HomeMy WebLinkAboutPermit Miscellaneous 1973-1-16
PROttftERTY OCATION -INCLUDE POST OFFICE
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. . .
PROPERTY LEGAL DESCRIPTION
LOT - BLOCK - SU6DIV,
TWP RANGE
/7 ~3
LANE COUNTY BUILDI~PERMIT OR MOBILE HOME USE _ICATION
PERMIT TYPE - BUllDING'J2( MOBilE HOME Dose REG. # -"ERMIT # ~-13
PROPERTY OWNER . MAILING ADDR~ . /J /! PHONE
.bu.t. /11 d ..I..0~ :/ 5' 5 ~~ J~K&". ~...{fl.fJ./1i..L,
CONTRt;tTOR MAILING ADDEYS / !J 'l2b .l'H2FC '-15
-6 ~ //Cd ;;6 ._Y~kz.u....
/
Io\ifES & BOUNDS 0 YES
/ ATTACHED ErNO
~
J
;z.;2. . .t/. ~
SEC.
TAX lOT # CODE
b:200 1'f-iTO . . Wd;-.~6-iJ
DESCRIBE EXISTING STRUCT RES ON PRUt-lERTY IF ANY
J;du,~ -
~~~T~~; ?;!/>?~/. ~
PROPERTY SIZE-WIDTH DEPTH C/"'-""'- '-~REA~.-
CENSUS TR
APPLICANT
NAME
AND
MAILING
ADDRESS
FOR MOBilE HOME PERMIT ONLY
Number of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
~
M
tf~
Connect to Existing Sewage System D
TYPE CONSTRUCTION SQ. FT.
or New System Req. 0
# .EDROOMS VALUATION
,
, ".-.-.~.
A~dA.~
1
PUBLIC 0
BLDG.
WASTE OIS.
PLUMBING
PLAN REVIEW
PARK TRLR.
<
SEPTIC ~THER 0
FEES WATER SUPPLY
PUBLIC )(
PLUMBING FEES
PLUMBING INSTALLED BY
SEWAGE DISPOSAL
_ F)XTURES
CASH 0 S'~
CHECK ~t,iN'ECTION FEE
OWNER 0 OTHER 0 NAME
PLANS.!:lR~ED FACILITY PERMIT
YE~t"L-"I'lO i7'" ~ NO fl1'
~~ /_/~_D73
.~EIVED BY / DATE.
(A4)J ___ (J /-/0-7'3
~#3/73
COUNTY BUilDING & SANITATION SPECIFlyATlONS
DRAIN FIELD REQUIRED /
L1N. FT. TRENCH WIDTH FT. OR SQUARE FEET
.I.1.1l../
PUBLIC UTIl. EASEMENT
OTHER
---.2-D. 00
TOTAL
-2.-0. DC, _
PUBLIC WATER
CONNECTION FEE
MIN. SEPTIC TANK CAPACITY
R~ Itbo
.:J~ ~ -w7~
WITH DIS1. BOX: GAL.
/":"1 ,/,
TYPE OF STRUCTURE
OCCUPANCY
REAR YARD
BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY
fRONT Y.r- SIDE INT. ...r- SIDE EXT. .3 S-- REAR ~ I
SANITARIAN Da;e rLfrNI~L L..AU. Date BLDG. INSP. /) 96 _ __. A. ~ /?/ Date
_41.t)~/S'7.3. "~T""'7; ~J<I:n... ~y.'J ~y.t"t../-/~ -?_?
Directions to Find Property:. (/
@/AVV'~ ~~/U./.~ ~
I / f/
USE CLASSIFICATION
-
COPY 1 - OFFICE
COPY 2 - JOURNAL
COPY 3 - AUDIT
Form # C55-12
Holes are in
RECEIPT No, 20266
.
o.
. 17 03 22.4/+,s.
TWP. RANGE.._ SEC, 9~ 20
TAX LOTNO.51ee-CODE' -
August .~II 1966
DATE Y
A 726-7883
TEL. No..
I?4+-
REQUEST FOR SITE
INSPECTION
Rt. 2. Box 251
BY
I1ATTERN.
Elden
MAILING ADDRESS
Eugene. Orggon
OWNER OF PROPERTY Virgil Malv81ZE OF PROP,
CONSENT OF OWNER? ves NO
EXISTING STRUCTURES ON PROPERTY
LEGAL ACCESS? Nev~ Street
SOURCE OF WATER SUPPLY:
PUBLIC
xx
SPRING
WELL: DRILLED
DRIVEN
DUG
DESCRIPTION OF SITE (DIRECTIONS, LANDMARKS, HOUSE OR BOX NO" IF ANY):
Off Hayden Bridge to Game Farm Road to Kerns Avenue to Nova Street. to the very
end of Nove. Site is at very end.
