' No OWNER I ROBERT N. HILL Other Distribution-Type NAHE HAILING ADDRESS 870 W. CENTENNIAL Lengj;h .oj... Li nes-Ft. 'Trench I .1.r27-S3. 4. 5. 6. Widthz" "lot Pla~(See instruct.ons): ~ ._-w \ Total Sq. Ft., -? DR> Feet from WEll Lot Li ne Front 1Ft. Between Lines i 0 Foundat ion /0 SPRING,IELO, OREGON S I de I 0 Rear I P IFilJ,l.r#L/I'lller Depth IFi11er)lelow T~IIAbove Tile 2. inJrile t, In. IV RECEIVIED ~-_. JUN 11 197~ I~~\- ~ ~~ COUNi1' I ~NVI~r1MOOAb M'iMT. p 2yi; \ t~~~~S;Ji, f.)o~' I H=t',',E- ..- --.JJ ~ i ~_r I /0#:' " r- ~~ I I I r, l.r~ () /I () -4.. r Signature It ~ 'J.,J If)';P'L.~1 CERTIFICATE OF SATlSFACTORVtCOHPLETlOpjl QI / 4&:: For Sanitarian Use Only: V Date: I ",-I - (....) In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certificate is I sued as evidence of satisfactory completion of a subsurface sewage disposal system at the above loca~ ~Approved: System Installation conforms to current standards c==J Disapproved: Does not conform to current standards Remarks: \ r ~ - ~ - ,- .----- Date (" ..... in - I 1..1 - / C55-11 ;,;.it::.I' ~ .IL Sk4 nltarlanfs Sfgnature ANE COUNTY STATE OF OREGON DEPARTHENT OF ENVIRONHENTAL QUALITY ~. .' LANE COUNTW,UILDING PERMIT OR MOBILE BUILDING 0 . MH 0- , MAILING ADDRESS ' I H9.' USE PERMIT PERMIT NO. / . . PROPERTY OWNER PHONE , CONTRACTOR MAILING ADDRESS , " PHONE PROPERTY LOCATION -INClUDE POST OffiCE -, . '" '\ PROPERTY LEGAL DESCRIPTION - ~ETES, BOUNDS ...... . . TWP RANGE SECTION TAX LOT NO. COD,~. CENSUS TRACT APPl. NAME & MAILING ADDRESS EXISTING STRUCTURES ON PROPERTY LEGAL ACCESS TO PROPERTY ..\ 1\' .." PROPERTY SIZE - FT. , WIDTH DEPTH AREA FOR MOBILE HOME PERMITS ONLY No. of Bedroo";'s . ~ ',\ - . !I- \. "- \.~ '.' "- STRUCTURES TO BE BUILT THIS PERMIT 'Connect" to Existing TYPE CONSTRUCTION S ....,... S 0 ewoge ystem SQ. FT.' :t+ BDRMS New System 0 VALUATION '. . \ ' \' .....' 1'_) '"" , ' \ ; , \ .....'r- ..) ,,-" . I . \';'~. ~ SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER I, , .. PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY , OTHERO j" ":. -J FEES SEPTIC TANK 0 - .' ~ PUBLIC 0 o OTHER ~ " TOTAL , MIN. SEPTIC TANK CAPACITY. WITH DIST. BOX; GAL. COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED L1N. FT TRENCH WIDTH FT.. OR SQ. FT. \' .~-. ........:., '" \-2..1 , '. "'f'" .J. .... '\R.-\ \". \ ' \.-.' ~..','\' . '\" ,\.' ~\" ',t .' ",,~'!"'~':.-lA"'. ,~"'~'\:--... ."..; ,,:{~l ,- , i\ c>.' 1.., '. ~~''''-'-' ~.'.' " V TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIl. EASEMENT BLDG. SETBACKS. FT. FROM CTR. OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT SIDE INT. SIDE EXT. AUTHORIZED SIGNATURE - DATE REAR DATE BLDG. PERMIT - WHITE OFF ICE COPY - WH ITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687-4065 to schedule 011 required inspections. All construc- lion shall comply with Uniform Building Code, D.E.Q. slandards 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 = 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 ":--- - . e " SITE I NSPECT I ON ApPROVED ~ INSPECTOR REMARKS FOUNDATION INSPECTION ~ APPROVED/~V ~ DISAPPROVEO~! DATE~..;'1~rf INSPECTDR~" . REMARKS', /f'{;Ad~n,&.Z~O: 7'-70 ('::%( &./1 ~,,/vvs.