HomeMy WebLinkAboutPermit House Move 1985-9-5
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~I~/, i ~~ounty Aut\J.orizatjpn jar'
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roW{'7)fV/ 7 "I RAtlGE /l '7 1 SECTlO:::?" ~ -? I ~7t'x ~~. - ~3/lF PROpOSED USE OF PROPERTY
'\ (~~ C/c:?"') C::;>/h,.~ , 'C/'V" $feSidential 0 Industrial
S~BD~ON/PARTITION (if applicable) I IDT/Ph?(~~ I BLOCK
o Commercial 0 Public.
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= OF BEDR.~S.-2' J # OF ~:;n../ ~ I #/?~~YECS I,'" ? ~y.~ ~PW~)" ./. . ~r<?po~ed
~ /,//Zp ~~ JU(/a-~U;7A./...#'"~~ nEmt1ng
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...{ HAVE c~ut ~INEO THE COMP~TED APPL&'OR PERMIT, ahd ,10 hcreLy cettify t.hat all information hereon is true and correct, and that I
have the fo6o"'i(g ~~~M'intere5t in the prope~ty .Downer of record; 0 con':ract- purchaser ;~uthorized agent. .. . .
I f:.:rther certify that any and all work perfonned shall be done in aCl;or-dam:f: with th~ O(rlillanCt!~ of Lane County and the Laws of the State of Oregon
pertaining to the work described herein, and that NO OCCUPANCY will be made of ar,y st,ructure without the permission of the Suilding Division. I fur-
ther certify that registration with the Suilder's Soard 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 HlWE READ AND
CHEC/-"IIS APP:;TI/?'jOROtx;HL);? Q / ;>
/~/ "LAd ,~~4Y ~ ~_ l_~
l..-' - NAME lpldase print) " ~IGNATUI}l0
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DATE
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION qAS BEEN BASED ON THE FOLLOWING CONDITIONS!
o PLANNING/ZONING:~~one 6~ I 0 Partition It Parcel It Parcel Size
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Minimum Setbacks: rL, front <.. L, side ' .l.nten.or ~ rear ,
COt<'IENTS, A1~/ ~ M W...l,zr~()J ~ J.&,;" ~ rYU
t;:;. t...C 10, IOe-flo)YIf'l I :'te, Cf'P4:r 5", r,6'S lUl
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% SANITATION: S. I. It (""f , <;-:-44 ~ B. P. # Installation Record Issued? 0 Yes 0 No
Installation Pl.1-"f'7AIIIA:....GallOn J Lineal Feet I, Maximum Depth
SpecJ.fl.cat.l.ons: 1'S"'o. . Tank /JO of Drainfield r.:l c{ of Trenches
C=IENTs~d-q/)._l~ f~),;;J~ p~~~ ~2'h/~,.oId~
~(?df~ {'A'~ifi.f~~dLL/z% Date, /()4--{?.r n
tt1 PLANS EXAMINATION: ~.... Group - Use MJ.I.
COMNENTS, 'ER~IITSFORAllELEcrRICAlwn~~ CAI-t, ~~ '1>1.~~
SEE REVERSE SIDE OF PERMIT AAQ -- ,~". co OOW"W .ROM THE STATE
ENCl"'''' '"1':"('0 F^~ !M~'U' M,nN ?~ ORECON, DEPARTMENT or.
REQUIREMENTS., W""'O"C<, ~L~CIRICAl SECTIOrf.
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pERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE (oer ORS 456."8"05 (1)) (!-.
Date, /0/1 0/85
10110/85
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DATE
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
C 14-25 R84-
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SETa;,CKS A~D 07~IER CO:;oITIO~:S\ or APPRO'/,iL ~lUST BE STRIC7:', OF.lSERVEb. VIOLATIO~ CA;>: RESULT IN REVQ-
CA';'IO:l or 7!IIS P;:R~1I7, CIT,-'TlO;; U~DER PROVISrO~s. OF L';~E COli::!,.,,:; l:-<FRACTIO:-l ORDI:;;'~CE:, A:-IO/OR OTHER
RE..1EDIES ALLO...EO- B~ LAW.
\o:HEN READY !"OR J:~SPCCTIO:-J, C,\i..:" 687-~065. ;" ~lIXnlu:.l Of i\T L::AST 24 !lOURS "IOW.:;CE ~OTICE FOR rNSPEC-
1'10:1 REQC::S7:i ;'::':ST ill:: GIV:';X. Hi.1'JC tnc 10110\oling in:or:nat.ion ready: j:"ermit number, job address, type
of in5pection, when it will be ready, your name and p~~~ nu~ber, and any special directions to site.
