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HomeMy WebLinkAboutPermit Septic Tank 1987-6-16 \. ;'''' , ,.' ,..~~' '. "i .~/$rf\""FOR"OFFICE :Lane.qount-y Altthqrlzatlo,n for: ...,' ,J" "". c',', SEPTIC'INSPE'CTION FOR to'N~ REVIE\~ USE 'ONLY ,-' " , APplicatiOn/" '~, 05":'" Q K1 : ' Perml t 1/, ' () 0 u" , " I I ." TOwi':sl-iiP';' ,. '::i'7" ,,-'..- - ',"RAi~GE "',D3'" ""-"~3~':8j'.'-3"'- PROP,OSED ,USE OF 'PROPERTY' ~ R8~identi~i 0 I,ndiistr'i~l , " -0 Commeicicii 0 'pubiic , fll.x'LoT' q 0 Q(:jTOF 215 ,_, "':' ,~' ,,'/ L~..T/PAi'C:EL , ' BL~CK'-:, '", "LOCflI7A~D~T~::,", ~rrncxXillcC]'Y ())r-~~' 0727'7, ''5"~)'~~'J ,,"" UU .1 "0 ,.':-' t D~~~X~sYbl~' ~ .'uvr~),: '. ,~;Uc1J;Dr 3t1ht ~, rd,~f..7: , ',.... ---:-' ~ -., ~ , S:.JBDIVISION/PARTITION (if, appl_i'ca~le!" " .. .j~,. .' , i iJ2SCRIPTION OF pROPOSED, WORK -, BE ,SPECIFIC, :-..;. '"j' DECLARED $ VALUE ,SEPTIC INSPECTION, FOR LOAN REVIEW t. OF~~~ ' # OF ~'-,' ,,<..I'_,'#,.9,hOY\R~) I \:~Rqrz)n~" , Jet) , 'S NAME ./~S{,,, .' " '~"~,'" \;/1,', '{J"\.~ /i t~,~'~ " ..,': ' .. , "/ ' l..UI..:..K.1In.> Ic::X)I..i~, y..o' L)..,VUl):v} .... ': ,': ~ C-e:n~'~OPf NMt~R #, '~YRt~f" ' 315 ~" "" 1Jr:ff:~' ~~~R>'::Jfo~~~'~., I HAVE CA F LY EXAMINE~ THE COMPL~~ED APPLIC~~~ f'O~ PERMI:~d p~ h:on\JY ~~rt.."fY t~at. ;;l:l',l;!f~~'Jllat.U hereon is true and correct, and that. I ihave. the folIo ng legai .~nterest. in th'e p'~operty: Downer of record; D con'tral.t purchaser';.Dauthor~'zed agent. . ..~ : I Lrther certify,that any and all' :;"oik pe'rformed shall be done, in ,a"coldal1(;" wtth "tho, 'ord,il~an,ce~"of L.i!-n~' Cowity 'aridt)1e Laws 'of the St'ate of Oregon j pertaining to the work described he.r:ein'/' and 4 that NO .'.oCCUPANCY' 'will be made of a~i~.?t.r>qct:u'revlftnout the permission . of :'the :Building Division. I fur- \ ther ce'rtify that registration' ~'i ththe Builder"s' Board, i.s in full force anll e-ffect....as' re~u~red. by IORS' 70.1.055, ttlat if "exempt the basis for exemption' : is noted hei"eon, and that only subcontractors. and employees who ar~' in comp'iian~e 'wi th.'.6RS. 7o,i: 055 - will be' used Q:n'~ this project" I HAVE READ AND . 