Loading...
HomeMy WebLinkAboutPermit Building 1975-1-29 ~ , - lo.h H'"'' _~ ',\-"'*'. .l-::...-~....~...........-;r...--;~t.. ....'_.~~..::-" "~.~""'t,r -i't',~;f'~.~~,,:hf~;:;r:4-~1~~~""''''''''''''''';V;l~''''~"'''r.-'~i~'.?-'7~:''''':-~/.\~:'i'H~':..t\ ~~.~.?,~.;.J"<J'"'--....,.. ...".....- ".-.,p .' '"1:... '''--''"~"''l1' (" ", ,-~.. -., -. . ~/F/b~"""''''. ~~\.~"%.t-:.~~~ ...?\..'l'o;.,*"i' \.~~f.I,;~~w:kiil~..~'~l;;.~tl'I~'~..u~....~'tI:'--v'~ .:...r--)~~...t'""""f"w"(,Jj'\~J-:r+r'bs'"f-?,l.~'''''t 'f-:,~~'''~~,;'~'''''''''~..tm-l-..... a,~~~-.;..;tt:;;.4'''''.~~ 'r_~ "-j;"f,'~...', ..;;.....,;-.U.~~ - , ~~ ,'J "~' ,\. ,:.\~ _,:,' ,.~:: :~ '.'::' " -, ',:, "~".,: " "~r~' , . ,:', . " ' :' " :\" " ..',', , ' . ..'.' , ',:. ,'-'. .i -:--. ;:':-, , .t.0 ': l: ", . . LA,NE CO",.,.olTY;"BU,I~D'ING ,PERMIT' OR 'MOB'ILE . ...)ME' U,SE.' PERMIT ' ,I '~ . ~~: . ';k':";::"'BUILDI~G IJl}C ,".MH 0 ", " :PERMI.T NO., l-i5... 7, I PROP.ERTY OWNER' MA.llINC;; ADDRESS "1 PHONE' ~. . '~.' ., JeMNSOJlJ, 'ff'lCHARD C .ANO RUtH G', '957 ANDERSON UCSPRINGF'Ie:LD ,7~7"'9660, , CON.T.R-ACTOR . . . "M.A:llINCf' ADDRESS' : ','. " PHO~E . " l~'I..i..tR CONsr. 102 V'f\N ,Buru:w EU~ENE, , ,.. 688-96)0" ',P.R()PERTY, LOCATION....,: INCLUDE:~OST OFFICE " " " . '. :9,57, ANDEI1SQN LAiH~ S'P~' NGFI El.Dt' (l';ltGt:>N97477 'PROPERTY LEGAL. DESCRIPTION:': METES,., BOUNDS, :: .';:'., ','.. " " "'lfe",.'/o' . PoRI; , ::~,:' ~'NJ 4~' A~l!)rJ,', R~c-/<, J1' "TWP, 'RANGE' SECTION ' TAX LOT NO, , : CODE':' ,i , CENSUS TRACT .I iT 01 . 27~3~. :3 -It-'/6,.g(}O ' EXISTI':'lG, STRl).CTURES ,ON 'PROPERTY AN~~A~GN~bAH~-~ EXISTI~QH$u~k LEGAL' ACCESS' TO PROPERTY ..ANOERSON l.ANE' PROPERTY SIZE"':: FT. ,: 'ApPL. 'NAME " . .4'__'''". TSllER 'CO"fST.> & MAILING .' .--" :102, VAN BUREN":' ,~ADDRESS ' EUGtN'E., OREGON, 91-.402 . 'FOR 'MOBilE HOME PERMITS ONLY, ,'No. of Ber;lro'o,ms ' , STRUCTURES TO BE BUIL:T T,Hi,s P,ERMIT' " , ," '., 'AOOfTl:ON',( RECREAT I-ON ROOM}'(20,X: HI-) WI[)TH: 70. DEPTH,' 87 I , AREA: .'~ ~ ' ,Connect,'to Existing Sewa,ge 'Sy~tem' D, '-:New System D TYPE..S:ONSTRUCTION ' SQ,. FT, ',', # BDRMS VA,"UATION, ,280 @'16..:10' '~, $4;508.00 '; " ' /? .:~".' ,PUBLIC D ,BUILDING 'WA'STE DISPOSAL' PLUMBING~ ' PLAN REVIEW PARK TRAILER SEPTIC TANK' D OTHERD : $ ~2':OO..", ~ .~". ., 'FEES PLUMBING'INSTALLED BY ; OWNER D.' OTHER: NAME WATER SUPPLY I', SEVy' AGE DISP,QSAL PUBLIC D, '0, OTHER '. i ' .: ',! 