The URL can be used to link to this page

Home My WebLink AboutPermit Septic Tank 1973-8-5 ,. ~' " ,( /. ./f .;(l . /_1 ~ ; . . t (/i:<i;.".,'/. ~'- c.~~~~, I, ' ~l-h"'~'//~~"":" LANE COUNTy'tnJILDING PERMIT'. OR MOBILE HOM... BUILDING lID MH D.... ~, ~ MAILING ADDRESS ". j. ~- ~~ I,' - .. . ,..\ PROPERTY OWNER JSE PERMIT /4'90- 73 PERMIT NO, H~,S(t=7~ PHONE GOY ;'.::~:u 0 C.Jr. CONTRACTOR MAILING ADDRESS PHONE qn',r) ~... ....'_.'w"'........ 7'~.1"'sSl1n :,-~ "'.,' I PROPERTY LOCATION - INCLUDE POST OFFICE 21<9:r God ~ i1Cl~Ori PROPERTY LEGAL DESCRIPTION - METES, BOUNDS c;ODECf0lW\l YilU]O;lQ ~tn'fCAdd~aaTl TWP RANGE SECTION " lilll~ n @]C~rt ~~. CODE ------ TI1 :; 'l4,1/ / TAX ,LOT NO. It ~tf02D CENSUS TRACT APPL NAME & MAILING ADDRESS 5CJri GJQv001cl p Or@9~i1l FOR MOBILE HOME PERMITS ONLY No, of Bedrooms tJC$~QVOr. It:l!DriSfc. 200[-;[}0 ~ ;:, EXISTING STRUCTURES ON PROPERTY n8~O -LEGAL ACCESS TO PROPERTY " k1a-Brfj~'a~9fc~lfV AV(3. PROPERTY SIZE - FT, 2~O~ W@r~h ~~~~ PTIoco' WIDTH DEPTH AREA []t:3 U 1 Q G1rJ t1Q hu GuU'oS!o Ime. GlC\C. If r 2:1113l n60 (J TI2 li3:)) l.JUk'J 0 3 New System D VALUATION rGo]28 ~_to~n:J5_;JL ~--~t p:~7?/(r~ STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System D TYPE CONSTRUCTION SQ. FT. # BDRMS ~:1~'2:aU! S.D.5. U~ ~n~c~l~g ~onturQs SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER ~ OTHERD 68.cO ~@.@ij' 5\3.50 FEES PLUMBING INSTAllED BY OWNER 0 OTHER: NAME WATER SUPPLY SEPTIC TANK IHJ PUBLIC []]~ o OTHER TOTAL <I: UTI.,SO COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED L1N, FT 22:;> TRENCH WIDTH FT, 2 OR SQ, FT, r~!t@ MIN, SEPTIC TANK CAPACITY WITH DIST. BOX: GAL SJ@~ Ri)~V drrobG to s~rcctl:. .- TYPE OF STRUCTURE OCCUPANCY ZONE Sf! 0 Co J It I BLDG. SETBACKS __ FT. FROM CTR. OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT P0SD I SIDE INT. 51 SIDE EXT, REAR 1 ~ AUTHORIZED SIGNATURE - DATE i 51 ..D.;; 0 DOGti bV C2v n !3QVi J~J:~:o C rlJ I ct~5hG:llt ~ ~. S. PUBLIC UTIL EASEMENT DATE O=:J~' 7:;) BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Construction to comply with uniform building code and county regulations covering plumbing and sewage disposal. All buildings require a certificate of occupancy before being occupied, (See Statement on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, BLDG. & SAN, DIV., COURT HOUSE, EUGENE, OREGON 97401 FORMitr"-I, BUILDING!SITE EVALUATION .Mh '/~. .. ' "" ~, f Building Permit Appl ica~jon () Site Inspec~jon () Pre-Permit Investigation. No/~90- 73 LANE COUNTY PLANNING DEPARTMENT NOT apD I icab Ie () () () () () () () () () () J. Zoning nrdinance Compl iance , . (Zone i? \ ) Subd i vis ;.on Or~ i nance Comp j i ance 2. 3. 4. Required Access 5., Building Site (Area, Width, Frontage, Setback) Other (see comments) to. T /7 R c:l~~~ TAX un i~ ~_~//T ~/ /#~ qu;pi., CANT: a . /J.. 1,_ N/\ME_~.. ~~Xr~~ ' ADDR~~( ~~ ~ _Vn/aL;~ {1n4l!L PHONE /' / DATE 7Eo/73 , / - NO YES o f\ T E NI\M E (" (~ (-r- (..