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Home My WebLink AboutPermit Septic Tank 1990-1-8 I .:::tU - I/b/-~C/~ :fMD AUTHORIZATION FORM ~ .. Land Managamanl Dlvlolon 125 E. $lh Avo. Eugono, OR 91401 , PE~~IT #r-: '" ~/- 9€9 l " ,. f TOw'NSHlP .. SECTION 114 SECTION 18 02 05.1.7 LOCATION ADDRESS 1 , 3559 CHEROKEE DRIVE, SPRINGFIELD, OREGON ITRUCTURES NOW ON P"Ol"fRTY EXISTING SINGLE FAMMILY, D',1ELLING, PROPOSED USE sEiiTiCiiiT..I.L&U ...iiEifiur.".LJiD *' OF "'"i,UtlIES .. RES IDHITI AL USE DESCRlPllON OF PROPC8ED WOf!;K SEPT I C S Y S T U1 V E R I F I CAT I 0 N_ FOR' LOA N DIRECTIONS TO SITIE FROII COURTllOUS&: SOUTH ON 32ND STREET TO JASPER ROAD, RANGE U.XLoT SU'Ol\/1SlOH I PARnTION 7finn 1 ADDRESSING o ~~lJO 0 lfiW .. I);.t. c..1liV1 eo!). ,. LOT/PARCEL ~OCK . REQUEST FOR .. " SEPTIC SYSTE~ VERIFICATION FOR LOAN , NO OF EMPLOYEU CONSTRUCllON C08TIVALU& NO. OF IIEDHOOUB NORTH ON 37TH TO CHEROKEE DRIVE, TO " SITE ABOVE, APPUCANT NAME It ADDRESS ARDIS SMITH, 'r ..... ;l! OWNERS N"Me It ADDRESS SAM~ AS THE ASOVE . . . , CONTRACTOR NAME OSR UCENSE . NA 'MAIL PERMIT TO _!'.RDTS SMITH, ~ NAME ~ '1'1 NA PRM HAM!;. ~ q 7 7 I II A (' I A"" .s.p.p 11'1 r." ) '" n. flR" r. n ,,- ql.iJ..I.8 ADDIIESS f BOTH sldos'of lhlS, apPII~~:~;';~ Informallon """""" .' I hava carefully reed ARDIS SMITH + 'PLANPJJI!~Z'~ ONING , READ CAREFULLYI Your Aulhorlzellon Is Besed On The Following Condlllons /tY/~ MINIMUM ,0.' ~"; // S~BACKS '~.;;.:- ~ s,.. ~.- -::r# ~ /? coo.,"" j6~Cp.:;~~ ~ ~~# - /~/A:7# (/ ,,~~ _- . ~"/ ~~ ........"', /~ /C/ ..T< yO/~ I sAiwrltffoN U'.. 0 '.S"'" "sf, .y,,,,, ... / / "PPROVED "-ot.,~ 0"'1'10 o 1JtE. 8V&TQll ..PPUR' "TO .. WO~Nifil $,I .~ .. . ~ST .ftee: 1&8" TIoNK .~. !.,IN, FT D; JilAx, ll\H DE~ Rlo.lon. II' $Y8Tl1W ,Alta.. yoU- /~ ^ 4- ~r ~ '(""""'I- '.:\.. Jl ~ "U8T ""","y 'Q" It lI!!:PAlJll 'IiiRIiII'f : ~ .A~~ ~ ) u ~ ~~ HO<* lo-PIB.TtHO ''taU>> j C:QMMiN r~ _...~~r-;1~ d -v'fI'-/ltf ..J ...lNIIT"'L,"liD~"Ii'II.PlilUliITNUfi.Ei" r:r~ () J: -_-'~-j:j ~'1r/'flY.Yu~~. u/o/~-~. }~j ~wd -tPtA",....,,1-<::bt~ ~ V ';'PPROV~tl.Yl~!_: ..,~4[~T. l'JA# BU/LDING V )... ,. Aa~..P.. 1J")L Ilp~q('j -, J '1 ".. QROU," us, C;O"U.iNT8~ , . OAT< FEES DUE , $ APPROVED BY ~./) ,~- - ,> DATE I:ryf"~? (J " CALL FOR INSPECTIONS (SEE BACK OF FORM F{OR/lNSTRUCTlONS) 687-4065 ' SEPTIC permits are good for one year ALL other parm/ts ex}w6 after 180, days unless inspections are current .' ~ , .' '- VIOLATIONS SETBACKS AND 01lIBR. ......................,) OF APPROVAL MUST BB SllUCTI..Y OBSERVED VIOLATION CAN RESULT IN RBVOCATION OF TInS PERMIT CITATIONS MAY BE ISSUED UNDER nIB PROVISIONS OPLANB COUNTY S INFRACTION ORDINANCE. AND/OROlHERREMlIDIES AlLOWED BYLAW , - A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS Have the followmg