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HomeMy WebLinkAboutPermit Building 1974-4-25 ',- ~<1f LANE COUNTY BUILDI. PERMIT OR MOBILE HOME USE eLlCATION . PERMIT TYPE - BUILDING'2< MOBILE HOME Dose REG. # PERMIT:#: (,..,05'- 7"1 rPR7!-~ ~~AI~~Z~:~H--<- ~~~4. -?:z4~N?35( CONTRACTOY ,/ MAILING ADDRESS PHONE I PROPERTY LOCATION -INCLUD&~ , PROPERTY LEGAL DESCRIPTION LOT - BLOCK - SUBDIV. TWP RANGE SEC. I, II D.'6 Q~,~.~. APPLICANT. ~ t.K~ NAME I';; AND /lT313y ~6 / ;~:~4);PAY/~/ - FOR MOBILE HOME PERM1T ON~ Number of Bedrooms STRUCTU}fS JO fE BUILT THIS PERMIT IfrlCJA '-/-, l5V\ SEWAGE DISPOSAL PUBLIC IZ1 SEPTIC TANK ""h!! fJ (~_-- FEES Srcl \~ clt hQ ,I o-v.) . hcv<:.;'P t91A. METES & BOUNDS 0 YES ATIACHED 0 NO TAX LOT # f:,7cm CODE _ '7 CENSUS TRACT 01 Cf-cw .2 I-I f)"t.1S DESCRIBE EXIST~f(;~S ON PROPERTY IF ANY ut ~ LEGAL ACCE~S TO PROP~TY ~AD NA~ O~ # (~\'n:P _ ~ My\ Kd... PROPERTY SIZE-WIDTH DEPTH AREA Connect to Existing TYPE CONSTRUCTION :?Q X 1'2- Sewage System D or New System Req. D SQ. FT. "# BEDROOMS VALUATION ;2b4 6)_12-. 31 {''T OTHER PLUMBING INSTALLED BY OWNER~ OTHER 0 NAME PLAN"S FLrRNISHED FACILITY PERMIT /' YES l'l( NO, 0 YES 0 NO &:,."- ___ SI~A.!UREY AP~~ / DATE CJ. ~;7R'.....f7~d----./ FEE ~ED~ Q(L. li-I b -7DtJ PERMIT # I / / BLDG. WASTE DIS. PLUMBING PLAN REVIEW PARK TRLR. OTHER 0 WATER SUPPLY PUBLIC k PLUMBn~.G)'EES 3- FIXTURES~ 3 $. q.- TOTAL 3t;. - CASH 0 S~ CHECK ~NNECTlON FEE PUBLIC WATER CONNECTION FEE = COUNTY BUILDING & SANITATION SPECIFICATIONS r MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAl. L1N. FT. DRAIN FIELD REQUIRED TRENCH WIDTH FT. / OR SQUARE FEET PwT 'VJ D r~n. +- D~ YJ".l<~ TYPE OF STRUCTURE .bIV OCCUPANCY / BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY FRONT ~4 S SIDE INT. S SlOt-fl:'. E: .,:!fi'L~ COPY 1 - OFFICE COPY 2 - JOURNAL COPY 3 - AUDIT Ilrrrrra... Form # CSS-12. ~n .5;/ / / / ~ZONE J ~ USE CLASSIFICATION REAR ~ /1 Date BLD 'pN' '.... ~ J 12. # / P Date '1-/7- 7 r? ~ ~ L/ -:..2q-;.. 7~ \ f / Ct!l"".J . C\l.Jed- REAR YARD PUBLIC UTll. EASEMENT