HomeMy WebLinkAboutPermit Building 1974-6-21 (2)
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Building Permit Application No. IDY/-7Y
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APPLICANT:
. NAMEfSa.kt'r /~h1t'l1lk')
ADDRESS I 1
BUILD1HG SITE EVALUATION
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( )
( )
( )
Site Inspection
Pre-Permit Investigation
PHON,E
DATE
h- /2-7 V
b'
l. Zoning Ordinance Compl iance
(Zone )
2. Subdivision Ordinance Compl iance ( ) \
3. Required Access ( )
4. Bu i Id i ng Site (Area, Width, ( )
Frontage, Setback)
5. Ot he r (see comments) ( )
NO YES
NAME
DATE
LANE COUNTY PLANNING DEPARTMENT
COMM ENTS :
BUILDtNG INSPECTION SECTION NOT NO YES
appl icable ~
6. Plans Subm i tted ( ) ( )
7. Soil Stabil ity (footings) >f ( ) ( )
8. Flood Plain ~ ( ) ( )
9. Ot he r (see Comments) ( ) ( )
COMMENTS:
NAME
DATE
fl)"~ &~2tJ~Pft'
"
v
SANITATION SECTION NOT NO YES J~~ DATE
app I icab I e f/L'(k~
10. Sewage Disposal ( ) ( ) ()
II. Usable Area ( ) ( ) ( )
12. Water Supply ( ) ( ) ( )
. 13. o t he r (see Comments) ( ) ( ) ( )
COMMENTS: \.
TO APPLICANT:
( )
( )
( )
Btiilding Permit / Site Inspection:
Can be app roved. '
Cannot be , approved at this time as indicated on item NO. above.
Questions and further informat ion on items 1 through 5 contact the Lane-
COUNTY PLANNING DEPARTMENT. Questions and further information on items 6
throughl3 contact the Lane County Buildinq and Sanitation Division.
Will be held in this office until you can resolve the problems indicated~
Is being' teturn~d.
Your building p~rmit appl ication fee is being returned under separate cover.
Your
A 1~1< 1r
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LANE COUNTY PLANNING DIVISION
135 Sixth Avenue East, Eugene, Oregon 97401
Phone (503) 687-4186
LANE COUNTY ENVIRONMENTAL MANAGEMENT
135 Sixth Avenue East, Eugene, Oregon 97401
Phone (503) 687-4065
C55-28
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t. PERMIT TYPE - BUILDING
~ PR1:; ~~N73 ~~ A.- '
, CO"WRACTOR ~
i r~hJJ" "'~i(W
I. PROPERTY LOCATION'':INCLU E POST OFFICE
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\ ~~~P~R~~~~~A~ ~~~~~~,TION &-cL Q eLL MckB/\ c:. \ e.... ' Me? ~ v
r'7 03E ~c.~ ,5.5 TAX4~ Crq-{)~
'APPlICANT /l I (' ~, .' (/\, 11 DESC:IBE EXllTlN? STRUCTURES ON PROPERTY IF ANY
NAME t.( Atl.,Q./) /'I d rA y-Lu....lfY\fYLLV\ ftl- i('t'll)'t.a., C':tkte.J \ H" Q
AND ) ~ ~ s=- Cjtq ( 0 . LEGAL ACCESS TO P~RTY -ROAD NAME OR #
MAILING (\ .. A\' JPRQPERTYSIZE-WID~ DEPTH
ADDRESS CM.. 'itA\.. IJ") ~L.la~~_ . '. //7> l'Sy
FOR MOBILE HOt}\E PERMIT 0NL Y d '
Number of Bedrooms Connect to Existing Sewage System 0 or New System Req. 0
STRUC~U ES TO BE BUILT THIS PERMI',.) , TYPE CONSTRUCTION SQ, FT, # BEDROOMS VALUATION
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L LA. '1, MWlIi'\r{ 0()
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lANE COUNT
J1 \ (!:'.II.
