HomeMy WebLinkAboutSpecial Inspection Building 1967-3-14
RECEIPT No. 'h4?~
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;~~ ~;r:~\;~t:~TION
SER I AL No. t'E-..a n
DATE . M;;Ir-...h ii"; :~~
TEL. No. '~l:-la40
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REQUEST FOR SITE INSPECTION
BY
e~81-fOM * :tCi""~
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MAIL ING ADDRESS 7St \4est J~th
EtJg~ne'" Ore9Q1l
OwNER Of' PROPERTY ftaS$muss-eo
CONSENT Of' OwNER? Ves
EXISTING STRUCTURES ON PROPERTY
Qnt'$ Sink
SIZE or PROP.' , .6 ac;;,e
LEGAL ACCESS? .Sar4en W~y
t .dt~n t i1q
SOURCE OF WATER SUPPLY: ~U~L I C )(X SPR I NG
WELL: DRILLED . DRIVEN
DUG
DESCRIPTION OF SITE (DIREC~IONS, LANDMARKS, HOUSE OR BOX NO., IF" ANY):
Gsrcfen ~'~Y $o...t h . c;)f Cri)fltenn i at.
. -. ' .
PROPOSED USE OF SIT(: (E.G.,. NUMBER Of' DWELLINGS, COMMERCIAL OR INDUSTRIAL USE, SUBDIVISION):
;$uhdi V hH 00
1:7 URBANIZING 'AREA.
L:? SPECIAL PERMIT,AREA.
FEE:
No. Of' SITES
No. Of' ACRES
e9:sk TOTAL
$ "LOP
--2.....{lO
$__7. nO
. RESULTS OF INVEST I'GAT I ON: /'.iF/:'~~' ~rv n ~~.,~_' A':'~' ;l\, '\ ,/::., / /J /~~(,A, / ',;',J ~_ '"
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v" 4// ~?' (7/ v~ ' -/ . . . ~ ~b" . ,"
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BEFORE c~ ~~T~RING 'HIS rORH '0 'HE BU'lOING AND SAN";;'ON D'VISION AND
MAKE APPLICATION rOR~ BUILDING PERMIT. Ir THE PROPERTY IS A PORTION ONLY or A TAX LOT, A
METES AND BOUNDS DESCRIPTION Of THE PARCEL MUST BE fURNISHED. EXACT SPECifiCATIONS fOR THE
SEWAGE DISPOSAL SYSTEM WILL APPEAR ON THE BUILDING PERMIT. Two SETS or THE BUILDING PLANS
AND PLOT PLAN WILL BE REQUIRED.
LANE COUNTY BU I LD I NG AND SAN ITA T'I ON 0 I V I S I ON :
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UBUILD.ING INSPECTOR SANITARIA~./?
3<- /S-(;,7
DATE
THIS REPORT IS NOT COMPLETE WITHOUT THE SIGNATURES or THE BUILDING INSPECTOR AND SANITARIAN.
C55-016-01