PROPOSED USE OF SITE (NUMBER
Kingdom Hall Church
OF DWELLINGS, COMMERCIAL OR INDUSTRIAL USE, SUBDIVISION.):
140 members epprox.
LXi URBANIZING AREA,
L:7 SPECIAL PERMIT AREA,
Minor subdivision to be submitted
FEE:
NO. OF
NO. OF
SITES
ACRES
TOT AL
I
$
$
5.00
7.VU
RESULTS OF INVES.T;,mo" ~:-' 4~~tt'r-
~ ~.fr ./~.~~ ~ ~
.L~ ,~~~".~{50P.~
~ C'L~{~~y'~-7~~
~.,~.~,n_ ~~~-e~~~~~J~;.4~
~~;L i ~~~r~uv~i- .. ,-/~,v"-f7
~~~f~g.--ec ' ,4l:A. ~rU<.
r!~C/#!L 2t%7~ ?t;-:Jt:~~-cL~--r-
,$f.~,,- ,
BEFORE CONSTRUCTION IS STARTED BRING THIS FORM TO THE BUILDING AND SANITATION OIVISION AND
MAKE APPLICATION FOR A BUILDING PERMIT, IF THE PROPERTY IS A PORTION ONLY OF A TAX LOT, A
METES AND BOUNOS DESCRIPTION OF THE PARCEL MUST BE FURNISHED. EXACT SPECIFICATIONS FOR THE
SEWAGE DISPOSAL SYSTEM WILL APPEAR ON THE BUILDING PERMIT. TWO SETS OF THE BUILDING PLANS
AND PLOT PLAN WILL BE REQUIRED.
LANE COUNTY BUILDING AND SANITATION DIVISION:
C2.c~~
d
THIS REPORT
55..125-09
BuiLDING INSPECTOR
c{cp s~f::~--
IS NOT COMPLETE WITHOUT THE SIGNATURES OF THE BUILDING INSPECTOR AND SANITARIAN.
.I?-- /z;-!t
DATE
NOTE:
NO PERMIT WI~BE ISSUED UNTIL THIS APPLICAT~HAS
PERMIT 1;3b-?~
BEEN APPROVED
APPLICATION FOR:
MOBILE HOME [=:J PLAN REVIEW [=:J
[=:J OWNER r:~NameBj(.4-Al~e.~(:~d-re:s k ~~ Zip
fV'1 CONTRACTOR ~ tJ~ - 9r/ h.4~~. ~..7'7~tJ:1
~ Name Address Citi'f {/ Zip
O,S, REG. II 11t/t/y
'lWp. / 7 Range-!''?,
CONSTRUCTION ~
CllANGE OF OCCUPANCY
CJ
Phone
J 9'.3- Y'..2 ~ 7
Phone
Section ~.;;. 1./. 'I Tax Lot t..;J 0 0
Code /' ?-r:?1
Census Tract ~ 1- 3 0 ~
,
Property Acreage
ACCESS TO PROPERTY (Road Name) ~~f12J). /
/J /.1"'.. I
Existing Structures on Property: ~
Ad~p~G2J).
/
/
Below fa r Of f ice Us e On1 vXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Sq. Ft. / UBedrooms Valuation
~ y. ~-~. JI.A?:I-, r:,~.:T- //a/? /l/l
an...LJ..Jlbl? - ~ 'P!:.. / /
1 . V I
/
Subdivision
-
Lot
Block -
Width______Depth
Property Location - Address/Directions:
.~,,?,?
PLUMBING:
Installe,\ by Owner
PLUMBING FEES:
_____ 0 of
Existing Sewage Disposal ~stem
Public c====J
communitl f'7l
d
/
Fixtures
/
J
~
or New System Required [=:J
SEWAGE DISPOSAL:
Site Inspection #
WATER SUPPLY:
Well Spring ______
Other
Name of Community or Public System (i?~~
FEES:
Bldg.
Plumbing
3% Surcharge
Waste Disp.
Plan Review
Mobile Home
~~
TOTAL
//00
Other [=:J Name
Sewage
Connection
Water
Connection
PLANS FURNISHED
FACILITY PERMIT
//- aO
/?::J .233
D CASH
~
[=:J YES iL'9- NO C:J YES iKI NO
Signature of APPlicant-?A~J ~
Fee Received B;9-'7" ___ Date: /./9/.?',c
Min. Septic Tank Capacity
Drainfield Required - Lineal Feet
Haximum Depth
Type of Construction
Group
Fire Zone
Use Classification
BIdg Setbacks - from Center of Road Right of Way:
Fran t
Side Int.
Side Exterior
Rear
Zone
PlANNING:
DATE:
SANITATION :
DA~' ...... BUILDING:
. ~lD~S !" 0,
. I
ENVIRONMENTAL MANAGEMENT
J1I~: '~J.'')I)
C55-12
LANE COUNTY DEPARTMENT OF
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