'TOTAL ~. ~. ~2 ,t ',~..~2 t" CQUNTY: BUllDINQ& SANITATION SPECIFICATIONS . DRAIN FIELD REQUIRED 'L1N:' FT, ' 'TRENCH WIDTH FT.' I,. . MIN. SEPTIC TANK CAPACITY WITH OIST, BOX:'GAL. OR SQ, ,FT. 2r-EET Of. QRAVELREQU I REO.. ,AOD 'MAXAlf.JOUNT ,OF ORA IN'F" I no THAT SPACE: AI:.L'O\;'/S.. '....., 'TYPE OF STRUCTURE OCCUPANCY ,ZONE : , ~ RA USE CLASSIF!CATION ' P'U,BLlC UTIL. EASEMENT ~N:" BLDG, SETBACKS ,_ FT, FROM CTR, OF, ROAD, RIGHT OF WAY FRONT': 40 ' SIDE INT. ; I) , SIDE" EXT. AUTHORIZED SIGNATURE - DATE j sl J.' E. BO$S By, CHAR~.lPE HARfllAUGH' , REAR, 6. JOHN SHOOK SANITARIAN DATE 1..29..75 l014; 1 BLDG, PERMIT ~ WHITE , OFFiCE COPY"':'" WHITE COUNTY TAX- PINK PLUMBING - CANARY BUILDING - GREEN SANITATION -" GOLDENR'OD IMPORTANT: Call '687-4065 to schedule all requireqinspections. All co'nstruc- tion: shall 'comply wit~, Uniform Building Code, D.E.Q. standards for. subs'urface sewage disposal and county regulations covering plumbing.' All buildings require a certificate "of occupancy before. be:'ingoccupied. , (See Det~i1s on, Reverse Side) (-. , { { I r ",.., F.ORM # C55-13 1,'" ' ~;'~.'. " (POST THIS PERMIT, ON MAIN BLDG. " AT SITE) , LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 :-; -' --'. .~ " ... t ~ . ,-'. . ,.,;.~. "...l,:\.~.-..~"!__:.:'_'~'~" P. ... .,:...~~ ,~. ','''- .'V. ,.-,...fo:'l,..,.'5'!.';l.T.I'.."'..;.......;",U i!;...~.I,.~ -'\O!'''-'F'ij "'--l~"'I-"~-."-..;:"-':;h':"- ,~ 'f..~r"l,~~<. ,j,..............,:..l...-...~ '.. .J~....,.,; sUP""eMENT T~BUI~~ING ~ERMIT NO: -I :;-1'5= ':Z r . - ) Lane County, Oregon '... ~, ~' '-;,. ::'" :;' ';!l,Il- ,. y ~1...." . .i.I' if .~. ~ ~~ i.. ,. \ , 1 " '\ I (~)', ,(' OWNER ~>7""'lk~~ll:'L/t"";:t.JI, R' '-t'./i/..'l(;;' j.-':;' , f' 1/ . / CONTRA~TOR \..-;fi,tl.-f.r'f. .",/ /~ ,_ _~/_.f. ' L.,(' ),L.,-:~~_, ^') _ #OJ "1 J MAILJNG f.D~FlESS -:;'~''J' .... ,'-[i7/-l/Z.'~~0.~ 1 It c.:'C ;i'( ,( .-J."';___tf)c.-;1'!..-:r I'" l ~ ,.. I "..........-." " " , U, t ,.' ,h, .i;' , . 1 /? '" MAILING ADDRESS J'''''' , '.-6.-'<:.;//./" Jt./:..,,,. r..f' . '. PROPERTY ADDRESS en 'ADDITION: /~ ').- /~.</j)/ j ~frLJ) /.~ " , /'/1-;}/:;;/;;2,/ /JL./ 1<'" 1''i7l..C-/ ,3. liP o CORRECTION: .?J'r:., /0 l'fo 0 CHANGE RESULTS IN: 'D REFUND OF FEE, OR , D ADDITIONAL' FEE: .~ \ ~-:.-- BUILDING SEPTIC TANK SANITARY CONNECTIONS ~ /.: r' , ., 0 ,'.' ~:; v~ _ ._.~//l.