lUILDING PERMIT OR MOBilE HOI _JjJSE APPLICATION (/
~ MOBILE HOME Dose REG, # fD PERMIT:#= I O'C; / - 7 '/'
MAILING ADDRESS , PHONE /
cJ 7C:: t2l12.tLA'\ S~_.~^a~--'~ It1 f)/;M~.;t~
M'~jJ'S1S (j 9 JJfJl'<H. f,!gJ'Ao_2 ~;'--/(;90
J 0 J;> ~,gES & BOUNDS 0 YES
c-- I I,J. -IUATTACHED 0 NO
CENSUS TRACT'
AREA
TOTAL
:2~.-
'K (: -=-
PLUMBING INSTAllED BY 1/1
OWNER 0 OTHER 0 NAM~
, I PLA, N: FURNISHED /
OTHER L0'€... n YES fjI( NO 0
. lJ SIG~E OF A~ ~N, T
\:)( <> /,rl C-,) #0 d.A4
~' FEE ~EIVE8~&i - - r}
CASH 0 SEWER h
CHECK~TION FEE
PERM\IT # I
PUBLIC WATER
CONNECTION FEE
COUNTY BUILDING & SANITATION SPEClf"'=AT/C)NS
DRAIN FIELD REQUIRED I
lIN. FT, TRENCH WIDTH FT, OR SQUARE FEET
f,<- ,l~Cc1-j-ed -'
FEES
OTHER 0
WATER SUPPLY
SEWAGE DISPOSAL
PUBLIC 0
BlDG,
WASTE DIS,
PLUMBING
PLAN REVIEW
PARK TRlR,
f6~t
$
SEPTIC TANK <<
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PUBLIC 0
PLUMBING FEES
FACILITY PERMIT
YES 0 NO bt
" ~ATE
, FIXTURES
DATE
6--12 'IV
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MIN, SEPTIC TANK CAPACITY
WITH DIST, BOX: GAL
o 0CA\~Q~f d
,
/d \
f\" 0\. V -t.
--}-o
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TYPE OF STRUCTUR( OCCUPANCY
BLDG, SETBACKS - FT, FROM CTR, L ROAD RIGHT OF WA~7
~;T SIDE INT, SIDE EXT,
\f~\~.2 tJ/~'F;2l. .
Uctions to Find Property:
ZONE
REAR YARD
PUBLIC UTIL EASEMENT
Dcile
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REAR 7 PuE i -'1
BLDG, INSP, . /1172. . A L, /~;? , Dale}l'
f/ I V ~~ ~fJ::! t=;Z t)-./l r
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USE CLASSIFICATION
y
COpy 1 - OFFICE
COPY 2 - JOURNAL
COPY 3 - AUDIT
Form # C55.12
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,v\E USE PERMIT
PERMIT' NO..
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lANE COU
BUILDING ~
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Y BUilDING PERMIT OR MOBilE
MH D
MAILING ADDRESS
a1S Ai 1011,' "
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MAILING ADDRESS
D~ wn~~oy gg roorth
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i'PROPERTY OWNER
J3ClOOl? o'H co
", r CONTRACTOR
:~Il'ond ~qoV$
PROPERTY LOCATION - INCLUDE POST OFFICE
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PHONE
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,....;
5~Q'8nfJ~O~Mo OtGIDon
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trt$~O~o @rrGgcn.
'PHONE
6~oU~ij
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" I PROPERTY LEGAL' DESC,RIPTION - METES, BOUNDS
';3ti'd AddfUM to MettofllaBo ~anQ&' Lo~ ~avo~tt no
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r,TWP
lit ,
RA~GE
SECTION
01\
a',,~oJ .
TAX LOT NO,
~~O
CODE
'19"'@9'
CENSUS TRACT
~Uer!fjH$@
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APPl.
~'tl?OO~Qrr
EXISTING STRUCTURES ON PROPERTY
~Jo. U un Y'aQ .
LEGAL ACCESS TO PROPERTY,
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,\, .NAME'
..: 'f
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f' MAlpNG
I, ADDRESS
FOR ,MaBilE HaME PERMITS ONLY
j. ',-. ~.;. " .
I No, : of Bedrooms
r. STRUCTURES TO BE BUILT THIS PERMIT
i$tJUr.-~~Sn~ w~or .. ' "
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PR()PERT.Y SIZE -'- FT,
,.
'f.
WIDTH,
DEPTH
AREA
CODnect 'to ;Exist(ng Sewage System D
'TYPE CONSTRUCTION SQ..FT" # BDRMS
Nev:.. System D
VALUATION I.
