HomeMy WebLinkAboutPermit Building 1976-4-19
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NOTE:
NO PERMIT wraE ISSUED UNTIL THIS APPLICATIAS
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PERMIT if
BEEN APPROVED
PLAN REVIEW c:::::J CHANGE OF OCCUPANCY c:::::J
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City P' zip
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City Zip
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Name Address
[=:J CONTRACTOR ~r'./L/~./d _n-'P~
- Na e ' Address
O.S. REG. II .I 0 ,1(~J:I~{f6
Twp. ,I 1 Range () ~ Section ~ 2---- Tax Lot Code
Subdivision ~I'~ ~ Lot~ Block ~ Property Acreage
ACCESS TO PROPERTY (Road Name) /~~,^.-.A ~)~~ ,-
Existing Structures on Property: I lI'~ ~(~
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APPLICATION FOR:
CONSTRUCTION c:::::J
MOBILE HOME
c:::::J
Property Location - Address/Directions:
Below
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Phone
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Phone
Census Tract~ --l51.~
Width______Depth
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or Of f ice Us e On! vXXX:XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX}QtxxXXX:XXXXXXXX:XXXXXXXXXXXXXXXXXXXXY~r,.,mYY1r.xxxxxx
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SEWAGE DISPOSAL:
Site Inspection U
or New System Required ~
WATER SUPPLY:
Well Spring
Existing Sewage Disposal System c:::::J
Public c:::::J
Community c:::::J
Other
FEES: PLUMBING:
--1-/ ~. to Installed by Owner CJ
Bldg.
1.:1 . fl (') PLUMBI?: Ft), ~
Plumbing
- <.lJ.j /? U Fixtures
3 % Surcharge -.-
Waste Disp. ","75- no
Plan Review
Mobile Home 0 CASH
TOTAL IfA~'Lf- ~
Name of Community or Publi~ System
Other c:::::J Name
Sewage
Connection ~
Water
Connection ~
PLANS FURNISHED
FACILITY PERMIT
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CJ~-
~~"'~
Signature of A
:~c Tank Capacity ql!ro Required p~l Feet I %0 Maximum Deptb ~
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Type of Construction
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Fire Zone
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Group
Bldg Setbacks - from Center of
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Front~...:.-_...:...-_Side Int.
Road Right of Way:
~ Side Exterior
~
DATE:
JI//~ / '7,t:
.2NITATION .
...L/..LIJ. ~___ . r
~ LANE COUNTY DEPARTMENT ~ ENVIRONMENTAL
CS5-12
Use Classification
-
Rear~ 'ptI.J3':one
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NAGEM~NT-' -/-' .