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HomeMy WebLinkAboutPermit Building 1974-3-20 ~ I. I , ! \ IV'\, ~ LANE COUNTY .LDING PERMIT OR MOBILE BUllDINGli!9: MH 0 MAILING ADDRESS HOM_E PERMIT PERMIT NO, '..,' '. -I' .' PROPERTY OW,~ER ?.-rr is!.. GLry l. CONTRACTOR S.-r.:c PROPERTY LOCATION - INCLUDE POST OFFICE j\bovu PROPERTY LEGAL DESCRIPTION - ME~~S~OUNDS.././ i1.-n-lll i n9 !1 crcs I?I:.f -I /'-1-/ TWP RANGE SECTION 21::0 n. 19th St. MAILING ADDRESS S')rinr<'iclcl. Or:'t"on TAX LOT NO. CODE CENSUS TRACT 17 ....... ,. 1L -' . ;(~.;l.1 1ii!!!Ji6. 38'1> I 19-0l EXISTING STRUCTURES ON PROPERTY n~ollrn~ end CQroort LEGAL ACCESS TO PROPERTY Iqth StrcClt PROPERTY SIZE - FT. 03 APPL. NAME & MAILING AOORESS FOR MOBilE HOME PERMITS ONLY No, of Bedrooms Gcry l. Purr ish WIDTH DEPTH AREA Connect to Existing Sewage System D TYPE CONSTRUCTION SQ. FT. :it BCRMS STRUCTURES TO BE BUILT THIS PERMIT ;:~i":>ort cUClvcrtccl into Steru"€; ~6o (~ t\ SEWAGE DISPOSAL PUBLIC 0 BUilDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER Pei1;' 1 ~:~, fC:J TOTAL PLUMBING INSTALLED BY SEPTIC TANK 0 OTHERD . U.OO FEES OWNER 0 OTHER, NAME WATER SUPPLY PUBLIC 0 o OTHER 8.00 . 16.00 COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FiElD REQUIRED MIN. SEPTIC TANK CAPACITY WITH OIST. BOX: GAl. L1N. FT TRENCH WIDTH FT. OR SQ, FT. .~!nt ...,pl ic.-:bic: TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIL. EASEMENT 5-~J J BLDG. SETBACKS._ FT. FROM CTR. OF ROAD RIGHT OF WAY USE CLASSIFICATION SIDE INT. SIDE EXT. AUTHORIZED SIGNATURE - DATE hi J.E. ['ons ";y C. I-L'rb~u:t:~ FRONT REAR BLDG, PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD , -\/it .. --' --., /1../ :' ~~-7;~' PHONE jl.~J~i;":'.1t.:, PHONE New System 0 VALUATION 7'0 DATE ~,-?~_7.'~ 51:' Call 6B7-4065 to schedule all required inspections, All construc- tion shall comply with Uniform Building Code, D.E,Q. standards IMPORTANT: for subsurface sewage disposal and county regulations covering plumbing. All buildings require a certificate of occupancy before being occupied, (See Details on Reverse Side) FORM:: C55-1) , (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY. OEPT, OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX. 13S EAST 6th. EUGENE, OREGON 97401 'J DUILUINu ~llt tVALUATION }; S,/ C. H-I 395-7tJ T-L2R Os S ;;(t:),.l,tAX CENSU~ACT . b /I'" Ares APPLlCA T: Q ~ '. J' NAME I Cirri Sf..., AODRESS LOT :20v0 t.,; . 1>( Bl>i id.irrg Permit Appl icat ion No. .. () Site Inspect ion () Pre-Permit Investigation PHONE DATE S-,2/-7Lf --'--' - L/\NE COUNTY PLANNING DEPARTMENT NOT NO YES app, icable - i. Zoning Ordinance Compl iance F () ( ) (Zone ) 2. Subdivision Ordinance Comp I i an ce I) () ( ) , Required Access \\ ( ) ( ) .). 4. Building Site (Area, Width, ( ) ( ) Frontage, Setback) 5. Other (see comments) ( ) ( ) ( ) COMMENTS: NAME DinE ~;K .