HomeMy WebLinkAboutPermit Building 1976-6-22
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NOTE: NO PERMIT WILL BE ISSUED UNTIL THIS APPLICATION HAS
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\ APPLICATION FOR:
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MoinLE 'HOME ' PLAN REVIEW I
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~..l.Ji"'t> OWNER---Eh~-l-e~ari1e..rk'~~)~\L 'A~S~ -xJsr;eh ~{i~~cfe/l~ ?~e ??~~ne ?(j'l69:JJ
f' (F"11.<:"':~'l tflU'1y , , A-lLi. 6}l- ~
. -=, CONTRACTOR N~h<( l~f"J r., Ik,Y.;;'",. <l1k .< ~ .
o.,.":.c., Ja'l;~~ ;;';'ifB1J9' ~~AZiP'l1q;Z
Twp.~') S6 Range 3U'-~M. Section,&tLb ~J~.':3\[Tax Lot ~1!J Census Tract
Subdivisior0!tJ1I f C/~f1r trl<:l.JI"-hd1., Lot BlOCk;' Property Acreage j J/~ Width Jf? Depth ~'j?
E::::::g ~,:::::: ~~;:o:::, )h~:q ~[~~ <no. _L% <'i u",
Property Location - Address/Directions: ,t,6s' ~e" Stl C;~ '
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t<tJ~d. s/,t. 'tk.it ..F~~J"e!e.i? ~~ 'lfedcl' . +U~Jt
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Below for Offtce Use ~IY~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
U~~) /V. /7//& /-q. Ft. . . 1!~edroOms Valuation
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P'" C/ I ~arA,.-&4//~, .'.-'
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PERMIT #./--5//56=.7~
BEEN APPROVED
, CONSTRUCTION
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CHJU~GE OF OCCUPANCY
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SC~ e>f'f C 'Pn :t ('11 me I ~o
~ es-r/- t'7~ ROck !loecf.
Bldg.
Plumbing
3 % Surcharge
Waste Disp.
. Plan Review
Mobile Home
//,,00
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PLUMBING: I
Installed y' oWn r I
PLUMBING F S:
isposal System
or, New System Required ,
SEWAGE DISPOSAL:
Site Inspection 1/
WATER SUPPLY:
Well ,Spring
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Name of Community or Public System
FEES:
I ' 'Other
I I Name
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C~ri~
Water
Connection
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" .,;f::1
)f Fixtures
TOTAL
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I. CASH
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'J j/ I CHECK
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PLANS FURNISHED FACILITY PERMIT
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LKJ YES . I I, NO .J) I ,] I YES I V NO
Signature of Applin: f4?L4.JIMY. P~a./U~ .
Fee Received By: }~,(/?a ./ Date?d-~
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Min. Septic Tank Capacity
Drainfield Required - Lineal.' Feet,
Maximum Depth
Type of Construction
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\.. '!V Group
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Fire Zone
Use Classification
Bldg setba,~, rom cente,r 0, f Road ~ht ::.fway:.,
Front ,'Side.lnt...,..,.. - Side Exterior
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,..-
--...,
Rear
Zone
P~yl.g,~
'.( ~tufMp-?~
DATE:
SANITATION:
~~6 --;<2~?6
ENVIRONMENTAL MAN.tm:ENT I w-
DATE:
C5S'- 12
LANE COUNTY DEPARTMENT OF