HomeMy WebLinkAboutPermit Plumbing 1978-4-21
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JOB LOCATION
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TRS,TI
LANE COUNTY PERMIT'
lOll200 sq :i:b
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RaW., D.r.~ .ili: 1st.ill)D
Acreage or Lot Si?"
Contractor's O.S. #
Partitioning #
) Completed
Subdivision
Lot
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Blocl<
S!?P.D!@,IEIn Q~G 7417=6535
Phonp
Phon"
Phonp
(owner, etc.) when ready..
uU':iLq NICimRL CORt.x..~
353 :3!~~~2-t:~:(f..t.J~.:;
APPLICANT'S NAME AND ADDRES~
OWNER'S NAME AND ADDRESS' "'
CONTRACTOR'S NAME AND ADDF{ESS
Mail permit to ;pr ) Applicant ( ) Owner
,;!"
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STRUCTURES NOW ON THE PROf?ERTY
J:'J$!\!:.fi'riJ.'O ~AIR / UPlli\.!JEOf/ EXISTn~G / & REROU'rE SDS
# BEDROOMS
) Contractor. ( ) Prefer to 'pick up. Call
EXISTTI'~ m1WT.T.n;G P>.:wo IDS
; THIS PERMIT IS FOR
# PLUMBING CONNECTIONS
~q ~~ DISTBJ:CT
EY:I~.t'lJ':'G
HA.
WATER SUPPLY
SEWAGE DISPOSAL
NA
S.I. #
NA
THIS PROPERTY IS WITHIN ONE MI LE OF THE CITY OF
. PLUMBING BY
I hereby certify that the above statements are true and accura~e, and that I have..ttle follo;riAg-legal interest in the property: owner of record;
contract purchaser; potential buyer; realtor or agent. I further,.{ertif,~ th~l (if not the owner) I am authorized to act for the owner of
record, and that saJ~to.wner is...a,ware and approves of this action. I hereby agreo/(o com~lifl'y, ~ith}1f applicable Codes relating to this permit. ' '.1
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Fee Paid $ . ~ ._~.- ,.//Signatl:Jre/..(1' / V-LA::-...... Date ..\ \ \ W
) NEW ADDRESS ) FACILITY PERMIT TO TRANSPORTATION DEPv-'T. ) SPECIAL PMT. AREA. MIN. ELEVATION:
SAN~
! <'""'()' Minimum Septic Tank Capacity (Gallons)
..;/' Drainfield Required c, Lineal Feet
:JO'I
Maximum Depth _.
;omments: f&..~ aL{ ~ 1':. yuUJ d~~~ .
/O("~ di~ ~ 6~L'~. "
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By: ~4~- Date:~-)Q~ 7g- BY} Date:
PLA.NNIJ~.G REQUIFlE'MENTSSATISFIED. By~-\c )d;r~ tt...Q.....Qate: ~\\ \\ \ '-\~. Date Issued: ,{t-2.f-7t>
'zON'E:~~ ~~~'rSETBACKS: FRONT SIDE FACING STREET (FROM C/U INT. SIDE YARD REAR (FROM P/U
LANE COUNTY DEPARTMENT OF'ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401 PHON,E.: \,7-43;',4\,
POST THIS PERMIT ON MAIN BUILDING AT SITE
C55.13 BLDG. PERMIT - WHITE; BUILDING - GREEN; PLUMBING - CANARY; SANITATION - GOLDENROD; OFFICE COpy - WHITE.
BUILDING
Type of Construction
Use Classification
Group .
Fire Zone
Comments:
TRS, TI
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~()1-\.-08
~121AJGPIC:LD I ~(.
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Written Directions
INFORMATION SHEET
) Building Permit
Acreage or Lot Size .."",. /L)cltJ?J $c.; f!r Test holes will be ready ~ 0 '"
Partitioning # ' I I CompreVed Subdivision i2n Yt"rL b '<'.LU;.- -L<;r A,,~ Loi ~-B ock"5 )
( ) Pending \ ~ Y /'
APPLICANT'S NAME AND ADDRESS '~~J fV\"1..~~ L (6tLCL~~! SS l~(flC.iC~'iiVt.J>.; <)A~one_/l.fUS-?S-
OWNER'S NAME AND ADDRESS, if different from applicant's ,", - I' 'F' Phonp .
--- --
CONTRACTOR'S NAME AND ADDRESS Phonp
Mail permit or results of site feasibility study to kkrApplicant ( ) Owner ( ) Contractor.
( ) Prefer to pick up. Call (owner, etc.) when ready. /" )
\..3 'g-z: t> (2.Ol) ~
STRUCTURES NOW ON THE PROPERTY c-<:;.~ If"\ r} ~ h.-'Y'.\\ ~ \>~.,.. (\ iy.r L.J~+~ 1\-,-\ AC \-\-(''J C'S~ ~
PROPOSED USE (this permit)f&.l2t)~ 5ff12{ uP2/fW mil) ~ A-iL()tJ CLJ~g: or tlffif;ry ~ Bedroans..::iff
5"'ffir-D
WATER SUPPLY R~~~\=S~j ,W~\ ~~L DT~, (existing or proposed well, etc. If public, name of system)
$(...7~c ~t\.."\ '(:. (existing or proposed septic tank, etc.) S.I.:#
) Site Feasibility Study for Septic Tank. Number of sites
Contractors O. s. #
SEWAGE DISPOSAL
PLUMBING BY.-O!AJf\Y;fl_
Address
) PROPERTY IS WITHIN ONE MILE OF CITY (
******************************************* OFFICE USE ONLY BELOW THIS LINE ************'***************************,****
( ) New Address Necessary ) Facility Permit Necessary
ZONF SETBACKS: Front Side Facing Street
(FROM CENTERLINE OF ROAD)
) Special Permit Area. Minimum Elevation:
I nterior Side Yard Rear
(FROM PROPERTY LINES)
To: Planning/Building 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
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Job Location (Street, mile post) ,35 3. 8LCLCJ'<...~~~-
Subdivision lS- nd.d.Lt~~O ~~0fLLt.a.- Lot 22 Block" ~
FOR SANITARIAN'S USE ONLY: IJll System Approved 0 System Disapproved 0 Needs Correction
COMMENTS:
Signat~!~ 4 ~-//
FOR INSTALLER'S USE: Trench Depth..... $b" -nFiller D~'~th Below (He f..~"
Tank Capacity Manufacturer
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Measu~d 'distance to well from tank~.a . / from Gramfleld
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Date: C - J3'-7?
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INSTALLATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION
When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat-
isfactory completion of a subsurface sewage disposal system at the above location.
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Return this form to: Permit Processing Section, Department of Environmental Management,
Public Service Building, 125 East 8th Avenue, Eugene 97401
C55-11
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