-. ,.., ,.3- ;<S"-7 II ~ - -' BU I LD ING INSPECTION SECTION NOT NO YES NAME DATE app) "cab I e 6. Plans Subm i tted ( ) ( ) ( ) 7. So i) Stab i I i ty (foot ings) ) ( ) ( ) 8. Flood Plain ( ) ( ) ( ) (fll~ 9. Other (see Comments) ( ) ( ) ( ) 'J-~8'-7t/ COMMENTS: I , -- SANITATiON SECTION NOT NO YES NAME DATE app I icab I e A I'f'rT"'2. ev-.-e... @.~ 10. Sewage Disposal (\ ) ( ) ( ) II. Usable Area ( ) ( ) ( ) 12. Water Supply ( ) ( ) ( ) 13. o t he r (see Comments) (I' ( ) ( ) --------,- COMMENTS: TO APPLICANT: Your 3- z.,t ~f fr ( ) ( ) ( ) Building Permit / Site Inspection: Can be approved. Cannot be approved at this time as indicated on item NO. above. Questions and further information on items I through 5 contact the Lane- COUNTY PLANN ING DEPARTMENT. Ques I. ions and further i nformat ion on items 6 through 13 contact the Lane Coullly Buildinq <<:Jo Sanitation Division. Wi 11 be held in this office unt i I you can resolve I'he problems iodicated. Is being returned. Your bui ldin~ permit appl iCilt ion fee is lJeing returned under separate culler. ["Nt' COIIN'IY I'/.IINN ING OEP/IRTMENT 1:l5' Si;<tlo Avellue [^st, [uyelle, ll'''9"n 971,01 I'llllNt: ~1j2.. 1:111 0 I, 211 LANE COUNTY aUILDING & SANITATION DIVISION 135" Sixth t-lvl;1'uc East, E"9cll". Ol(."gon 97401 I' 11L1 N I : J.lj2-1311 flIT. ~1I 1155-=28--'- ----- II""'" -' -~ ~ ...... ., \ '~~. ~ LANE' COUNTY BUllOIN.G)'@ .LDING PERMIT OR MOBILE MH 0 I MAILING ADDRESS HOME4lE PERMIT ( PERMIT NO_ " I' ...i. )' ,. . .. 3~.74 PROPEII:TY OWNER .... Porrlnh..-Ollry I.. CONTRACTOR 5 Cl::C 2130 ~. 19th St. MAILING ADDR~SS SDrlROflold. OrenDn PHONE 'q7.CIIIlfI PHONE 1 PROPERTY LOCA liON - INCLUDE POST OFFICE .Above PROPERTY LEGAL DESCRIPTION - METES, BOUNDS 1\cm~llno Acres TWP RANGE SECTION TAX LOT NO. CODE CENSUS TRACT 17 03 2$.2.1 2Cl!n I~G1_ EXISTING STRUCTURES ON PROPERTY ~lllnn end COrDort LEGAL ACCESS TO PROPERTY APPL. NAME & MAILING ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms Gory L. Parrloh . ...... . .' '\~ ...' ,..:......:.- l!'l.th Stroot PROPERTY SIZE - FT. WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System D. New System 0 TYPE CONSTRUCTION SQ. FT. # BDRMS VALl.!ATION Cal'j)ort cO:Jvortod Into StCITOI',o li!(1O 0 f'I nn ... '\t ._'".... SEWAGE DISPOSAL PLUMBING INSTALLED BY , PUBLIC' -0 . SEPTIC TANK 0 OTHERD . 6.00 FEES OWNER 0 OTHER: NAME WATER SUPPLY BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER Pcnul~y l'c:J PUBLIC 0 o OTHER TOTAL -a. en $ 10.00 COUNTY , BUILDING & .SAN.ITATlON SPECIFICATIONS_ I. MIN. SEPTIC TANK CAPACITY WITH DIS1. BOX: GAL. D~AIN FIELD <REQUIRED L1N. FT TRENCH WIDTH FT. OR SQ. FT. C!