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BUILDING DIVISION:
'.
REQUIRED r:;SPECTlO%:
1. Foundation Insoection: To be m,)de after trenches are excavated and forms erected and when all
rnater~als for the tounclation arc <.lclivcred on the jOb.- \,'hcre- Concirete-from a c(ontral mixIng - -,
plant (commonly termed "transit mixed") is to be used, materials need not be on the job.
_2. Concni_te Slab ~ .LInder_Floor Insp'cction: To.be m<:ldc after all.. in-slab or under-floor buildin<;l
serVl~e e~uipment, CondUlt, p1pln~ accessorles, and other ancillary equlpment items are in
place but before any concrete is poured or floor sheathing installed, including the subfloor.
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3,
~raming & Insuljtion Inspections, -To be made after the r6of~ all framing, fire blocking, and
raclng are in place ~ all pIpes, fireplaces, chimneys, and vents are complete and all rough
electrical and plumbing are approved. All wall insulation and vapor barri~r are, in place.
,
Lath and/or G,psum Board Insoection: To be made after all lathing and sypsum board, ;nterior
anc-e^terIOr~n:rrace but betore any plastering is applied and before gypsum board joints
and fas.;eners. a.5.e _tat:ed ,~~d_ f,inishe,d.:. :.
-5. ~ Insnection: To be made after the building is complete and before occupancy.
,
4,
APPRQVAL REQUIRED. ~o,work shall be.done on any part.of the. building or structure beyond_the point
..... indicated in each successive inspection wl.thout first obtaining the approval of the building official.
Such approval shall be given only after an inspection shall have been made of each successive step
in the construction as indicated by each of the inspections required.
NOTE: All building permits require inspec"tions. for 'the wo;k 'ii"uthorized, s~ch as -b-;'t not limited to:
A. Block Wall: To be made after reinforcing is i~ place, but before any grout is poured. This
InSPection is required for each bond beam P9ur. . There ~ill Ge ~o aPPEoyal ~ntil ~h~ plumbing~
and electrical inspections have been made and approved.
B. Wood Stove, To be made after completion of ~asonry (if applicablei and' when installation is
co~plete. Installation shal} be in accordance with an approved, nationally recognized testing
agency and the munufacturer"s' installation instructions,
C. Mobile Home, An inspection is required after the mobile home is connected to an approved
sewer or septic system for setback requirements, blocking, footing connection, tiedowns,
skirting, and plumbing connections.
1. Footings and piers to comply with State foundation requirements for mobile homes or as
recommended by the manufacturer.
2. Mobile home minimum finish floor elevation shall be certified when required by a flood-
plain manage~t }ctter,:., ~
3. ~lobile home tiedowns, when required, ane. skirting shall be installed and ready for inspec-
tion within at le~t 30 days after-occupancy. Tiedowns and skirting shall be installed
per enclosure.
D. Swimminq Pool: Below grade when steel is in place and before concrete is poured. Above grade
wnen pool-rs-insta11cd.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES OURI~G WORKING HOURS, ~HIS 'PE~~IT WILL EXPIRE
IF WORK DOES NOT BEGI:J WITIlIN ISO DAYS, OR IF WORK IS Sl;SPENOED OR ABANDONED FOR NORE THAN"ISO DAYS.
i~~6~~~6N~R REVOCATION HAY OCCUR IF THIS PE&~I~~AS ISSUED O~ THE BASIS OF rN~OMPLETE OR ERRO~EOUS
ANYONE PROCEEDING PAST, THE POIllT.'Or REQUIRED INSPEe,nONS WILL DO SO AT THEIR-DWN RISK.
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SUBSURFACE AND ALTERNATI~E ~ DI~OSAL-SYSTEMS:. \
1. ~ermi~~ srall be effective for one year from the date'of 'issuance. ..
2. Upon completing the construction for which a permit'has been issued, the permit holder shall
notify the Lane County Department of planning and Community Development by submitting the
installation record form, The Department shall inspect the construction to determine if it
complies with the rules contuined in this division. If the construction does cOlnply with such
rules, the Department shull issue u certificate of satisfuctory completion to the pcrmit{holdcr.
If the construction docs not comply with such rules, the Department shall notify the permit
holder and shall require satisfactory completion before issuing the certificate. Fuilure to
meet the requirements for sutisfactory completion within a reasonable time constitutes a vio-
lation.of ORS 4S4,605 to 45~,745 and this rule.