'CHECKED THIS APPLICATION THOROUGHLY: " , '7,j" - , ' " " ,( '.- , .. ' , , ,,' , . .... .: '-f, . o Proposed I5<l Existing TELEPHONE, NUMBER ! ' J(~LEPH~)-- _ GY ~I ... 1~~E0~ :-*= :\0.41\ tA)J;*,~, ",: " ',':' , ", .' ,',.- ~ ",~," ; \ ' ' ,NAl'lt (please print) , . / . ,;l; '101I.. ......~."..U.....I..~. 1..I......Io...~I.I..... ....,U._.-"'.......~....~~~_........_~........~~.,~~...:--_~~.~.. ~ 1101;1,11,..10.. .1. ..,~.i"'. . ...._,. ", ". -'...., ".""." I "......... ......... . '.1'" ;,1.. ...... ,.. ............1.'.. ...._... ...~I ,,,....".'....,.. _.."_~.....,,......,..._, . ....oJ, ", ,." ,,, .... .........", ~. _." ......".".._ _ I. '" II." "",_. '" READ THIS SECTION CAREF,UL~Y;, 'lOUR. ,AU'THbR.:i:Z~'p'ON, ~-jASBElE~,:BA,SED',~N\TH'E,'F()+-LOWIN.G ~..CONDITIONS! , .' ~~ ' , ,_.. ,', ;"~~~A~..,, ". _ b-//-'~ ? DATE ~'PLANNING/ZONING: , Zope, . Partition #'" , ,Fa:r:<;:el,# Parcel Size ~Unirnum se:backs: ,C~,'J:~nt,",', '. . ,,'/~\'Si~e ',', .~' ,)nter,~,C;~ ,'," rear , COMMENTS: ,SEPTIC, I.NSP:Ee'~ION FOR ~OAN RFVTF~ sptCllil ,PI ANNT~(j, ,Ar.nON RF~IITRI='n , , , --" " ' '.;. "'-," o'~te:~' 'Jn/$(~ D .' , I~ SANITATION:, S. 1. #,,' B. P. #, .. ,_.,.:.. ,I~s,ta'iiat~o 'ecord ISSued?DYe~DNo .~ ~.. o Installation , ,Specifications:' , , 'COMMEi'ITS:~ 'I .- .tJ " ~ .. otYrl ~ "Gallon.' f. . -.:t ~. Lineal Fee~ ~ > '; 'l~ '. ,'.~ , "r. 'T'ank:: ;", "" , ' of .Drai"nfield' , .. ~~6liS. ,.~' . ."6i:f A.L f ~. ,a,~. . (7~~r.r~M+ ~1"%"'i' : TYpe' GrouP' , Use.., . ~:,~. COMHENTS: ',' .\ '. :...'t ,,' Date: n,: ".I~ . , ' , ,~tl '~~<L; > J( r, . .... . ~,--)~r#7 PE~VED -BY BU~~F~ - AL/DE"SIGNEY(oer ORS 456 <,80S (1)) . ' " - DAT! / ~NE CO~NTY DEPART' T O~ PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061, ' " : .' ,12, EA~~ 8TH AVENUE, EUGENE, OREGON 97401 ," , _ ,SEE'REVERSE FOR INSPECTION INFORMATION r.ll.._'" Q~ ", , ' " ,,'\ SETB1,CKS A~O OTHER. CO~OITIO~S 'OF APPRO)lAL"MUS'I" BE:,:STiUCTLy'.OBSERVEO'...':' VIOi.ATIO~ CA~ 'RESULT IN REVO- .." .~~~~~~E~F~,~~~~~~,E;~~~AW ~~,?TIO~lUN;~SR P~T?S,I,~~S:I,~r:~r;~t,;~;~~t~?~Y;;~\j:~~I,~,NOROI~ANCE ,;' A,~O/OR OTHE,R , ~HEN RE.;DY' -F'OI( r'N'SPECTION;'~ ~ALL 6 8 7-:4'O.