~ Q;ll !cable " ': I ,I , TYPE OF STRUCTURE 5-tl OCCUPANCY J lONE PUBLIC UTIl. EASEMENT \. BLDG. SETBACKS h FT. FROM CTR. OF ROAD RIGHT OF WAY FRONT USE CLASSIFICATION Inl J.E. SIDE INT. SIDE EXT. AUTHORIZED SIGNATURE - DATE Co06 bv t. NJrbcugh REAR DATE " '" \- .. '_.,;).', ... . '-'\ .....f I Call 687-4065 to schedule 011 required inspections, All canstruc- '. -. tion sholl comply with Uniform Building Code, D,E.Q, standards' IMPORTANT: for subsurface sewage disposal and county regulations covering plumbing. All buildings require 0 certificate of occupancy before being occupied, \ (See .Details on Reverse, Side) .. \'.. !l.lt9-74 !I1~ BLDG. PERMIT - WHITE OFFICE COPY - WHITE . COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD " . (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 13S EAST 6th, EUGENE, OREGON 97401 " .' , d FORM ::= C55-13 . .. ,-1_ d..' ~,.....,..'~ 0.'.... _"", ,-.. -"~.._~,, _ . ....,_.. _. . f. """'III . . .. " . SITE INSPECTION ApPROVED Cl 01 SAPPROVED Cl DATE INSPECTOR REMARKS FOUNDATION INSPECTION ApPROVED I 1 01 SAPPRDVED / / , DATE~ { INSPECTOR REMARKS FRAMING INSPECTION Cl DATE ~dt INSPECTOR ApPROVED / / DISAPPROVED REMARKS LATH OR SHEETROCK INSPECTION ApPROVED I I DISAPPROVED I I DATE INSPECTOR REMARKS FINAL INSPECTION ~ ~ ApPROVED ~'SAPPROVED ~ Cl Ao;;TA-J.9-7~NSPECTOReL.- REMARKS AU-J'-~l-f6 -71/M.- CERTIFICATE OF OCCUPANCY :::::K:O ISS~~~ f? DATE A~nV~ ~~ , , Jf5'1t/~~ 2)3D 71. /9~ INSPECTOR ~ J .'..,.- ..----.. . ~ :.->; y , - . \.. ...-:.. . .,l,) . ", '. I /'t ~\ ~' '~~l-/~ / - -. 1. '/:\'1'.' ~\J~"';:" ~~..~'- ~ "". .";'- - ," SUPPLEMENT TO BUILDING P~RMIT ,NO. a<9..<)"~ 7~ . . Lan~-Co~nty, Oregan .. "",' . , OWNER .1J~ e::<: p~ J V' CONTRACTOR .A /l ~ c ./ PROPERTY ADDRES!' .xl ~ ~ 'ria' ADDITION: ! '" /J ,- r /ddJ/7J'9 /7~_./~ J v If' :, , ~ ~ J1J..-d q 0' fl7.J'./I./ 7;-1 -d'Ja'd . /' V y- '"77:" fJ/Jfl'7J (l ~ ('/?LA /M1A '7;-( d-tJ y;){) ) , ~tI/? @!:?,YIJ -' .$!> /,J,/}: to/) =~2.0- l.l.t..l...L::1f1/J'r"P ...J14.tl/J .,tJO '-U- /I~k~ '"It.'~ C~ANGE RESULTS IN:D REFUND OF F~~ - '1f:,7.;LtJ :~O .=. / MAILING ADDRESS c::J/3:J :;no \ /cnL ,fA#f). '17 MAILING ADDRESS D CORRECTION: ~ I , .. '""7~_~~-'__' (!C__~~ ~., [>/Y!~ 8',' 0 r'/ ~"JJ, ;-' v o ADDITIONAL FEE: BUILDING SEPTIC TANK SANITARY CONNECTIONS 8".O~ ~ ,.... CI: -r=-m ::r- lr.O<:S ~,~'-1 {2~~4j Dat" /I-IS'7~ -- /- - . TOTAL ~-'':.:,'~ DATE FEE PAID //-/<;"- 7~ / LANE COUNTY DEPT. OF HEALTH & 9,ANITATION D 0~ Cash ,Check err Supplement N2 _ 1831 5Byk .~ . ,!'. . ~ , LANE COUNTY ~U NG PERMIT OR MOBILE HOME U.APPLlCATION ,/ PERMIT TYPE - BUilDING __ MOBilE HOME DOSC REG. # PERMIT:it: 39 f)- 7v PROP;JU.Y OWNER .... AILING ADDRESS PHON1: l-'.Ci>"k\.... \)~'V...,~~ '2-\~O \~O. \C\yl., <;:.+- 'q,-.::>t.c9... 7cf-7-S"3'3c.!- CONTRACTOR MAILING ADDRESS PHONE ; I Se. \ PROPERTY lOCATION -INCLUDE POST OFFICE :2.'">, 0 -N..~., l\.l,,"'-.. S\-. , AND '\ \.. :J'so ~() <;. '? 'T .. ,.\<\L~ \~ , O'Y~() 0 ","-, ~h I'Y\. h1 i rvl A- ('tOe. ;;z;.r / ,tU(. / . SEC. '" '- TAX LOT # 78". CODE ;? h . .r.1? .Q.__~ -6 01 Ol q-03 DESCRIBE EXISTING STRUCTURES ON PROPERT'{,J IF ANY <;:Vl",\e~ ~Y~~_ "rI"C LAlc...-.,... LEGAL ACC/;) TO PRrqi--hOAwE. bR # PROPERTY SIZE-WIDTH DEPTH METES & BOUNDS 0 YES ATTACHED 0 NO PROPERTY LEGAL DESCRIPTION LOT - BLOCK - SUBDIV. TWP RANGE II '3 CENSUS TRACT \ APPLICANT NAME (~Ci '-t\A , ~~...""