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Home My WebLink AboutPermit Building 1974-8-5 Ol!.ffN ~; , i~j t..,. .. .,' \.' LANE COUNT.ILDING PERMIT OR MOBILE HOaSE PERMIT BUILDING 'il!l MH D ' PERMIT NO. MAILING ADDRESS James 30 Crosby Avenue Sprlngflled Oregon MAILING ADDRESS 1302-7;1' . PROPERTY O~INER Dean CONTRACTOR Same PROPERTY LOCATION - INCLUDE POST OFFICE Flamingo Avenue PROPERTY LEGAL DESCRIPTION - METES, BOUNDS Lot 2 Block 3 Farmdale PHONE 747-6434 PHONE //; Gb TWP RANGE 17 3 SECTION 22 ~ 'i' ?..- TAX LOT NO. pt: 2-00 CODE CENSUS TRACT 21-200 APPl. NAME . JllII1CS Dean EXISTING STRUCTURES ON PROPERTY None & . '30 .Crosby Avenue MAILING / ." AOORESS Spr I ngf I Uti Oregon FOR MOBILE HOME PERMITS ONLY No. of Bedrooms -STRUCTURES TO BE BUILT THIS PERMIT LEGAL ACCESS TO PROPERTY (..,~ \ Flamingo PROPERTY SIZE - FT. WIOTH 77 OEPTH 111 .36 AREA Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. :t; BORMS New System 0 VALUATION House Wood Frame 1024 @ 2180 Bar age Wood Frame 420 80 @l 5.30 @l 1. 50 22.323.00 2.226.00 120.00 Patio Deck , .9 Ae... PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK 0)( ~,'~~'" '/ OTHERD 112.90 FEES Wood Frame -.......~ PLUMBING INSTAllED BY OWNER 0 OTHER: NAME WATER SUPPLY ;t&f.OO~.UU SEWAGE DISPOSAL . PUBLIC []: o OTHER 22,-00 1% surcharge 1.34 $__ 1~'i.J4 COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN fiELD REQUIRED 150 L1N. fT TRENCH WIDTH fT. 2 OR SQ. fT. 300 TOTAL WITH DIST. BOX: GAL. MIN. SEPTIC TANK CAPACITY 900 24" Maximum Trench Depth " , TYPE OF STRUCTURE 5N OCCUPANCY I&J lONE AGT PUBLIC UTIL. EASEMENT FRONT BLDG. SETBACKS _ fT. FROM CTR. OF ROAD RIGHT OF WAY 45 USE CLASSIFICATION SlOE INT. 5 SlOE EXL AUTHORIZED SIGNATURE - DATE REAR 6PUE Isl J.E.Boss by C. Harbaugh DATE J. Shook/Sanitarian 8/5174 dm 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 = C55-13 (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. Of ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 . .",' - <. i . . ":Jtl> . ._:A" tl h ._ ..':l ,. ").. ,.. ....1> i OWNER 1/,..i17.f V' CONTRACTOR , ,',f' SUPPLEINT TO BUILDING PER~IT NO. ---f[itJa,lod. - 7'/ Lone County, Oregon ,." ) ,1)..-t~n MAILING ADDRESS 0L '--. MAILING ADDRESS ( fd'( Jlndtl It- , PROPERTY ADDR":C'" t- La IVl " /1 G 0 . 'v o ADDITION: ~ i'l" <;C I' 'I f 'f et- a IJ r1 ' :fr Q ~q9RRECTION: . \ CHANGE RESULTS IN: '0 REFUND OF FEE, OR o ADDITIONAL FEE: , ~ ~~ ..1 ()- , BUILDING :0: SEPTIC TANK "0. ("r-:- SANITARY CONNECTIONS TOTAL !l: 0 0---- DATE FEE PAID . ~-f'. ('(~ Cash Check LANE COUNTY DEPT. OF HEALTH & SANITATION Supplement N2 d . 1717 5 By LC,/rJ J (\OS0ll AIlt'. StY<!. v L-f ~ I~Lt:: 3~ ';.\ -:::>/. 7'/ Dalo 7 - ,) L. -~ ur ~!N " ~;. LANE COUN.UILDING PERMIT OR MOBILE BUILDING 00 MH 0 MAIliNG ADDRESS 30 CrC~JY ~vc~co MAILING ADDRESS HO. USE PERMIT PERMIT NO. / .' PROPERTY OWNER Q;;an Jc.