-7 (~ ( ) /1- 7 I::, l {;3 COMM ENTS : ..--........"'............ . - . ~ ......."... ,,,." ",..- \ BUILDING INSPECTION SECTION NAME 6. Plans Submitted NOT app I i cab 1 e ( )( .) ( ) ( ) ( ) 7. Soil Stabil ity (footings) (vY (v( ( ...y' ..8. Flood PI a in 9. Other (see CO/TVTlents). NO YES DATE P6/73 , (~~J - - " ( ) ( ) () COMMENTS: DATE SANITATION SECTION 10. Sewage Disposal 11. l,Jsable Area 12. Wat'er Supply 13. o t he r (see Comments). COMMENTS: NOT app I icab I e () () () () () ( ) ( , () TO APPL ICANT :.' NO YES NAME .)4 ... . !7{ Q~ r;J>J7"3 Of-t?' ( ) Building Permit / Site Insp'e~~.~n: Can be app roved. t- J -'l~ . , Cannot be apprbved at thfs time as indi~at~d-on item NO; abov~. Questions and further information on items 1 through 5 contact the Lane- . COUNTY PLANNING DEPARTMENT. . Questions and further information on items 6 through 13 contact the Lane County Buildinq and Sanitation Division. Wil I be held .in this office until you c~n ~esolve the problems indicated. Is being returned. Your building permit application fee is beingreturned under separate cuver. Your ~ () ( ) ( ) LANE COUNTY PlI\NN I NG DEPARTMENT 135' Sl.><th Avenue East, Eugene, Or6agon 97!fol f"l1oNE: 341-- 1311 (;)(1. 231 ., ~ . ..--.--. -.. ..-.. ..,...,.~.,..... . . . .._. . . .0.........___._._....._.__.___ LANE COUNTY BUILDING & SANITATION DIVISION 135"Sixth 'Pl'IenueEast, Eugene, Olegon 971101 P'~'ONL: 3-42-1) II [)\T. - 10 I . MC;C;-.'Hl .. ., , . Date Permit No. CURB CUT PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY WHEREAS, the attached application has been fully considered by the Board of County Com- missioners of lane County, and it is the opinion and judgment of the Board that the said application should be granted, and that a permit should be issued, now, therefore, it is hereby. ORDERED, that a permit be and is hereby issued to for placing, building or constructing the following facility: upon the right-of-way of County Road No. , Mile Post in strict conformity to the exhibits attached hereto, and subject to all terms, conditions, agreements, stipulations and provisions contained in the appl ication and permit, the Rules and Regulations Gov- erning Facilities to be Permitted upon County Road Rights-of-Way, as set forth by the lane Man- ual 50.190(2) any amendments thereto, and any other applicable regulations, law or ordinance. Specia I Provisions: 1. Driveway will be constructed in accordance with the attached driveway approach specifica- tions (Drawing M98-50). 2. Permittee will be responsible for the immediate removal of all mud, dirt and debris from the roadway and right of way caused by his 0 peration, leaving the roadway and area in a neat, acceptable condition. This permit is revocable at any time, and will be strictly adhered to and no work other than that specifically mentioned above is hereby aut horized. This permit shall be void unless the work herein contemplated shall have been completed