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HomeMy WebLinkAboutPermit Building 1976-5-10 ~ . ,;y..,. . c " . . N<n'E : NlD PERMI T ~, 'a~-.7G' ." ,.,. ,. ,.PE~rt~,." . : ~ BE .ISS,UEW UNTIL THIS APPLlCATIQN,HAS .BEEN APPRW...i~ , . '.. APPLICATION FOR: CClNsiR,uchoN>I :'L I MOBILE HOME I., . :1'.' 'PLAN.'REViEW I' I. :'tiW~G~ OF.OCCUPANCY """ER '(;io"Y (;}~g.J, ,'.90 ;1:; S/;J??~/Jt+>JIY;;;$' ''.?Ikcff;i(6~ '. e07/iid/laiir~,S, ~~m.:iJfb/tP._., :'97~,P;j, ;~~:'f~~/ . . . Address , ,. CW . ,'. Zip . Phone'" .' . :o.s: REG.: fI~tp~CJCJ/()2q~. . ::3. -. :~..' ,.', " " ::" -.' . " ." , :rwp.n 'Ra~geO:3 's~d~ion~ d'7.3'::TaJ{Lo~ ,/elF?):: codeO/1""':"D:3 Cens~s Tract. r J ' Subdivision . Lot . Block ,Property.' Acr'~age .Wiath:' Depth , ,.,. V \ . ACCE~S' T6'P~ROPERTY (Road Name) JhJcI&>C7~ ~~7/ r' ',' . . ,.,.. ":" .' .,." , . ,. . .' ',Ia)#;r J"t';.. EXiSdI!~' Struc~ures.)~rt"pr.~~erty: :MJi5e ~ ~)j(6# ,. '/-5 ~>~ '~rlpq;~,f>'/i-;a;W"/7"::-e< ..':' '/ 0&3 H 77 dcP~j 071 ....Xd ?P'P;' ': '. sh i~Jfr;'.p/r/ "., . " \;J ", .{ Name " i " I . C?NT~<;;TOR Ex'(J.e/ . . Name propert~L~c~tion ': "Addr~~s/Dire~~'ion's:.. ; -0 /. e.:'. . .. " '.'.. -- Below ,for "Office Use Onl YXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX~XXXXXXXXXX:XxxxxxxxxxXXXXXXXXXXXXXXXXXXXXXX: . ~/'" '/U,~' ~n".'T.n' .~,~ ~!DV ~~'" . "ASq, :t~ ~'. ,....droo~ . . /4-::0'06 ./) "......~ _,"'., ~~.-/ 1/. ~ 11~, ~A/lAt~,..AAh~"~~, - ... ~- . r .- .;- .;y i,. -"::" ~.w! w. . .-'; 7< .~' ~ - {I SEWAGE DISP9SAL: Site Inspe~tion'fI. " t. ' "'J Eidsting 'Sewag~"Dispdsal. System. I '.' . . ~': . ", . Public ,'1 'I', c..-r. ,~,- /. '," pr New. System ~e'quired;1 '1 -,(, WATER .SUPPLY:' " Well' ..,. Spring O~het ," . Co~uIl:;iiY"1 .. ./ . " .l~ame. of Community'or. ~ubiic System FEES: .,~ , ., ~ . , ':' .... . PLUMBING: ,.... '. 'l! . _71r2"tYb.":.:installed. by()~n~r:.' " .1J:':~r Name' :. . P~UMBING,'FEES:.. ... ! /1 ' . . ~J.~ - -.. "':. ,1/ of Fixture~., , SIJ-"age.,' . , , , " '. Connection '. '. . Bldg'. Plumbing' . 3 % Surcha,.rge '. . Waste DisI>. plan .Review Mobile Home ,,' Water Conn~cti"6n , . ' PLANS FURNISHED '.' fACILITY PERMIT TOTAL, ,. - ~ ,'< 1ft? .' '" . ,J ....,., '!"CASH',' ..,.:.." ~,,/~'.~. '" ,", ~ '. ."~CK'~.. , , ' ..', >. I 'YES I. ~ i i'V :.,.,.....~_I~ I~ES ' I HB ; .,' ' i~~'~' , 's~gnature,of A~'can't~ '??~;1~' Fee Received B' ..., ,~. D~tt:5" -?- ,.., '==' , .....