Setbacks - Subsurface
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F:"o~:
I:1terior property lines
Edge o.i'rond rH;l1t-of-way
BUllding foundation
l,~\~el:~" ot:.h~r .....~.tl?r.,s?urces
Sewaqe Disposal
Septic Tank
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10'
5'
50'
Drainfiel~
10'
10'
10'
100'
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APPLICATION #
LOCATION
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The Lane County Building and Sanitation Division cannot proceed with processing
your application because:
NAME
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Verification of existing system required (see attachment).
Two test holes (2'x4'x5' deep) required for expansion or repair
of existing sewage disposal system in the area of the proposed
drainfields.
4. 0 Other: A,t~ /jjAf.-75----"L _~_.,?'hJ.A/;,=~ / ...,,,;-p:t-/.;
:fl. ~/.~!Z ,<1A/"../"/_>-'--~,/, ",-!hJ_ ;;~";.....~/ I""f!/ j/Jo;,~/:_.L~_.:" /-
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SfGNATURE' ../ L I "
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OFFICE HOURS
to f:OTJHkt
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tr7-.'J9 JJ from to
PHONE
If no response has been received in regards to this matter by
the application will be denied.
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BUILDING & SANITATION PROGRAM / LAND MANAGEMENT DIVISION q
Courthous.e-Pub 1 i.c Service Bui,l ding / 125 Eas.t 8th Ave. / Eugene, OR 97401 / (503) 687-4061
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PUliJS APPltO\!E-II
A ~uilding permit is requir"c
pf/or to starting ~ructb
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BY,~~
l3u!~ding & Sanit&, OJ,;:>,,
125 E. 8th {iveJ1?,;~,. .:2r:. C:
ECE;lne, Crez~.l 9...1 .
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.<:::\4c)O Written Directions ' .. ../.. x . ' I ,fiA, _, .. ',' "t. .
,.... "\~~~bdivision: I '1- A CI r I j;".:, (( i i 'J
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I ' , Lo' fl ~ 'BIOC~ ," _ '...'. ' WATER l,>U~PLY ~. ': ,. L....;
-'-*APPLlCANT'SNAMEANDADDRES," (,I,ln.:-!.. '..- 1>)u.1""~~. ,;;:;.0('(", AJ,av)"''''' ' J;" (';1p:....d 0;:q-('A Phone 7P'?'- (l~3c
OWNER'SNAMEANDADDRES" (I t. W,(JI...., nf. (1J1(jJ'j--fy)(1rn, iJ.O. ~ftx '.t.jP.f.l. ~f:1~.tn"L' _Phaneo-a1~l
STRU~URES NOW~N THE PROPERTY Wo Q ~?-l-t n;'= Ll~t It r-h.trt 1." '~..,:\ PROPOSED USE O'F1.ROPERTY t~f '1( ,1 rrn r-{;;i I '
. I hereby certify that the above statements ars true and accurate, and that I haY8~the following legal interest in the property: _owner of record; -contract purchaser; _potential buyer;
_realtor or c..gent. Ilu~certify thai (il not tho owner) I am authorized 10 act for the owner of record. and that said owner IS aware and approves of this action.
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, TEST HOLES READY, ~ '1""""" _ /I t.J>> .'T/ Signature' '. Oat"
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S,I. # 85 - 009-S
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SITE MEETS STATE STANDARDS
. '-,' Standard System
Sand Filter
1 Foot Capping Fill
YES .NO
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Low Pressure Distribution
'HOldi!1g-Tank ,
Other
YES
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LAND USE COMPLIANCE
ZOning..~;? ~ .-' r. . . Acreage or Lot .SiZ9 I
(T01l\L)
Partitioning #
Parc."
., ) Completed
i ) P.nding ,
.', " '/FLOODPLAIN, INFORMATION
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, 0 Appjilximate ,.AII or part of this sll. m.y be in a flood hazard
S1lH/'t'Araa , area lor which 100 y.ar HoOd I..... have nOt
, f,', ' been .stablished. Extra pracautions may be
~ " ' .ppropri.t.1O assura that the building sh. will
, ' , b. raaaonably sa'. from f1ooding,
o D i1ed All or p.rt ofthis sh. m.y be in a flood hazard
.. Sloor.Area . area for which 100 year flood levels have been
TH, IS IS A PRELIMINARY REPORT WHICH DOES NOT' ENSURE THE ISSUANCE OF A FUTURE '_ "" ' .stablished, Abuilding.lev.tion _the 100
. " ' I - .. year floOd leveI,m.y be raqulrad. '. ."
