HomeMy WebLinkAboutPermit Plumbing 1978-8-8
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SubdivIsion
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FOR SAN ITARIAN'S USE ON l Y ~ System Approved D System Disapproved D Needs Correction
COMMENTS
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Filler Depth Bel w Tile
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Date :>5-JT-7,i'
FOR INSTAllER'S USE Trench Depth
Tank Capacity 4CXJI"JG,t:,{, Manufacturer
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INSTAllATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION
When signed by the County Sanltanan, this certificate IS eVidence as per ORS 454 665 of sat.
,sfactory completion of a subsurface sewage disposal system at the above location
Return this form to Permit Processing Section, Department of Env,ronmental Management,
Public Service BUilding, 125 East 8th Avenue, Eugene 97401
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C5511
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TRS, TI
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JOB LOCATION 11\0) [":~It S','r-P-:-. '-"i'~n.1H<"ld
LANE COUNTY PERMIT
Acreage or Lot SP~
Contractor's 0 S #
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21{}70
Partitioning #
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SubdivIsion iT'! I1f1-'~-;:1rn \",) So. ~r.'( Ec;tl'lY;~'"
Lot n Block ~
THIS PERMIT IS FOR
OATER SUPPLY
APPLICANT'S NAME AND ADDRESC: ,."('r,~,'",, <:l--,1r;'1nt. 1')","11.. ~n" <:",,,~h <1?,-..,l <:n",~"..."~^lil
OWNER'S NAME AND ADDRESC: :kl'-l!:')') Cr>-.w'On. -1&,1 C;:,p(l'r 5~'lR"'L S:n~1nn~11">1il
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CONTRACTOR'S NAME AND ADDRESC: r"ar,,,,I,,, P""l<< 91.l&. ~.~h "l~"c1 <::..",.",...<7..",1.1 ."
Mail permit to ( ) Applicant ( ) Owner ) Contractor Um) Prefer to pick up C'all 147.7')4..,' J-,
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# BEDROOMC: Nfl # P,LUMBING CONNECTIONS i1A
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Sm1l:'lb Tan!r /1 f
Phone 717-7245
Phone 14J -l<;lt::
Phone 747-724~
(owner, etc) when ready
STRUCTURES NOW ON THE PROPERTY~
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SEWAGE DISPOSAl
S I # 21119-66
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THIS PROPERTY IS WITHIN ONE MI LE OF THE CITY OF
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PLUMBING BY CilskhG? Itonls
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I hereby certify that the above statements are true and accurate, and that I have the followlrlg.legallnterest ,n thAoroperty _owner of record,
contract purchaser, _ potential buyer, _ realtor or agent I further cert,fy that (,f :not the 'owner) I am authorozed to act for the owner of
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record, and that said owner IS aware and approves of th,s action I hereby agree to comply With all applicable Codes relating to this perm't
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Fee Paid ~ 1\'21111"1 Ci7 ,'ill Signature 1... ".,.eA fi.-rl'I''''rCl'Hsl Date 71?i'iI7B t I,.;\..
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) NEW ADDRESS ( ) FACILITY PERMIT TO TRANSPORTATION DEPT ( ) SPECIAIo-PMT AREA~ MIN ELEVATION
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Comments l.Q",,-^.~ ) - , -
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SANITATIOlL
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M,nimum Septic Tank Capacity (Gallons)
Dralnf,eld Required, Lineal Feet
MaXimum Depth
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PLANN ING REQUI REMENTS SATISFIED By S~~~ L , , Date 71?511f1. Date Issued '0;'_ I 'c ~ I C
ZONE ,li\ SETBACKS FRONT f1H SIDE FACING STREET t/1\ (FROM CIL) INT SIDE YARD WI. REAR-7'PlJ(fROM PILL
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE, EUGENE, OREGON 97401 PHONE 687-4394
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C5513
POST THIS PERMIT ON MAIN BUILDING AT SITE
SLOG PERMIT-WHITE BUILDING-GREEN PLUMBING-CANARY SANITATION-GOLDENROD QFFICECOPY-WHITE
~--
SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED / / DISAPPROVED ~ DATE
INSPECTOR
REMARK S
GAS PIPING GROUNDWORK
ApPROVED / / DISAPPROVED ~ DATE
INSPECTOR
REMARKS
ROUGH PLUMBING
ApPROVED / / DISAPPROVED ~ DATE
INSPECTOR
REMARKS
ROUGH GAS PIPING
ApPROVED ~ DISAPPROVED ~ DATE
INSPECTOR
REMARKS
FINAL PLUMBING ~~/-R~~ ~~-If;_;...
ApPROVED ~ DISAPPROVED DATE<=) INSPECTOR
RE~ ~c;;~- ~ ~ 'Ir ~ L~h:::1 tJ~~~
FINAL GAS PIPING
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DISAPPROVED / / DATE
INSPECTOR
ApPROVED ~
REMARKS
CERTIFICATE OF OCCUPANCY
READY TO ISSUE ~ NOT READY TO ISSUE ~ DATE
INSPECTOR
REMARKS