~J:l SDrlno),i led Grq,;:m PHONE 7I.i,"ju(J)30 PHONE CONTRACTOR BCiJD PROPERTY lOCATION - INCLUDE ~OST OffICE 91mlojp Avc;'!:.:e PROPERTY LEGAL DESCRIPTION - METES, BOUNDS Lot 2 BUcxt~ 3 va7Qdolo TWP RANGE U7 ;) SECTION 22' '-( , 2.- TAX LOT NO. f$ Z 00 CODE CENSUS TRACT 21-200 ADDRESS Gprlo(JvlWd FOR MOBILE HOME PERMITS No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT Orc(;Cn ONLY EXISTING STRUCTURES ON PROPERTY CIon::! LEGAL ACCESS TO PROPERTY t:,')\ rlanlillj') PROPERTY SIZE - FT. WIOTH 77 DEPTH III .36 AREA APPL. J:;:::3~ GC:;:l NAME & ;!::l !;O'iX>~V Alfcm::J MAILING Connect to Existing Sewage System D TYPE CONSTRUCTION SQ. FT. # BDRM$ New System 0 VALUATION [-:::)t~no Ucod vrrn;:o 10:<4 @ ~~GO tJccd tlra::o ileO o !J.1I0 tlcctl vr<CJ 56 0 1.!iO K~ 'I ~rr'J. (~.' &70;,3 D.2..rj.c' PoC I 0 GcZ:, ~~J.C:::; ~"?:;9""!:: ---:-"'::'--,' (:'~'.i...-;"'J.'->O ' SEWAGE DISPOSAL PUBLIC 0 SEPTIC TANK 0 U BUILDING (. WASTE DISPOSAL PLUMBING PLAN REVIEW OTHE'O Ul2.~ fEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC c!r 0' OTHER 22.G3 PARK TRAILER TOTAL . 1.34 1]5.31f COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED I~O UN. FT TRENCH WIDTH FT. l! OR SQ. FT. sea i'i'\ cllrc.icPfj:! MIN. SEPTIC TANK CAPACITY ~JJ WITH OISl. BOX: GAl. aV r.Gllk.:hiJ Yre"ch ilqth TYPE OF STRUCTURE !?:J OCCUPANCY 15J ZONE AGT PUBliC UTlL. EASEMENT BLDG. SETBACKS __ FT. FROM eTR. OF ROAD RIGHT OF WAY I;,':. 5 FRONT ii SIDE INT. SIDE EXT. AUTHORIZED SIGNATURE - DATE lo! J.a.Oc!l5 t)11 C. I'.ari':lcur;~ REAR 6PUlr USE CLASSIFICATION J. Sh~A/Scniterlsn DATE G/~174 Qj BLDG. PERMIT - WH liE 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 subsurface sewage disposal and county regulations covering plumbing. All buildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) ~ORM "C55-1' (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 . ApPROVEO / / D,SAPPROVEO ~ DATE REMARKS GAS PIPING GROUNDWORK ApPROVED /7 DISAPPROVED /7 DATE REMARKS ROUGH PLUMB I NG ApPROVED .LJ.?:l Ot SAPPROVED .c::J REMARKS ROUGH GAS PIPING . INSPECTOR INSPECTOR DATE 9-/q.7Q INSPECTOR.d..---I!/ (/ ApPROVED ~ DISAPPROVED ~ DATE REMARKS FINAL PLUMB I NG ApPROVED fj?:J DISAPPROVED ~ REMARKS FINAL GAS PIPING INSPECTOR DATr/2-2/}'" 7'1INSP[CTO~4 , 1/ ApPROVED ~ DISAPPROVED /7 DATE REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE ~ NOT READY TO ISSUE / / DATE REMARKS INSPECTOR INSPECTOR ..... ~ j . j, ,,' .' PROPERTY OWNER - n~c:~ CONTRACTOR LANE COUN.UILDING PERMIT OR MOBILE BUILDING [J MH 0 MAILING ADDRfSS t:--:: ~ ;;0 \:fC:'~V tVC::::~~ MAILING ADDRESS HO. USE PERMIT PERMIT NO. ~ I Jft2.~7'f G~:?i;:,~1 Cd 07C;.