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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