-=; I _ 1 Il . n /1.1 'II /1 /)b "'J,/ I vir L?J ~ dA-U-t"'tltt c~-%()< o€4J/2/t,"zidll,-II- (.tJl.% ('::. . r 1/ J FRAMING INSPECTI DISAPPROVED /7 DATE..t, ~/ / u ~NSPECTOR ~ ~I ~~l,~t1,,'1f I I ApPROVED REMARK S , LATH OR SHEETROCK INSPECTION / ApPROVEO~! DISAPPROVED .. ../ L-! DATE/> ..;2 :J .. :IIJ /) /. Iv . INsh~o:...-: ID I l.___ '. ',Ii REMARK S FINAL INSP;;?: /)# ApPROVEO DISAPPROVED!! DATE ~ IJ-7J' INsPECTol!;ill:: REMARKS/X,,;J;'4I1#141, t2 Iiaa.UI-I~~J'4.</ .7<A.r-7KM.' (LI/ q ~ , CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE ~ DATE INSPECTOR REMARKS rl/~-7S' - 6/1 /f)/I' ~/ ~~~ ~7 76d/ J 70/ i)~ - ~ r . . PERMIT lft....!.l.!i.c, -7.1 NO PERMIT WI E ISSUED UNTIL THIS APPLICATI.S BEEN APPROVED -- ~ APPLICATION FOR: ~ CONSTRUCTION ~ MOBILE HOME c:::J PLAN REVIEW og. OWNER~..Ld /'1 J..fdt!' ~zl..) ff7ZJ 'b./. Name Address [=:::J CONTRACTOR~ h d.&7 ,g~L .J...J Name Address NOTE: c:::J (l~~_,:L. Ciy C?/p_fl City CIUiliGE OF OCCUPANCY c:::J 77Y77- Zip , Phone 7t/~'9'1/C Zip '/c/L-4<;/6 Phone O.S. REG. C S) I Twp. ; tf Range D .:2--section (') (; fuJ!Lf!t{f-j; fl1LcL'J /t~. ~ Lot Tax Lot Code 3c: /; "I Census Tract ~."J, .-/....J.- , Widt~Depth lIP ::J;:L ACCESS TO PROPERTY (Road Name) il), J'. ..J~,.r Existing Structures on Property: ~~d~ Bloc k ..::J _3701 Property Acreage Property Location - Address/Directions: 3? 0 I /JJ..J .Jtv..l, +-i~'/'Y/' Oh..../ A~ rg.A?A~& 0 U /j .. ~ -~- .:........"'i:- -'1. ~ ' r J ~ for Off ice Use Onl vXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX:xxxxx:XXXX:XX Sq. Ft. (i)J/~. (IJ CBedrooms Valuation /IJ. ~'L _:" _ ~-~ / I. c'"3 /.3(7 ~o le1 v . '" - " , VEt! ~/:;7,'1t} -,' < I p-,,~. ~r) , i,,'''';,) , Below SEWAGE DISPOSAL: Site Inspection # Existing Sewage Disposal System Public cz:J Community rKJ c=J WATER SUPPLY: Well Spring Other or New .System Required c=J / / #'11 ....J" Name of cOmmunity or Public System 1:J)A.l~ / Other ~ame ~::::;,,~ .:), ~ tI FEES: PLUMBING: 7' .2.00 Installed by Owner c=J Bldg. Waste Diap. ;;),);" () PLUMBING FEES: Plumbing ---"'- ,r. () 0 7 n of Fixtures Plan Review Mobile Home 1% Surcharge 1./7 0 CASH TOTAL 1/Y-17 ~C~ Wa ter Connection -.2. PLANS FURNISHED FACILITY PERMIT ~ES c:::J NO Signature of APPlicant~~ Fee Received By ~ A--.. --/ I2J YES c:::J NO :J?~7J. dUe 1 " , Date: ~-.2.. ?-:?.....- Min. Septic Tank Capacity qoo Dr'ainfiell Required - Lineal Feet ./ tS-o I I L/ Maximum Depth :'4 Type of Construction 15 AI Group I t.:p''V Fire Zone Use Classification Bldg Setbacks - from Center of Road Right of Way: Front 45"" Side Int.-.-5 Side Exterior I Rear 1 P()tE. Zone 1<A.. PY'C,7-~ 1I,l.Ik cJ, '1('., DATE: ~NtON: D~~E~~ if fa li17.,- tM~/ kLU~~6' ..!;~ OF ENVIRONMENTAL a;"N~:~ENT / . CSS-1Z LANE COUNTY