HomeMy WebLinkAboutPermit Septic Tank 1976-3-10
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LANE 90UNTY PERMIT FOR:
PERMIT NO. 331-;'6'
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SOS
CONSTRUCTION [] MOBILE HOME
PLAN REVIEW [] CHANGE OF OCCUPANCY [
DOwner
n"M:1..~tA,.I I D",...1_"..
--,uNAI\iIE- --,J.........,
Route 10
ADDRESS'
Box 269A, Euaene Oreoon
e-IT'? ZIP CODE
::: ---" _.-
_.' ---7-
7.J/-7401i
PHONE
Q Gontractor
Same
NAME
'"ADDRESS //
Subdivision
NA (
//)
Ra~;,~Q3 _,,:~e6tion
!\Ii.\. Lot
///
CITY ZIP CODE
s.Lt \> '-\ ~ -- 0 lo~
Census Tract
)"NE
0.5. 'Reg. #
,Twr 17
23
Tax Lot ( 200' Code 004-04
Block \, Acreage
,~,',
R III 1 ,hi " .:; /!lIh' I t"\f:\a -c-.._
- -- ~ -" ~. ~.. -~\lV-
/
/
/
Access tQ Property (Road Name):
/'/
Width - /'
~
....'\
\4
Existing Structures on Property:
~~~~~ S~~~~~!0?f~~~~
Directions to Property - Address:
s
1//1 Moi ~nl1i>h n~ i)",,,, A..,,,,,,, I!:"",,,,,,, DA ^" 10 '" '..4..
~, .. ~-.. ---...... ----...-..::i. -- -oJ --'-01
'!~'=''.^! ~~!!~
!.TRUCTURE (# BEDROOMS)
PC!l"mlt for Rena; r of S~H/Jaap.
. \{1ir~ f'~y. ~Jl~~_ 4 E~~~~y,=~!:
" j.FT.
, ,
ni!tnn~llll ~\lc:tt:lm
" +LA~F r.OIlI\I1 v' ~PI='(:TAI
VALUATION
~ Rat!.
Pl=tiJITT ARi=.n.
SEWAGE DISPOSAL:
PUBLIC [] SEPTIC TANK [
BUILDING
PLUMBING
3% SURCHARGE=
,
MOBILE HOME=
WASTE DISPOSAL.
PLAN REVIEW,
OTHER [] Wate\" Dist
PLUMBING INSTALLED BY:
OWNER [ ] 'OTHER [ 1. 'NAMF
WATER SUPPL Y:PROPOSED '[ ]
'E'XISTING []
, [ ] PUBLIC
[] COMMUNITY -,NAME:
[ ] PRIVATE WELL
[ l OTHER - SPECIFY:
.~ '.....--..:.;,
1)1: n/'l.
o..W'OV'lcI
TOTAL
?J:: 00'/
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEP-::r-I'C-~CAPACITY:
GALS. (1J?O,f) ) MIN, DRAINFIELD ?nn L1N. FT. MAX. TRENCH DEPTH, ~nll INCHES
-~. 'ill1l~1:i'lff-~1;;'n-ili'lf'ijl:)1r1 nl!:!>t-J;Yld'! '~o}"'lIr;;:;;'1Q !t",~... ...I",,,,,,,,,,,,';...,,,,,, .... ..1......... oa.... ..-60_.._.6...__
.- -'. --. -=---~ - ..........rr __..__..u. ...-_ _""'" ",.,....Vw'"'" ,,",v -.J"'lI.~VIV\I,lI~
~l~ ratls::qil"~p ~'ii':;)" in(j-Pl'/> f'fi'nm ;llll,lf.)H~ 1<f4~h.rl~"'';'''~''ftl...lo
TYPE OF CONSTRUCTION
GROUP _
FIRE ZONF
STAY 100' FROM ALL WELLS
USE CLASSIF.
SETBACKS, FT. FROM CTR. OF r/W:
FRONT SIDE EXT.
FT, FROM PROP. LINE:
SIDE INT. REAR
ZONF
AUTHORIZED SIGNATURES:
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ISSUANCE DATE:
'.lIl n /7h ...11 t'l'l
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BLDG, PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING,- GREEN'
SANITATION - GOLDENROD
\. IMPORTANT:
. "
Call 687-4065 to schedule all required construction inspe<;tions, Call 687-4061 to schedule all required
septic system inspections, All construction shall comply with the State Buidling Code, D,E,Q, standards
for subsurface sewage disposal and the State Plumb.ing Code, All buildings require a certificate of.
occupancy before being occupied, .