~ " ~ ' " . .... .' . . . . . - Min. Septic Tank Capacity' Dr~.infieid 'R~~uir~d-\i~eal Feet Maximum 'Depth: , . \ . \. \ , '>l' \ , ' \'ype 'of ,Constructi~n { , .: \" . . ,- \dg Setbacks - from "Center of.'Ro~~Right' of Way:' . \ . onto I bNING: \ \ ' 55: 12 \ .' I',. , l5'/V"'Group ". :J , ': F'ire Zon~ .Use Classification -, ,J .< ' ..' Side Into Sic;le Exterior , REiar' Zone },: ~ ' . J:?ATE: . .~TE' IPk ~fP:J" If) ~. ~E:.~O~T:'I?~~AR1M~NT OF~'~NVIRo~~Tll~NAGp:MEN~:.~'I'~' ". SANITATION: 7? " .,.",-,1 ~j.,:J!~., ~. ;;; 'i",. t:" SITE INSPECTION AppROVED j I DISAPPROVED / / DATE INSPECTOR REMARK'S FOUNDATION INSPECTION ApPROVED / / 01 SAPPROVED / / DATE INSPECTOR REMARKS F,RAMING INSPECTION ApPROVED / / DISAPPRO~ED / / DATE INSPECTOR '. .' , REMARKS LATH OR SHEETROCK INSPECTION ApPROVED / / 01 SAPP~.OV.ED / / DATE . INSPECTOR ) ;)y,/, (J ,.'-/' // .' /J. ' '7;: /} (~1 . R.EMA""~ !!UL'Y.ht(,fi0':4-V~,-:, .... ~,~ '..J:lh-: l'hZA,., '. . .'# /.1 {I fj I ... J1', " J -I/I&/) I .-n..t.tJ;&,/..a}1LtI -.Y~ l."~.c;' .' ~/<t?Ai< r-LC'~''fr.Lf'''A...(-7? / . . t/ .j , . .--- READY TO ISSUE / / NOT READY TO ISSUE' / / DATE INSPECTOR ;~:;;J:!,l;.g~~J~.~ A9;~ J::/-:'/I~'m.:: ~~ ~- jI '.A~~'t.r ~.~~ ~4It4.~ f/ " 0 0./' ~r.r. ,. . , -~. - /" r;;r.. f()bJ?~:RI~ //)33 ~~ j<f.~ (, .~3'.fH\rDE~ON 6~;t' Cw,,6-.- ';",' ':A~ " ",' ~Q "-Mh"""-....c...'""- ' , ' , _,' ~ LANE COlJr..l-iy ~'ERMIT For .LoJ.J--., ~ -- , t ~- . :..... .r. " . "~ :tJ Owner ~:~~~::<:~ t"l ' ~~l ~:') :1I~~:~! {. '{" , ," . ~~,:~J',~.iit - [ ] . C~;A:NG E OF OCCUPANCY. r,?'~'-"l(""" l..j."" ",.:, ' i. .~" ~(~.! ,:.; .:.:,;l,~" .' 'AI()' ...,L.... .', rv 'Ie- }~ CITY ..;,~ ZIP CODE PHONE ~~:~,.~~:")?;(\:J:~:::f~'~~~~' , . j~~'~ 0 1'",' -,~.- . :~~ CONSTRUCTION [:] MOB'ILE HOME: [] PLAN'REVIEW :0 Contractor NAME. , {;~ ~;, - '.l.(-l ~ ~,~~; ,p'] .~~ ti .~~ "(': ~f ~, ~j 'ADDRESS ;.. ".,"( ,,: ~l.~););<~ ~1~~J~- O;S. Reg. # NAME . '-i 'T',",', ,~,,;+, y1"J';Ct( ADDRESS CITY f..) ZIP CODE PHONE :Tvvr" l....\'}' U : ,',,) Range . "Id Section /? ..~th ',. I Tax' Lot llt~;:; Code ,... 'i,.. ......~ !~t~" '~~ p. "\ Census TrC\ct '--' Subdivision T~Jt~ __ . Lot Block Acreagp Width . . 'Access to Property-(Hoad Name)~ ti~~(;,(lL""ctftD a,(';{r~:tl ~,,\-.,.,. '~"-' Depth' .~:;. 'h.. ~ 11 , S;:Jf'!/ r.;;,,'tf.~ c~? ~"l (~;Krf'f:~f1 /' 'Existin9 Structures'on Property: Dir~'ctidns' to, P'roperty'- Address:' ,-, . -..:..... N\'Z~~~r.<:' " .', , ,1111.53 &'H~;:'f"f!'t;.1J' ta!i3e ....<.. '.....:f .~ :..;,."...-<". 'STRUCTURE .(# BE'OROo.MS), . . " . 1..;..r..rJv "\~b' ,..,,"''''~ . w?,-nr: t:':'f-. , 1"'x1> ~,}.;'\.D, f,",l, '''',.'',' C0. '".. ",...... .,', 'f _<Y ~ i/.J ~v.' r'<~~,~\... V~ _ 1;" ~....