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Home My WebLink AboutPermit Building 1976-2-5 (2) , , .LANE COUNTY PERMIT FOR: . PERMIT NO, 122-16 .' CONSTRUCTION (X] ""~Jn () NAME MOBILE HOME (J PLAN REVIEW (J CHANGE OF OCCUPANCY [ ] :>4,!:> n""\lI n~,. SPI> . NFl'" , no. 01>. q7~77 726-0604 ADDRESS CITY ZIP CODE PHONE q7477 72&-1 'l20 ZIP CODE PHONE 3?~ ~^Tr~~y. ~PRINn~IVln. O~~ ADDRESS CITY EiJ Owner ~,^aI'")Y RI)DTl' NAME 01 Contractor ~)I"~UIPc.- O,S, Reg, # <> Twn 1"7 , '. 3RO. AOI). Subdivision Range "-3 ,;13'0.(, <{ Section ,.- .:,.'--' Tax Lot lit Codo Census Tract NOllTHl-iOOO EST'lotS 17_ Blocl< 4 Acreage Width Access to Property (Road Name): nll"A.~ n~_ Depth Existing Structures on Property: ~n~JlC' Directions to, Property , Address: o;:.h7? rhWh(l ng. STRUCTURE 1# BEDROOMS) ^...n.. or I nM_t". n.C!l" I M I 1\lIMn O""'\M SQ, FT, 1114 VALUATION 2.q87.68 BUILDING PLUMBING 3% SURCHARG~ MOBILE HOM~ WASTE DISPOSAL PLAN REVIEW SEWAGE DISPOSAL: EXISTING PUBLIC [] SEPTIC TANK [)J. OTHER [ 24.00 b.OO .90 PLUMBING INSTALLED BY: OWNER I laTHER r I NAMF . - -. --- WATER SUPPLY: PROPOSED [ ] EXISTING [I [ ] PUBLIC 10J COMMUNITY, NAME: [ ] PRIVATE WELL [ ] OTHER, SPECIFY: TOTAL .0,00 CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS MIN, SEPTIC TANK CAPACITY: GALS MIN, DRAINFIELD L1N, FT, MAX, TRENCH DEPTH INCHES TYPE OF CONSTRUCTION ,)-N GROUP FIRE ZON~ STAY 100' FROM ALL WELLS USE CLASSIF, SETBACKS 40\' FROM CTR, OF rNV: FRONT SIDE EXT, FT, FROM PROP, LINE: SIDE INT, ')' REAR 5' _ ZONF AGT. (RA) AUTHORIZED SIGNATURES: 1,1 J. E. BOSS, BY, C. HAR3AUGH ISSUANCE DATE: McKAY/CRUICKSHANK, SANITARIA~ 2-5-76 JI'I BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD IMPORTANT: Call 687-4065 to schedule all required construction inspections. Call 687-4061 to schedule all required septic system inspections. All construction shall comply with the State Buidling Code, D.E.a. standards for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) C:l:l.l3 LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 ~ (POST THIS PERMIT ON MAIN BLDG. AT SITE) -' ~ COUNTY ENVIRONMENTAL .AGEMENT . PLOT PLAN Name and Address of Owner Telephone: The building being, constructed under this permit will be used for Date this property was purchased Do you now, or did you ever own property adjacent to this tax lot? If so, please list those tax lot numbers or draw those properties on the plot plan below. Indicate on your drawing the location of all homes (including mobile homes) now on the property, as well as the location of the new building. - - - - -I""~ .n1 - .- - .. .. _ _ --_ ._~__ . _ _. "._ ...100 _ _ 1_ _ __ ",,1 __ _ _ _ __. _ __ ------ I ~,~ h -- -"....., - \ --i---". ----.- _..~---I'I~I._. . '1_ --- .