mfonnal1on ready when you call 687-4065 Penmt number - Job address - Type of mspecuon requITed When It wIll be ready Your name and phone number - Any spectal drrectlOTIS to the SIte PUBLIC OFFICIAL RtGfIT TO TRESPASS ON PRIVATE PROPERTY ORS 21S 080 POWER TO BNrnR UPON LAND 1HB COMMISSION AND ANY OF ITS MEMBERS OPPlCERS AND HMPLOYBS IN nIB PERFORMANCE. OF TImIR FUNCTIONS MAY ENTER UPON ANY LAND AND MAKE E~ATIONS AND SURVEYS AND PLACE. AND MAINTAIN nIB NECESSARY MONUMENTS AND MARKERS THEREON REQillRED INSPECTIONS FOUNDATION INSPECTION To be made after excavations for footmgs are complete and any requITed remforcmg steel IS 1Il place UNDERGROUND PIPING INSPECTION To be made after all underground plpmg has been mstalled, pnor to any backfill CONCRETE SLAB OR UNDER-FLOOR INSPECTION To be made after all m-slab or under-floor bu1ldmg servIce equlpmen~ condul~ p'pmg accessones and other ancIllary eqUIpment Items are 1Il place but before any concrete IS placed or floor sheathmg mstalled. mcludmg the subfloor ROUGH MECHANICAL INSPECTION To be made after all ductmg and gas p'pmg has been mstalled and pnor to bemg covered ROUGH PLUMBING INSPECTION To be made after all plumbmg rough-m 15 m place, pnor to bemg covered FRAMING INSPECTION To be made after the all frammg, frre blockmg, bracmg and roof are m place and all pipeS, clumneys and vents are complete and the. rough electncal, plumbmg, and mechamcal mspectIons have been made and approved INSULATION INSPECTION To be made after all msulanon and vapor bamers are m place, pnor to covenng LATH AND/OR GYPSUM BOARD INSPECTION To be made after alllathmg and gypsum board, mtenor and extenor, IS m place but before any plastermg IS applted or before gypsum board Jomt5 and fasteners are taped and fl111Shed ADDITIONAL INSPECTIONS MAY BE REQillRED, such as but not hrmted to, BLOCK WALL To be made after remforcmg IS J.t!. place. but before any grout IS poured. The mspectIOn IS requIred for each bond beam pour There WIll be no approval untIl the plumbmg and electncal mspecl10ns have been made and approved FINAL MECHANICAL INSPECTION To be made Just pnor to the structure or remOdeled area bemg occupied and pnor to operalIng anyeqIllpmenL FINAL PLUMBING INSPECTION To be made Just pnor to the bUlldmg, structure or remodeled area bemg occupied FINAL BUILDING INSPECTION To be made after flJUsh gradmg and the bu1ldmg, structure or remodeled area 15 completed and ready for occupancy MOBILE/MANUFACfURED HOMES An mspeclIon IS requrred after the mob1le home IS connected to an approved sewer or seplIc , . system, pnor to covenng sewer or water Imes, for setback requIrements, blockmg, tIedowns and plumbmg connectIons "- Footmgs and pIers_tf) comply WIth State foundatIon requIrements for mobIle homes or as recommended by