...,:.:~ljiLDI~G PERMIT. ANY PLAN'S OR EXPENDItURES MADE IN RELIANCE UPON THIS REPORT 0 FI~.y All or part of this sn.';'ay be in. bel haz.rd
":<A~E'Af;YOUR OWN RISK. IF SITE IS APPROVeD, SEE REVERSE SIDE., . .. i " .rea in which a Hoodwayh.s been design.t.d,
'~', .- ',', ",~: ' , 1" .....i'!} , . .. . . /?'. -- . / ' Building m.y be prohibited subtect 10
,:~' ';.. .".". '.._~~;. ,~:::;-l.fA,., ._ ~ .". .:" .~. ~?~ JO"'":/..) : ...-/. ." demonstration that the cumulative eflectof
. '.\Ii', ..,..-' . AUTHORIZED SIGNIlrURE DArE' ,proposed d.velopment will nOllncr....th. ,"
t . I" , 100Y8artlOOdlevela~anypoint.
, LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401
. """ . C55-32
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PLANS APPllOVED
A building permit is required
prior to starting ~truction
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BY 0~_
'Bugling & Sanitar.1li' Divlc:'c
125 E. 8th AlJe.l'?uY2~-rJ. r.:~:.
Eugene, Oregu;1 97.:~ 1
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-WATERTIGHT CONC, RISERS e. ,,LIDS 2" G V,] , 11 "" ~
. . 1--4 X4 P.T, POST'
H:'~DLE """,::' :l:~CHECK .VALVE \.--., 'I ~ \
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PRE-CAST, PRE-ENGINEERED, D,E,Q. APPROVED
GUARANTEE D WATERTIGHT
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PLANS APPRO\!~D
A building permit is required
i I },', .." ~ priorto starting C~E!:uction
- -' '(;,' I J,' DillE /0 -'I-;;,f?
BY~~_
Bui!ding & Sanitati9~i~!,~
125 E. 8th AveJM,tZrJ~6'd"
Eugene. Oregan 97f.Jl
(5031 S87,,:,!
TANK r,ROSS SECTION
INlSl
PARTIAL PLAN
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WATER DIVERSION BER'"
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'.,:: ..Lie. ,FILTER ci.:Crr'H ',:::, MEDIUM SANQ~,";:",' .. : ",.,.',::>f.., "":'. 24" ~' DAYLIGHTED 4"
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SAND ,'=',:":..,' ,,2-112.,..~.4 'DR.AINROCK",,-, ,'~'~ ...,.;/4 RIGID PERF. P1PE~:"__' <,of" '.' :'" _ UNDERDRAIN
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UNDERDRAIN TO D.L. (AT ALL LINER PENETRATIONS) ~-- 4" P.II.C, PIPE TO
,-" ______ 2.0' ..__, _ , ___... OARSE SAND DRAINFIELD
SECTION -TYP,ICAh. HillSIDE P.V.C. LINER SANDFllTER
1/4"011-0"
.
DOSING SYSTEM 8 EFFLUENT UNDERDRAIN
900 I NCREMENTS TO FIT SITE,
PIPING MAY BE ROTATED IN
PILANS APP[lO\f~D
A building permit is requirec'
prior to starting constructi0"
D!II" 10 - <t-;?J
BY. ~ ~,__
Bui!ding'& Sanitati&ivi~i~:'
125 E. 8th Ave.lPub, "rI, n:j "
Eugene. Oregon 974JI ~
(503) 637-,0i1
UffnEtt F'HEEMAN
SOILS Gc SA~rJ 'PA rIu'f,1 :'UI'rl:.:'Tl'I'A),I'll
. . . . ',J . vu.;...r :, ~
576 Warrington Avenuf.;
~ugen~, Oregun 97~04
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PlAr~s APPRO\!~ij
A building permit is requirec
prior to starting construction
;, 1fI':---
nm..,,__/ A - 9.::c J
BY ~
Bui~dTiiii & Sanilali nil":""
125 E, 8th Ave./Pub.':. I. 6:,
Eugene, Oregon 974~1
(503}6::i7....061
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OUT EDGE OF ./' I
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O~R EDGE 30 MIL. p.V,C, 711--2:-: FEE~- - - _I
LINER "
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PLAN VIEW- TYPICAL SANDFILTER DOSING SYSTEM
311611= 1'-0"
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lPllANS ~~PRO\l~~,
A bUilding permit is require:
prior to starting constructi ^
Dm /O--7~\,
B" ..sc<;;7. ~
Bui!ding & Sanitat; r 'U
125 E. 8th ~v,.!p,:,
Eugene, Crc~~
(5031
.
