HomeMy WebLinkAboutBuilding Miscellaneous 1968-4-18
HOLES ARE IN
RECE I PT No. 400.2..7
-
.
~-
OUr OF
REQUEST FOR SITE INSPECTION
TWP. '7 RANGE "-.. SE~. 41
TAX LOT NO. ~RnO COD c1.S-03
DATE 4 _ ,0 _ r..~
TEL. NO.~~~
BY UARTWIr.K ~Aln
MAILING ADDRESS ~nn M~OTU ~7TU
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OWNER OF PROPERTY AROVF
CONSENT OF OWNER? Y~R
EXISTING STRUCTURES ON PROPERTY
SIZE OF PROP. ,on X ~40 LEGAL ACtESS?
Is PROPERTY CONTIGUOUS TO ANY CITY LIMIT?
,..,.., DI"\IIo" fI. ~
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Nntdt:"
SOURCE OF WATER SUPPLY:
~M~?~W
r;
SPRING
WELL:
DRILLED
DRIVEN
DUG
DESCRIPTION OF SITE (DIRECTIONS, LANDMARKS, HOUSE OR BOX NO., IF ANY): 3G9 GAME fARM ROAD.
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PROPOSED USE OF SITE (E.G., NUMBER OF DWELLINGS, COMMERCIAL OR INDUSTRIAL USE, SUBDIVISION):
DWELLIIING
~ URBANIZING AREA.
L::? SPECIAL PERMIT AREA.
MT (RS
FEE:
No. OF SITES-1-- $ ~ nn
No. OF ACRES
TOTAL---- ~ ~ nn
RESULTS Of INVESTIGATION:
,----
Iv.:>e> 17 K_U) S'e.C, .:;.(;;)..<;'1
I I) ) /
14x L Of Aia. <16"00 / 0 elf ~Y'c\uQ,cD
--.y(W th e / h S fQ U G.:.-1- ;d/U ts.e 0 Yle..-
<Suvlostu....p~ SewE:VCKfe. ciiopcuoJ1
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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!
BEFORE CONSTRUCTION IS STARTED BRING THIS FORM TO THE BUILDING AND SANITATION DIVISION AND
MAKE APPLICATION FOR A BUILDING PERMIT. IF THE PROPERTY IS A PORTION ONLY OF A TAX LOT, A
METES AND BOUNDS DESCRIPTION OF THE PARCEL MUST BE FURNISHED. EXACT SPECIFICATIONS FOR THE
SEWAGE DISPOSAL SYSTEM WILL APPEAR ON THE BUILDING PERMIT. Two Sf.TS OF THE BUILDING PLANS
AND PLOT PLAN WILL BE REQUIRED.
LANE COUNTY BUILDING AND SANITATION
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~ BUILDING INSPECTOR '
Dill}; PI n ()
r)Jj)0ffi Jl <0
- -SANITARiAN
~-~~-b~
DATE
THIS REPORT IS NOT COMPLETE WITHOUT THE SIGNATURES OF THE BUILDING INSPECTOR AND SANITARIAN.
u!t-Cln-07