the manufacturer Mmunum fl111Shed floor elevatIon shall be certtfied when reqwred by Floodplam Management TIedowns. tf requued, sh~ll be mstalled and ready_ for _~tlon warun ~o d~ys after occupancy.. TIedow..ns sha~ be lIlStalled pe: enclosure APPROY AL REQillRED No work shall be done on any part of the bwldmg or structure beyond the pomt mdlcated m each succeSSIVe mspectIon WIthout flIst obtammg the approval of the bulldmg offICIal Such approval shall be gIven only after an mspectJ.on shall have been made of each succeSSIve step m the constructlon as mdIcated by each of the mspecuons requIred APPROVED PLANS MUST BE ON TIlE JOB SITE AT ALL TIMES DURING WORKING HOURS TIllS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WITHIN 180 DAYS, OR IF WORK IS STOPPED OR ABANDONED FOR MORE TIlAN 180 DAYS SUSPENSION OR REVOCATION MAY OCCUR IF TIllS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR-ERRONEOUS INFORMATION -ANYONE PROCEEDING PAST THE POINT OF REQillRED INSPECTIONS WILL DO SO AT THEIR OWN RISK - - ~~ Your Slgnarore 'on the front of tlus 'form vermes the followmg I HAVE CAREFULLY EXAMINED THIS COMPLETED APPLICATION, and do hereby certIfy that all mfonnatJ.on hereon IS true and correct. and that I ha~e a legal mterest m the property as owner of record or authonzed agent I further certlfy that any and all work performed shall be done In accordance WIth the Ordmances of Lane County and the laws of the State of Oregon per. tammg to the work descrIbed herem I further cerufy that If I am not the owner of the property. my regIStratIon WIth the BUllders Board 15 m full force and effect as reqUlred by ORS 701 055, and that If exempt the basIS for the exemptlOn 15 noted hereon, and that only subcontractors and employees who are m comphance With ORS 701 005 WIll be used on the Job '. SUB SURF ACE & ALTERNATIVE SEW AGE DISPOSAL SYSTEMS When subsurface constructIon IS complete, the penrut holder shall notify the County Land Management DIVISIOn by subnutung the mstallatIOn record form An Inspecuon WIll be made by a qualtfied samtanan If constructIOn comphes WIth all rules a certIficate of completIon will be ISsued to the pemnt holder If constructIon does not comply WIth rules, the pemut holder wIll be noufied. and all correctIOns shall be made before a cerllflcate of completIon WIll be ISSUed FaIlure-to meet sal1sfactory completIon wlthm the alloned tune constItutes a VIOlatIon of ORS 454 605 to 454 745 and tlus rule SUBSURFACE SEWAGE DISPOSAL SETBACKS SEPTIC TANK From Intenor y__y..-j Imes 10' Edge ofroad nght-of-way 10' Bu1ldmg foundalIon 5' Wells or other water sources 50' DRAINFlELD 10' 10' 10' 100' ~ane ~~unty - ;REQUEST FOR ASSISTANCE Land 'Management 01", 125 E, 8th AVe. Eugene, OR ~7401 ~ lANo MAHAGEJm.lr OlVlSlOH f Please ~mplet-r, all ':7 in~~_e white boxes, If possible. {C)7/i.