(See Details on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
C55-13
LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 ,EAST 6th, 'EUGENE, OREGON 97401
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JOB LOCATION /i.~'('/){ e:!5r~!:3:. /1:;;'-:'://) ,/f:;,..;~.;:;Lt;:::?~~'. ' '0 ~ ~'/c
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LANE COUNTY PERMIT
Acreage or Lot Si?p
Contractor's O.S. # '
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Partitioning',#, ( ,) Completed Subdivision
, Lot Block
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) Prefer to pick up. Call
Phone
Phone
\ . Phone'
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(owner, etc;-.)~ ready.
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'APPLICANT'S NAME AND ADDRESS
OWNER'S NAME AND ADDRESS
CONTRACTOR'S NAME AND ADDRESS,
Mail permit to ()-(Applicant ( ) Owner
(
STRUCTURES NOW ON THE PROPERTY / ~'S~V
THIS PERMIT IS FOR, 10' .1{2..PL~Aff',..i;;;?~~/ X fjPLJL..J # BEDROOMS #PLUMBINGCONNECTIONS
_1/ a-" ~' \
WATER SUPPLY. ~/A,~w&../Aft~~Uat::lJr: SEWAGE DISPOSAl' Se-~/G. , S.1. # ..
;~
THIS PROPERTY IS WITHIN ONE MI LE OF THE CITY OF .::5.Jl?b/'V~a.o . PLUMBING ~t, OI.4../1:"\II._r<.-
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I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: owner of record;
contract purchaser; potential buyer; realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of
record, and that said ow~is aware and approves of this actiOn. I hereby agree to comply with ~II applicabl~ Codes relating to'this permit.. ' ./ <<"?,
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Fee Paid $ /~ . """V ' ".' ' Signature A-':Z:J,-:? ~ /;ft7'-;}'! h.d'~ JI/"'Da1p .;;;.if1/~1 f P ~-".,
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( ) NEW ADDRESS ( ) FACILITY PERMIT TO TRANSPORTATION DEPT. ( ) SPECIAL PMT. AREA. MIN. ELEVATION:
SANITATION
Minimum Septic Tank Capacity (Gallolls)
Drainfield Required - Lineal Feet
Maximum Depth
BUILDING'
Type of C;:onstruction
IJse Classification
Group
Fire ZOne
Comments:
. Comments: -'
By: Date: BY:_.?"'.''''~::~-_:-' ',1/'1:'1 ') Date: ,5--.,3(1- f)l}
--.
PLANNING REQUIREMENTS SATISFIED. By: ,"15ate: Date Issued: tj-I-77
ZONE: SETBACKS: FRONT SIDE FACING STREET (FROM CIL) INT. SIDE YARD REAR' (FROM P/U'
. ,
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~~,.:, ~fN'I;:~C~;~NT~ DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401 PHONE: 687-4394
, " .... POST THIS PERMIT ON MAIN BUILDING AT SITE
C55-13
BLDG. PERMIT ~W.HITE; Bl!.ILD.lNG -GREEN;- PLUMBING - CANARY; SANFrATION =-GOLDENROD; OFFICE COPY-WHITE
.,,..'
\
SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED I / DISAPPROVED / I DATE'
INSPECTOR
~EMARKS
GAS PIPING GROUNDWORK
ApPROV~D I I D~SAPPROVED I I DATE'
INSPECTOR
REMARKS
ROUGH PLUMBING ) ~ _
ApPROVED / VI DISAPPROVED I I, DATE r/S-/77 'IN~PECTOR~~'
REMARKS b-9':....77~, 'ZJI(~,. ~~~~a
5'-;z.,7~'77 ~~ 4' ~' - '?T
,
ROUGH GAS PIPING
ApPROVED I I DISAPPROVED I I DATE
INSPECTOR
REMARKS
HNAL PLUMBING
ApPROVED /
I DISAPPROVED I -/
,/?!,jf' (D ~ ,
"" I .
p/1Y/.7
INSPECTOR
REMARKS
FINAL GAS PIPING
ApPROVED / I DISAPPROVED I I DATE
INSPECTOR
, REMARKS
ctRT! F I CATE OF OCCUPANCY
f\
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,
RE~DY TO ISSUE I I, NOT READY TO ISSUE / I DATE
INSPECTOR
REMARKS
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~ob Location,
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INFORMATION SHEET
(X) Building Permit
~( ). Site Feasibility Study for Septic Tank. Number of sites
/ ( ) Would like to meet on site. Call (owner, etc.)