be- fore , 19 Expires , 19 Inspected and Approved Approved by Board of County Commissioners By Date By Director of Public Works WHITE - OFFICE FILE GREEN '- RESIDENT ENGINEER PINK - PERMITTEE BLUE - ROAD SUPERVISOR ORANGE - BUILDING & SANITATION DEPT. YELLOW - REAL ESTATE c98-79 LANE COUNTY BUILDING 0 culLDING MH 0 MAILING ADDRESS PERMIT OR MOBILE HOMe USE PERMIT PERMIT NO, PROPERTY OWNER PHONE CONTRACTOR MAILING ADDRESS PHONE PROPERTY LOCATION - INCLUDE POST OFFICE PROPERTY LEGAL DESCRIPTION - METES, BOUNDS TWP RANGE SECTION TAX LOT NO. CODE CENSUS TRACT APPl. NAME EXISTING STRUCTURES ON PROPERTY LEGAL ACCESS TO PROPERTY & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT PROPERTY SIZE - FT. WIDTH DEPTH AREA Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. # BDRMS New System 0 VALUATION t FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY SEWAGE DISPOSAL PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTIC TANK 0 OTHERD PUBLIC 0 o OTHER TOTAL ~. MIN, SEPTIC TANK CAPACITY WITH DIST. BOX: GAl. COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FiElD REQUIRED lIN, FT TRENCH WIDTH FT, OR SQ, FT, TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTll. EASEMENT BLDG, SETBACKS _, FT. FROM CTR. OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT SIDE INT, SIDE EXT. AUTHORIZED SIGNATURE - DATE REAR DATE BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Construction to comply with uniform building code and county regulations covering plumbing and sewage disposal. All buildings require a certificate of occupancy before being occupied, (See Statement on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, BLDG, & SAN, DIV., COURT HOUSE, EUGENE, OREGON 97401 FORM = c:ss- n 'S LAO~r LOOR PLUMBING GROUNDWORK ApPROVED I XI DISAPPROVED ., REMARKS ~AS .PIPING GROUNDWORK ApPROVED I I DISAPPROVED / REMARKS ROUGH PLUMBING ApPROV.ED (/'\ j DISAPPROVED REMARKS ROUGH GAS PIPING ApPROVED / ./' DISAP-PROVED . / REMARKS FINAL PLUMBING. ApPROVED ~--r-I DISAPPROVED / REMARKS _ FINAL GAS PIPING ApPROVED / I DISAPPROviD / R;MARKS CERTIFICATE OF OCCUPANCY READY To,lsSUE / " '" ..:, . 0:.- / / DATEff'-/o-7J / DATE / DATE <l-?" ?-? J / / DATE / DATr;I/- 1- - J J / DATE / NOT READY TO ISSUE / ! DA TE :'i> REMARKS INSPECTOR INSPECTOR .1 NSPECTOR INSPECTOR \) 4/::>/ f/ .'4t~ V """~ ,(/ INSPECTOR .:......... INSPECTOR "".' ,c" 1\1 ~, LANE COUNTY BUILDING D ..,JILDING MH 0 MAILING ADDRESS PERMIT OR MOBILE. HOMf!'\,SE PERMIT PERMIT NO, PROPERTY OWNER PHONE CONTRACTOR MAILING ADDRESS " PHONE PROPERTY LOCATION - INCLUDE post OFFICE PROPERTY LEGAL DESCRIPTION - METES, BOUNDS .TWP RANGE SECTION TAX LOT NO. CODE CENSUS TRACT APPl. NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY No, of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT EXISTING STRUCTURES ON PROPERTY LEGAL ACCESS TO. PROPERTY PROPERTY SIZE - FT, WIDTH DEPTH ..AREA .