HomeMy WebLinkAboutPermit Septic Tank 1990-1-1
.
ACTIVITY INFORMATION
,,('.
Idne county
SHEET
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
'~~.'
......... ....... .
f
~. f 1
'I
j
Bill Medford
PERSON MAKING REQUEST
John W. Mehlert
PROPERTY OWNER
1216 Mohawk Blvd.
MA I LI NG ADORE SS
5527 Sara Dr.
MAl LI NG ADDRESS
Springfield, OR 97477
CITY STATE ZI~ CODE
Torrance, CA 90503
CITY STATE
ZIP CODE
746-7613
BUSINESS TELEPHONE #
726-2056
HOME TELEPHONE #
213-316-6664
BUSINESS TELEPHONE # 'HOME TELEPHONE #
i
.1:. 2
~, .
;
,
PROPERTY ADDRESS 723-Ander$Qn Lane
(IF DIFFERENT FROM MAILING ADDRESS)
SDrin~field. OR 97477
.
l 3 MAP & PARCEL NUMBER
(REQUIRED INFORMATION)
(from tax maps in Department of Assessment and Taxation:
or from tax statement)
17~'t 3-W 33 f 1,/
TOWNSHIP RANGE SECTION
500
. TAX LOT(S) OR PARCEL #
/f&T/U i
ZONING !
!
: '~
;~~~
i
TAX LOT(S) OR PARCEL #
ZONING.
Seotic Dermit for buildin~ home - Owner
'BLOCK "/
Q . - -.. (
0; ~\f_(,r!o-n__) \
I ! b
' I
1/
v
"
1
!
TAX LOT(S) OR PARCEL # ZONING ;
.336.34 X 104.28 ACRES""- ~().__ ~
!
LOT
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4 SUBDIVISION (if applicable)
5 REQUEST (state exactly what you plan to do)
i .
6 DIRECTIONS TO SITE:
Centennial Blvd to Anderson Lane.
** FOR STAFF USE ONLY **
NUMBER
DATE
. . ...., .... ... 1
-i
;;0
(/)
ZONE/LAND. USE:
BY: DATE:
..
-i
..r-:
TIME IN:
OUT:
LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 / 687-4061