-:7 ---;"':;'/}>,rl //?/9r) ~ _~ ~ _ ,I, ~,.., ',c-- L/). '/" -' - ~ '-r L_ '7'~---i:. -cz-c'_<:." ~~L("".J 7'?~:"'51/-? YUUH AUUH~ 1/ ,y . t'hU!-t1;. _--;,hc,6"___ CITY 1/ I' ,- -~~-;'~"'''.''~f~} -- OWNER Of PROPERTY (II not Mm. .. .bo....~ . UUH <<AMI: z'P ....nul'oII:: .: OWNERS ADDRESS (If not same as above) z'P \.CUNIHA(;IUH ucense . Request for:. , \ MAP, PARCEL NUMBER :J:pn :tJ7'n oh. A'-l.~ T~:?bt::7 t) 'lownsrup ~ ~ \14~eetlon laXLOI x ZONE FLOOD, PLAIN, Township Range Section 1/4 Secllon T.x Lot . lo.....n$lllp ~ ;oeo;llon 1/4 Section Tall; Lot , , , , " SITE ADDRESS ::~ C?C? .'l () I) U < J {I I L..--/;:::[k.-...t. ~........,.""- fJ fl..J /I---')L-, J. -"Zti" " I(ES<<<.7S MAIL Pf:RU:1" TO ( /. I --, /-. [e......... !'c...- ____-..:: .c.~~-----V///- / c~::r ?--~<---I-) -'..~ ~-1- _.J-: / ~~--y.::----"'......'---~<.J ___ -.-f""__ AUUHt:::>~ ,...--. 'J A --- ':::::).j'--.J-1 ~~,- C?f.;:' -?/~'7 ),/ (;IIY NAMt: ZIP STAFF EVALUATION Information Request Only c::::::::J COMMENTS J FOLLOW-UP Partlt,on / SUbdivIsion TRS Verified Allowed Use c::JVes =Ves No c::J No= f Land Management Dlv staff can not be held responsIble for evaluations or recommendations based on falso. inaccurate or Incomplete Informatlon .. . . , ExIstIng BuIldIngs or Improvements on Property c=lHouS6 c::J Barn - c::J Garage c::J Mable Home c::J Shed " _SEPTIC INSTALLED qVes c::J No Water Olstnct,.. c~f '/' .=, 'J...-'-!... 1/ /, , , Directions to site .r.<,rom Courlhouse I j.J o,/+, AJ..'k .7..-,f /]'-,,, / L...- Ii. AlY) ') [7\ . _~.2~ -"J ~4--.b.~r \ I ,\ '....1 '/ , CY/h';);(, hu 3-'7 )//1 -...j (Y' I J:'\ fA ,y,u2.hJ,'J,C', '/I";,~' , C(7 If '75f ZIP -~ . '~ObJle Homy/ Plac enl Only Bran Year ......... t""" S,ze /'- No Tip-out0 of Bedrm"" ........... lcense # "\.. . \ I Lot & Block ------UiiI. ~"I..1I 1",'''1. IT ~,~~ $~J 9 ~ fJ}-\V~ l-u~ ~ - ~t ~'1' C/l/.?/_~~ 2 (!Y o " I ~n " , 1 (I' ii , ! I j ~ , j " I 'W ~, ,,11"1 I r,ANI SM I) 1-1, ()Inn.': II ~ i 8cl;}06i ,'O,Y600 SllJ3DJ V HI vJ III 1)[, ) i I 'E USI I, l:'lJht'lS (I CJI"INI f,' Nt'H- SM j 111, (~IW I S ('tiDE "I I L NO ;,n] nN DFS,- h II I I ilN HI' 1'1' I<F x<F \,F l ANI' cnllN IT !)[ 1'1 1 NV I'll, I 1,'11:1] I'j (,DDI( -16';9 LlII- hCJI<I-1 lJf(" ')i9() DnT[ oiOl!)io "~I R [NGI I I L \) 01([ LilT 1<11\ UN I I." ()() i S roF~ 11. S :~I,L DC S 00 j f'llnNlc ..r)f-, ',:'4 i' (,1'(>1-( :\6~>9 CHI I ,'lll< 1:1 j)[( , SI I(J N(,I-ll L J), (J1(E SI~ I 1 UN] r CO.':! V{,L lito! ION r-EY D" y;, II' .1 I: I I'L ~I 1 >:/Hi'I If! ,~(")r( 1 I. lVlI~ 1--1. 1(" I N I I MI-CH I1I:CIU,N j CAL ITI ,....'UF..: S~II~1 J E SlIl;:CH(\I':l,1 I.)j I 1,1, I-I {)N ,-:IH (,1\ liT :11}/" I f~ Ll, ~) 1 'I () SIi:::;! 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