----- - u -- - I .. ; - - - ", -- - (}/.:., .,- - --- ~:==-==-=~=~== - ~::~; =:.::::: ,- =~i~j ~'~"'/~ ====n _ ___=====_n __ ~:~!C~~ ~~~\~t(}=lL)H .~~/<)i ..... ., .. .. -= -=::::. ..' L --h'l;, -- , :::::i::::' -:-e) :~': -, ~\,:--:. ~::~ ~I~.<~=::- :-::'::::. .. -- ::t(~~' , ,-I<J~/-- ~' ._':\ : IL~)~ - '~1"'Y ' -'tP --------.--- - !-- - ',' ! " , ! ' !"'I-' . !---" . 'n_ ~.. __ _ _ , ._ i.. .. .. -.. -- .,' __ ." __ ". _ u Name of Applicant (if different from owner): Address Telephone Applicant's Interest: Buyer c=J M74-99 Seller D Agent D Map Tax Lot Permit II J' .' r /./ jI ." r .':_..-:" . ;-,., ~/ , I /..," //~ -'1'L /,' _.f_ ..;"I (1r.t"':"1J,..(l-c.-'\ ,/ , . - S'?,:-- r,;PfJ -/""f..A'I.AAl (.." 'I .:'- "'r'~"'" . / /..t ,?;,'n....._ ...." . v , PROPOSAL and CONTRACT Da'. / - s;:.- .19 7 ~ Tn !3/1RRV (.(). /3uRT:2. ~ .?</72 .Ou,.n.H~ /),,;1, .--. ,'I ,"'.K'.ur' r/~'u;> f'1<>.'1 ?V? 7 Dear Sir: T _ prppose to furnish all materials and perform all labor necessary to complete the following: ~./...cl;{ ::;~/ .A.-.r?)'>Y) ~ ,,~u.-;/~ "''' ....-':./,:~.JI 7'.;- h. j7- ''L/~'''M.i/l .Lf .I-dL. """,,M/w ~......~ f/'u-- ~'~ r fJ I" 1'-' fi...:- 1-J? ;( 'Y-{' . I..f , /7 l ., ' (J f, ," /J.d ' 'j ".~,.::> (-<,.{In. -- 'J'-!'''-d.'.A-,U''I/l-C-'-_y:; ;fA'/'A".I'---v.'.1 j"~''.:'__ ':"_ "" .. 'A .... ^,.J.j ,'C1-'/O, I,,;,-I!f .1~'lJ' M/:.,..,,, ,j( /t,a.... v-.f .t,-JA..~, /JrM1;fj ;:10 ..tL ~Ju).~j j;" t,.", "',0,.....'..:-... (f/.o,q,.~. ~."r:"" A..~_.t ~ J ~ r"-") /1 _,?1-,,;I~1,D.~'i.'-""-/ 1~.,.tr1 ('......J'1--vt.-<.--o.~. 4- . _ . .r. ,rl~"",.h-JA1U" ~; ,Po..L..,. ~-:j a~P.P .,,,--~ rr;.t;-Ij,.)~lt jd:;).~ -;t.f.,,7;-':'~. ,JJ~l tf.~,~ t':-k A-~ jJ~d to (U ,,-1l ^'- l' (~'3 ";-u_J;...y C J..,_ ../~J... ,t.., p'",,~-oo.JI.. <>UJ>^V1 , All of the abo~e :ork to be i;',mpleted in a substantial J"d workmanlike manner according to standard practices for the sum nf Dollars ( $.:2. '1f{?, "8 ) Payments to be made t1!",';'..-rYl r~y~ ~V'l-~ "p~'1~ -of: I P' CJ '" / ~ 4.1t:' ....,.\......A'..v. !'./.A':'I ,<,,{.r7JlJ/e ~L.,.-f'l-lA_Q./UJ . (/ , as the work progress6ll to the value of ' per cent .) of all work completed. TIle entiro amount of contract to be paid with;n ,5-- , '-- --' days after completion. Any alteration or deviation from the above specifications involving extra cost of material or labor will only be executed upon written orders for same, and will become an extra charge over the sum mentioned in this contract. All agreements must be made in writing. Respectfully submitt~n ~ If __-.p:l.~...iA A..../< ,'4~?p , <:::Ry (_ \'" ,,4-7<' 9?7r,^"I,/......~ f' '. ACCEPTANCE ~ You are hereby authorized to furnish all materials and labor required to complete the work mentioned in the above proposal, for wWcb agree to pay the amount mentioned in said proposal, and according to the terms thereof. AC":'W~. . i .,)l), . -/:1. UN~VV'.) \/ 0"'\(-j "'W :;x 1 - Date Iy VI l r .) J . .' '"' 'lb ,19_ ;" ~ < -.