-1""- / Connect to Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. # BDRMS New System 0 VALUATION '~ ~..::5\., ...J '..j r '0 -" \ -~ ''\ Y "',\ SEWAGE DISPOSAL PUBLIC D BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER ;; FEES PLUMBING INSTALLED BY OWNER D OTHER: NAME WATER SUPPLY SEPTIC TANK D OTHERD PUBLIC D D OTHER TOTAL ~ MIN. SEPTIC TANK CAPACITY WITH DIST, BOX: GAL COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FiElD REQUIRED lIN, FT TRENCH WIDTH FT, OR SQ, FT, ',,"<' }~J ...t;,' ~~'.. \ \ '- _ .:-~.~.. ":J' .. ".' .. '. ::~\\ .,. \ ~ :.. 'r~\("~"",\ '\" t" .\.\'-\~. -:-".",,\-..,\' ,'. ~~ _". ,l ,," .1 -., \, ,,,, , Ii TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIL EASEMENT BLDG. SETBACKS __ FT. FROM CTR. OF ROAD RIGHT OF WAY USE CLASSIFICATION FRONT SIDE INT, SIDE EXT, AUTHORIZED SIGNATURE - DATE REAR DATE BLDG, PERMIT - WHITE OFFICE COpy - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Construction to comply with uniform building code and county regulations covering plumbing and sewage disposal. All buildings require a certificate of occupancy before being 'occupied, (See Statement on Reverse Side) (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, BLDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 97401 /~ FORMftC55-13 ..; >I. \ .~ ~- I.~ SITE INSPECTION ApPROVED I I DISAPPROVED I I DATE : INSPECTOR REMARKS FOUNDATION 1N710N ApPROVED I VI DISAPPROVED I I DATE r-/10' ?J INSPECTOR II REMARKS FRAMING INSPECTiON APPROVED' /~DISAPPROVED I I REMARKS~Cf'~ <;'-IJ .'?'J / DATE ~-/~ ":'~7 INSPECTOR ~ LATH OR SHEETROCK INSPECTION ApPROVED I I DISAPPROVED I I DATE INSPECTOR REMARKS. FINAL INSPECTI~' /~ ApPROVED I ~/ DI/JPPROVED I I /lATE /0-023 ~ 711 NSPECTORl.6( REMARKS4~~ Inl'/!)*' 77tK - , . - CERTIFICATE OF OCCUPANCY READY TO ISSUE I I NOT READY TO ISSUE I I DATE INSPECTOR I?uJ~ / ......... . / I/rO~73~.2.1(,f (Zs.~ .,,?{)~3tl~ REMARKS ~. ~J 'A I. _It- . Date i"~ """-.J ". '~ '" . !II ,.,' ... ..' ~- ~-. .,., ('0 "'-' . .,. ',. ~ APPLICATION FOR FACILII Y PERMIT IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY Your appl icant, hereby makes application under Rules and Regulations Governing Facilities to be Per- mitted Upon County Road Rights-of-Way, to construct the following facility: Upon the right-of-way of County Road No. , at the following location: as shown on the exhibits which are attached hereto, in strict conformity to the state- ments of the exact nature and amount of work to be done, and to the description of the facilities contained in said exhibits. Your applicant will be the beneficial owner of the facility as constructed, or otherwise primarily liable and responsible to members of the public for its proper maintenance, repair, operation and use. Your applicant accepts all terms, conditions, agreements, stipulations and provisions, in Rules and Regulations Governing Facilities to be Permitted Upon County Road Rights-of-Way, dated March 31, 1960, and any amendments thereto, and any other applicable regulation, law