HomeMy WebLinkAboutMiscellaneous Miscellaneous 1976-10-18
Name
and
Addres<
Surname
L ·
Twp. Range Section Tax Lot Code
, -
-.J .' to.
Census Tract
Receipt No.
Date
I Owner
Owners Consent
Yes No
~EQUEST FOR SITE FEASIBILITY STUDY
S1 S 6a.'{v'\,C \-lA(('h
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT, ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
ARE AT YOUR OWN RISK:
No. Sites
$ "
$
11,
No. Acres
TOTAL
s
"
Telephone No. 'Appl i cants Interest
,,: ,I;' '..."
Property Size Legal Access Road
1
Existing Structures
Proposed Water Supply
Publ ic District Sprinq We! I
in Property I Prop?~e~~se of Property
Name ISpecial Permit Area I Urbanizing
Yes '" No Yes .. No
Is Property Within One Mile of a City?
What C i tv? . IJ . r .1' ." ' Yes No
Other
Specifv
Area
1,
8EFORE CONSTRUCTION IS STARTED bring this form to the Department of Environmental
Management and make application for a building permit. If the property is a por-
tion only of a tax lot, a metes and bounds description of the parcel must be fur-
nished, Exact specifications for the sewage disposal system will appear on the
building permit, Two sets of building plans and a plot plan will be required.
LANE COUNTY DEPT, OF ENVIRONMENTAL MANAGEMENT
135 EAST SIXTH AVENUE, EUGENE, OREGON 97401
Authorized Signature
C55-32
Date