~_5'~' . ~ :~q::~~~lY;'1:.!6._~';A_!.>~E~S,~ ~~ t !ip~RS . ADVANCE-,~ NO.:'IC::"~ fOR, :rNs~~f-::- , .' '~ TIO~, REqCES:rS'.~:-lusT' B;E 'G"IVE;y:_ : Ha'Je.' tt)e. follow1.ngJ..1;-n(oFmat:l~:m r,eady: (r.~rmlt_.number-~ 'Job address, t'r;pe. .~; ::i2:::c::::~:;:::~,~~'t '~il~,',!~~ reaq~'" YOGr, ~a~e"an~;.?T{~:.;,~m?~ ,,;?~:~a;~~'~?'~lcta:}, d~re~tio~S' t9:' ~~te, '. . ' . _.......'(~ ,:.:, '," ~ , +"'}"." , ..~ . , ..;. '.;;~'. ~ REQUIREO,I~.SPEC~IO~~:;, :' i .r' :,..,/>~: ';::'1.\,.,,';- ;);\X':;<~" ,';, .': /i. ". it , , ,''':0- .~_. : __.'~ounda..t'i'on ~ Inspectlon: J To._ .~e ~c;,?~r'afte.:>,tr.,;n~h~~ :,,?~e exr;::..t:f~....te~~~~!2?' f,orm_s, re.reete?_ a,!).d ,...":,,he;'1. all .' "_ :"materl'als.; for th~ '~oundation are del~ve:t;"ed;.~qn th~; ~.9?' N!1ere.;~.c:"n.~ret:,e 'from a eentral",mi'xing. .'~. '~\.,j;_ p1.~~'(\(CO~o~~~.t'~'r!1le(r "-tran~i.t mi,~~_~,I~'l ~'i,~."~?~":'~_~',:.~~eq;' rr:.a,~~r;~a:~f":~~,eed n?t b~e.qn: th~~j,ob..i ~'" .'~ -< . ~~,-i~':. c~Ancr'~~-e ',Sl"~b; o~,.un~er-?16or~~~soe~tiO~n:' '~"To"~'i~~~:de~af,~~~ ,~_{:i,:ji'~~~l.slab. o'~, unde~~il~or bu;il~i'~9'" ., ,-t.-"'~1> ,'.."'serVi-C,e,..equ'ipment, -conduit, 'piping aceessori"e.s:,'afld-:o\her'anc'i11ar.y eqq-ipme~t'lt~ms':ar~ ~n'- 1.-, place bU;, b"e.f~'re ~ny .eoricre'te is"p~ured:o'r 'fld?r~:~?hea'th~-n~:i.iri~talred, lncludlng th~ -su~f'loor. , <.Jo.-, '. ;.:',-.,.~_.~ f' " ,'__"':_'''~' . ~ '~","" '-, {"" i ;,;,....'~.'...'- ...!-;..{,t;.",',. :. -,. _"'. . _. '1',"_ . '_' 't- 3:". F-ram~nq~'.~.In~ulatlon Inspectlo~_~::.~,,""';L:o~,be '.m~~e':,af~~~.:~.th~ .7.5?Pt, ~.aFt.lfram~ng t. f~re bloc}<~ng.~r._?n.d ' ~. .," 'bra<;u:9. ar.e"ln,"p}aS,e, .a:1d ,!:l.l pl:pes, ...f.1Jep.lac~sr,:>chl.m~eys.;..~<?n9-'.yents. arec compl~te and. al-l rough ...} : ~'JO ,e.l.e~~~_~ca~~;.~~:., p~l,U~mbing. a.re., ~:P~;~V~d ::.:r~'A~t~_~,~.tl..i!!S,~~~~t~~~~:~~fld: ~~~~r /bar~.ier, a~e.l~n'~P#ra'~.e '._ .....>_> -"~,~:":' ,'4.. ~', Lath',;a'hd/or "'Gvpsum Board Inspection: ':1'0 be '!TIade/';:ifter' a.~i 'l~ thing. and., ,gypsum .board, . ;.n~e~ior' . anq: exterIOr', .; lS .",In,'' p}.ace.:;-bu f:~"b~tore any~:pl~~'ter.