~) ., PHONE 'i" 'J, ~",", >1''-' ,-~ ~ PHONE ~>~J PROPERTY LOCATION - INCLUDE POST OFFICE :0. ~ ell.;:...) (Lk;::: :~::; I PROPERTY LEGAL DESCRIPTION - METES, BOUNDS ~--_~~ ~~ :';0/_;.:::.:1. S ~~c:~:-,'~)D() , TWP APPl. NAME & MAILING ADDRESS BJi RANGE J ;) SECTION Ed' I, l~ TAX LOT NO. CODE CENSUS TRACT 2102:-~:) J.... .~--.:') ,;,::::": EXISTING STRUCTURES ON PROPERTY C:~~o ::;:.; :;~-.~:~ -v t\t:~~;:"::~ LEGAL ACCESS TO PROPERTY \ (lia!:;:,::) PROPERTY SIZE - FT. . 'nj " WIDTH " DEPTH : ~ . ~ J AREA ~:.~:':~~)-:'~~j \. C?::;' --:.J FOR MOBILE HOME PERMITS 'ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT SEWAGE DISPOSAL PUBLIC 0 BUIlDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER , 1'. TOTAL Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. :;:: BORMS New System 0 VALUATION ;:;~C~~I:~OC' :~,-':'~ t'r:.'_,) ;':~;~ ~~> ~'\Z\\..~\ , ~~~ -~\-~ '1~~~\~~~*\'~~~iv;. ';(~:;~~~ l'lr;).'~\ .,....... ,) anJ;J ::;;cd h C.;;:) C.f~ ~ G.J:J 0:'(, , '-"(~, ~,... '.' ,~~ 0 .',,'L: . .,.-...., j;~j "0 SEPTIC TANK 0 ~~ PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY . OTHERD ..0!J."J FEES ....w, \, ~\ ",. . \- ,," ,., , \ PUBLIC [::l o OTHER " :.. $" , J',:--~;"""'" ~ . 0 :.;~) ~ :~,).;.. J ., .' \.~ .... " " .~ ~ ,"" COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQl!I,RED I MIN. SEPTIC TANK CAPACITY WITH OIST. BOX: GAl. TYPE OF STRUCTURE BLDG. SETBACKS FRONT L1N. FT ,0 ';.l TRENCH WIDTH FT. OR SQ. FT. "" .,. .,', ~~. ...,. '..... .\..... } '. j'~ ~ "\--~'\\~'''-'-.. .\\,...?\~. ~\',c'\.~\:'\'\;: ~\,,' . - ,::-. .' ~ ' " ,.,.. :; \ . '\~~. ~\ .""'.,~~~~,~~~"'>>.~': '":' .\)~~~~(:". -t ,', " " '~ Of.<:~-i~l,.~,\ ",~:,,:,--<,",rt~.NE '\ '\ ~ ,\ \ ':;Vp"~lIC'IJTI". EASEMENT . r';:.n.x' \ ~ - ~ ~~'<;> \";JU.~~"""\ \ ., !~f FT. FROM CTR. OF ROAD RIGHT OF WAY SIDE INT. SIDE EXT. AUTHORIZED SIGNATURE - DATE DATE I':H ';'. r.. I '" . REAR :.DiJ;, USE CLASSIFICATION ( ',~ 0 - 0'. ,~ '.:y ',; 0 C:':7~;:::;::~ Uo ['::..:.. '!~;,.:JvCC::>~~_::l BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUilDING - GREEN SANITATION - GOLDENROD ~RM"'C55'13 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) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY. DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 . . '"'l. SITE I NSPECTI ON ApPROVED Cl DISAPPROVED Cl DATE INSPECTOR REMARKS FOUNDATION INSPECTION ~ ApPROVEO L.,?Lf~'SAPPROVEO /I DATE, 7{'-/ f-7i/ INSPECTOR ~ REMARKS-12fIliJ '..4 d.. ~ $r'~~"~ ~I ~ , 6r FRAMING IN~~C~N ApPROVED DISAPP~~ RE.MARK'S !;t~L!~ ~ j'_ (7- 30-7ttE4.. / LATH OR SHEETROCK INSPECTION ~;7 APPROVEO~ D,SAPPROVEO II OATE/O-/~r7f INSPECTOR{~ t( REMARKS FINAL INSPECTION DATE 'z~/g/1.j INSPECTOR~ /D-/'V?f/ ~ 11...f~n IR'_ n t: l' _ ~~j;:?kry. - 'I.'7Sr< Jc>"L.,; ~J. , CERTIFICATE OF OCCUPANCY READY TO ISSUE L:::7 NOT READY TO ISSUE L:::7 DATE INSPECTOR REMARKS . - /11 / e: ;r.,/ 4,~~ ~.y /3(/,j-'11 iJ~L cjf'~7~ -~ 'AI .' \\0,0 .::rllkWltJ/l-L..t:=. Cr~ ELI\:. 