~""-- ~ c......-\:- MAILING ADDRESS - -fell MOBilE HOME PERMIT ONLY Number of Bedrooms STRUr:;;;~~~HIS PE~^~V\ \tf\~ A q-\-"'- s-L--: S 1..\:ci. AREA ~ Connect to Existing TYPE CONSTRUCTION ~i-'1'lflW.p . \,J Sewoge System D or New Sys'em Req, 0 SQ. FT. # BEDROOMS VALUATION '3t..()GJ 4 --:J = Q 7;< 0 SEWAGE DISPOSAL PUBLIC 0 BLDG. t' WASTE 015. PLUMBING PLAN REVIEW SEPTIC TANK 0 <;;;t_- FEES OTHER 0 WATER SUPPLY PUBLIC 0 OTHER PLUMBING FEES ?Jo ~1!t/~~f~- OWNER 0 OTHER 0 NAME PLANS FURNISHED /' FACILITY PERMIT _ FIXTURES / YES 0 NT:",\ '1 I/'L...., NO n DATE ~~\iy fe1' T'.- 1"6.- CASH 0 SEWER CHECK ~ECTlON FEE J~('\u ~ !PERMIT # / PUBLIC WATER CONNECTION FEE COUNTY BUilDING & SANITATlON'SPECIFICAT\l!5NS DRAIN FielD REQUIRED / lIN. FT. TRENCH WIDTH FT. OR SQUARE FEET "---' DATE ?'~20-IY TOTAL MIN. SEPTIC TANK CAPACITY WITH DIST. BOX: GAl. TYPE OF STRUCTURE 6"# BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY OCCUPANCY ~ lONE REAR YARD PUBLIC UTll. EASEMENT USE CLASSIFICATION FRONT j I~ SANITAR(tJ 1\ .)tDe-l,..,. Date SIDE EX!. REAR PLANNING Date BLDG. INSP. ~ .3-~r-7'1 /l JM~/!L -:J~~'iT-71,7 (j; / Directions to Find Property: COPY 1 - OFFICE COPY 2 - JOURNAL COPY 3 - AUDIT Form # CSS-12 .~ CONSTRUC~N/PLACEMENT' 1- PERMIT q 0- FOR OFFICL USE ONLY COMPLETE THIS BLOCK. PLEASE USE BLACK INK AND PRINT. ~~~~t~";~~~~. o Two C;pics of Plans D'l'wo Copies of Plot Plans [JMechanica1 Checklist o Plumbing Chec}:list . Dplan Chec); Info Sheet I , TOI_""HI" / 7_ I RANGE ~3';ZOtl LOCZ~ ~ ~y 97 PROPOSED USl.; Or Pri.OPERn' ~l'C"'" CURRE"W~ ?RaPERTY ~ '/ '" ~ _,. ~/f1) &csidential DlndustriaI ~~~ . o Commercial DP7ic . , iJEdf' · . , P ~ ~ a~ y u.,-./ ("~ A'~#~j' ./~ k,,;u7 ~a a,sZ9: I~J!)W'I 'a~~-r\'ATERSUPP~.p~) ~~~~~~ OI<NE """IE AND A '5;%.~ ~A'W'/ a ~. \/. _?'/~. - 7;;?_Y;~7 @;;/;?A;;~.E~' ~;Y//t7 ~~ ;;R.t??/?7_ 7.?1;;fi"y /\:6N~CTb~::;~# ~;;;. .;f-/Pf~;g~~ ~ ~n~>7';~~~ // /, r:/ ~ IS~~?/13~~OF 1 LOT/PARCE: 1 ~LOCK I !lAVE CAREFULLY EX1l.MINED TilE COMPLETED API'LICI\TIQ PERMIT, and do h~cl'by ,-,p.ctif-i tl1ilt .111 inf..,rmiltioll h('I"')1l 1'1 trll'! ilnd 'Corre':\. ill\rl 1 fllrtll\'f certify that any and all work performed shall be done i accordance with the Ordilla:1CCf> of I.<lne CO\lnty i.lnd th" l.aws of th,) 5Lid.<:, of Q,,,,,'JIl 1,'~:l.lihir1<1 to the work described herein. and that NO OCCUPAllCY 1 be made of any structul"~ without the permir;~ion of tlll~ Building oiviRion. I (urth"t" c-, r:;ify thilt registration with the Builder's Board is in full force and effect as rcquir0d by ORS 701.055, that if excmpt the basis for oxemption i~ Ilot.'d hcrcon, and that only subcontractors and employees who arc in compliance with ORS 701.055 will be us"d on this project. I HAVE RE.,O AlID CIlEC'Y..F.D TiltS APPLICATION THOROUGHLY. ~-)#<: ~~ zon"~ \..."artition; L#/di~~~~5~- / 0 F~PLAIN: In flood