SPEC] F I CATI ON
-]-
\PLANS APP1UmE10
A building permit is requircc
prior to starting con~n
DI'" /d -Cj-rJ
BY [.--v
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Building & Sanitation D' ,i, 0~
125 E. 8th AveJPub. SeN. ~:J':,
E.ugene, Oregon 97401
(503) E87'(GCl
GENERAL RESIDENTIAL SAND FILTER SPECIFICATIONS
OREGON OED "STATE STANDARD SYSTEM"
1. All materials used in the cOGstr\jction of this system n\\Jst be
new. first qu~lity as approved by the D.E.D. Olrector or his
agent.
Remove all larqe roc.~s. roots or
wIll damage the PVC liner or will
the sand filter'.
other sharp objects that
decompose from the are~ elf
.'.
liaterial depths are shown as settled depths or after
cOAlpactilJfl has occured. The sand bed shoLIld be
compact:t?d to pr-event sLlbsequent settl ing Clf the
tr"enches and piping.
fl,]ture.l
I.>Ja ter
dosi n~l
4, Al I ve'E:sels. tanks~ pipe conrH::,C t. ions." ti:\nk r'i ser'S to nrol\rHi
IE-vel . \/211 '/F..~s.' 2I.nd the 1 I kE' hl~11 ch are part of thlS 5VSt f-'rn
shr.d 1 he j n::;ti.d 1 ed tc' insure ~~.lter tJ gtltness.
5. Thp L~ne Cot.~nty BLlilding and S~nit~tion Sect:on of tllP
Plann'lnq and COlltmt.tnity Development Departmerlt will reqc.tire
scr-eF:"ninq rE"rort:~, Dn the DED Standard Medium S21.no. "Ml?djunl
~:;2nli" m~?,:=-n~, Co nll}: tur"e of s2-nd \.--J1 th 100i: passi ng the 3/8 t net-.
sjE"''.'E'. ern:,: t.o 1(11):': p~s.sinq thr" No. 4 sieve. 62i: to 1(1(..):':
p.~,=-:.sin(;! lht;> No. Ii:; si(;'ve~ 45:~ t'1':1 82%. passinq the No. 16
~ifave. 25% l~! 55% prlssing the No. 3(1 si~ve~ 5% t:o 20% passing
thr.' ND. ~:I(l sit.~ve.. 10:-: or .less f-I.:\ssinq the No. 60 sieve.. and
4% or less r~ssinq the No. 100 sieve.
6.
The P.V.C. plastic 30 mil liner IFLEXABLE MEMBRANE
mLlst meet DED specifications pe~. Section 34C)-7}-C~85
DED "ON-SITE SEWAGE DISPOSAL RULES".
l.,lNER)
of thE'
7. The septic tank shall be a pre-cast pre-engIneered 1500
aallon tank with a partitinn separ"tion ..,cre"tina a 1000
- ~ r"-'p -
gallon septic tank, and a 500 l)i'llon ~.'tanl section. The
tank is to be certified and provided water tIght by the
manufacturer/supplier. Provide a water proof f"tSer over the
pUfOp section and t.ne septic. t?"nl~ sections. The ~ is to be
< ' 7
.
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L
P!.At~S APPRO\![ij
A building permit is require::'
prior to starting constructico
DfUI' ~ - 9.::-Ir'
B"~
SF'ECTFTCATTml
~
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Building & Sanit' 1I~' Divi('"
L25 E. 8th A\jeJP~'-. ~~rl/. c:
Eugene, Ors2G-1 ~i-
(503) E~ 7-, .
screened. Screen material
with a 1/8 inch ma,:imum
typically of a molded P.V.C.
is to be a fICin-corradi ng rnar.er--i al
openings. Pumps screens ar,~
rnaterjal.
8.
~;I''''~ ,....-'
Use 2 Il~ ,G .:.?'-- -...~~ as si:ed in the 2ccomrC\nyinc~ head
loss sheet. contra-l-i-ed-t, '=:ly..dr_o=m-a-t:-t= .=:'-9\:I{; ",,=M-e~meCCLlCY
fl,..-,..:o+- sw-i--i._h-:::r.-:: l..b..l....-..:--=-, . e'4L\;' ",J~--or--t~= :-. EleLtro--'s,~",itcjl
c,':-'(:.+ ~s. P~'rl"'; rte :' . 'R-i-e~-. '-1-'~ _. ---di-sconnect.--f l_LLl ng.. 'B_
ct.:l..i;.~ ve. ana _ - ;:,t'lt::' v dlve-rnt~ 1 sch-a"f""(1 e-!-j-ne --tr-'em _lh(.'""l
p.L1JIlP',
9.
Tnstall a NEMA-3 water tight junction bo. at the edge of the
septir tank pump t.ank mounted on i::'\ pressur-e treated 411 X 4"
post. M~~~e all possible electrical connections ir' the NEMA-3
jl~nction bo>:. Electrical r:onnections in the pl.lmp tan~" are
sLlbject to shari: life dl.le tD 8ttac~r by corrosive sewage gas.