Acreage or Lot Size /~7 ')( .5' 99 / Test holes will be ready
Partitioning # ( ) Completed Subdivision
( ) Pending
APPLICANT'S NAME AND ADDRESS ;!/t/;e/~/'.J::7.R P
OWNER'S NAME AND ADDR'ESS, if different from applicant's
CONTRACTOR'S NAME AND ADDRESS <:;'/l/llf
Mail permit or results of site feasibility study to (1 ) Applicant ( ) Owner ( ) Contractor.
( ) Prefer to pick up. Call (owner, etc.) when ready.
'-
, Lot Block
~ ~~, jffl9 )/e' jJf,;g;5' -;J> :3 ~ 3 -"37;2 -z-,
,/. /3/JYLL'5) ) ?r/}Z?;;x'.?ff/l E;h.&..t/~ Phonp 7r?-7i/!Jo
<;A ~ Phonp
Phonp
STRUCTURES NOW ON THE PROPERTY
PROPOSED USE (this permit) CrP/) 1/ j7 II/J~d hk?
~' -
WATER SUPPLY ~JJV?J',)lL) ;;r/tfE-P~<;,T,
L/J//Y (fJ/pry ~)l/TI-I f'/JRE r;-A/1?R'5
- ., .- -
f'.,t.JrP, ;{!r7" h, Ie; 7(,
SEWAGE DISPOSAL 5e' ?TIC- 7/tjV/{
(existing or proposed well, etc. If public, name of system)
(existing or proposed septic tank, etc.) S.1. ~N. -~(o
PLUMBING BY
) PROPERTY IS WITHIN ONE MILE OF CITY ( 5.1PIf//VC rdEL,L/
Address
******************************************* OFFICE USE ONLY BELOW THIS LINE *******************************************
( ) New Address Necessary
ZONF
) Facility Permit Ne1cessary
SETBACKS: Front Side Facing Street
(FROM CENTERLINE OF ROAD)
) Special Permit Area.
Minimum Elevation:
Interior Side Yard Rear
(FROM PROPERTY LINES)
To: Planni ng/Bui Iding Inspector/Sanitarian/Surveyor.
This applicant appears to have a problem with
Your assistance will be appreciated.
By
Permit Processing Section
Response:
C55,12
By
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Permit Processing Section
125 East 8th Avenue
687-4394
nivision
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-
~
SPRI~GFIELD, ORE~ON 97477
FIRE DEPARTMENT'
August 19, 1977
.\-
- Lane CoUnty Yout...l;. Care Center, Inc.
-3405 Baldy Vie,.,
'Eugene, OR 97401
Attention: 'JoM T~ Fioto, Director
;A . Cli':...--C ~
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< ,
,4TH AND NORTH A STREET
tii~
'fiNj.3137 -
The above facility has been inspected ,and is al-'l-'Loved
for occupancy the the extent of the jurisdiction of this
" deparbr.ent. ,_,'
BUREt\U' OF FIRE PREVEl\i'TION
(2~~
A.M~ Matsler, Lieutenant
, St:' lUl'JGFIELD' FIRE, DEPARTMENT
150 North 4 th Street
.' Springfield, OR 97477
jba
cc:,Jolm Smeed, Lane County Building DepartInent
'fu.,T'l Ewen, Deputy State Fire ~..;rrshal'
, < ,
,A~CE8V~ ~ .,
, Lane County' ' u;;,O
, Censtruetlon p' '. , ' . ,
" ermlts & 'Ins '
, " ' , <, peet,on Div;sion
A Va 22
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INFORMATION SHEET
) Site Feasibility Study for Septic Tank. Number of sites
) Would like to meet on site. Call (owner, etc.)
Acreage or Lot Size ,;(.1 J9 Test holes will be ready
Partitioning # ( ) Completed Subdivision
( ) Pending .
APPLICANT'S NAME AND ADDRESS .2/~rA.;U:? /', ??-{'t) ~LL!".5" ;rr /1> OiJ;( 2(.4 h- 11:-"l;{Y#~
OWNER'S NAME AND ADDRESS, if different from applicant's~l9J.n Y'
CONTRACTOR'S NAME AND ADDRESS $Ah41:::'
Mail permit or results of site feasibility study to ()() Applicant ( ) Owner ( ) Contractor.
( ) Prefer to pick up. Call 74/7-7.y/Jl. - (owner, etc.) when ready.
Lot
Block
Phone '747-7~OO
Phonp
Phonp
STRUCTURES NOW ON THE PROPERTY
/
Jr'd'5/ D.r#C r
PROPOSED USE (this permit).