~~j~' i~ f ap~p~ied\ ~'Dd ..geAorel{g~psum board j:>ints ~ ',~..~ ,'-/, ana'fasten~rs ar.e-,tapl?d:,and flnlshed..=,,~1;'.,:' .).J., '\!J,.;. "''-'" .,.f") . '." .' '.>".. j. ,~.', __,~ r ., \,.J: ,'.'< 5;":' ;'i;~~lL~n~p::ti~n:'-' To~e;~:de '~ft~r, :~i\~,~:l~~:~:hs>c~o';;Ple,~~' (h~ ~efore, occupancy ";'..q " ~.:\\ .i....~..~ .':- .~;> -~._~'!:.-~" .;,'j I_~,.. -\ 'c'_-; ;"[,'.';~'_.;~:' .~' _"\'_{_ ~-~t ....,>.':~'_ ,\,,' ....~t. .;..~. .;, ,:_~._..' ,.'<:,..:~.. ~ ": " 'I: { ~Pfl}~OVAL'," REQ9.:F~,~D'.:' r:.:o wo~k ~Qal:l be Cj.qne ~~~_~'~!lY',P~7t qr .trr~,'_ ~]ui.ldKng oi, ~tru~tu're ~beyo!ld':, tJle polnto' ~........ " .~' ~ ......~' .;d' i-nd'icateq q:n eaph: 'successive inspection .,;.-Ji t.lio"~t. first 9b.t~i'n,i.ri.9' the, ,~pproval. of .~he- b~lldlng offlcial ~,J'. ~ . Sueff ~:f;proy.a~.'s'h~ll _be- ~iv7n. cnly aft.er.~p'l:~flsp~~,:t~Pr:' ~.~at~~~!,1C:Y,e.. b~,eh.:~>a~de of'-!~a~h 'sqccess~ye.~:step ""-\ int,~~, ~onf,~r~:.;.~o;,;as p~dJ'? t~1. b~ ~ eachl.(),~,tt~~,~n;.p;~},~o.ns ,>~:{.:u'':,e;d..;,:~:, "'. :~ ,'~.; i .. ',' :",,' !~, 't'~ ,I ,,\,', N~_T,::. All b~_l:~_Q:~.~" ~erml'~s requ~~e. ,'~n~p~,~t~;C?~s: ~~_r:~_,..,tJl~ _;tO~~,,}l~~~,~r:~e~/ :< S.U,Ch ,~;... ~'':!''~ not ~~m,:'t~~. .to_.: o',',; ~A.'.'" ~loek .Wal:1.:, To. .~e _ maqe at ter ,re'i~for~ih'g,\i".s .,i,n; 'P'+<3.~~' .but ~b~'f9i~,' ,ary grout "i'~, :pouredo'; This . '~r:spectism~, is' req~iE~? ~or le~c~.b9~d, ,b~a,m: ,p,9pr"..,_., ~.ti~r'~}.wi>lll,~~p.~ ~'na:' ~R~rovall .untIl .,~h~ p~uinb!-ng..J'" . " ;j f(~ ~ : ',:"Z;.d ~~~~c.~r .t~,a.<l ~,nsp~f?f~q~s have::;97'en., m,~d.e'''l ~.n~ a.~pp~v.e~.: :..~', ~" ::: :.~.., ';,;t .' -' ~ _. .... .,.-,,' . ''-.Ii '" ,'f- ~. t B,' . M6,ad'.~Stb~ve:' _ ;;TO' _be:::'mad{ ~ft~r: ,c9mpletlon: ~'t m,~s'ol!ry '(i.f" a~pipi'~c.abte.l~ran,4 .~hen i~s ta{la tion: ,'~_~ > '. . h_ ,,"'-;-' 'F~' . .. '. 1.. .:> complete. ~;~nsta'l}<t t~Ol) '.shal;L -' l:!~~ fn ~ a.~~c6r~ane~ wi:t~._'<3:,~' <?,-ppro'%~<l,'-~.":;n~ tiq~al~y recogn~ze~: testing Ii ';, 'r ~,~ .: )..' ":;fa.g~~;qt.,~'~d' th,~, ij1a,l!l.}faqt~re~',~:.,~~s~?-,ll~~i?~,: ~~~tru~:tf~~s:,_ "~_i~~ :;-;~:r'i':": ' . C'. ,':,';Mobile Home ;-r" ,~n' inspecti.on .is., r~qui~,ed.. a.ft~~ ~ th"€{ IDs>bil_e, hp~~ . i.