~,f:... ./>~"n ,.' I . ,- Dat~ /...2'1-70 f: r f..... p~, ...). ..,-' V )(/ .~..;)....-. .........-?l (." (-~r ~;:~.<:: \ I' TOTAL $ /..'), /)t) []] 0 DATE FEE. PAID J -r,"};";/ ,- ' ),,~' ras~ Check LANE COUNTY DEPT. OF HEALTH & SANITATION , , , " I / (';' '1) (.~ ~'. :,~ ",' oq~; Supplement N2 _ '1861 /. .' 5 By ~/Lfl.lV C?Jj~ ()...-i'.'V ~. #- V,---:, I 'if~ /-7 f . 1 ENVIRONMENTAL MANAGEMENT , 135 EAST 6TH AVENUE EUGENE, OREGON 97401 YOUR BU I LD I NG I 1$5-75) MOB I L E HOMEL jb~~ IPERMIT IS BEING HELD FOR THE REASONS STATED ON THE BUILDING SITE EVALUATION SHEET. 'WE WILL HOLD THIS APPLICATION F;h .5/CJ75 . IF, AT THAT TIME, YOU HAVE NOT FURNISHED ) THE REQUIRED INFORMATION, AS SHOWN ON THE ATTACHMENT, YOUR APPLICATION WILL UNTIL BE CANCELLED AND ONE-HALF THE FEE REFUNDED TO YOU. HOWEVER, IF THERE IS A PLANNING DIVISION PROBLEM OR SOME OTHER LONG TERM PROBLEM WHICH YOU HAVE NO CONTROL OVER, WE WILL HOLD THIS PERMIT UNTIL IT CAN BE ISSUED. M55-88 ~~'""'t..L- ,~ / . ~ T 7 R Q3 s.{2,7 TAX LOT, SUBD I V I S I ON: - . ! " LOT:, BLOCK:! . T;'l1er- (&n:;r I-rZ/-7/-) CK'D BY: ~;?' /-;;.,p....:J~ 6. Setbacks from c/l of road: \ Front -7" ti Side Exterior ' S,etbacks from inter i or 1 i nas: Side '~ Rear ~ BU I Lll I'NG ~ irE 'EVALW~T ION -, c\t ( r BUILDING PERMIT APPLICATION NO. ' I "tl. t"-,'?,J;:.... () SITE INSPECTI9N . AP'PL I CANT DATE PLANNING DIVISION 1. 2. 3. . 4. 5. 'Not , . Appl icable ,No Yes Zon i ng Ord i nance Comp 1 i ance: Zone ~ () () ( ) Subdivision OrdinanceCompl iance ~, ()" ( ) ( ) Required Access ,', () () () Building Site (Area, Width, Frontage) () () ( ) Other (see comments) r (), () ( ) r COMM~NTS: PLANNING DIVISION ACTION: PENDING: 'YESl j NO,l ) APPLlCATlON# BUILDING INSPECtiON DIVISlb~ ,Not \ App 1 icab 1 e ( ) (IC) (Il ) (,) No Yes' ,() VO ( ) (") ( ) () ( ) ( ) .7.- Pl ans Submi tted ~ 8.' Soil St~bil ity (footings) 9 . Flood ' P 1 a in' , 10. ,Other (see comments) \ - COMM'ENTS: Not ' Applicable No' Yes 11. Meets Department of Environmental () r-) ~ Quality Standards. 12. Other. (see comments) , () .fIjiY ( ) COHHEIJ.TS~! ~ ~ U/LM/ "'" jwu;41 ~,_, ~At/I'M~ '.M,J'/iU(', ,'O,,^,- \S~ ( )\t"\ .