HomeMy WebLinkAboutPermit Building 1976-4-8 (2)
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. lANE <;''lli~TY ,P.ERMIT FOR:
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PERMIT NO. 620..7(j
CONSTRUCTION [,] MOBILE HOME [] PLAN REVIEW [] CHANGE OF OCCUPANCY [ ]
o Owner Leroy Taylor
NAME
o Contractor Same
NAME
O.S. Reg. # NA
Twr 10 Range_LSection 6.4.2
Subdivision
NA
Lot
Access to Property (Road Name):
Existing Structures on Property'
Directions to Property - Address:
STRUCTURE (# BEDROOMS)
~~~~~ ~~~ ~:~~~~1~:
O.o"\!llr, _ ^".:. !oHio" M:lr,o """0.
3705 Garden Avenue Springfield Or~gon
AOORESS CITY ZIP COOE PHONE
ADDRESS CITY ZIP CODE PHONE
Tax Lot 800 Codp 19-28 Census Tract
Block Acreage Width
Garden Avenue Depth
None ( Housel
nfl... M!:).f... C+~n'" ...... c.......,f.......oP.;,,1,.t ....... .,,,.......
..-... --.--- ... -,... ....... --.- -- --..-
~~ ~~~~~ ~~~ ~~:~~ ~ ~~~=:~ ~~:~~a
SQ. FT.
VALUATION
$1 fi Q 00
":ton nn
r-:'~~ 1:: ;::~~
$4fi9.00
SEWAGE DISPOSAL:
PUBLIC [] SEPTIC TANK [
BUILDINr. l; (l(l
PLUMBINC'
3% SURCHARGF 1 ~
MOBILE HOMF
WASTE DISPOSAl
PLAN REVIEW
OTHER [ ]
TOTAL
5.15
Exisg
PLUMBING INSTALLED BY:
OWNER I I OTHER I I ~IAME
WATER SUPPLY: PROPOSED [ I
EXISTING []
[ J PUBLIC
[J COMMUNITY. NAME:
. [ ] PRIVATE WELL
[ ] OTHER. SPECIFY:
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY:
GALS MIN. DRAINFIELD L1N. FT. MAX. TRENCH DEPTH INCHES
TYPE OF CONSTRUCTION
'iN GROUP
SETBACKS. FT. FROM CTR. OF rfW:
FRONT SIDE EXT.
AUTHORIZED SIGNATURES:
Is! " ~ Rf\I!'~ ...." l..b"'l'ohDaI"h,
- - ---.."
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT:
T
STAY 100' FROM ALL WELLS
USE CLASSIF.
FIRE ZONE
FT. FROM PROP. LINE:
SIDE INT. REAR
ZONF
4/8/76
ISSUANCE DATE:
tilm
Call 687-4065 to schedule all required construction inspections. Call 687-4061 to schedule all required
septic system inspections. All construction shall comply with the State Buidling Code, D.E.a. standards
fOf subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy before being occupied.
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
(See Details on Reverse Side)
C!S!S.\3
LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
NOTE:
PERMIT #
NO PERMIT WILL BE ISSUED UNTIL THIS APPLICATION HAS BEEN APPROVED
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APPLICATION FOR:
CONSTRUCTION ~
MOBILE HOME CJ
PLAN REVIEW. CJ
CHANGE OF OCCUPANCY CJ
XCJ
OWNER f4111/!f11 Ifl.l e..;;. C/
Name -- I
27~~ I?a.rde.<<
Address
, .
q. 7 t:.77
Zip
7 t,I~ - 3!i>3"
Phone
c:==J CONTRACTOR
Name
Address
Zip
Phone
0.5. REG. U
ACCESS TO PROPERTY (Road Name)
.:<705
(P. '-/.,?, Tax Lot S 170
(;a~'.Y ,,~.," ..,-.
&,J;i '"nL~~~ ~d V-" 3;;1.."'-<1-
...)z,<:.;; ~ ~ or- "*' L ~ ~ U.L..A-n
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19 -~e
Census Tract
x: Twp.
J9
Range ;?
Section
Subdivision
Lot
Width______Depth
~Existin8 Structures on Property:
'>( Property Location - Address/Directions:
WATER SUPPLY:
Well
~//~ .:;>:1"""" -fa
&7J-rd~k
Below fo r Of f ice Use On! vxxxxxixixxxxxxXXX:XXXXXXXXXXXXXXXXJ0CXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXx:xxxxJCXXY1fV'1r"lnr'1nrxxxxxx
J ) _ (\ / Sq. Ft. IJBedrooms Valu8ItJ.on-
l\. e...rrx-'i A/I -
KK'Clk- -C')tIT lA~ \ \ - ~K-e t"'r\.\..E' ~. \Clr?1e1 .'?01:>.-::
I V 1./ /.~
I I v /.
\istlng sewag) Disposal System ~ or New System Required r-t
, I L--.J
\ rublic C=:J____
Other \ /community b::::::J Name of Community or Public System
\
PLUMBING\, I
Installe\ by Chiner C=:J
PLUMBING ~EES: I
\ III of Fixtures
'., I
/0
ri
SEWAGE DISPOSAL:
Site Inspection U
Spring
FEES:
Bldg.