or ordinance. ., ",~ Signature Address WHITE. OFFICE FILE GREEN. RESIDENT ENGINEER PINK. PERMITTEE BLUE. ROAD SUPERVISOR ORANGE. BUILDING AND SANITATION DEPT. YELLOW. SURVEYOR Phone No. .... f.J bJ /II Ii &taller's Name r1. . No.LivingUnits 'Bedrooms'Baths / \:J I Septic Tank: . Ft. from well Steel 0 InS1de D~ens1ons: Ft. Length Width Applicant" Name , INDIVIDUAL SEWAGE DI".3POSAJ~ SY~\1 RECORD Installer: C6mple~e top part form to signature and return both copies to Lane County Building Sanitation Department. P.RMIT No. l#p--7~. . ,14, .11 .J<..I [?" Address W~stover Con-d:: ,,- i J Q r.Pt. Feet from :L~8"g N ) ~~ '\y\ . ,JY~H S ~ is' ~ Lot Line .. PY'l'J" e..JQ I ~ ) re I' . :..Front Side I ~ Rear I CI Length of Lines ...JFt. .. Tr~nch Tota.l sq,Ft.between Fil~ F~l1erdePth E'111er depth 17f2.1f3. 4. 5. 6. Width \:? ft. ~ lines ICJ . Typ ~i~~e 2-- in. ~~i~w j, iIJ.... 7 ~ket~ (See, instructions) : . ..... ...., '. ! ,E . U- . . ,pro,gefty A94ressl7" .L 2' / t If' <~~.q l/h _ Basement Water ~plY Yes 0 No ~ PUbliC,' Other-List Concrete e(' No. compartments/ Gal. Capacity- / ttJtt!'Jd . Tile Disposal Field: ~ Diameter Depth : Distribution Box:Yes ~ No 0 Other Distribution- Type Mailing Foundation /0 N ) () ~ . ~c;:, ~. ,. 'J-t)' r1i 0-1 -1 , -- TITL ---, I T I :JD_ Di I~ @ rn \VI ~ ill. AUG Z9 1973 ~ I I I _I ~ I [ I I I 1-- LAi\lE COUNTY HEALTH UNIl 3()~ .}. . Date~'- z.-:!! - /9 7 ~i n ~ , Signature~---~_ _~fJ4[ V~ For Sani tarian U~e Only: I t/. {J; ~Approved' System Installation Conforms to Current Standards Date, ('~. ~ o Disapproved: Does Not Conform to Current Standards ~;f~ Remarks: Lane County Building & Sanitation WM.J~4,~) . j')Y' Sanitari 's Signal:ure Dept l/ C\ -4\ ~ 13 r...... -" . .' / , ;::::: 17e?7-99 ij' ~ ~tF;. V_ ~4.' ~/ ~~YES /~ ~ ATTACHED 0 NO TAX LOT # CODE CENSUS TRACT /7 ..3 f .. ~(}--..c-D /0--0 APPLICANT /. / ~ / /C1 DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY NAME L..(/.$a.if"~(.-~~.~. . ~~ AND ~s-f- 9 ;y;;;:'Y'/ =<.r~A~ACCES29~-2RO~:;;'::k., MAILING .~- ~. . - - -,;? PROPERTY 4ii~TH ~EPTH AREA ADDRESS., . FOR MOBIL PERMIT ONLY Number of Bedrooms STR"RES TO BE BUlL THiS.... PERMIT. '" ~/ -'~ ~ ~---7~ 7 --'.:.~-'" J a-r/- PERMIT LANE COUNTY Bl ..JING PERMIT 0 R MOBILE HOME TYPE - BUILDING ~. MOBILE HOME 0 OSC .REG~;# . MAILING ADDRESS ~ ..; APPLlCA TION PERMIT # /t:/7c7 -7--3 :.->A. ~ . Y1,/!.h./' CONTR.ACyJR . - - - /f!) _ ) v.; MAILING ADDRESS IA.A ~~_ PROPERTY LOCATION - INCLUDE POST OFFICE e:2 7 t;, ~ ~/ PROPERTY LEGAL DESCRIPTION ~ #. / / LOT - BLOCK - SUBDIV, ~ / / TWP RANGE 1/ . SEe. .Connect to Existing TYPE C~TRUCTION . _7A~/-P__' Sewage System 0 or New System Req. 0 SQ, FT,B'I2# ~EDROOM~ VALUATION . I. =? bO (3 ) 1t:....=?.;ljJ '. ~ ,,-,.-. ~?~ ~ 4S""oL .; /7) 77J- , .-- ., 'Z~.--d./.tfJ f ~--:. DISPOSAL . - PUBLICO' SEPTIC TANKY $ U, tfiJ ~ FEES . c2 if ~tJt/' -.3:3 1tS7l WITH DIS1', BOX: GAL PLUM.~ING INSTALLEp BY .~ / ,7./ ~ OTHER 0 OWNER 0 OTHER~AME !I~.