HomeMy WebLinkAboutPermit Building 1975-1-9
NOTE:
E I~~~APPLlcATI(
APPLICATION FOR:
:(
PERMIT iff 21- 75
\8 BEEN APPROVED
NO PERMIT WE.
\ /.
CONSTRUCTION I ~
1>'- I OWNER ;lJan U
I "" L? Name F
I CONTRACTo.0'"~
Name
0. S. REG. II
Twp.
J'7
Range L? 3
r
Subdivision
MOBILE HOME I I PLAN REVIEW I CHANGE OF OCCUPANCY
b)d+lflcJ_, -?t76~O.4r/M4t0U ~~~~
{/ Address City / Zip
Phone
Address
City
Zip
Phone
Section
~~, J. .Lj Tax Lot
/
s ~ ..:3\5U
/ZJO
Code n - t'.,.;l
Census Tract
Lot
Block
Depth
Property Acreage
Width
ACCESS TO PROPERTY (Road Name) C2n~.-_ICL/~
/0 .li~<=)' _
Property Location - Address/Directio~s: ~ ~ CLt/ J<V1 /' (~d L.-7 w ~
Existing Structures on Property:
. ___." Below for Office Use OnlyXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
.' Sq. Ft. f1Bedrooms fr:) Valuat:4J.2
/~ 8uJdvn3 r laT~L >0)(32 (~40~?~~"7.7'1),OO
/
//
SEWAGE DISPOSAL:
Site Inspection f1~(j1_~~
WATER SUPPLY:
Well Spring
FEES:
Bldg.
/7,00
Waste Disp.
Plumbing
Plan Review
Mobile Home
1% Surcharge
TOTAL
./7
1/. f ')
Min. Septic Tank Capacity
0<
Type of Construction S"}/'
Public
Other
Community I
System
Name of
PLUMBING FEES:
, Name /
~~::~ ~::::'tion
PLANS FU SHED FACILITY PERMIT
I I ES I I NO I I YES I I NO
F . Received By: ~ Date: - 7- JS-
ReqUired~ineal Feet Maximum Depth
I
/
PLUMBING:
Installed by Owner
Other
fI of Fixtures
r)<~
I I
CASH r
CHECK
Drainfield
I
J
.--.S;- .
Group-...J
\
/ Fire Zone
/
/
Use Classification
Bldg Setbacks - from Center of Road Right of Way:
Front SO' Side Int. ~I't!:) I ;:'1oe..~"XreTror
PIANNFNG: L
rc;I/ar!n/~
, tf f
C55. 12
DATE:
Rear
..e:; I
Zone A-& T
&.ION:
DATE: L It;. BUILDIN99.. {:I/' DA~: .I7fJ..)
/-"!-7-j ./ff/J-61 ~~ / "" I tJ -;"
, I
ENVIRONMENTA MANAGEMENT
LANE COUNTY DEPARTMENT OF