The pump must have a special water and vapor tight electrical
connector which is in the the pump tanl~ environment for pun.p
nlainterlarlce removal. The control panel shall have aL,ton\a~ic
pump switching with with manual overide~ alarm bell ~nd pUlnp
cperatiarl statLls lights. Panel operation and ITlateri~l~ sl,a'[l
be to OEQ standards. F'acl:~qe(i pre-assembled panels 21-['
available from Hydrcl-matic.
l(l. F'FT::>%5ur.e distr-ibtltion pIpe JS to be class 160 F'.\J.C.
] 1. t_ane COllnty Sanitation will require constrLlction permits and
pha.sp. inspection dLwinn constr-uction. The contre.ctor- =-h2111
co-ordinate. sch~dule. and be responsible for such permits
and inspections. Three inspections are reqLlired as follows:
No. --\JLlst prior" to lirler placement
No. 2 --At the clear water pump test.
the bed dosing pipe system.
just priJr to covering
No.3 --A fin,::d inspection at cor:lpletion.
12. This design is as permi~ted and specified by the Oregon State
Department of Er,yir-onmenta1 Ouality. Oregon Administr'atiye
P~lles Chapter 340. No warranty is claimed or specified as to
~ffluent quality or life span. The equipment i~ only
warranted as specified bv the manlJfacturer of s~me.
.
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APPLICANT DUBRM, GARY
TL~ f -'02:'~6:'~004400 SUBDIV
et,.lEW I~LDG TYPE, MB ' USE' f( BDRMS3
OWNER NME CHAPMAN, CAT/-1ERINE
, CODF.i APPL NO ACTION' DESCRIPTHlN
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LANE CDUNTy'DEPT ENV MGT RECEIPT
'ADDR 3000 MAIN ST.,
* ,254H15 DATE 090~>rr~
SPRINGFIELD, OF~EGON ·
, ,LOT BLK "1'
IJIHTS 0~)1 STORIES ~BLDGS ~)01 PHONE 726 0352e
ADDR PO BOX. 426, NORTH EIEND, OREG()N '
"
sr~ rl' U!'lIT COST VALUAl):ON FE~~, DI\'S
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MECHAN1CAL FEE
ST,~TE SURCHf,RGE
, PLAN CHECK FEE,
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4%'
RAIN:'
6~~. ~~e -,
FT 75,.0.
5.. 50 i~ J'
1'2,50
, 140. f)0'
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2:i.00
,n.50
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CDMPLPTION }lAl'E
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TOT-AL. FEElf* ' 3'13 .:~)0 CK
EST.
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ACT~TY INFORMATION.HEET
lane cady
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
<I
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1
PERSON MAKING REQUEST
, PROPERTY OWNER
MAILING ADDRESS
MAILING ADDRESS
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
BUSINESS TELEPHONE #
HOME TELEPHONE #
BUSINESS TELEPHONE #
HOME TELEPHONE #
2 PROPERTY ADDRESS
(IF DIFFERENT FROM MAILING ADDRESS)
3 MAP & PARCEL NUMBER
(REQUIRED INFORMATION)
r--
[- s-rtJ9 s
/7
TOWNSHIP
(from tax maps in Department of Assessment and Taxation
or from tax statement)
o Z ~5C-3 ~f't1o
RANGE SECTION TAX LOT(S) OR PARCEL #
ZONING
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL #
ZONING
TOWNSHIP RANGE SECTION
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4 SUBDIVISION (if applicable)
5 REQUEST (~tate exactly what you plan to do)
TAX LOT(S) OR PARCEL #
ZONING
LOT
ACRES
BLOCK
6 DIRECTIONS TO SITE:
** FOR STAFF USE ONLY **
--
NUMBER
DATE
.
-<
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ZONE/LAND USE:
BY: DATE:
.
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.-:
TIME IN:
OUT:
LAND MANAGEMENT DIVISION / 125 E, 8th AVE., EUGENE, OR 97401 / 687-4061
~, 7/1{:1
'TRS,TI 17-02 -3b,:3 Job Location ~,T.01!!. d-t. . dp8d.
. ~ -4400 Written Directions ~l!!! ~-"Jl::h , Q(!';jf- pa~ "(,1\ Xtr-P()+.
t"~UbdiVision: ~ ~ _ 6h +Ro J (0 J.t . .