6-
Other C=:J Name
Plumbing
3 % Surcharge
, , "S
Sewage
Connection
Water
Connection
Waste Disp.
Plan Review
TOTAL
6,16
\
.,
o CASH'
~\
PLANS FURNISHED
FACILITY PERMIT
Mobile Home
c=J YES ~ c=J YES ~
Signature of APPlican~ /1 ~~.~(JC..-?< ;-L ~
Fee Received By: R P ~ate: If - '5J:7.b
~.
Min. Septic Tank Capacitv
Drainfield Required - Lineal Feet
Maximum Depth
Type of Construction
,;--.{/ Group I
Fire Zone
Use Classification
Bldg Setbacks - from Center of Road Right of Way:
Front Side Int. Side Exterior
PIANNING: DATE: . SANITATION :
~ CSS-1Z LANE COUNTY DEPARTMENT OF
Rear
Zone
DATE:~~K~:f;~ 7?
ENVIRO~~Lt::GEMENT .....
3"10S GFt""Dl:r\l fWE
v o.
. .
. LANE COUNTY PERMIT FOR:
.
PERMIT NO.
CONSTRUCTION [ ]
MOBILE HOME [J PLAN REVIEW [ ]
CHANGE OF OCCUPANCY [ ]
NAME
ADDRESS
CITY
I i ~ ~
ZIP CODE
~!l}V
. jq(:~
~ONE
\'l\ ",.to "'0.....
PHONE
\\"!I- M c,-
DOwner
~~'"C1
.;., I
\ .
'"
. ~ ,-,
., ,:r;.
o Contractor
NAME
ADD R ESS
CITY
ZIP CODE
O.S. Reg. #
Twp
Range
Section
" ;
.".1.... '.
Tax Lot
Code
Census Tract
Subdivision
Lot
Block
Acreagp
Width
Access to Property (Road Name)'
r:
,- .
\;.. ,';:'1
Depth
~
Existing Structures on Property'
-'I"
,
"",", \
\.'~. . ,
Directions to Property. Address:
r: ~^
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.. _. _." '.~ 1'.,
. 'f .
-,."." r"'.,':
r".
....,l
(',l ~ -'.
-., r~_,
~
^
STRUCTURE (# BEDROOMSI
SQ. FT.
VALUATION
.Iw_........r..
. "J .,-, ,
~ ., :,~ '~...,
. "
SEWAGE DISPOSAL:
PUBLIC [I SEPTIC TANK [
BUILDIW'
PLUMBING
3% SURCHARG" ".
MOBILE HOM"
WASTE DISPOSAL
PLAN REVIEW
OTHER [ ] l~ ";\r'_~
PLUMBING INSTALLED BY:
OWNER [J OTHER [] NAMF
WATER SUPPLY: PROPOSED [ J
EXiStiNG []
[ J PUB L1C " .
[ J'. COMMUNITY. NAME:
[.J PRIVATE WELL
[ I OTHER. SPECIFY:
t..J
-J
~
(j)
~
~
.,
"
TOTAL
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY:
GALS. MIN. DRAINFIELD L1N. FT. MAX. TRENCH'DEPTH INCHES
TYPE OF CONSTRUCTION
GROUP
FIRE ZONE
STAY 100' FROM ALL WELLS
USE CLASSIF.
- .
SETBACKS. FT. FROM CTR. OF r!W:
FRONT SIDE EXT.
FT. FROM PROP. LINE:
SIDE INT. REAR
ZONF
AUTHORIZED SIGNATURES:
/s/ '~.. -
. .........
ISSUANCE DATE:
'; 't., "
, '"
-E;'
~
I
~
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT:
Call 687-4065 10 schedule all required construction inspections. Call 687-4061 10 schedule all required
septic system inspections. All construction shalt comply with the State Buidling Code, D.E.a. standards
for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of.
occupancy before being occupied.
(See Details on Reverse Side)
v
,
.....
~
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
CS5.' :3
LANE COUNTY. DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
.
.
SITE I NSPECTI ON
ApPROVED Cl 01SAPPROVEO Cl DATE
INSPECTOR
REMARKS
FOUNDATION INSPECTION
ApPROVED L-/ 01 SAPPROVEO L-/ DATE
INSPECTOR
REMARKS
FRAMING INSPECTION
\
'---
INSPECTOR Iv
............... 6r/J ''16
APPROVED?#i/ / 17'JFROVED";---] DATE
REMARK/ ZJ~~~'
A'fhAnJl/ . "".;.I t1~7'" II ~I
.
LATH OR SHEETROCK INSPECTION
ApPROVED L-/ DISAPPROVED ;----y DATE
INSPECTOR
REMARKS
~L INSPECTION
~ ~.^.~j ~l DISAPPROVED Cl DATE j1::2.3-~ INSPECTOR_ ~~
REMARKS ~ ~A
'l-?-~'XZ- ~ "---,Ilf'~i"P~ /~ ~~;~~J/ L
/G> .
~
CERTIFICATE OF OCCUPANCY
READY TO ISSUE Cl NOT READY TO ISSUE Cl DATE
INSPECTOR
REMARKS
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