- ~ _ WATER SUPPLY PLANS FURNISHED " FACILJjrI PERMfr /L. PUBLIC l)(" OTHER YES~ NO d YES ~ NO 0 Zt:;u~:s3J,OO \/~. ~URE -, ~~ 7 ~3;-;(? CASH 0 s~/\ ' FEE RECEIVE.?,J1Y DATE CHECK pfi"ONNECTION FEE ~ ~ Cl C). ;;:r.o:.u e.-- 7- 2 (J --Z) PERMIT # - / / ...., / c-7} PUBLIC WATER . . .~ / /::-r. . ~I",,,,,, <L- CONNECTION FEE ./ ;.:s0 .)/ ~ 7' 0 -/.....? COUNTY BUILDING & SANITATION SPFCIFICATlONS DRAIN FielD REQUIRED lIN, FT. 2~ TRENCH WI~TH 1'1, '.:2- OR SQUARE FEET~ // / / BLDG, WASTE DIS, PLUMBI.NG . PLAN R~VIEW PARK. TRLR, .' TOTAL MIN,. SEPTIC TANK CAPACITY 9ao Rd<Sf ~ UJ 8.~ TYPE OF STRUCTURE ~V ZONE REAR YARD \ \PUBLIC Pll. EASEMENT \/ V OCCUPANCY , 14~ ;r BLDG. SETBACKS - FT, FROM CTR. OF ROAD RIGHT' OF WAY 4-t.. - L . FRONT I-:::::J SIDE INT. ~ SIDE EXT, A ARI ate PLANNING fUn IU~</'- / I K1 REAR 7 ,A BLDG, INSP, USE CLASSIFICATION Date ') 1<,h'2, I 1- -..J" .~. ~ Date /11lLfi F--!Lt&ntA~ ~ . /,.;j_~ ./ ,,. ",' to Find Property: COpy 1 - OFFICE COpy 2 - JOURNAL COpy 3 c:.. AUDIT Form #' C55. 12 f t' / ,f ~,/' u t :< ~, ~" -I~.,t' - '1./. 0" . 4' ~ ~/ I t ~;I. \ 1)/.-:( , r);;;~:;' s Name (/ ~ No. Li v ing Un i ts. Bedrooms Ba ths ~. / \J ~ ~' Sept~c Tank: ~ Ft. from well Steel LJ ~ Ins~oe I.nmens~ons: l:'t. l . 1 Length Width ~ ~pplicant; ! J Name. t've.sZover Cun ct __ ;M ailing :L,S:'6"Cj iv)) )$"~:O/\ ; Address SDt-'\).y-{ie.\c\, (J\-r?" . j j . , Length of.Lines -1Ft.. Trench Total sq, 1?J2.)J'3: 4. 5.. 6. Width \/' ft. '5/j(1. Sketqh (See. instructions) : q) ".t~"Ut ~~ '\NDIVIDU1\L SEWAGE DF;POSll1, sysr . RECORD .nstalle.t': Cumplc ,~e top part .form to signature and return both copies to Lane County uuilding Suriltation Department. /~'''l 14' L/ /.1,_. . P..(RM.LLNO-L-C..l~_~' .' -,r / I / . / PEOP2fty A49res~1 ~ '/ '1 / J./ /\..,.' ~/, t ft. t-. .; (.,. . I:"": L ':..:Li:L'c..;L. /!:J._____ Basement Water~~p y Yes 0 No ~ Public [.<', Other-List Concrete 9f No. Compartments / 1::;al. Capaci ty /OC;f.;' Tile Disposal Field; i Diameter Depth Distribution Box; Yes Il1\ tJo c:: Other Oistribution- Type ,\ :" Feet from Well Lot Line ~ron t , . i Ft.between FilleIjCL 2-- F,ille.c 1 ' . /1 ;,~ . . above ~nes/v TYPC/(l"U.,,/( ti Ie Foundation It) Side' . / Cl Rear 10 decth ,Filler depth be low / 'l.---jn'ntj10 ~ i.A. t LC 1 I j\I . n 'jcJ ' --:- ---- .--~\) r--'--)j' V, ~o-Cc;_._._------- -----. \)-~J ..J ~1 ~ r l_l-[ ,IJ r TI'~ .0 ~ I I :JD_ [ I D) . , Ln c;. (....'\ ' T-:! n \\11 re: I j c, I - I : r.' r: ::: if': ,. '---.., '" I I I _I I I I I j ) ! ~ . I i I ~. . ~e N--- l g - / C/ 7 3- / For Sanitarian Use Only: ~APproved: System Installation o Disapproved: Does Not Conform Remarks: ~\U G i) q I...J l,/ 1973 LANE CUUN1Y HE.i\LTH Ui'lll I I ... -- _ __. _. __ ,__ _1 ()..~ ,-l (~d [ V-+c1 Confomsto Current Standard: ~at~' S:;/'j;j rJ >~ to Current Standards ~; ~l. n / jJ-- . (I Signa ture (,1---'(( I Lane County Building & Sanitation . l);? &/,aAfl.~ . )-'?:1'~~i~a~:~la~ure, Dept.V . l\" \ ~ ).,