.1 Lot (7\ Block ct> WA~ SUPPLY n~5<<L
-}fAPPLICANT'SNA~EANDADDRES~ 0::t~ Q(J..~, 30m tU-airrv3,/ ?p .0~"(A Phone_'fp,t;-n.3?3
OWNER'S NAME AND ADDRESsb ~Qrt'..Ln..o , (fr1r~am_ 'PO. ~ ~: Kr:, m(i. ~~
STRUCTURES NOW.ON THE PROPERTY WO ~ah.:nO L2tru I r'T.urt...d. ~ PROPOSEOUSEOFPROPERTY~Otnhl7l
I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: _owner of record: _contract purchaser; .-potential buyer:
_realtor or agent. If er certify that (if not the owner) I am authorized to act for the owner of record, ani:l that said owner is aware,and approves of this action.
TEST HOLES READ ' /1.J.4 j; ~ ' Signatur.. "Dat..
.. "'.. * * * *.. * *.. * ,o......... .~** ** ****...1l ***. *** ,*.... ****.. ..*_.. OFFICE USE ONLY BELOW THIS. LI~E *** *..".. *..... ~.'..**~'*... ... ***.. ***.......... *.*****
*****
~ ~ ~ .~'?fb ~'~ c:J/h~
~ ~~-" ".,~/if-' ?-3e> -iF ~ ~ '
,,~~ {~O- ~rfn;--r/~, ~~~
--":J~ ~ /;"'#'~ ~ ~~.
,~'-' (J p.P}~~~~:" ;v,p"'~ A-M-tJ!, ,
l_.....-R J to~/:d.Y/b.... .J I~ ~. '
7./,t'.yr -c...
~FLOODPLAIN INFORMATION
o Ap ximate . All or part of this site may be in a flood haz~rd
8tll Area . 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 flood level may be required.
way All or part of this site may be in a flood hazard
ARE AT YOUR OWN RISK, IF SITE IS APPROVED, SEE REVERSE SIDE. area in which a lloodway has been designeted.
_ ~.......>> ~ . . 0 Building may be prohibited subject to
~ ;: ~~..c...t: ._ ~ -30 "7l J demonstration that the cumulative effect of
___ AUTH-ORlzED 8~.1 - - . RE DATE proposed development will not increase the
. 100 year flood level at any point.
LANE COUNTY DEPARTM T OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401
C55-32
i'
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.
SITE MEETS STATE STANDARDS YES NO YES NO
Standard System 0 O. Low Pressure Distribution 0 0
Sand Filter ~ 0 Holding Tank 0, 0
'1 Foot Capping Fill 0 0 Other' 0 ,'0
...
.
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
S,I,J/ A5-00Q6
LAND USE COMPLIANCE
Zonin~A -/0
A.creage or lot Size_ J
(TOTAL)
Partitioning #
_Parcel #
) Completed
) Pending
,<'...7" ')IT)
. COMMENTS'
./-v U.C -&.
o De ailed
StUt Area
~
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MEMO
TO: APPLICANT'
FROM: LAND MANAGEMENT DIVISION
SUBJECT: - CONDITIONS OF SITE APPROVAL
lane county
-
'.
, Any ~Iterati?n Qf the_ ~atural ~onditions in the area approved for the o~-site system of replacement area may void this approval.
This approval is given on the basi~ that the lot or parcel described above will not be further partitioned or subdivided and that conditions
on subject or adjacent properties have not been altered in any manner which would prohibit issuance of a permit in accordance with
O,R.S, 454,605 through 454,755 and Administrative Rules of the Environmental Quality Commission, Any such subdivision,
partitioning or alteration may, void this report. _ - .
WARNING: This document is a technical r~port for on-site sewage disposai only, It may be converted to a Rermit only if, at the time of
application, the parcel has been found to be compatible with applicable LCDC-acknowledged local comprehensive land
use plans and implementing measures or ttie Statewide Planning Goals. The Statement of Compatibility may be made on
the attached form or its equivalent. Authorized Agent approval is required before a construction permit can be issued,
This report is valid until an on-site sewage .system is install~d pursuant to a_construction permit obtained from Lane County~ or until
earlier cancellation, pursuant to Commission rules, '!Vith written notice thereof by the Department of Environmental Quality to the
owners according to Department records or the County tax records, Subject to the foregoing, this report runs with the land and will
automatically benefit subsequent owners,
Only persons having a valid license issued by the Department of Environmental Quality under ORS 454,695 to install subsurface
sewage disposal systems or an owner or contract purchaser or his regular employees may install subsurface sewage dispo~al systems,
A certificate of satisfactory completion will not be issued if persons other than the above perform the installation,
.