hazard area? 0 No 0 Yes, see attached sheet. o R/{RAL ADDRESSING: o SlUHTATION: Y-- 9' -1.7 - '8"Z- D.;TE o (1I.,'ller ~n~rl.lc:;o:: o Ag<';llt GRID COORDINAT~ Parcel SiZt',,$ ~ / ff ~~~_ d:V~~ D.te/~-Z7-R2-- W- , n o Parcel i: o PLANNING/ZONING: Date: N E Date: S. 1. *' B. P. # lnstallation Record lssu~d? [] Yes [] No Inst.allation Specifications: Gallon Tank Lineal Feet of Drainfie1d Maximum Depth of Trencher. Comments: '\/PLANS EL!:fl.' i"" ~j omo"_-e?; r Co,,"cnts, ~ UJ.-f . , / Date: use.Jf o Date'_VJ~ 0 CONSTRUCTION AUTHORIZED BY ~ PE~~IT /~~~ ~4?..a; /~..</ c..~' :::J' If." -../ .., ~)d~ /f';~A?v/ tI Fixed Feel Floodplain Fee S Sq. Ft. Unit Cost Subsurface Fees S ~ -7 <r~ sL/7' ~ Building Fee S ',.:;I. ;:::::.-- Sewer/Storm Drain/Water S Plumbing Fixtures S Mechanical S J./ 7,5f Plans Check Fee S rJ'~ State Surcharge S _~'7_ ~ t:/ TOTAL FEE S ~ ;...;.- TOTAL VALUATION s I. 4/0tJ g:p..- FEES PAID BY: .>> Check 0 Cash ~ /:" By: 7--..z7-Tf2..: /' Date: ~":;,~.1z':/ ____kJl~II'j,,, T ~V OFFICIAL/DESIGNEE {.<:,er Ol~~ DATE PERMIT APPROVED BY BUILDING LANE COUNTY D8PARTMENT OF PLA."JNING & CQ1':HUNITY DEVELOPHENT / 125 EAST EIGHTH AVENUE, EUGENE, OREGON 97401 SEE REVERSE FOR INSPECTION INFORMATION . . ,. '---4 SETBACKS AND OTHER CONDITIONS Of APPROVAL MUST BE STRICTLY OBSERVED, VIOLATION CAN RESULT IN REVOCATION OF THIS PERMIT, CITATION UNDER PROVISIONS OF, LANE COUNTY'S INFRACTION ORDINANCE, AND lOR OTHER REMEDIES ALLOWED BY LAW. WHEN READY FOR INSPECTION CALL 687-4065. A MINIMUM OF AT LEAST 24 HOUR ADVANCE NOTICE FOR INSPECTION REQUEST MUST BE GIVEN. Have the following information ready: Permit number, job address, type of inspection, when it will be ready, your name and phone number, and any special dlrections to si~e. . . ~ BUILDING DIVISION: " REOUIRED lflSPECTIONS 1) FOUNDATION INSPECTION: To be made after .trenches are excavated and forms erected and when all materials for the foundation are delivered on the job. Where concrete from a central mix.ing plant' (comnoj,ly termed "transit mixed") is,to be used, materials need not be on the job. ., . 2) CONCRETE SLAB OR UNDER}FLOOR INSPECTION: To be made after all in-slab or under-f100r_bttildjng service equipment, conduit,'piping accessories and other ancillary equipment items are in place but before any concrete is~poured or floor sheathing'installed., including the subf100r. .. . .. '. . 3) FRAMING & INSULATION INSPECTIONS: To be'made after the roof,.a11 framing, fire blocking and bracing are in place and all pipes, fireplaces and chimneys and vents are complete and a1i roug~ e)ectrica1 and'plumbing ar, approved. All wall insulation ~nd vapor barrier are in place. - . -. . ~. , 4) LATH'ANO(OR GYPSUM BOARD INSPECTION:. To be.made after all lathing and gypsum board, interior and exter,ior,~s in .place but before any plastering !Sapplied or before gypsu"l board'joints and fasteners are taped and finished. , " 5) 'FINAL INSPECTION: To be made after the bu'ilding is complete and'before occupan~y, ' , APPROVAL REQUIRED. No wo';k shall be done on any part of. the building or ,structure beyond. the point indicated in each successive inspection without first obtaining the approval of the building official, Such approval shall be given only after an inspection shall, have been made of each successive step in the construction as indicated by each of the inspections required. ,',' . ... . . NOTE: All building permits require inspections for the work authorized, such as but not limited to: A. BLOCK WALL: T9 be made after reinforcing is in place, but before any grout is poured. This inspection is required for each bond beam pour, There will be no approval until the plumbing and electrical inspections have been made and approved, B. WOOD STOVE: To be made after completion of masonry (if apolicab1e) and when installation is comolete. .Installation shall be in accordance with an approved'nationally recognized testlng agency and the manu- fai;turerls i'nstallation instructions.. \ '\ C. MOBILE HOME: ~An inspection is required after the mobile home is connected to an approved sewer or septic system for: setback requirements. blocking, footing connection, tiedowns, skirting, and plumbing connections.i: . . (1) Footings and piers to comply with State foundation requirements for mobile homes or as recommended by the manufacturer. (2) Mobile home. minimum finish floor elevation shall be certified when required by a floodplain management Jetter: . ,. . .' . (3) Mobile home tiedowns, when required, and skirting shall be installed and ready for inspection within at least 30 days after occupancy. Tiedowns and skirting shall be installed per enclosure. .... D. SWIMMING POOL: Below grade when steel is in place and before concrete is poured. Above grade when pool ; sins ta 11 ed,~. APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS, THIS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WITHIN 180 DAYS, OR IF :WORK IS SUSPENDED OR ABANDONED FOR MORE THAN lBO OAYS. SUSPENSION OR REVOCATION MAY OCCUR IF THIS PER~lIT WAS ISSUED ON THE BASIS OF INC0I1PLETE OR ERRONEDUS INFORMATION. ANYONE PROCEEOING PAST:'THE POINT OF REQUIRED INSPECTIONS WILL 00 SO AT HIS OWN RISK SUBSURFACE ANO ALTERNATIVE SEWAGE DISPOSAL SYSTEMS (1) (2) Permits shall be effective for one year from the date of issuance. Upon completing the construction for which a permit,has been issued the permit holder shall notify the Department bysubmittin<g the ~ns,anation record ,form, The Deparl'!nJnt'.shall inspect. the construction to detennine if it complie.s with the .rules contained' in this divis.ion: If the construction.doe~comply v/ith such rules, the Department shall issue a certificate of ~atjsfactory 'completion:.to. .the permit holder, If the construction does not comply with such rules, the Department shan notify th~' permit holder and shall require satisfactory completion before issuing the certificate. Failure to meet the requirements for satisfactory completion within a reasonable time constitutes a violation of ORS 454.605 to 454.745 and this rule, . :~ ~ ., Setbacks ~ Subsurface Sewaae Disoosal From: Interior property 1 ines Edge of road right-af-way Building foundation Wells, other water sources Seotic Tank 10' 10' 5' 50' Orainfield 10' 10' 10' '100' ......