HomeMy WebLinkAboutPermit Miscellaneous 1976-7-15
NOTE:
NO PERMIT WI~E ISSUED UNTIL THIS APPLICATI~S
APPLICATION FOR:
PERMIT td77~-?b
BEEN APPROVED
CONSTRUCTION ~ MOBILE HOME
CJ OWNERJo" , 6I.-J ~,'~ f( '" "'- (
Name
CJ
PLAN REVIEW CJ
CIW,GE OF OCCUPANCY CJ
~CONTRACTOR
I1'Lf/~_ (I~... (I
Name
L:,~<'?",~." f(d (I",-, w~/I
" City Zip
---
718r; yj JJ+1. .l: /J 5'''''''' e.
Address City
.:?;;) C I
Address
.ft?<;'-..<~
Phone
(Ie
'97'/02-
Zip
~?-Y'-/,(,'.<'"'
Phone --
O.S. REG. II
I
,
Twp.
/7
Range
..:J
Section
.:::> '2--,LJ~Tax Lot
,{, /i' ,.",.,
Code
/9-c:'3"
Census Tract
Subdivision
Lot Block ,.
ad""'" hi,..",., RJ,/
Property Acreage
Width______Depth
ACCESS TO PROPERTY (Road Name)
Existing Structures on Property:
JI A? "
ce,
Property Location - Address/Directions:
.<;' ~.
('.,.,/1 ffl '" r:;, or 1?1 k' ~J
s P-_: k ", .r: - ') tfJ.-e'l
Below fo r Of f ice Use On! vXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
em nA ~ _ ~ S4: x3 fa <t 6t1';jdroog, ~O v;}.':57Q.2n
I.' r I: ,(i () - _ ' ,~ -
'I?CJ/f ?~' <~J F ~(~'/~~./WJ
SEWAGE DISPOSAL: S ...A"
Site Inspection II eu.)f,',
WATER SUPPLY:
Well
Spring
Existing Sewage Disposal System ~
Public ~
Community c:=J
or New System Required c:=J
Other
Name of Community or Public System
FEES:
Bldg,
Waste Disp.
Plumbing
Plan Review
Mobile Home
1% Surcharge
:s;2,-
PLUMBING:
Installed by Owner c====J
Other c:=J Name
PLUMBING FEES/'j
A) 7 I( "i-l<t'ures
Sewage
Connection
Water
Connection
PLANS FURNISHED
TOTAL
~1..<j~
~
Signature of Applican :
Fee Received By:
'~mR~'
~~~ E~;~
~.JC" ;r~~h
.'1h
o CASH
CJ YES
.......~
Min. Septic Tank Capacity
Drainfield Required - Lineal Feet
Maximum Depth
Type of Construction
/
(~ It!
--
Grou,,~J Fire Zone
_Use Classification
Bldg Setbacks - from Center of Road
Front u:;-D Side lot.
Ri~t of way:______
~ S~xterior
Rear
/'
~
Zone
~
P~<<Z4:' ,lk'y1/0'11 &,
~
DATE:
SANITATION:
DATE: ", .A:"IIJJING:
.( r'("~ /!,' ;~-1
,If', ...~t ~
ENVIRONMENTAL/MANAGEMENT
.& hlATll; ~ fh
.d#I!::t. ;y~/~ ~X'cJ
(;/
LANE COUNTY DEPARTMENT OF