HomeMy WebLinkAboutPermit Building 1978-8-19 (2)
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LANE COUNTY PERMIT
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Acreage or Lot Sizp
Contractor's O.S. #
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Partitioning #
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Lot
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APPLICANT'S NAME AND ADDRF""
OWNER'S NAME AND ADDRESS
CONTRACTOR'S NAME AND ADDRF""
Mail permit to (' .,) Applicant ( ) Owner
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) Contractor.
) Prefer to pick up. Call
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Phonp
Phonp
(owner, etc.) when ready.
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.,' STRUCTURES NOW ON TH,E. PROPERTY,
~HIS PERMIT IS FOR ,. '. ,". "-.
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# BEDROOM'" V...,# PLUMBING CONNECTIONS'lL'
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WATER SUPPLY
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SEWAGE DISPOSAl
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S.1. #
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THIS PROPERTY IS WIT.HIN ONE MILE OF THE CITY OF
PLUMBING BY
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I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: _owner of record;
contract purchaser; _ potential buyer; _ realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of
record, and that said owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit.
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Fee Paid :t. 'C '.. Signaturp ... /~..-,.. . -:r- JJ <,'/ _ -, - A. Datp -.. - rc..(' ~~ . rtf'
) NEW ADDRESS ( ) FACILITY PERMIT TO T;RANSPORTATION DEPT. (~),SPECIAL PM;. AREA. MIN. ELEVATION: L;A
SANITATION
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Minimum Septic Tank Capacity (Gallons)
Drainfield Required. Lineal Feet
Maximum Depth
BUILDING
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.,. !I~'" Type of Construction'. --, r::roup
,.., I: " J" Ilse Classification
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Fire Zone
_omments:
Comments: ..'. ,
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By: Date: ;' '.' /:By:'>>'/". -=) \ ,., I .~ -'\, Date: c;A :~,'7,;'"
PLANNING REQUIREMENTS SATISFIED. By:, T I . l Date:-- , _' ,. Date Issued: I.; .:i-;()
ZONE:, '; , \.. SETBACKS: FRONT,' . " " SIDE FACING'STREET- (FROM C/L) INT. SIDE YARD REAR (FROM P/L)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, 'OREGON 97401 PHONE: 687-4394
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C55.13
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POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. PERMIT - WHITE; BUILDING - GREEN; PLUMBING - CANARY; SANITATION - GOLOENROD; OFFICE COPY - WHITE
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SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED lET DISAPPROVED Cl DATE ~.;)b"7t" INSPECTOR ~
REMARKS ^'f~ .T....... ~- /6- "79 !?;J.
GAS PIPING GROUNDWORK
ApPROVED Cl DISAPPROVED Cl DATE
INSPECTOR
REMARKS
ROUGH PLUMB I NG
DISAPPROVED C1 DATES- ~-Jb INSPECTOR~
ApPROVED ~
REMARKS
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ROUGH GAS PIPING
ApPROVED Cl OISAPPROVEO Cl DATE
INSPECTOR
REMARKS
FINAL PLUMBING
ApPROVEO 0' DISAPPROVED Cl DATE..3~~?/ INSPECTOR W
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RE"'ARKS ~Vt.-
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VlU'i"'_' ~ I~"r_ ~~.a...d:--:( ~.-..I ~-~ ~-91 flJ- .
FINAL GAS PIPING
ApPROVEO Cl DISAPPROVED Cl DATE
INSPECTOR
REMARK 5
CERTIFICATE OF OCCUPANCY
READY TO ISSUE C1 NOT READY TO ISSUE / / DATE
INSPECTOR
REMARK 5