~- "\;f' ~ , WATER POLUTION CONTROL /~ ./ \. . '-- -.J ~ "-, CK"D BY~Itdf-1'~~o~~,~~ . . ," ,-.r'TE, , C~'D BY:\'UljA~/I; ~~~ ~;/~ ) #' /~ ~/; -' TO APPLICANT: , )'" Your ~uilding I Site.lnspection: , ( ) Can be approved~ ~Cannot be ,approved at this time as indicated on item,NO. /';1 above. Questi ons 'and further informat i on on items 1 -thr6ugh 6 contact the LANE- COUNTY. PLANNING DIVISION.. Questions and further information on items 7 through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION. . ~ Will b~ held in this office until you can resplve ~he problems indicated. ( ), ,Is b'eing returned.' "' ( ) Your building permit aeplic~!..L2.!l_Je,~_L~!?eing, ,=~turned un.s!er,_seoarate cover. DEPARTMENT OF ENVIRONMENTAL MANAGEMENT , , , " 135 Sixth' Avenue East Eugene Oregon 97401 \ PHONE: \687-4065 LANE COUNTY PLANNING DIVISION PHONE: 687-4186 , I 1\0 \\ . \\ ~ "')0 \ ~ C55-28 ~ r..' ..._~~.. ::-- .~~'~: ~.--'-~-.:....--':~::,:,~'~~~:,,~:::-~~:::~;~::'?~ ::~~':~~::::':~i-:~- ~':'~ :~-'~~'.~"-t:'~'::~.:-:~:::~:~:'::.:=:~~~2.:- -.~-. ,_.~ -. .. ,;."" '''- . ...""""!'--,.:........- - ,....- ....::....q.~-"._-..- '"" .' .~.J,: . lME USE PERMIT PERMIT NO. ~/ LANE CO, fV BUILDING PERMIT OR MOBILE BUILDING DM MH 0 'PROPERTY OWNER MAILING ADDRESS' ":,."/",I,;~ (~~(~AQO [. AND nut$~ e r;;51 ik~Dt)~J()'l l:' Jf\JH~j'(fdl:~.@ CONTRACTOR MAILING ADDRESS "1". 't ,"'\ e"".,\",il'<'i.(j, ,1",r, ~,,-fj", ;;.,"":('''',0 . ," .!I 1! ~ '\..:tL\ .t:h....~, . Ci "t"\..J -- v~""'.) ~~f"\~... w-t;...._~"':-,<~.:l{,""'~bl ~:iPROPERTY LOCATION - INCLUDE POST- OFfiCE ,~~j( i~~~~tR;'jO'. ~{i,:.!(l: 3~QWf:'9-ijr,:U:Jj') (:wnC(];J ~rq!,Yrr : ',PROPE.'~F~ESCR[pT ION - )!>fjES, BOUNDS# !' ,~,L/7 C4f2tR. t/~ . I- i , I" TWP ," RANGE' S ION TAX LOT NO, :'~ f ' 'tY1' fL( i'Zi<,. '? PHONE ""'-~\ ""-~ _ r" <>. {fl. I' - PHONE (l'J~f \~, ~'l' U~':':'-,,:.;.^":)'l..l 'J'"iJ 'I .3 /' ,~;~ CODE CENSUS TRACT ,"", . EXISTING STRUPURES ON PROPERTY (?,!'.\OOQClGW"'&4~C""<;,> C~l *t'W ~;::(', ~~<n3~:,C LEGAL ACCESS TO PROPERTY At~~ti'~~t3,,~ ~,M~e PROPERTY SIZE - FT. WIDTH t~ j) DEPTH f.jr "AREA APPl. ( NAME' & YQ~,,-tt(.~ C(~c91. t.\ lO:,"::' '\INJ ,G!5~Q';i~~ ',- - ," , , . ,. - p MAILING ! ADDRESS Ct;:'1 f,<~'E,O:lU:,i)f2;<J 9Tbr] ,FOR MOBILE HOME PERMITS ONLY , . , No. of ,Bedrooms, ' STRUCTURES TO BE BUILT THIS PERMIT ~,j[.),: nr vC;,' Q ~~t.:::;:~ftA'fe''Q::<''i~6C''':'' ~ ,~:@, ~ ~k\p Connect to Existing Se~age System 0 TYPE,CONSTRUCTION SQ, FT, # BDRMS r"I.!j.~ .... t \"1 f-~ ,\^ l :O;jj c. ~ 4iwo )j\;~.' New System 0 'VALUATlON (}~J.t ~2'{;:'~:4' . t.~:'. . \. \ '. .......' ~.. .