1
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0'
it
-~- ':
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, ,'\ 'f; '~"_< :
. ,~ . SEWAGE DISPOSAL' e ", '
~,: ipiJ,~L1C,: tJ. ','. ,'.,',S.EPTIC:TANK}t~'
. ;;'BUllDING .' :,', .;:' :
',1 j '( :', . c '
", WASTE 'DISPOSAL
,'r '~luMBiN'~, '.' ,
,r ~LAN 'REV'I~W:""".'
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PARK~ ,TRAILER "
. ,; fS~JS~U~4Y' ~CiG'U
"I tOT~L" ',. ,,'." ,,'
,
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FEES, "
PLyMBINGINSTAHED '~Y
OWNER 0 'OTHER: N'AI;<'E '
WATER SUPPLY , . '
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. '-~.s,:;
.r!"
" ': OTHERO
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,)>UBlIC 0
o ':OTHER
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, CaUNTY BUILDING&, SANITATlaN SP,ECIFICAHat)lS.
DRA!N FIELD REQUIRED " :'
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'~ ! MIN, SEPTICTANk"CAPACITY ',',
I . "; :, " '.,",' '.
'1 'WITH DIST',' ,BOX:: GAL ',;' \.
1 '.-\ F , t '. ~,\'~,
".';. ': Lh',~~ n~~'o ti d' t7J'8 a', ,lle3'1c....t~'~ ~~
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lIN: FT
TRENCH WIDTH FT,
. T~...."' .
" ... PR:,SQ, FT,..
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,/TYPE OF 'STRUCTUR,E.'
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OCCUPANC:Y
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'ZONE
,:,'PUBlIC UTIL EASEMENT
'_'-1.
....1
t BLDG, SETBACks.. Fl,eFROM ,OR, ' OF; ROAD RIGHT OF WAY
'I " ,
. FRONT, SIDE INT,.: ' 'SIDE EXT: .' '
,J' : ,;' ,.' , ';, " 'f~THORJtED SIGNATURE,~ DATE:
.1/sl ,Jo~.. 00S9 '~y ~9 ,~G(I'tD~-g~ ,,' .
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REAR
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J.Sb'c~~,
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: B'LDG"PERM!T ,- WHiTE '
,OFFICE coPY :""WHITE ,
;,' ICOUNTY TAX ~ PINK
i, ; PLUMBING _ ,CANARY.. ,.' ,
.; ,'BUILDlto-IG- GREEN"
, SAN,ITATION','- GOlDENROD
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',~ ~aJl.68.7'~'4065;.t~' s~~~dule .all reqiJ!re~ 'i'nspe~tioris.'A:1I ~onstruc-~+'
, ., ' ". tlOrl.", ~hall comply w!th Unl~orm ~uddlng, Code, .D.E.Q. stando~dsl ':
'IMPO~TAI\IT: .,for',s~,~s~rfoce~,se.~a,~~:g,isPQ~al O??' c.o.unty re~ulatior;l,s covering~ ,J
',. '."', p1umomg. Allbu.ldmgs require ocert,fl,cate of occupancy before! j
beingoccupied:.< '~, ., '; ,
, . ,;: ,(See,Details ,on Reverse';- Sid~)'" ~:;\ ' ,
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,(p()Sr;,THIS~IERMll':ON :MAIN, ~LDG,.' ,AT ,SIU)
LANE COUNTY, 'QEPT;, OF EN.YIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX; ,135 EAS'l 6th" EUGENE, OREGON,,?740;1
. . . - . . . .
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FORM7'{~S,,~P_: '~:'" '~.,'" ".,
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S lIE I NSPECT I ON
ApPROVED /
I
DISAPPROVED I
I DATE
INSPECTOR
REMARKS
FOUNDATION INSPECTION
ApPROVED I
I 01 SAPPROVED I
I DATE
INSPECTOR
REMARKS
FRAMING INSPECTION
ApPROVED /
I DISAPPROVED /
/ DATE
INSPECTOR
REMARKS
,
f
LATH OR SHEETROCK INSPECTION
ApPROVED /
I DISAPPROVED /
I DATE
INSPECTOR
REMARKS
/'
FINAL INSPE~T~
ApPROVED II' I DISAPPROVED
/
I
DATE
?, tv / l./
"S'ECTO~
REMARKS
CERTIFICATE OF OCCUPAN~Y,
READY TO ISSUE /
I NOT READY TO ISSUE /
I DA TE
INSPECTOR
REMARKS
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