{:c~nnected to ~ an' .approved sewer or ,sept'ie. systemrfo.!= se.tbaek .:L"equi:f'ements~, bl'6c~iJ.1g't '~?qti~g; c.cinnection';.-t-iedowns, ;...:, ., :')i;;1~ii;;:~;1~ti~;~b!:~li~7~::::;,~:;::~1;;;i:!:~:f;1;:::;" :;;~:::, '::":' .:L::-~{"/ ;\" .....', ~\ '!' '.{:. 3.:,::~-E16b"il~~,,,tlo!l'e...ti,e?oJJI;1~, .when._, re~q}li,r~'?, /9-nd. skir_ting"sh~ll.:b~'~i~s'talle? a,~d..,peady for l:n.s~pec~~ .' '- "j"- ::.....;.. ._.' 'tio~n~.~t..tl:ir at re~stE-'30"da'y~s ?l.'{ter: occ~pan:=y'. "ITled,a:vns a~~.~sklrtlng shall be lns~al-led :'~.;n ..;r~~'f. .'. ." ""_~ ..,pe:r:.J.enc~~s\;!':re. . :;, 1, ",~, '-'1' I j,;,'. ~ j" I',. '.' .::,' ," .. . ',:/;0:, ;~~~:~~~lP~~l;,~~s~:,~,~;~~.~ld~ wh~n 's~:'e;" i~;:ln'~,\~~rf~d~ b,~,~~?:";.(Jf!~,r~:t~ is,.poured.'Abbv'~' grade '. . ;';f~xL~,R~=>:"~ED' PJ;.ANS' MkUST B'E ON, :I:HE JOB'~SITE ~~T" A'LL~ 'r"IME$fJju~:{fid". WqRKINq, Ho6R,S ...~: .~gIS~ _~ERMI_T..,WI:~,!:/)::.X~.I,~.E_~.'. . ,; ~t~~~~~ig~~;/~~V~~~~~O~I~~NO~~~R D~i,s~H~~' ~I~~~l5w~~ :f~~~~~02~~~k l}~~~i~N3~ 'i~~O~~[~T~H~~~~~~~~b~~> "."" ....:.; '~~NF9RMAtION'. '. J~.,f;~' "'.._ '., '. '... .... r '~~~:-",: .~ :_-,_~:",.', ';',;- :..,.;,:~ ': ,'- ..' '. ANYO!'lE I'~QCEED:F'jp }?AS-r "THE ,P:OINT'or, ,.REQUIR~D INSPE'ST'i:ON~':\;iLL ~Db'.so"~:r. ';~HE.IR 'OWN RISK:', S~~~U;~~CE, ANO~~~~;;TIVE~~\'AGEDTSPOSA~: S;~TE~;S':'-'~~:"~ >:~:' '.',~', ~." .',' ,~ 1.. ~Perml.ts'shall be, eff:ct.lve ~~r ~ne;.ye~f.~.~?m'~!;:::.~~~,!:~,...~J~ ~ssu~.D.~e.~ ..;' . ,_. . 2. ()poQ~'compl.eting: _ the cons tn.i c.ti oil' f9r.:.wnic)1'::a:":perm,i ~_,;h'~'s:','b~~n-...i~~u~d, the. p'ermi t h~ldef 'sh'all- ' noti.fy _',the Lan"e ,County Department 6~ :"p.l:ann,i,i1'gf",and,,'co~unity~tDe_velopment by' !?ubrnitting .~he. ..'~. .in~;-ta\rl'a'tl~<n .record :fo!,m'~., ~., The. Department .sJia,rl :~in~p~ct.:~'th'e:" construction to '._determine' -if ~i:t" _ 'co~p~i~'~r --~~ th ;~the" ,rules, ~on~aLhed, ~h "tlfi's' diyi.sio!l'-') If :th.e ';c,o.nstt}lc,ti,ol}.,_ ?-oes e<?!Tlply wi tl}.. such ,'rule;s-, .t~~ .',Dep.~~~tment shall 'issue. a" c:ertif ica_Le ~<of "sa tisfa~.tciry, c'ompletion to. ~try~, perm~ t(halder. . if "ill'e' eons'truct.ion doeg not-.co~ply with- shch ';ruiE/s"if~~tne:;~jjep'a~rtment "shalF not.'