- '\ ! , , . " --1 ~UHDING . WASTE DISPo'SAL t . , 'PLUMBING ' \ . ' \ ~L-AN REVIEVv' """ i . ' PARK TRAILER ~ OTHERO <,~;,.t~~; FEES' PLUMBING INSTAllED' BY OWNER 0 OTHER: NAME . WATER SUPPLY 1 SEW(lGEDISpoSAL . PUBLIC 0 ' SEPTIC TANK 0 PUBLIC' 0 , o OTHER I ", \ , ~~. 't 't" . " .... :;.\ .-'t ~ ;f~-'''' 1~C>TAL , I, i tMIN, SEPTIC ,TANK CAPACITY . ,_ ' ' I ! ~1'rH DIST, BOX: 'GAl. ", \"" ;, "~\" ';'~ v(r':.I' .:: "~ttC:~, ;~~clt' ~' '{e,: '~,:l, COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FiElD REQUIRED > ' , , 'L1N'. FT TRENCH 'WIDTH FT. OR SQ. FT. j~/~'~,\ "^-~H !\~~>;.7W\r,.'~ "\':('1 v~~U;,nj~V D?L\q;C \ ' , .. , ~ '::. ::...2:7r~), . , ~ ..., I , , :. i ZONE ,ret., USE CLASSI~ICATION PUBLIC UTll. EASEMENT ~TYPE 'OF STRUCTDRE 1 ':1 . , 0 BLDG, SETBACKS _, FT, .fROM CTR, OF ROAD RIGHT OF WAY t(.. )!,rt: .~ '. 'FRC>NT ,.:, , , SIDE INT. ,,:I SIDE EXT. :~, \ I ' AU:rHO~IZED SIGNATURE - DATE '. .' :/[1' 'J~ C'" &0'21<:) thC'L'V"'!\ is ~1l,:1r'DY::::t:l ,,', ' Y' . OCCUPANCY REAR rs DATE "J:,'~;'J r;:K~.en ~CliJ i .'M, ~ n:1. i ,{..: ~' .~. \ BLDG, PERMIT - WHITE 'OFFICE COpy -WHITE 'COUNTY TAX - PINK ~ 1\ PLl,lMBING - CANARY i 'BUILDING'-:GREEN , SANI!ATION - GOLDENROD IMPORTANT: , Call 687-4065 to schedule all required inspections. All c:onstruc- tion shall coOmply with Uniform Building Code, D.E.Q. standards, for subsurface sewage disposal and cO!Jnty regulations covering , plumbing. All buildings require a certificate of occupancy before; beiJ;1g occupied. ' (See Details on Reverse Side) . ,FORM :F, C55 -13 (POSY THiS PERMIT ON MAIN BLDG. Ai SnlE) LANE COUNTY, DEPT. OF ENVIRONMENTAL ,MANAGEMENT COURTHOUSE ANNEX, 135' EAST 6th, EUGENE, OREGON 97401 ~~ .0 SITE INSPECTION ApPROVED / / DISAPPROVED / I DATE. INSPECTOR REMARKS FOUNDATION INSPE~~~ON ~~ ApPROVED / V j DISAPPROVED / / DATE"z,w 7- 7~ I NSPECTO~ R'"'.KS f)/(~ ~1-;:~$~;;':/-2?-1.r~ t::P.). , FRAMING INSPECTION ApPROVED / v: DI SAPPROVED / / DATE.,),-7.....76- I ""'CTO&! ~ /. REMARKS LATH OR SHEETROCK INSPECTION ApPROVED / / DISAPPROVED / / DATE INSPECTOR REMARKS' / FINAL I NSPECT ION ./ ApPROVED / ~~DISAPPROVED / I DATE tj-r- ?~ '"S"CTO..~ REMARKS CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO ISSUE / / DATE INSPECTOR REMARKS I JJ,7J'- J~ ~/~1f1 /i/)~ ~ (,) 9'~-7 ~ -'-~~..~~ '. .. LANE. COUN BUilDING PERMIT OR MOBILE H( . USE APPLICATION t3S-7S . PERMIT TYPE - BUILDING IX! PRO"ERTY.OWNER MAILING ADDRESS ' 1Z.j~hA'(r1 E. ~ Ru.