WATER SUPPLY ?i3?/H"RIrl.1
hJJ71()C' V/$T..
(existing or proposed well, etc. If public, name of system)
SEWAGE DISPOSAl
SI:'}?7/r-- ~A.v1
"5' L:' L r
(existing or proposed septic tank, etc.) S.1. #
PLUMBING BY
Address Jrr /0
/3 J ~ ,2,1: q /f
EWc;V[~ 9),1/'1
(y'(PROPERTY IS WITHIN ONE MILE OF CITY ( SPR'Ig6 r/f~ p
******************************************* OFFICE USE ONLY BELOW THIS LINE *******************************************
( ) New Address Necessary
ZONF
) Facility Permit Ne1cessary
SETBACKS: Front Side Facing Street
(FROM CENTERLINE OF ROAD)
) Special Permit Area.
Minimum Elevation:
Interior Side Yard Rear
(FROM PROPERTY .liNES)
To: Planning/Bui Iding Inspector/Sanitarian/Surveyor.
This applicant appears to have a problem with
Your assistance will be appreciated.
By
Permit Processing Section
Response:
C55-12
By
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Permit Processing Section
125 East 8th A ven ue
687-4394
I) ivision
I I YES' I LI NU' I I YES I' I "u
SignaMe of APt'hn~~~
Fee Received BYr/fLZ' ,Date3'-Je'-7b
:J;i!li6. . Septic Tank ca,pacity. /;1.trO, _ ",D Drrllaiinn}f . eld, Required - Lineal Feet ,~ Maximum Depth .$0 P
, ,..,' d.,A,"':/'n#.i,.).. '~, '~~ ~ 'J~~~ ~, ~
r~ ~ 'i1..AA'7A;;,A, - .4 I J..i..' - ~ '
~~,:;<k:.'-} -=-. r,_:.0-<. ~ ItI1JF 1"-- <1// q,4~ !J~
3-,~ {-- 7 c:.,
PERMIT if
BEEN APPROVED
,..'/
MOBILE HOME I PLAN REVIEW I CHANGE OF OCCUPANCY ~
Pi,,:: w f:j rs 0 LJ3 01; Lid.' '!Cr., b , j3 0 l' .2 ~ q H ,'if. ilf,1! IVI<' Me ,Q7t;' 7 ~7- 7'1oi
. ,Name ,.I Address ~ City 'Zip' Phone
I
, City I Zip
Tax Lot ,.;z.o'O Code OCl ~ <!censu~ Tract
;' I
Subdivision Lot Block Property Acreage
ACCESS TO PROPERTY (RoadName)~Lv't to 1:'lJ LANE"" I
Exi"ing S"='u'" on Prope"Y'':;> },lAD >>" *' tC/lm4' A.A8 OUII-1' Il $ /I~~DIb ~1vPI. fi,?- J'}""S
. ' , " I ~J' .J /. r:" 7'1" l ',I /
Property Location - Address/Direc~ions: ' /~ miL;!" S (W 1/1 Or j/J;/J[pml7lV &.' 6'l2te; 1?D ,OA/ ''81JLP ~
-.k/L!t<.(' L'fWl:/j PA~ 1Jlfn/".lA/ '?nui.-.P/I./(j C 8ouli.5/l1 ml :SJi-r~ ~C.Vl ~r/ ~KtiJl1 KO,
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Below fo r Off ice Us e OnlyXXXXXXXXXXlQOCXXXXXXXXXXXXXXXXXXXXXXXXXXXXXxxXxXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
o -' Sq. Ft.j/ " ?...e;o,\ms, Valuation'
fv/;Fp...4.-1/1Z. ,v V :S.D. ~ I , (... ) )
, , - I ~ -
,YlM C!i/nvt)- /?1.~ / [) l J /
1/ I Cfi{Lt~~' ~-M-,f!d.. .Lf..~",}. " "
SEWAGE DISPOSAL: tI '~t'-~ ("(~~ i,)Xry s.Pt;t!j~~~k"JI,.,I~'~Hau~ -"':
,Site Inspection II . A 'f.' .st'tfig,pS~wJie DispoS!11 System or ew System Required I
" j
, 'Public/ I I '
WATER SUPPLY: /
Well SPring' Otl:lrr' Community I I Name of Community or Public System ~ 1''''''' J W
\.1
, ~~1~~~~' by awnttft' /it r I
PLUMB~NG FEES: '
l '
# of Fix ures Sewage
~ Connection
&,5' ,.t9-() ; II
II~
-,-;:;),5., f)::O' Il..-""f. CHEC
PERMIT WILL BE ISSUED UNTIL
../
C9(:J ,
THIS APPLICATION'HAS
APPLICATION FOR:
v
CONTRACTOR
Name
Address
Phone
O.S. REG. II
Twp.