-,., \ \ / In Pad.. Th. UTILITY lIn.. Form No. 55.037 " Spiral Bound. Oupllcar. . Farm. No. 50-250 BU'ILDlbWi SITE {"-v ~~ . EVALUATION o/~ ~~I\\P PERMIT APPLICATION NO. \ (')1 BUILDING () SITE INSPECTION PLANNING DIVISION Not Appl icable ,1fft ~ ( ) ( ) ( ) /? It /I (d'~.-IlJ ~ /:-H~ - IJ 1. 2. 3. 4. 5. Zoning Ordinance Compliance: Zone Subdivision Ordinance Compliance Required Access Building Site (Area, Width, Frontage) Other (see comments) COMMENTS: /.1_ /7 A~ :..?3~fl;;;'f //' T. . (/'./S TAX LOT //& SUBDIVISI . LOT: BLOCK: APPL I CANT DATE No Yes CK'D BY: wflq" ;t7\k'Vl7~ ~) ~ 6. Setbacks from ell of ~oad: ( ) ( ) Front 'L/ !J ( ) ( ) S~or ( ) ( ) Setbacks from interior lines: ( ) ( ) Side .6 . Ii /' ,Rear 4,- ~'>1l-vv-e-.~ PLANNING DIVISION ACTION PENDING: YESl ) NOl ) APPLICATIONH Not Applicable No Yes () ~) TI () ()() ~ ~ ~ ~ ~ ~ CK'D BY:titU!:d-'J(p)'t . 'DAfE 1~,flh;;1.. .J~~~^/;1: ~J-' , /:' N)" d," . '" ;y1.,,':r1ft.ff7;;J:::vf'j;fj;}'}A;"';;'./w /...."' ", lor /./{l ',M /I 3 M/ f/# ./;1 , ;,) tAh/11 =-- r;{.,.- - f W ( /.A- BUILDING INSPECTION DIVISION 7. 8. 9. 10. Plans Submitted Soil Stability (footings) Flood Plain Other (see comments) WATER POLUTION CONTROL Not Applicable {0' ( ) 11. Meets Department of Environmental Quality Standards. 12. Other (see comments) COMMENTS: No Yes ~) TI ( ) ( ) CK'D BY: ~~ 1_rl---~JJh DATE TO APPLI CANT: ~~ Building I Site Inspection: ~Can be approved. 11 () Cannot be approved at this time as indicated on item NO. above. f) l\:1 // Quest Ions and further i nformat I on on items 1 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 buildinq permit ap'pl ication fee ,is bein.q r~turned under separate c:over. .crM~IMENT OF ~NVIRONMENTAL MANAGEMENT 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4186 C55-2B . t,' ".' I .,... / .'~ Bu'fLDltiG SITE EVALUATION A .lei' " ' .) :. ,. ,...' . ~ \, (').. BUILDING, PERMIT APPLICATION NO. I , . . () SITE INSPECTION PLANNING DIVISION Not Appl icable jiA/iT( ) '\I v , ( ) ( ) ( ) ( ) 1. 2. 3. 4. 5. Zoning Ordinance Compliance: Zone Subdivision Ordinance Compliance Required Access Building Site (Area. Width, Frontage) Other (see comments) COHl1ENTS: 1/ A /J 0;: {(--,"-kj ,.Jc,'/_' / J.,f:J::(' - /J /-'. )' . ',"...', T ; r .. () -;'S ,~ SUBDIVISldIP LOT: . OJ ,A " TAX LOT , BLOCK: APPLICANT DATE CK'D BY: ll,10..q" ,)71..'",. /~ 6. Setbacks from ell of ,road: Front .{ :i S J!!e..Exteri or Setbacks from interior IJnes: Side Rear L4'.{,l'~ ";;"'_..-I'~ No Yes () TI ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) I, t,- PLANNING DIVISION ACTION PENDING: YESl ) NOl ) APPLICATIONH , BUILDING INSPECTION DIVISION Not Applicable No Yes 7. Plans Submitted () () ~ 8. So i1 Stab i 11 ty (foot i ngs) () () ( ) ,.. /i ' 9. Flood PIa i n () (t ( ) /v' I. . I. 10. Other (see comments) () (n () CK'D By:r/,'~';,'a!.;:',:-'~::;'~' .;J., 1 I' DATE COMMENTS: /J!