HomeMy WebLinkAboutPermit Correspondence 1999-3-4
P.e:pui t Routing
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S P 9 97 05 6
TRS# 18-02-06-24~01200
Date:
03 / 0 4 / 19 9 9
Applicant:
SHARP RAY
2495 DEVON AVENUE
EUGENE, OR
Owner:
WHITE JAY
36670 BRAND S
SPRINGFIELD, OR
97408
345-2(E7 ~
117ft; Iv __")
Job Site '~S :,TH PL_~
Description: install septic system (
Directions to sit~: hwy 105 east to 42nd right Ito jasper rd
The signature below authorizes the applicable Jrograms to review this application and assess
fees as determined by Lane Code. The signature :also signifies that this does not mean that an
application has been made until all Lane County programs and applicable state divisions have
reviewed the submittal. The above information is also certified as true and accurate.
97477
741-7713
Date
(Owner/Applicant Signature)
Approvals:
Name'
Date
Planning:
Sanitation:
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Pe~.LLLi t Routing Sani tationc
SP9 9705.6
SP997056
TRS# 18~02-06-24-01200
Date: 03/04/1999
Applicant:
SHARP RAY
2495,DEVON AVENUE
EUGENE, OR
Owner:
WHITE JAY
36670 BRAND S
SPRINGFIELD, OR
97408
345-2279 1.1'1 -lY 7J-
Job Site: 1164 S 34TH PL SPR
97477
741-7713
. Description: install septic system
Directions to site: hwy 105 east to. 42nd right to jasper rd
Sanitation Notes:
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BY <::..L.,. 1." .-
ENVIRO~ErI;At .~~~
HEALTH SERVICES
125 EAST 8TH AVENUE
EUGENE, OR 97401
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Public Works
LANE COUNTY
RECEIPT
RECEIPT NUMBER:
R99001061
PERMIT #:
TYPE:
SITE ADDRESS:
PARCEL:
SP997056 >
Sanitation--Permit
1164 S 34TH PL SPR
18-02-06-24-01200
APPLICANT:
WHITE JAY
36670 BRAND S
SPRINGFIELD, OR
POSTED ON:
03/04/1999
97477
741-7713
SUB-TYPE: INSTALL
Payment
Type Method Description Amount
470.00
2000
2100
3000
4010
4100
Check
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Description
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------------------------------------------- --------------
Current pymt
New Technology Fee
Administrative Fee
Planning Signot"f
.DEQ Surcharge
Sanitation-Permit Review
10.00
56.09
275.00
30.00
98.91
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SE'V AGE DISPOSAL
PLOT Pl..AN AP~ROVED
A permit is reqUIred .
prior to starting o7~n.
DATE.'.! ./
BY _ :HolME~ HEAL.T SE;t'ICE&.
ENVIR~_l>~.eTH AVENUE.
EUGE5:f~7 87~1( Z1
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02/04/99 THU 06:44 [TX/RX NO 8720]
SEWAGE DISPOSAL SITE EVALUATION
T~~:rL/e"~02~ ()~:"';Z4-;
Subdivision:
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Job Location
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Written Directions
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Phone ~l L.t I. i ' .::) ...,
Lot Block WATER SUPPLY
'APPt:lG'A~T.lSNAMEANDADDRESS \/1', 'I it') -L,v\/\ v"\ .'.. "-'J>I V\/~~V'n., ,Jp_,-;\ /" H' Ii nT
\ , ,I c:~._' -~. \\-\:\--' ~\ ,.----- CJ\ \
OWNER'S NAME AND ADDRESS -~_",-_i57_ \ \ '," i-\,"-, . ,'-< '\ y-. ' -'q=~ -, .i.
STRUCTURES NOW ON THE PROPERTY ,r", ,- ,p (' ' . , ') \', , i' \;., I I) ~ l \ \, f:':" PROPO~ED USE OF PROPERTY (
I hereby certify that the above statements are true and a~curate~~n(/~~h ~:~e the following legal interest In the property: / '1wner of record; contract purchaser;
realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of record, and that said owner is aware and approves of this action.
TEST HOLES READY /;.';.- - ~~ :/>1 Signa~ure I/!?;/-' I\f k:'/.=-!T
Phone.
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potential buyer;
Date. ,/ ;:i
:>"1(/
,.. ,.. . * ,.. ,.. * ,.. * * . . * ,.. * . * * · .. .... .... * . * * .. . * * * * . . . . * * . * . . . . . . . .. OFFICE USE ONLY BELOW THIS LINE * * * * * * * * * * * * * * * * *
* * * * * * * * * * * * * * * * * · * · * * * * * * * * · · * * *
7'
SITE MEETS STATE STANDARDS
Standard System
Sand Filter
1 Foot Capping Fill
YES
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NO
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YES'
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Partitioning # .
NO
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Low Pressure Distribut,on
Holding Tank
Other
Zonin2
COMMENTS:
~121f-/ A/ A:ot!b'
,... <;. ('..
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LAND USE COMPLIANCE
Acreage or Lot Size
(TOTAL)
Parcel #
) Completed
) Pending
': -:" c~ r~ \. ' :-
o Approximate
Study Area
FLOOOPLAIN INFORMATION
:h',
o Detailed
Study Area
THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
ARE AT YOUR OWN RISK. IF SITE IS APPROVED. SEE REVERSE $IDE.
AUTHORIZED SIGNATURE
o Floodway
/
DATE
',ANE COUNTY ENVIRONMENTAL HEALTH, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (687-4051)
;55-32
All or part of this site may be in a flood hazard
area for which 100 year flood levels have not
been established. Extra precautions may be
appropriate to assure that the building site will
be reasonably safe from flooding.
All or part of this site may be in a flood hazard
area for which 100 year flood levels have been
established, A building elevation above the 100
year flDOd level may be required.
All or part of this site may be in a flood hazard
area in which a floodway has been designated.
Building may be prohibited subject to
demonstration that the cumulative effect of
proposed development will not increase the
100 year flood level at any point.
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Pubic. .Works
Existing Buildings or Improvements
on the property: House ~~~
Barn
Garage
Mobile Home
Shed
Industrial Building(s)
Commercial Bldg
Religious Building
Public Building
Other:
Sfl-V1 Wl/-I '/--L 74/-77/s.
Owner of Property Pho'ne
.3f.t,Co7CJ ~/IId S s~j2/J C)7477
~~+-I-4;U? ,. j45-2279
Your Name l ' . Ji Phone
~4CfS b~N .4-( Evt,9 179cJZ3
~U, ;:. dress Zip
Co",~ "ri~~ ~;i, dl, CCB:~~.2f Ph!.4.5~79
Proposed work: X t\..l. <\ -rA \ \ <s~ DTic- ~ 'i ~ .,...EM
SEPTIC INSTALLED
Yes BP/SP#
No SI~ ~ x ~ C, I ~ 'f
Water District Well
Yes
No
,
valu~posed work:
MAP/PARCEL NUMBER: ~:T~J-I~AP
(Found on tax maps in the Assessment & Taxation
Department.) J~OO ;;4q;- :L)e0',J )Jz;L-
Ie 0;;2.. (5)(P 02..4
Township Range Section Yo Section Taxlot Address
bV//.e/l/L D~. 9740B
Township Range Section Yo Section Taxlot City/Stat Zip ,
47~o;te;:~ares~;~~h
4-2--A/J.. 9- ~ ~ /
X~ N(/ ~ ;4;uM' ~
34-fL ,<>f-.A1f 1f -?lA k)
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Date: :3 /4/ 19
I {
Site Ad1\iJS:
afJ.((YZr:;,sC;
~4 PJ.
-Sf/U:V ;r:J/
Size (L&~
/
No. of Bedrooms:
'"
LCPW 149
PLOT PLAN
CHECKLIST AND DISCLAIMER
..,
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"
ane
ounty
PROPOSED USE:
TRS:
Please, use this checklist to review your Plot Plan to make sure it contains the following
items. Acceptance of your application submittal requires your signature along with the
date of application.
In addition to the "Plot Plan" requirements listed below, each building permit application requires a minimum
submission of two (2) sets of construction plans and supporting documents for the project. If needed, you may
refer to the "Minimum Plans" handout that is available.
Please, check all applicable boxes:
1.
2.
3.
4.
5.
6.
7.
8.
9.
o
o
o
o
o
o
o
o
o
GENERAL INFORMATION
Owner's name, address and phone number
Assessor's map and taxlot number
North arrow
Scale
Accurate shape and dimensions of parcel or development site
Lengths of all property lines
Natural features: creeks, riveri, cliffs,...
Label public roads
Parking areas, driveway location and intersection to a public road
PROPOSED STRUCTURE(S)
Distance of the proposed structure(s) from two property lines
Distance of the proposed structure(s) from the septic system
Distance of the proposed structure(s) from nearby structures
Distance of the proposed structure(s) from natural features
Utility access for new development (such as power lines)
EXISTING STRUCTURE(S)
Label use of all existing structures
Location and dimensions of all structures and distances of each to property lines
Label any structures to be removed, replaced, or demolished
SEPTIC SYSTEM
Location of septic tank, sewer line, drainfield and replacement drainfield
Distances of septic tank, drainfield and replacement drainfield from structures and
property lines
Location of wells (or source of water), waterlines, and distances to drainfield and
dwellings
I understand thiS-information is required to rocess my application. I also understand that unclear,
inadequate or mbsing :::;;:~h~au ay 0;;" e processing ofm::::iL3 ) sf PI'
--- ~ I {I -/ /
This Checklist and Disclaimer Form I not a permit application and represents no express or implied
approval for any anticipated development activity. 6/97
LAND MANAGEMENT DIVISION / PUBLIC WORKS DEPARTMENT /125 EAST 8TH AVENUE / EUGENE, OREGON 974011 FAX (541) 682-3941'
BUILDING (541) 682-3823/ PLANNING (541) 682-38071 SURVEYORS (541) 682-4195/ COMPLIANCE (541) 682-3741
10.
11.
12.
13.
14.
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15.
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