-..... o "........" ,......1<' A -". .. ~ ~.:; :') '~~ :,;j ~ n . . ~t;h,,-~-t.;~.;)~ b,\::"G.t:R-; t;. f....'1-r'.- SQ. FT. v 1;\ L 4{\TI ON .~~"~' .';/" ~ ~.; ~ ._-~---;g:."~"'-7":~ , '- ~.-,~, I. ~ . SEWAGE' PISPOSAL: ( ~, PUBliC [ ] . SEPTIC TANK [] OTI~ER [ ] J.:': ^ nt Jf......._~_;.~.:, ~ A. u' jf .~.4:: .:': -a.~ ~ __~~ . ~ !\ "'-'-"1 .~.. - o Qt "v-l ,..p 1 W>> .1 j PLUM'BING I NSTALL'E'D BY: .OWN'ER [] ',OTHER ,[.] N.AMF BUILDIN0 PLUMBING I, ~ . 3%SURCH'ARGE MOBILE HOMF ~ WASTE DISPOSAl lr' PlAN R,EVIEW. ," ~~ I.}t .~~. '~J .. WATER SUPPLY: PROPOSED t.....J;., EXISTIN.G (]", '\. ~. - ;" . ,: .-~ \'.~' " ..,....~ '\' [ ] PUBLIC [ ] COMMUNITY - NAME: [ J.PRIYATEWELI,.. [ ',) (~THEH},- SPEC~.!::Y:: .., " .- , \ '"'::lA TOTAL '. '\ 't \ \- '~'" '" ni',.~\..~ -'i' .. '. \, ..'- _. :)- , , . , '-. ~ '..... '. . ~ ~. . - , ""~ . \. '\.'-. ';,,', 't-:'" ... ,\: . 'f::, ,"\ '\,"\~ " 5.. ,'~~'~ -~~.\:: ..".... ~ \ ~: I \..'~~'~.'~' .: _~\ 'Sb~Y 100' FROM ALL:WELLS-'-~ " .-. USE.CLASSIF: ' "\\~ :',",':-;- ~:"~I~""", "~3, '-~':(';.-" \~.. , ,~j<;~ . ~, \- ' , -..'" 'i." .j '.' \ ~ \;:;'i ...~ \ "'~ ~ " . ~ GR<3.UP , ~> ,\ ' ,,_: 1 ,";I"", '.i '. F.I R E1"ZONF \. ;j -Y TYPE OF CONSTRUC;fION ' "" - ' ' ,,; ') " -?'-\\- \ ' \...... , .. - " .. '.....\,-; ~!'--,....., \. \. -l',t ;. ~, ' --.,. -~':;;'!." ~ SETBACKS - FT. FRG,M CTR. OF 'r/W: FRONT -<, ';.\-,--) . \SJlSJ:EEX'T:l<~:" .\ '~l . FT. FROM PR'C:)P.'L1NE~ ','; -,~~..~'~-S~D E-rNT:--':',~ . . REA R \ ___.. w _.' .-.... -.......... . .".,. ""-.,f' ~ ,;, J 1,-;' .... "-'IJ ZONF " , ',' ~ .AUTHORIZEDSIGNATUHES:. '.~.'I<,I1"~ h. '''l'\--<-)~'~;~' --: ,,\- "ISSUANCEDATE: /s/' ~~" ~~~. -,;/,,: U' ~r ,r If ,,,":lb' t'11/Jl'jln.. ;"f,q, f;t '. . . .' .:(~~.;' _ ~ . ..... ;. ___, 1.1 '.. . ,~~x,...~. -l~ "..'~ " ....",.:.--. . ~ Gall 687-4065, to'sc,h,e"duleali"reqUired",construc,t,io~ inspections. Call 687-4061 10 ~;~'ed!Jle all required,' D septicsyst~m inspeclion.i;....AII construction shall comply with the State-Buidllng Code, D.E Q, standards ~~ IMPORT ANT:for.su, bsurtac,'e iieWa"gepiSposal and the:,State Plumbing: Code. All buildings reqUire acert,f,cate ot..,.... ," ../occuRanqy.,befo~e'~eirig oc,upied " , ' ' ..., '. :. . ';;,.'"""" · . (See Det~i Is oriReverse Side) , . ~ (PO~T THIS PEJ;{MI:-(,j6~"iM~rN 'BLDG. AT SITEY' ~ LANE CQl!NTY, DEP'+. 'OF 'ENYIF!O~iiENT~l\1ANAGEMENT ..CO~RTHOUSE ANNE~:,.<135',E?HtZ~UGENE, OREGON :7401 / ')< \ BLDG, PERMIT - WHITE OFFICE COPY-- WHITE COUNTYTAX~P\NK ' PLUMBIr;-J<;l -:CANARY BUILDIN(i - GREEN, '." SANITATION - GOLD~N89D i " C55,.(3 /, k :':.....