-I'A//;;.I>'i1I... -:1/f.1"':'1, /}/ 1/:";;/lJ~;'-Ajd~/4Z';;;. ,cf".-IvJ1':f;f;:'~. A/-"".._ _.>1/,/.(/ "'- ,,} r.-"/../J?I A/':{y,',"' '~_ Jf)-"'$( r' r-_'vf~/~:'f: ~ "f.{'l)A':'.;:/' .4'1)'-"A_,,~'I.'t. ......"'l:.t:,!!".. - ';t./f'j. ,1<. 1-"':'1/--1 l' . ( ~'.'. "'/ JflX:'~.' ~'//'/;,\ l;"-f.'f'/'t-J' fl,!;~jf/I~--?' ,._>~/-;'--,;'~ /~-IVJ'4/: ~;'~"'.-< .~_'/l.xr./;,-f/I/ , . 11' /:' ,/ , ,1/ / V i ~ . I, (.~ ,.....'1 <. WATER POLUTION CONTROL Not Aoplicable ( v)' II. Meets Department of Environmental Quality Standards. 12. Other (see comments) ( ) COMMENTS: . j ..., _1,' ~/ / l,. I.... " '" ,;, No Yes ()~ ( ) ( ) , CK'D BY: ~),Y\1L4'{"~1 ! - +.0.7"-" v DATE TO APPLICANT: Your Building I Site Inspection: AX.} Can be approved. / L () Cannot be approved at this time as indicated on item NO. above. ') ~'\ ,\ ,,0 ,Questions and further information on items 1 through 6 contact the LANE- \J' 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 application fee is being returned under seoarat.. cgye}"_ ~EPARTMENT O~ ENVIRONMENTAL hANAu~M~NI 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4186 C55-28 .. . aANE COUNTY PERMIT FOR: . PERMIT NO, j, ;'..--~' . ! ,~ CONSTRUCTION [X] MOBILE HOME [] PLAN REVIEW [] CHANGE OF OCCUPANCY [ ] DOwner "~!:\ ~;' ,-' ~'" . .'.:i~ NAME ~lL~ '. ~,~ I':.. :'j1"~-"'fNQ?I~':Lf~~ ,";.. Cr,4.,.....: ADDRESS CITY ZIP CODE .;c.-::,,"J::~/: PHONE ~ Contractor ('\-..' 1.' p- "'1(':~' IS:':" NAME ''''''1 i~;:'.~;""', '" :.,''':, ).......7 "'!.O.. /", :n:.:"i ADDRESS CITY ZIP CODE ~ (\c'-/''' J " ' . t ~~J PHONE O,S, Reg, # '" Tw~ 1'7 Range ~'" '.,' Section ~,:!! a Tax Lot Codp Census Tract '~.' :,. 'f); ~ . Subdivision :1r.P:~'J~/c-..1D CtJ'rli};itl it Block Acreage' Width Access to Property (Road Name): f ~~.,..;, <}i~. Depth Existing Structures on Property: :.o"'-~ Directions to Property - Address: ,.....r;? I~...f},~ i STRUCTURE (# BEDROOMS) --.~ '~rw. (u:."'~' ~~; ~ ~tf .'~;, "~_\L'"'! SQ, FT, r~;i VALUATION ~;,,:~/l.~'~:~ SEWAGE DISPOSAL: U.. ;:";j'" PUBLIC [J SEPTIC TANK [.J OTHER [ .:. ~ i PLUMBING INSTALLED BY: OWNER [] OTHER [J NAM" WATER SUPPLY: PROPOSED [ ) EXISTING [] [ ] PUBLIC [i>J COMMUNITY, NAME: [ J PRIVATE WELL ( J OTHER, SPECIFY: BUILDING PLUMBINI" 3% SURCHARGE MOBILE HOM" WASTE DISPOSAl PLAN REVIEW . ''f', r1 ~ ~,'~., ~., , L:.\J'.J TOTAL "'[:.:~) CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS MIN, SEPTIC TANK CAPACITY: ,; GALS, MIN, DRAINFIELD lIN, FT, MAX, TRENCH DEPTH INCHES TYPE OF CONSTRUCTION;-';' GROUP FIREZONF STAY 100' FROM ALL WELLS USE C LASSI F , SETBACKS,- ,FT, F'ROM CTR, OF rlW: FRONT . , ,'r II SIDE EXT, , '" J' FT, FROM PROP, LINE: SIDE INT," REAR 'J' ZON" (.':. (,,'.