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Tax Reference
Appl1oa1lt
Depth Texture
(') - 117 S/e..-
Pie , 17~ ~~
-S'O-~O
Pit 2
f)-/J
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.:s I' (!"
(J /""~ _
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Pit 3
. !.~
Pit~
SITE EVALUATION FIELD WORKSHEET
'<7~?
Evaluator:
IIate:
?-3D ~S-
Soil Matrix Color and Mottling (NOtation), 'Coarse Fragments. Roots,
Structure, Layer Limiting Effective Soil Depth, etc.
<S' /J,L Z- ~M~ Am-...C~) ~;; 10 rlt-?'i: ail f{1
n1~:U; j, -n.r-. ~,~ ~ I ~ II '-/tjI7A...JV
(-r-e., /())j.lk~j ;
;Sb~ Z-; ~ffYL/. ~
/Y}"""';'.<AV i /~ or
aI 14/'1 /0,//1 W;
I
1.aDd3cape Notea
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S!llTEK SPECIFIC&TIIlNS
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ACTIVITY INFORMATION
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COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED I
-4r<< ~grCvvl. ~t-Jpr/~ e C4.C1~YnA/J"L.-/
;'PERSON MAKING RE~EST 'p OPERTY OWNER
~ (')cr'Jn /v1~ . PO, I? n-< ' V Z0
MAILING ADDRESS MAILING A~ESS
S;;LJ ~ Cf7C//B Alo,t!.. ~J a~ 97.v59
r trtY , - STME lIP CODE CITY STATE ZIP CODE
226 -(};;!S L 77{; -()3 22- /N1r->'-,
BUSINESS TELEPHONE 1/ HOf.1( TELEPHONE TBUSINESS TELEPHONE 1/ HD~E TELEPHDNE 1/
2 PROPERTY ADDRESS ,17
(IF DIFFERENT FROM MAILING ADDRESS)
j'../t:>
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6/le
/7
TOWNSHIP
(from tax maps in Department of Assessment and Taxation
or froi::f:,x~t~l~ment) t/. i... 00
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RANGE SECTION TAX LOT(S) OR PARCEL 1/ ZONING
3 MAP & PARCEL NUMBER
(REQUIRED INFORI1ATION)
TOWNSHIP RANGE SECTION
TAX LOTIS) OR PARCEL 1/
ZONING
TOWNSHIP RAN~E SECTION
TAX LOTIS) OR PARCEL 1/ iONIN~'
# 9 9 ACRES
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4 SUBDIVISION (if applicable)
,5 REQUEST (state exactly what you plan to do) ~t~
LOT BLOCK
DhC1p2ctlOY-V
~ 6 DIRECTIONS TO SITE:
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**FOR STAFF USE ONLY **
NUMBER
DATE
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ZONE/LAND USE: '11/
BY: DATE:
TIME IN:
OUT:
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LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 / 687-4061
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APPLICANT DDBRAY, CARY ADDR 3000 MAIN ST., SPFD., OREGON
T~~ 1702363004400 SlIBI)IV L.OT BLK
.NE~I In..,DC TY""E ~.JSE :>< BI)/'(hS 0 UN:~:":'S 001 STim:rTS :~BLDCS 001 'PHONE 726 1:)3",;;:..
OWNE~ NME CHAPhAN, CATHERINE ADDR PO BOX 426, NORTH BEND, OREGON
CODE APPL NO ACTION DESCRIPTION SQ FT UNI; COST VALUATION FEE D' ~ I
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APPLICATION #
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The Lane County Building and Sanitation Division cannot proceed with processing
your application because:
LOCATION
.5.
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NAME
ADDRESS
97Y7J?
Zl P CODE
1. r=J Incomplete application (items deficient).
~ Address and/or directions to application site.
~oposed number of bedrooms in dwelling.
Approvable plot plan (see attachment).
Notification of date test holes will be ready.
2.
3.
r=J Verification of existing system required (see attachment).
r=J
Two test holes (2'x4'x5' deep) required for expansion or repair
of existing sewage disposal system in the area of the proposed
drainfields. I
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4. [;] Other: ~~~/>f /k ,~~ (-1-,"'1.4-
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SIGNAr~ rJ.
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OFFICE HOURS
to q: 0-0
7-3/ j?J
DATE
'6:17- J'1S3 frcm to
PHONE
to this matter by ~(
/ffr,
If no response has been received in regards
the application will be denied.
BUILDING & SANITATION PROGRAM / LAND MANAGEMENT DIVISION
H~~_~ou!'th()us~-P~~i.c~el^vice Bun di,ng ( 125 E<\st 8th I'\ve. ( EUge~e ~ OR 97401 / (503) 687-4061