.ify:the: permit "'-'... ,,'~. ...,~.~.;' ,holder>'a'nd ,~hal~' er,eqUl.'re~ satlsf~ctory cqmpletlon before~.".i:rs.sUlng: the "certlfl~ate.. Fullur~ ,_to . .. .mee t '\h$". r~qu>r,emer{t-?:. (q,t!. sa tis~fac'~ory ',.c~;:)mtilet'iqp', w~itJi/n' j,~: '~e'also.n~ble, t~m.e,.caQs ti:iute~ . a ~~'C:?:-~ .. .... . ... .,~ '~-~~;-t;ion:of~.6RS 454'~'60'5 t?,..~~4~.745' and. 'this r'-?-le..../~~)~,... ".:~~.'~'''''' .......,. ...... '~~ ;;:" Tr "-"~.......' ". Setbacks ...; 'Subsurface 'Sewaqe. Disposal '. > :'" to,. -"'1' :",':,.' ...~.. ~ .~.v : --: -' " -,'f,' ~ ,~; ',i~:r' ,-..,t , .,f" '" , l. ~ . -l.;i :1, ,.; ;~:; .- ~ . "~' .;: ;\~~, :j.f- 'JJ ,'J~,':" 'E..!'_ "\:',~;::' ,. .~ ;. , ;,.. '.- ~"'~' ~~ . <' " , .' ~:'''' , ~L - ;~'''~r;.... ...~. .. !.:.;.: t tt,,;;- ;,~,,:,~!....-J-' ~;-;...' ,,~....... ',r~'.. ,,' ,,\ ~ " : .j: . ~ ~ ;#'., " '~.' '? " . '"\ ~,- , " '..:1.. !, f>. -: ~', I ::);1:: '" t; .' f ,-. ." .;" . \'{ ~, ,( " " ';4.;. ..; . ~. .J:' ',. ,:.: .~Jr '_I,' ~ :~:'~ .., ,.:;:.r; :g~., t. ',,: ".~':. ' ,~ ',' .,~, " l~~fJ.:.:~~;~', ~'~j;it!~~~, , .,:,~l-\ :;' '~... '~'. ~<>..:' , '. .~. ,',:<'. F~?~: .- In.terior, property lines -< Edge: at r'6ad .-r}S{lt'--af-;w~y '., "B,lriHfinq foun'da-tion .. . .;~,.-':'~~'\~/~,~~~~ '~.~h~~~w~~:r' sa,urces :-. : " ,,0>...: II -,c' ''''::, ,~. , . ,',' '" '. '" . :~~ . I,l -' , ~~:"~':" :. ~. i' .,.-.,.....- '1; " ;"" ,-.., . 'v, ~-'F.-l' _.~"'~..~'i,f-:<t{.--.'.:-:'C "'.'''' . '" ,.''t-' ~ './; ',W' '... l'..^ ~" ..... , ~;~ ' '; ,.;~ , ~. 'i, " ~ . t : ,-I J'i' , ".. .J.. < If J.; : -~ .~: .~~ :.~. '.' ':'r " : . ' ( t" .'" ~ ,< '.. -"- '... ...:~ "'. Jo..-"~. , ..'":-.... J " ; ~I..;..~.:;..;'c.:.. .t'i "- .,.".'.. . "J .:~rn:.":.: ...~~ c\i- ;--1, ,. 1;','. ;<.. '.". t:.' ....... ,~;' J " ',.' ~"-' , , .:-.~..',' , " . ~" .)..:~"';6. 'J', : _'r..' ;.~, I , ' 'r:'-",;" . 't. ," ".., '{'r; : :;: . ~ .~ ' <, \.: .1'. ~ ~ ~: ~;. ;'1-' "',' ,; ,'''r!,,:: " I' ;: ; ""-'-':' . 'j.~ ' -.. ,~ f':;::'.' "4' .~7; .. '. ia:~~~t; ACTIVITY'.INFORMA'T10N SHEET ~;' . " T2,,-;~l\' ,,-j'I, "',\ .Elv~ L #l.Nll'M^N^f~f ""', N"l Orvr'.'