} AUTHORIZED 31'G'N'ATURES: " "",' "/ " a"o< /s/ ..),. ~ ,-' . ". 'L":.:;l ,..I;" '-J. : 1 lJ\ ,11):}l 'l",,,v/q"j,n', , '''K ,'. -- " -- ~\.;t\-l t.,~, $.".',;.',":. ~- I ....i1,,,~, ''1.' ' ISSUANCE DATE: ',.._ __r" c-'~;'~ r' BLDG, PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD IMPORTANT, Call 687-4065 to schedule all required construction inspections. Call 687-4061 to schedule all required septic system inspections. AI! construction shall comply with the State Buidling Code, D.E.Q. standards for subsurface sewage disposal and the Stale Plumbing Code. 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 ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th. EUGENE, OREGON 97401 C55.13 ~ . . SLAB FLOOR PLUMBING GROUNDWORK . , ApPROVEO ~ LTISAPPROVEO Cl DATE.~-~~-?L.. INSPE~ ~- ~,,,pti) t7. - Ak 74 (!J ..{" REMARKS....~ &u, N~Ik.. GAS PIP I NG GROUNDWORK ApPROVI:O / / 01 $APPROVED Cl DATE INSPECTOR REMARKS ROUGH PLUMB I NG ApPROVED Cl DISAPPROVED Cl DATE INSPECTOR REMARKS ROUGH GAS PIPING ApPROVED Cl DISAPPROVED Cl DATE INSPECTOR REMARKS FINAL PLUMBING ApPROVEO ~ 01 SAPPROVEO Cl DAn-"Y'- fl- ?t:: INSPE~~) " REMARKS FINAL GAS PIPING ApPROVED Cl DISAPPROVED / / DATE INSPECTOR REHAR)C,S CERTIFICATE OF OCCUPANCY REAOY TO ISSUE Cl Nor REAOY TO ISSUE / / DATE INSPECTOR REMARI( S ./ .' eANE COUNTY PERMIT FOR: . PERMIT NO, . CONSTRUCTION [] MOBILE HOME [] PLAN REVIEW [J CHANGE OF OCCUPANCY [ ] o Owner NAME ADDRESS CITY ZIP CODE PHONE '0 Contractor NAME ADD R ESS CITY ZIP CODE PHONE 0.5. Reg, # ,Tw~' Range Section Tax Lot Codp Census Tract Subdivision Lot Block Acreage Width Access to Property I Road Name): Depth Existing Structures on Property: Directions to Property - Address: STRUCTURE 1# BEDROOMS) SQ, FT, VALUATION SEWAGE DISPOSAL: PUBLIC [J SEPTIC TANK [I OTHER [ I BUILD IN" PLUMBING 3% SURCHARGF MOBILE HOMF WASTE DISPOSAL PLAN REVIEW PLUMBING INSTALLED BY: OWNER I ) OTHER I 1 NJlME WATER SUPPLY: PROPOSED [ I EXISTING [] [ ] PUBLIC ( ] COMMUNITY, NAME: [ J PRIVATE WELL [ ] OTHER, SPECIFY: TOTAL CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS MIN, SEPTIC TANK CAPACITY: GALS, MIN,DRAINFIELD L1N, FT, MAX, TRENCH DEPTH INCHES , TYPE OF CONSTRUCTION GROUP FIREZONE STAY 100' FROM ALL WELLS USE CLASSIF, SETBACKS, FT, FROM CTR, OF rlW: FRONT SIDE EXT, FT, FROM PROP, LINE: SIDE INT, REAR ZONF AUTHORIZED SIGNATURES: 151 ISSUANCE DATE: BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD IMPORTANT: Call 687-4065 10 schedule all required construction inspections. Call 687-4061 to schedule all required septic system inspections. All construction shall comply with the Slate Buidling Code, D.E.Q. standards for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of- occupancy before being occupied. (See Delai 15 on Reverse Side) (POST THIS PERMIT ON MAIN BLDG, AT SITE) C~5.