-rt,' G-. :TohlLl-SoN 9511-l.4!cI~rL~I'JJ lA,J, MAILING ADDRESS -riiL!! /2, ~A1STI6u.f!.1 ,.n~J /t<bJ. UAAJ ttJ./"reJJ fua,e Ale PROPERTY LOCATION - INCLUDE POST OFFICE I -9J)'1t))Jd~19 iJ Lp.JJ~. Sf!-~/' JJ C~i'p.ld/ (Jre 9flAl ..114 ;7'1 PROPERTY LEGAL DESCRIPTION , '-;:7 I. ' A AI j I-r. ~ I.' , .--;-) METES & BOUNDS DYES LOT - BLOCK - SUBDIV. LO/.=? DIDc.K f{' 0eCo.u.rI (KZ/I/d./J 10 /YlpA)i.(;. -M/l.K ATIACHED D NO TWP RANGE SEe. TAX LOT # CODE CENSUS TRACT 97 MOBILE HOME DOSC REG. # PERMIT # . PHONE 7tf1- Soe;v ClP,'t::./r/ 9~hf) , -..J PHONE . ~??~9'=.5tJ CONTRACTOR "'7 t73 APPLICANT _, 'A ') NAME -I 'i L l t- e c I'J A)ST~ u.ti, I ,..-1 AJ ,AND I j) ~tl1;u1) B ur (J~ A.J MAILING ADDRESS k u- 4 t tV .e...) () r ~ a IJ ..J FOR MOBILE HOME PERMIT 'ONLY . I q 1 t/-D ;L DESCRIBE EXIS1NG STRUCTURES ON PROPERTY IF ANY GX' ;ST/.<J 7 ~IJ ...5. t" ~-:t~ ,.) ,(. .-. .k #{)ILS~ LEGAL ACCESS TO PROPERTY - ROAD NAME OR # A.JJder.5t!) A.) Lf\JJ It PROPERTY SIZE-WIDTH DEPTH AREA ~7 0 (''/ Number of, Bedrooms Connect to Existing STRUCTURES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION add~iLnr)/~vLZ1~)~) ~XJ4) " - ..-/ Sewage System 0 or New System Req. 0 ~. FT. # BEDR009 VALUATION , 7_ff)~ II/) J l n ./(> ~ 5~g-, 1J 7J / TOTAL ,3 2- 32.32- /- / /,p' PLUMBING INSTAllED BY /~ OTHER D A'0WNER D OTHER D NAME FEES WATER SUPPLY../" PLANS FURNISHED FACILITY PERMIT PUBLIC D OTHER' /" YES iK NO D YES D NO M ~J~~' SIGNA _ E OF ~PP~T4~) /~zd:15 r\{ ~~E EIVED BY DATE CASH.l:":o SEWER CHECK n CONNECTION FEE / - to -/5' PERMIT # PUBLIC WATER CONNECTION FEE SEWAGE DISPOSAL . A JIIV ,,\ PUBLIC D ' SE 'TIC. TANK D $ -.:52, 00 BLDG. WASTE D'S. PLUMBING PLAN REVIEW PARK TRLR. MIN. SEPTIC TANK CAPACITY WITH DIST, BOX: GAL. COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED L1N. FT. TRENCH WIDTH FT. OR SQUARE FEET 2-' o-V B NJ.,~~l i-Aa + <SDa r ~ ,/ ~P(t.'A" red. Q !ityU \ .S' . 4&/ Jh6~_ a n1..A~ -f ("'}~ afret I~,",-D~ IrJ TYPE OF STRUCTURE , A ~ OCCUPANCY 01V I BLDG. SETBACKS - FT. FROM CTR, OF ROAD RIGHT OF WAY ZONE REAR YARD PUBLIC UTIL EASEMENT 6<..~ FRONT Y t:7 SIDE INT, . $" SIDE EXT: NITARIAN I /' .Jate PL~NNING ~ ) '1 <6 1 ~ ~ /- ..:lL"? -?.s- ! f , ' , Date REAR c::::, , BLDG. INSP, USE CLASSIFICATION 1 .tI'\ .I) J IF.!;; h !J d 11/ V Date 1A2 (;PU.~lf r.;:,t:L 1= d< (f! -:;yf l I Property: 1/ COpy 1 - OFFICE COPY 2 - JOURNAL COpy 3 - AUDIT , " " /' / I l"'" k/" ; .r I I , '" "" Form -# C 55' 1 Z f