IYJ
Range~I?, ~Section
~~
Width
Depth
--0JA-r tit<.
FEES:
j){~'.Ri r.'"
I Name
Bldg.
Plumbing
Water
Connection
3 % Surcharge
Plan Review
PLANS FURNISHED
FACILITY PERMIT
Waste Disp.
Mobile'Home
TOTAL
Type of Construction
Group
Fire Zone
Use Classification
'Bldg Setbacks - from Center of Road Right of Way:
Front
Side' Int.
Side Exterior
, Rear
Zone
PIANNING:
DATE:
SANITATION: DATE: BUILDING:
~lt/.~ ~-s:-7h
COUNTY DEPARTMENT 6{ ENVIRONMENTAL MANAGEMENT
DATE:
'/
C 55 - 12
LANE
I
PERMIT 1fc2ftj'--7 b
NOTE: NO PERMIT WILL BE ISSUED UNTIL THIS APPLICATION HAS BEEN APPROVED
APPLICATION FOR:
CONSTRUCTION I
I
nur(,()()ref L,
MOBILE HOME
I PLAN REVIEW
!?D\/!es Rf /0
~dress
City
,ffo X 026 9A
Zip
.. ,
CHANGE OF OCCUPANCY L.~
Euq Y7YO/
JPho7Y"7 -7L/oc
. ,,, I
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OWNER
Name
CONTRACTOR
Name
Address
City
Zip
Phone
O.S. REG. fI
1Wp. ---Ll
Range (i~
SectiorJ ~
Tax Lot
02cro
Code
lj;..()/
Census Tract
Subdivision
Property Acreage
Width
Depth
Lot I Block
ACCESS TO PROPERTY (Road Name) Po /dy ()/-fW L1
Existing Structures on Property: - RCl& () S'io f1 ~ :7
'''pmy Lo,""on - Ad~m'/D~'fr'. . () d /9 r ~ . ~.
. .~-1.f. VI). V '-7 ~ V . ..
Below fo r Off ice Use OnlYXXxxxxxxxxxxxxxxxxxxx4xxx~~xxxxxxxxxxxx~xxxxxxxxxxgxxxxxxxxxxxxxxxxxxxxxxxxxxxx
RC\d1n, S\-rA41~ (lad- ~PC(lJDa~~~':i\ F\ ~ V}~ ~~Bi~ooms{ \)~ _('v~~O~t/y)
rh.;tIl1Qo TCJ; f}Y p '~€- I~(} t"f-v. ~ /~
(1 dn }~*( -fJ lA:+-~, ~ u. ~~/i f.}-v... ~ nt aX" 1W\. LJ '^^ .
r--> fh( P - r b? -' //1 (:!.-/tJIcIf.i .
- , - ~ ~ J...: / - ..--
Exi ting Sewage Disposa~stem~~ or New System Required
WATER SUPPLY: Public tfJ.>n
Well Spring Other communi:; I'~: I Name of Community or Public System
o J l'
n j' ~~
PLUMB,.! G: 0 t
Insta ledi1J.Y r;; Othe~
PLUMB NG FE If j ~
''4,,:, ~
7 f ixtures ~ewage
) ../ c~;ction
V PLANS FURNI'!lltED
SEWAGE DISPOSAL:
Site Inspection fI
, .
FEES:
Bldg.
Jo. :--
I Name
Plumbing
Water
Connection
3 % Surcharge
Waste Disp.
Plan Review
FACILITY PERMIT
TOTAL
do.--
./
I YES ,~
Signature of Applicant: ~
Fee Received By: 'kf?'-:-
.;;;.. v
.----.
, I YES r I' NO
:.""~
Date:.d)-025~-7b
/
Mobile Home
...
d~~---",/S'.
Min. SePtic~ Capacity
B~~_
~~e~d Required - Lineal Feet
Maximum Depth
Type of Construction
Group
Fire Zone
Use Classification
DATE:
/~I-..
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Zone ?/t.:::r' (
~a.'r)_ 11' CytING?'.~"i-'2"?(o
COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
r . :;; Cenw of end Rig" of w& ~ L-~
Front N 1'1~ "'=Side""Int. ,~-'-~ 'Si=deJ;;ii:erior'==--:" '---rt.ear-
/'? Su e.v~e~~..,94U!l..d
P0i~
n(fJ.I 3,t,/ffe,
C55 - 12
LANE