~ , '. " , <' " , .'L . , , . , I;. .J. . s. .. . --, . ...!.. 10 . " ..!.'.. 16 . " l!L J ". n -. " ~. .. -. -1-1 j ~. .. -. . . . : ' . " i. . . . i' , . . u . . . . Ii! < . I LANE COUNTY TlFF-T EN'I l'1(;t RECEIPT ;:, 169782 DATE 09278:.. ,','~T TIRRILL. JACK AD DR 6849 G'ST., SPRINGFIELD, OREGON 'II,~ "i M7f.\"J:";';'';)'!-{:j-.:.t'l/.'"17) Slj"J)IV LOT BLI ~. NEW "'I:':: :':-'-.; ".:\~~ f~' B'DF(MS 3 "t. ;1':' ",,;, nn~' n.::s . '~BL.T'GS e)01 PW';\~E 726." 1':~"'4. OWNER ~M:' . ADDR ..0 .. ' -. en DE APF'L NO . ACTION. DESCr<IPTION S(~ F'" .';,'n CO.~T VALUATION I ElF',' . , , E. BP i..U ,. I ElF' '~.l{P , flP ~, Br,;. , eF'L ~ . MFGH eStlR so 'I'r.'( - -',I 36 "EE DAY,. e l.'~ < ,'.' '-p.., RAAA NO. FI -: -- >.::;, - ,-,..;. "''''CHJRS: . " M':'CH~N I CAL FEE STATE SURCHARGE PLAN CHF:CK FEE 1400- .15.00 E''lCH .- ~~3 _ 50 ei 41. 65% 0. ~J4 15.28 .j ,; 154 . [;, ; I ;..'C(HG; , . SEQU'_ ..!.'... TAKEN BY .. .. , Ii eS . . '- t"2.' ;; lle; 1 .101 : , : I CK t.,~ . 52 ,-. f)PP o RLH RA' r-p SDS' SI PCK .1 OTH ISS 2 HiT f) I:. >'"EEIH 39.72 EST. GnMPLETION DATE '. ..!!. , ~ . . sei o : , e . I'.. -. \ bne county " --' ~NING & COMMUNITY OEVELOPMENT ... ACTIVITY INFORMATION SHEET COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED! 1 ~~',11 \S~ ~rnJr'^S~'cM -r PER50N'MAKING REQUEST oJ ""Lie. 1/\2"'01 , b A <-{q I, &" 57 MAILING ADDRESS 5I;J;>11.J'1 ~"Pd c::!-112.. v crn S'IAlt 97,/0) ZIP CODE '7iAWiI/lc-1 LI~v--k v- e. PROPERTY OWNER /61 L KA-w, hL/~ ~ MAl LING AbB'RESS )P:1Ir/5r:~fj (~ . CITY STATE 97'-1,,-- ZIP CODE "7 z. b - I ~ '- { 7 2. b I ~ '-I BUSINESS TELEPHONE # HOME TELEPHONE # BUSINESS TELEPHONE # 2.. PROPERTY ADDRESS 5~.Q.. 1 biZ. RIhvI b L;~<: (IF DIFFERENT FROM MAiLiNG ADDRESS) F?'i6-3r:.'77 HOME TELEPHONE # lJ-1 _ 3 MAP & PARCEL NUMBER (REQUIRED INFORMATION) II 0 ~ "}, '~, I ~ RANGE srcTTON (from tax maps in Department of Assessment and Taxation or from tax statement) "3 t..f 0 () fAX LOT(S) OR PARCEL # ZONING TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL # ZONING TOWNSH fP RANGE SECTION TAX LOl(S) OR PARCEL # ZONING TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: ACRES 4 SUBDIVISION (if apPliCable);)~ ~ ~ BLOCK 5 REQUEST (state exactly what you plan to do) k.o'O A-<. t=:-I. <:..<;J''"I<, k'D D-r , .coM 4-;1 ,.-.J "7 V\ 111 dIU L,~ 6 DIRECTIONS TO SITE: r:r",p'~<4-7 --I,., />7DI,~-< I,.. (') t/.Javo-r.:> It/h--fA. -/-0 PmnM.14 0. . I J ** FOR STAFF USE ONLY ** NUMBER DATE -. ;c V> --f .-; ZONE/LAND USE: BY: DATE: TIME IN: OUT: