HomeMy WebLinkAboutPermit Septic Tank 1988-10-24
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Lane County Authorization
SEPTIC INSPECTION FOR LOAN REVIEW
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for:
FOR OFFICE USE ONLY
Appl~ca tionj ~c.. r. <vd
Perm~t # ~~~-oD
17
03
23.3.4
7200
D6uT.OF
~. .' .-. . ~.__.
PROPOSED USE OF PROPERTY
~ Residential 0 Industrial
o Commercial 0 Public.
! 'I\5Wr'~SHfp .
RANGE
SECTION
TAX LOT
, S:JBDIVISION/PARTITION (if applicable)
LOT/PARCEL
BLOCK
LOCATION ADDRESS
STREET
CITY
ZIP
468 BLACKSTONE STREET, SPRINGFIELD, OREGON 97477-1460
. STRUCTURES CURRENTLY ON PROPERTY
EXISTING SINGLE FAMILY DWELLING
DIRECTIONS TO. SITE
COBURG ROAD TO HARLOW, TO 5TH STREET, LEFT AT FIFTH STREET, TO SECOND ST., LEFT~ TO SITE ABOVE
. ;:J:::SCRIPTION OF PROPOSED WORK - BE sPECIFIcSEPTIC INSPECTION FOR 'LOAN RgVIEW
DECLARED $ VALUE
RAINBOW
::J Proposed
Xl Existing
TELEPHONE NUMBER
746-0009
NA
# OF STORIES
NA
# OF ENPLOYEES
NA
\'iATER SUPPLY
OF BEDROOMS
; O;';NER' S NAME AND ADDRESS
LESTER H. ALLISON, SAME AS THE JOB ADDRESS ABOVE
CONTRACTOR'S NAME AND OSR #
./ TELEPHONE NUMBER
SAME
SAME AS THE- ABOVE
, PO:Rl>lIT TO BE MAILED TO (NAME AND ADDRESS)
TELEPHONE NUMBER
SAME AS THE ABOVE
SAME
...1
I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION l'"'OR PERMIT, and do here].;y cert.i.fy that all infol.-mation hereon is true and correct, and that I
"have the following legal interest in the property: [])owner of record i 0 contract. purchaser; 0 authorized agent.
;r f:.:.rther certify that any and all work performed shall be done in accordanct':: with the Ordinances, of, Lane Cqunty and the ~aws of the State of Oregon
pertaining to the work described herein, and that NO OCCUPANCY will be made of 3,.y st.rllcture without the permission of the Building Division. I fur-
,ther certify that registration with the Builder's Board is in full force and effect dS re~uired 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. .
.N.,.j.;~f;;>?~#/d~H-/
~ - / ~ ~ SIGNATURE
LESTER H. ALLISON
NAME (please print)
DATE
,., . ',_",.,.J
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION qAS BEEN BASED ON THE FOLLOWING CONDITIONS!
[] PLANNING/ZONING:
Zone
NA
Partition #
parcel.#
, Parcel Size
NA
COMHENTS:
CL, front CL, side interior re.ar
SEPTIC INSPECTION FOR lOANREVIEW**NO SPECIAL PLANNING ACTION REQUIRED
Minimum Setbacks:
Date:
10-18-88
RLH
0'
Installation
Specifications:
COMHENTS: ~__
Jj d} .
~ .. -tJivYJ ~."
[] PLANS EXAMINATION:
Gallon
Tank
Lineal Feet
of Drainfield
Installation Rec,?rd Is;>ued? 0 Yes 0 No
. Maximum Depth
of Trenches
~~
o SANITATION: S. L #
B. P. #
~ " ,.~'_D,f afffiAm~ ~~k..-.,,~~ ~
< .~{]p---,.(M,,:f- a-tl'*, ~~ rAHrJ;~~te: CAt) -J- v-
Type Group Use
COMHENTS:
Date:
n
'~~) .~.~--.,--- "'.", '/()~~~
--~ APPROVED BY B6~~L/DESIGNEE (per ORS 456 .805 (1) ) . DATE-
LANE COUNTY DEPAR~ENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
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APPLICANT ALLISON, LESTER
TL#.1703233407200 SUBDIV
.~E~J BLDG .f\'PE USE F~ BDF;:I"iS
OWN~R NME ALLISON, LESTER
CODE APPL NO ACTION DESCRIPTIoN
DEPT ENV MGT RECEIPT # 305988 DATE 10188S
.1::1D:0!:;: "\.6::) BLtIC!< STONE S'T. ,,-. :::-;PF: INGF I ELD, C)I~:E
L(]T .Fll I<"
0'UNITS 001 STORIES .#BLDGS 001 PHONE 746 0009
1;\DDr:: 4'~lB BLI:~ICi<STONE ST ,., SPRINGFIELD, OF::E fj 'I II
5' .I'.~I. _ I.:~ 00100 II '-. i.'. ..... 1'-. (.., .:;.' 0000 ',/';~ I .1 J {~ nr .1. ,.1' ...1 I::. 1:.1::' ..~ .:~. ..1' ':'
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l..F~ L(: 305988 SDSV
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