HomeMy WebLinkAboutPermit Building 1978-9-20
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LANE COUNTY PERMIT "..... FT .
Acreage or Lot Si7~ ..,,- .4-c, Partitioning #)1 312:.2l.~Completed
Contractor's O.S. # AI I<- f/#..Ce.i.. ;l-
APPLICANT'S NAME AND ADDRESC: 1JI't/ll 01 11-0 rf ~ f'-S - //.2J- .)l'iI), Ue -fl,'t:.l'-IJ.t:
OWNER'S NAME AND ADDRESS L -,e" '1' tt!t.YLo~ - ~~d~__ Ru,,--'~ sf' FL_rI
CONTRACTOR'S NAME AND ADDRESC:
Mail permit to ( ) Applicant ( ) Owner ( ) Contractor. J>\') Prefer to pick up. Call t:F9- -::21/.2.
Alo-r,vc. y
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Subdivision
Lot
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Phone
(owner, etc.) when ready_
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STRUCTURES NOW ON THE PROPERTY_ _______,__.__
_HIS PERMIT IS FORl2u-"<.bj..~~..e. 0 Jif x..'O-).{ ohJff_jA~!!,:/. ZAlff,IJL( ~~ = SEDROOMS--3'.3 PLUMBING CONf'!ECTIO;";S~_
WATERSUPPLY f,Je-L(" ,SEWAGEDISPOSAI S~.Pf'tL ~<;y5J'-",,bt S,I.# 7i-5-~.:L-
AJr'T
THIS PROPERTY IS WITHIN ONE MILE OF THE CITY OF
,PLUMBING BY Llf\K r\"'J,,~.10
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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 lif nO! 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.
Fee Paid S '7[;, 90 Signaturp/,/ 1I//fIolC y' !Ior/(; E.5 Date ~//'7.Y'
(Xl NEW ADDRESS M-FACILITY PERMIT TO TRANSPORTATION DEPT~L (~EC~AL PMT. AREA, MIN, ELEVATION:A/....Lf-_
SANITATION ~'? b~(.fco().~ BUILDING
/oC':~? Minimum Septic Tank Capacity IGallons) ~.H-_ .:!i'pe of Construction M~Grol!P ~__Fire Zone
'75 (:) Drainfield Required. Lineal Feet SEJ> Use Classification
. zv ~.1aximum Depth -te k ~.ti. --' ...:C c.o- '~
L. I L "',,-'"'' ,U.-..j.-;j,~{.;c'" s.,~t~..... ,~ <'cC<i ;:::;;.ents: 00'\0," " ..,( -~ '00 ~.-fn 'h',-
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mments: "'''''' _ -Mo.r- _ _ _ , . ........... ~
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By:/ 6. ..J~ /l..--i Date: 9/oU/7? BV~..J.>." Date 1-':2-&-7.'
,-",~ PLANNING REQl/fREMENTSSATISFIED. 8y: ~N/JJIf-Lc-E-) <!IC5 Date: 7'; // 7'.Y'" Date Issued:":::-zK
~NE: I1C 1; ~- 2ETBACK,?,: FRO~T 60; SID_E FACING STREET NI't-(FRO,M CILl INT. SIDE ,YARD~ REAR ~ {FROM P/Ll
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE_, EUGENE, OREGON 97401 PHONE: 687-4394
C55-13
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. DEP:MIT - WHITE; BUlLDING - GREEN: PLUMSING - CA~ARY: SANITATION __ GOLDENROD: OFFICE CO.,.( _. WHITE,
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Job Location (Street, mile post) ,::57 ()~ Jjo crI p.n ffi..l.C?" n (. Jc:.....
Subdivision
Lot
o Needs Correction
FOR SANITARIAN'S USE ONLY: ~~~n;~.~~_:...sYs,tem Disapproved
COMMENTS: 1i11bir_ ~
,_'.',__ Signature: ,,(/ P1...d.;:.r
FOR INSTALLER'S USE: Trench Depth 1.'1 Filler Depth Below-t-ii~ _ t1
Tank Capacity Ie c' C Manufacturer.L.c, (_, r <;".,.{
Measured distance to well from tank /C (i fro~ drainf-ield..il S
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INSTALLATION RECORD AND CERTIFICA E OF SATISFACTORY COMPLETION
When signed by the County Sanitarian, this certific e is evidence as per qFt 454,665 of sat.
isfactory completion of a subsurface sewage disposal sstem at the above \oqallon.
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Retern this form to: Permit Processing Section, Departme t of E.t'."i- . . '.
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