3 . J}A' H tlJ i&sft-f.,,' C:U <AX lOT ,ur'JID APPLICANT: App 1 i cat ion No. / 3~ t7? ~ /( NAME~ fIl; :"-I~)\r\ E..,- ADDRESS ' - . . .. BUILDING SITE EVALUATION . ( ) ( ) ( ) Bu i 1 ding Pe rm i t Site Inspection Pre-Permit Investigation PHONE DATE "7 -/'? - 7<::/ I. Zoning Ordinance Compliance (Zone ) Subdivision Ordinance Compliance NOT appl icable () ( ) ( ( ) ( ) ( ) NO YES NAME OATE LANE COUNTY PLANNING DEPARTMENT 3. 4. Required Access ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) JU (/{P --- 2. Building Site (Area, Width, Frontage, Setback) Other (see comments) 5. COHM ENTS : BU I LD ING INSPECTION SECTION NOT NO YES NAME DATE appl icable ~) 6.' Plans Subm i tted ( ) ( ) 7. Soil Stabil ity (footings) ~ ( ) ( ) 8. Flood Plain ( ) ( ) (JI~) 9. Ot her (see Convnents) Cj) ( ) ( ) 2'- 2.-"1 V - COMMENTS: ; SANITATION SECT! ON NOT NO YES NAME DATE aDDl i cab I e ~ - ArR~ 10. Sewage Disposal ( ) ( ) /' II. Us ab 1 e Area ( ) ( ) 5k) ~ 1V 12. Water Supply ( ) ( ) ( ) \bv;/?l~ 13. Other (see Comments) ( ) ( ) ( ) /)' -/' COMMENTS: n TO APPLICANT: ,,/1~ Cbr '11 Your (\},JI -(ij \}Y I() ( ) ( ) ( ) Building Permit / Site Inspection: Can be approved. Cannot be approved at this time as indicated on item NO. above. Questions and further information on items I 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 application fee is being returned under separate cover. 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 INSTALLER: Complete top pJlltSED SEWAGE DISPOSAL SYSTEM REC~ ~ part of form to signature and submit both copies with application. PERMIT NO. 1,6~-74 . -. INST~; Ni1/U'~ N~iving Units I Bedrooms Baths Septic Tank: Ft. from well Steel c=J Inside Dimensions: Ft. Lenqth <;( Width ~ Diameter OWNER NAME PROPERTY AODRESS J.S. Basement Yes No Water Supply Publ ic V Other-List James Dea'1 Concrete ~NO. Compartments I Gal. Capacl ty lt1r:JO Tile Disposal Field).,A') Depth ~ Distribution Box: (Yes No Other Distribution~pe HAILING _0 Crosbv Avenue ADDRESS S~rinafield, Oreaon Leng1.h of Li nes-Ft ."'7~ 1 Trench I ".~. 3. 4. 5. 6. Width1 'lot Plan (see instructions):' Feet from WEll Lot Li ne Front Tota \.~..:.. Ft. Between Ft. u..~ Lines !..t1 4,,7/01 t:' A"']' - Foundation Side IFlllerk IFi tIer Depth Type I j... Above Ti Ie f Rear kJ IF i 11 er Be low in.!Tile JJ. in. -. .-- 1J11' ,,--- '" fr(q{).S{ 1\ ~ Jr" I,' \., [10 ,l {.o~ . ~ \ .r' 7 .,/'" . 11>(<"" rG'C' T ./ (d fO",1 --- .- By ~ f C !E D V f D ~ , f AUGl G 1974 LANE CO ENVIRONMENTA~N!y lV/GMT. I l_ I // or-- ---,.. l- "rT _ I I AI E.. Date-7.