()N U..~..,...........I ""toUor; w....... Please complete all Items above dotted line FILLING OUT * LINES WILL GET YOU INFORMA TION ONLY *DATE b / /1 / <;',7 jdJ.e..,' ~, ' ACTUAL r Z PROPERTY J'j c., "" /J /J , OWNER" /, / ~ ADDRESS /17 a{~ ~ , ,TELEPHONE~BUS) , ~~ 2)~R, STATED.( ZIP, P> Y? i * PERSON - ~~I~~ST ~~ 'uJ ~ AD~RESS C3J5 W ~ " CITY ~ ,', STATE $1:- ," liP' '1 )f/O( . CITY TELEPHONE (Bus)_7'g5 -,,~ 00 (HOME) *PROPERTY ADDRESS . J /1 OR MAP & PARCEL NUMBER (Found on tax maps in the Assessment & Taxation Dept.) - , 111 ~A,,~ '( ~ETERMINE /7 CJ5 23;;>,:8 :;'18 u.-~/,)rw~ Town~'hip Range Section - Tax Lot Zoned , ~od Plain '(HOME,1 Township Range Section' Tax Lot Zoned Flood Plain Township Range " Section ' ' , 'Tax, Lot Zoned Flood Plain TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: ACRES * R E QUE S T (describe what you want to do) 4r~~ ~ ~ 711 J4. I -f~ Oirections to site ',~,%~ ~ ~_":.~/. ~"~/ir!~1,,I.~~,,, ,'....................5taff Use Only.................... Comments: Land Management Division, Public Works Department 1~5 E. 8th Ave~, Eugene, OR 97401 phone 687-4061 I .... " ;1';" _ , ' . .,' .. e111 n " '1' i, i! " 1 [I II I ., .j '~ W: 5 I ,~ANE COUNTY DEPTENV MGT APPLICANT ,WHITNEY, JOAN AD DR 315 W. TLO 1703233300218 SUBDIV NEW BLDG TYPE USE R BDRMS OWNER NME ~UCKER} ROY CODE, f.IPPL ND ' ACTION DEST!=(IPTION ' BP BP BP DP hl,', P I~ ' PL MECH sU!=:: PCK Lf~ :~:FI)(/BATH : L,C 188~::;87, SDSV Cf~TG : f~PP F:PI .. "'EG~U : 1 ") tAKEN .'- BY Cf~D FP' EST. 5: IJJ F;~ : F T. . , 1,-.1 T F: : ,rlECHf~,N:t Cf~IL FEE ST(.ITE SURcHp,F;:GE PLf~N CHECK FEE, COt-iPLETION Df-ITE ,S'l)S S I "Z ..J PCK r1"i i , ' A ~i i\! c l < I] fa ~ ) . i ! li'jI . ,~ I 'j ::: r < ... -,-- - --.------ ,9 DfYT'E (:)t,-J 1 ~), ' OTH B I... 1< 48~:> 62()(; FEE ~ ~" D fY(~i' I . I' RECEIPT I 188587 BI:W/~DVJI:YY ,i EUGENE " LOT O'UNITS 001 STORIES IBLDGS 001 PHONE ,ADDR 117 ALLEN AVENUE, SPFD. , SQ FTUNIT COST ,VALUATION FT. ~~:AIN: " If ! e 3 D , '< , !l .. ~ FT ... <: 4A: ~~ ~:) ~~ o i. ~ ~ ~, III ~ ~ ~ 60.,00 I 1S"I~~ , ;: 11 g ~ " ?, 4 DEPDSIT' *~, 60. ';)0' CK , ~ .' 0 0' ~