HomeMy WebLinkAboutPermit Septic Tank 1984-11-20
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I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION FOR PERMIT, and do hereby certify that all information hereon is true and correct, and that I
have the following legal interest in the property: []owner of record; []contract purChaSerj~uthorized agent with evidence of authority attached.
I f~rther certify that any and all work performed shall be done in accordance with the ordi~f Lane County and the Laws of the State of Oregon
pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I fur-
ther certify that registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption
is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project~ I HAVE READ AND
CHECKED THIS APPLICATION THOROUGHLY. . .
KF\-n-rL-eE:v\ 111\ MVlO LD
NAME (please print)
SIGH.TURE
11/20/<64
I !:fATE
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READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION HAS BEEN BASED ON THE FOLLOWING CONDITIONS!
o PLANNING/ZONING: Zone ~ r A Parti tion # Parcel, # Parcel Size
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Installation
Specifications:
Gallon
Tank
B. P. # !~ee~3
of Drainfield of Trenches
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r Date: "~}t'H/"": ? ? tC[!<f)Q
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Installation Record Issued? DYes D No
Maximum Depth
o SANITATION:
S. 1. #
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o PLANS EXAMINATION:
Type
Group
Use
COMHENTS:
Date:
n
TOTAL VALUATION $
CONSTRUCTION AUTHORIZED BY THIS PERMIT
Descril2..tion
LDa 1Y\ fZ/lix()0
Sq. Ft.
Fixed Feel Floodplain Fee $
Unit Cost Subsurface Fees $
Building E'ee $
M8ch/Plmbg Fee' $
Plans Check Fee $
S ta te Surcharge $
DEQ Surcharge $
TOTAL FEE $$
__ ~l ,~/~ ySORS 456.805(1)) ~-d-(:f~
LANE COUNTY DEPARTM~F PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061, C 14-25
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE'FOR INSPECTION INFORMATION
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SETBA,CKS AND OTHER CONDITIONS OF' APPROVAL MUST, BE STRICTLY OBSEF-VED. VIOLATION' CAN RESULT IN REV0-
,CAT,JON OF .THIS'P~~MIT, CI]ATTON UNDER P!l-OVISIONS OF LANE COUNTY'S n:iFRAC,TION ORDINANCE! AND/OR OTHER
.REMEDIES ALLOWED c BY 'LAW. ' .' ,
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WHEN READY FOR, INSPECTION, CALL 687-4065.. A MINIMUM OF AT L~AST\24 HO~RS ADVANCE NOTICE FOR INSPEC':
TION REQUESTS MUST BE' GIVEN. Have the" fOll'ow,ing infotrria tion' ~eady :perrrii t ;number, j'ob,'address, 'type,
of 'inspection, ,when it will be ready, your name and phone number, and any special d,ir;eFtions to' s):'te.
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BU~LDTNG DIVISION:
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.- REQUIRED INSPECTIONS:'
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Founda tion Inspection: ,To be m.a:de' after...trench'es ,a,r,e .e'xcava ted and -forms erec,ted a.nd 'wh'en all-
materials for the foundation are delivered on the job. Where con;~ete ~roma~en~ra~ mixing
plant (comrnonlytermed' "transit mixed") is to, be"u,s~d, mater'ials need not- be on the job.
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Con<;:rete Slab or.:Under-Floor .Inspe';tion: To be made af:ter all in-slab 0; under-floor building
~ery'i'..::e-'e.qu,ipment,. condu~t,. piping. accessories" and other ancillary equipment items are ih-"
" place.:,b~t before any concrete is poured or floor shea.thing installed, including....tl'ie- subfloor.
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. Fr,aming& Insu.la.t.ion I.nspection:s': To be m'ade after the roof ,- alF framing, fire- blocking;' 'and~,
'b'racing ',a:re in place: and all pipes, .f'i~eplac~s)"chi,mneys, "and vent's 'are' complete and .~il rough'"
eh~ctrica.'l. and plumblng are approv;ed. Al-l wall'{nsulation and vapor barrier are. in, p1a.c~. '
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Lath and/or Gypsum'.Boar,d Inspection': To be made. 'after' all lathing and gypsum ,board, ' ;nterior
.a{ld ex,ter'i,or, is.. in. place bJlt Qef'o.re' any plast.er,i:ng .is', applied' and .b~fore..g,ypsum poa:r.:d~oJ.nts ~ ,-'
and fastene~f ~~e taped and finished.
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'5,. Final Inspection: :. To be ma~...e,.:~~.ter the buildin~l:,.is complete' and before occupancy. ,,' ',,'; ,
APPR'OVAL REQUIRED. No work.shali be' 'done on any part of thebliilding o~stru'cture,'beyond"d~e "point "~o..' ,:. ~
~ndicated in ~ach' succes~i,!e inspecti'on ~i tl10ut ,firs'f obtaining' i::heapprovCil of th'e building, offiCIai,."
Such approval shall be given only after an inspection'shal'l have' been made of each successive step" ,. ."-."
in the construction as in~icated ~y each of the inspections required.
NOTE: All building permits req,:i::e: i.n:,p~<:tio~s for the work a!;1~horize,d,. such as but.not limited to:
A.' Block Wall~ ~6 be made aftef reinforcing is in place, ~ut'before any grbut is poured. This
inspection is requir'ed. forep.ch bond' ,beam pour. There- 'will' be no approval until ,the; piUffibing'
and el!=ctri.c.al inspec.tions have. beer)"mad'e 'and approved: ,:' . '"
B. Wood ,Stove., To be made' afteI:' . c,ompletion of masonry (if applicable) and when instal1atiol/ ~s ,
complete.' 'Installation shall cbe in accordance' with an' approved, nationally recogni zed testi'ng
agency and the manufacturer"s ins,tallation instr~ctions. '
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C. Mobi'le Home:', An inspect:i:on' i~ .required after the ,mobile home is connected to an approved
. ' ~ewer 6r septic system for'setback ie~~iremen~s~blocking, footing ~onnection, ti~downs~
----'-skiitTng,.and"piunib{ng conriections'.~' -- u ~~,.. ", '..' .-' --'--,' '-.-'.-' .. -,'.
....1. Footings and piers to comply with State foundation requirements'fo~ m'obile homes-or as
recommended by the manufacturer~
2. 'Mobile' home minimum' finish floor eleva'tionshall be certified when required by a flood-
_pl~~n 'man~~e~~t let~e~. ,
3. Mobile home tiedowns, when required, and skirting shall be installed and ready for inspec-
tion within at least 30 days after occupancy. . Tiedowns and skirting shall be installed
.. per enciC?s~re. . .
D. Swimining Pool: Below grade when steel i;';. 'in . place and before c.oncrete is poured. Abovegra~e
whenpool"'is inst~lled. .~ -
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AP~ROVED PLANS MUST BE' QN THE JOB SITE AT' ALL TIMES DURING WORKING HOURS~. THIS PERMIT WILL EXPIRE
IF WORK .DOES NOT BEGr't'l, WITHIN 180 DAYS,; 'OR- 'IF WORK -I.S -SUSPENBED OR ABANDQNED. FOR MORE-.THAN'180 DAYS.'
SUSPENSION OR REVOCATION MAY OCCUR IF THIS PERMIT WAS. ISSUED 'ON THE .BASIS OF I.NCOMPLETE OR ERRONEOUS
INFORMAT+ON: . - , -'" : .,' "
'ANYONE. PROCEEDING PAST"THE POINT OF REQUIRED INSPECTIONS WILL. DO" SO AT T!iE-1I3.~O~N RI~K:,
SUBSURFACE AND ALTERNATIVE SEWAGE 'DISPOSAL SYSTEMS:
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1. Permits shall be effective for one year from the date of issuance.
2. up6n completing' the construction for . which a permi t"has been issued', the 'permit holder shall
notify the Lane.County D~partm~nt of Planningand,~ommun~ty Develqpment by submittingtp~
"installation record .form: The Department shall inspect the construction to determine if it
~compl.ies with the rUf.-es contained ip.this division, If the constructi9n does, Gomply witl:lsuch
rules, the DepartITlE:nt, shall is;3}1e,a c,ertific.CJ.te pf.satisfactory ,cqmpletion totheperJIlitfholder.
If the constructiol1 does not comply with such rules, the Department shall n'otify'the permit
holder and'shall :r:equire satisfactory completion before issuing the certificate~ Faillire to ..!,.
meet tqe requirements for satisfactory completion within areasonable.time constitutes a vio-
lation of ORS 454.605 to'454.74,5 and this rule.
Setbacks' - Subsurface 'S'ewage Dis~osal'
From:
Interior property lines
,Edge of road right-af-way
'Bu'iIding' foundation
Wells,-~other water sources
.Septic Tank
10'
10'
5 '
50'
Drainfield
10'
10'
10'
100'
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ACTl vfTY INFORMATION -:5HEET
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
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MAILING ADDRESS j
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ZIP CODE I
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6t.l-~ -113. 314-1-~3 73 )-702 -LfS"Cl-bCr72.. :
BUS INESS TELEPHONE .# HOME TELEPHONE # BUSINESS TELEPHONE # HOME TELEPHONE # I
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I 2 PROPERTY ADDRESS 411 b~OD k-DP\L~ A:v'f=., <:;PR I VI b MfS1-D I o-r.:<..',' I
; (IF DIFFERENT FROM MAILING ADDRESS)
rt\A11-l-LEBt/\ vY\., ARnOLD
PERSON MAKING REQUEST
(070 N 60 f>LRCE.
MAILING ADDRESS.
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JOI+V\' J.6; ~l5 c. ?4-1 LL-l PS !
PROPERTY OWNER
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SP R I y) Co F1 eJ-D
CITY
DR..
STATE
074--/7
ZIP CODE
LA-s VBG:::>PtS
CITY
NV
STATE
TOWNSHIP RANGE SECTION
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(from tax maps' in Department of Assessment and Taxation I'
or from tax statement) .
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TAX LOT(S) OR PARCEL #
ZONING
i.' 3 MAP & PARCEL NUMBER
(REQUIRED INFORMATION)
TOWNSHIP RANGE SECTION.
TAX lOTlS) OR PARCEL #
ZONING
TOWNSHIP RANGE SECTION. TAX lOT(S) OR PARCEL # ZONING
TOTAL CONTIGUOUS PROPERTY. IN SAME OWNERSHIP: .
4 SUBDIVISION (if app11cab1e)
LOT
ACRES
BLOCK
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6 DIRECTIONS TO SITE: ~A1Lwnv fGD \0 Pf40ASM.. T ~.D / ~ ~L~S. 'j]
~ Po~fe...OftLE - . ULL.-OE- S<f\c - PLb~ IbeMCG 15 W"ELLt!JW 1.iJ/BR-ICJ<..:,
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** FOR STAFF USE ONLY ** NUMBER ~
l./)
5 REQUEST (state exactly what you plan to do) j;V\SPE'-C-Tl{5Y\ ~ flU.Q.(>OSE
L5t- \AVv\5'E ~(:; VI V\A10 CE:- (\ 'S'I . I n~ST A-rr 6fh1 K ')
ZONE/LAND USE:
BY: DATE:
DATE
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TIME IN:
OUT:
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LAND MANAGEMENT DIVISION / 125'E. 8th AVE., EUGENE, OR 97401 / 687-4061
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APPLICANT PHILLIPS, 'JOtlN
TLI 1,703224204100 SUBDIV
~EW BLDG TYPE . USE R BDRMS 0 UNITS 001 STORIES
OWNER NME ADDR
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION ;
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ADDR 477
310784 DATE 112184
BROOKDALE,: SPRINGFIELD, OREGON
,LOT BLK
IBLDGS 001 PHO~E '343 1133
FEE
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. FIXTURES:
SWR:
FT. WTR:
MECHANICAL FEE
. STATE SURCHARGE
'PLAN ,CHECK FEE
FT ..
RAIN:
FT.
LC 320784 SDSV
50.00
5.00
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4%,
65%
~ATG: APP
SEQU : 1
~T(JKEN 'BY RLH
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F~A
FP
SDS
SI
PCK
OTH ISS
3
TOTAL FEE**
10
. 55.00' CK '
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EST. COMPLETION DATE
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