HomeMy WebLinkAboutPermit Building 1974-9-25
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, LANE COUNTY Bl
PERMIT TYPE - BUILqlNG 0
HNG PERMIT 0 R MOB'~~ HOME l APPLICATION
MOBILE HOME DOSC'~.# PERMIT' #
MAILING ADDRESS, fl\ , ' ,
,//7 .4- /I.p,~ A VP 'l> P \'"' " k a-f ,'-e-/d..
MAIlIN6 ADDRESS '
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, ~
1 q 5~-7t/
PHONE!'
PROPERTY OWNER
R fJ '-l T u..,cY..., Ir'
CONTRAcTOR '
IE In era.. I J.. , S\J J:- \IV'\. '^""~ '" <:
PROPERTY LOCATION ,-INCLUDE POST OFFICE '
PHONE
c ?'r--/09 0
PROPERTY LEGAL DESCRIPTION
LOT - BLOCK - SUBDIV.
TWP RANGE
METES & BOUNDS 0 YES
ATTACHED 0 NO
APPLICANT
NAME
~ Q~y'"aj d
~(A/{'m ~ ;kL!
\
;::>001...!1
T~X LOT #', CODE Iq -03 CENSUS TRACT
~.;Ll't> fl!!~ 02-3 -eD '50
DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY
, /-1 ("'JU ,~
LEGA"L ACCESS TO PROPERTY - ROAD NAME OR #
A-/ I U1 Ilw..JIlu L
DEPTH
'~/n Co (
PROPERTY SIZE-WIDTH
(t,t
AREA
/7
t) 3
SEe.
.i< ~,,3.~
AND,
/lffs-
MAILING (
ADDRESS 6~ Ii!.-ne-
FOR MOBILE HOME PERMIT ONLY
Number of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
1+ vV "-
Cfc; /Y"
I .
, Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT.
or New System Req. 0
# ~EDROOMS VALUATION
S w I. '^^' \11'\. ~ '^ '\ ,Po ("\)\
SEWAGE DISPOSAL PLUMBING INSTAllED BY
PUBLIC 0
BLDG.
WASTE DIS.
PLUMBING
PLAN REVIEW
PARK TRLR.
$
SEPTIC TANK 0
~.
FEES
OTHER 0
WATER SUPPLY
PUBLIC 0 OTHER
PLUMBING FEES
, FIXTURES
OWNER 0 OTHER 0 NAME
PLANS FURNISHED
YES.ld- NO 0
SIGNATURE OF APPLICANT
FACILITY PERMIT
YES 0
No-er-
DATE
TOTAL
:2.5., ,
CASH 0 SEWER
CHEC~ONNECTION FEE
'PUBLIC WATER .
CONNECTION FEE
FEE RECEIVED BY
~, wJL1trYl
PERMIT :#
. DATE
1/25/71
COUNTY BUILDING & SANITATION SPECIFICATIONS,
MIN, SEPTIC TANK CAPACITY'
WITH DIST. BOX: GAl.
TYPE OF STRUCTURE
, I
., OCCUPANCY
--
---J
R/4
: ZONE
OR SQl,lARE FEET ~
:/ ~
r
~AR YARD PUBLIC UTll. EASEMENT
DRAIN FielD REQUIRED .
II N. FT.
,TRENCH WiDTH FT,
BLDG. SETBACKS - FT. FROM CTR, OF ROAD RIGHT OF WAY
USE CLASSIFICATION
~-~IT' . 'SIDE INT, 5' ' &I-G.f OVT
~~ ~D/;/7:;te PLffG Q/U174
.... ,., , , , ,
ir ctions to Find Property:
REAR 5: '
Dote BLDG. 'INSP.
/J1h ~. t€/,
I /
Dote
I fl ~~ -I) (t
COpy 1 - OFFICE
COpy 2 - JOURNAL
COpy 3 - AUDIT
Form # C55-12