~ - - ~- It"-- ity S i 9nature u..ar'"! {;l.; - ./ - (' /'- ' -CERTI ICA OF SATISFACTT~- MPLETIOt+" '/ Fo~anitarian Use Onl : I~ accordance with 19 3 Oregon Laws Chapter 835. Se Ion 214 this certificate as evidence of satisfactory completion of a subsurface sewage disposal system location. ~ Approved: System Installation conforms to current standards 1:=J Disapproved: Does not conform to current standards Remarks: KI~ f..pf \ Date: t ~/'f-7 f is issued at the above C55-11 r-V. itarian's Signature E COUNTY STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY , LANE COUNT_JIlDING PERMIT OR MOBILE HO.SE APPLICATION 'I' PERMIT TYPE - BUllDING~ 'MOBILE HOME i Jose REG. it _ PERMIT :#: /3 &dl -?Cf' \-.1'ROPERTYOWNER------~----- - MAiiiNG.-.;:ODRESS----- ---.----- -- - -.--------- --'--,:- PHONV -..P~AfIJ;J - ;JQ.J'n~_ _ _ .3lJ....C. ras);.Y__Bv..e~) _S#J_fJ.____ ____ ._ __~_~~L1.'L- 6<1.3_ ~RACTORe.... ) MAILING A~R-ESS r'.. .' PHONE ... $OJr7I ____ ____ ____ _ .. m_______ PltoPERTY lOCAnON - INCLUDE POST OFFICE i~~~~~~~ ~~~~~I~~--tt~~---'-e 1~~L.3 -- Fa ~ -- )_ TWP . - RANGE ---"'.- S~c: ' ---- TAX-'OT# - ~D4CA_-f' .3 APPLICANT .,. NAME VQme.9 AND 3D c...rDs~-y AVe. LMAllING , ~oRE~;Scn'n~:fl~loL\,_()r f..~ 0 J\. FOR MOBllEfHoME ~MIT ONLY J J Number of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT ...lU')tJ.~ e _ ~o.Y'~je.. (mf-f1cle.J) f'1.h n dpt>. f ' METES & BOUNDS DYES ATTACHED 0 NO /'J d2:l.... J)eah CENSUS TRACT ..::l1-.;l~O DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY Ylone.... LEGAL ACCESS TO PROPERTY - ROAD NAME OR # f:"lfl \'}'\ 'In q l\ . pROPERTY SliE-WIIUIl MPTH 111.3t. AREA '71 Connect to Existing TYPEl1;~'ON i ~ '7{>, WMd ~ hlE'# /)J~Pld -A-,.,", €' Sewage System 0 or New System :Req. 0 SQ.;, L) # 6EDROO~,\ V ALUA liON 1~'Lf[!;/...2.l1' I) t 3./ d:/" .%13. 20 4.:21'> ~~30 '-- 80 @ I_~ .;/} ;l.:l /,..JU> 1:1.0,00 .:14, '1.9..;1..0 SEWAGE DISPOSAL --.A.r...g~ PUBLIC 0 . SEPTIC TANK /".....c OTHER D BLDG. ' $...JI..2...o..0__ FEES WATER SUPPLY WASTE 015. PUBLIC ~ OTHER PLUMBING ,2~ . 0 (J PlUMBING FEES _C- FIXTURES IF. ()O P MBING INSTALLED BY ,!.Of) / ~ OWNER 0 OTHER IZH'I'A'M'/'1.. #11. ~ I~ r~ PlANS FURJ.lSHED ~~Y }''JIT 0 YES ~ NO [J YES D'V /~ ~G "JURE OF APPllC T 7. /(:/% r/. IVE B fjL-; -D!1T . .:I. IJ () /h.?r- _ 7, 1 C) ? r/ t'/"MIT # I r' .;2. 0 ~--.----l2 t, :2-7 .. PLAN REVIEW PARK T~. I O"/D ii, CASH 0 -) . 3 f-:.- CHECK ['l 135". 34 SEWER CONNECTION FEE TOTAL PUBLIC WATER CONNECTION FEE COUNTY BUILDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY WITH OIST. BOX. GAl. ,9 6 D 1.l.f /r m o.x , f.f'Q;~ DRAIN FIELD .REQUIRED TRENCH WIDTH FT. ~ OR SQUARE FEET 3 ():.'~ / // , / ;:i: ,~~;.{~"i':o;2?::T---.~; :::~:::."~,,," .~"::~'''~'"' · ~",.. ,;"~~'!i~'"~~~'7! '"'r~(PL ~~ ~___ - UN. FT. /stJ d ~p iL . ) -------- --- .- '------~ ----.~--- ~~_._-- COPY I - OFFICE ___ COPY 2 --;' JOURNAL COPY J - AUDIT ....._____~.. ~___ _._._'__n__ ...._...___~.__~.__.__._.___.~_ ______. _._____.__.__ Fnrm -!!: rr,~ '7 ",' . If . . '2-' ~lf 'l,.' 'flt( -2.-~ '2, ~ . ( 0 {j 'Z-p./ . l.-'\. (0 Yf:ri ~ Lf '" <.{J,. L <(ii ,. -.