\ 3 LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 . . '. SITE I NSPECTI ON ApPROVED ~ DISAPPROVED ~ DATE INSPECTOR REMARK S FOUNDATI ON I NSPECT I ON ApPROVEO L-! D,SAPPROVEO L-! DAn INSPECTOR REMARKS FRAMI NG 1 NSPECTlON ApPROVEO ~'SAPPROVEO! ! DAn 3, ;;L - 7 b Q/) /'-j . I NSPECTORl~" (;;, I. REMARKS LATH OR SHEETROCK INSPECTION ApPROVED m DISAPPROVEO 1/ DAn J ';L3-1? /";f/I I ~ /' ,2 . INSPECTO~ _' ~~ = REMARKS DISAPPROVED . , If) CJ DATEtI-/f1tl INSPECTOR.:;;'7 I ~ ApPROV[O REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE CJ NOT READY TO ISSUE CJ DATE INSPECTOR REMARKS //}~'1 /1 . -/.- {f '?/4Y/~ - -- Zd AA .tr1 ,,,,-U ~'"A_ /jY -'U/~ - ~ 5" . r/ oP~r /cJ)"76-V3~ :2 '-17 c2. . NOTE: .. .. PERMIT iF NO PERMIT WILL ~ISSUED UNTIL THIS APPLICATION ~ BEEN APPROVED /J..).-7f:,. . APPLICATION FOR: MOBILE HOME CJ PLAN REVIEW CJ .x CJ OWNER t8~ i3~ ":<7"72 ~t-<_..-..QA J __ I J/fJY?7 tl/1 ' 1(7 AddreSS) . C~ Zip iVl CONTRACJI14j{9/lXJ~ 3:J.:>S' (~jM(h, J.., . L..b 9;?Y?1 ~ Name Address 11 - - CiP/-....o Zip O.S. REG. II CONSTRUCTION CJ CHANGE OF OCCUPANCY c====J '):J..t.-!5(,9Y Phone ' ?;;., ~ -/.32.0 Phone I '1 Range ?, Secrion 1,(;u.J.. Tax Lot , . 1 I.... u, _ . C\\--lre{ /1.0.0.. -- 7 Subdivision~ (_~Lot ( )<. ACCESS TO PROPERTY (Road Name)~ c.t),,-, ~~ Existing Structures on Property: ~~ j Property Location - AddresB/D'\ctions: :2 t;? 2 CU."-<A"Lo4/)'-..:Q ~ )I Twp. Code Census Tract Block If Property Acreage Width______Depth " .J-,.,Ld ./ ~.--..<-- Below for Office Use Onlvxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx I\ddA ti Oh 144q,,;. UBedrooms (rjnc;.p In 1.\Vi~ ....-nn\(h.} .4 Valuation Y'~'1 <;<'7. (,.., g ./ /' SEWAGE DISPOSAL: Site Inspection # t:: ~ i 51\'" Existing Sewage Disposal System CJ or New S CJ Public [=::::J Other Community ~ Name of C nity or Public System WATER SUPPLY: Well Spring ______ FEES: BIdg, Plumbing 3 % Surcharge Waste Disp. Plan Review Mobile Home .1.,-\. 00 Co .00 ,'91i PLUMBING: Installed by Owner [=::::J Other Name PLUMBING FEES:tfJ 3 . ~ ~f Fixtures Sewage Connection Water Connection PLANS FURNISHED FACILITY PERMIT TOTAL ':J . o CASH :l,n.'U,) ~ECK []2t""Yts CJ NO Il YE/J~J ~O) Signature of APP~ r~J ,2.. J/ ~t5! J.I,U>';p Fee Received BY:~~ VtJ Date: -d.7~, Min. Septic Tank Capacity DL Drainfield Required - Lineal Feet Maximum Depth Type of Construction /' r~ AI Group I Fire Zone Use Classification Bldg Setb46ks - from Center of Road Right of Way: , ( , -c-f Front Side Int. '-.) SJ.de Enterier Rear .........,-1 Zone tl6. r( reA- \ PIANNING: DATE: ~,::/ ~ 7~ CSS-1Z LANE SANITATION: DATE: '-r\')~ IrA-,-,_>/I..dwJ:- (- COUNTY DEPAR'IMENT OF ENVIRONMENTAL