HomeMy WebLinkAboutPermit Septic Tank 1993-4-5
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AUTHORIZATION FORM .// 7 ?-~3
Management ~ivision 125 E. eth Ave. Eugene, OR S7401
Lane!
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REQUEST
FOR
REPAIR EXISTING SEPTIC SYSTEM
YADDRESSING
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'011 CHAROKEE DRIVE,
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lDT/PARCEL BLOCK
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SPRINGFIELD, OREGON
97LI78
STRUCTURES NOWOO PROPERTY
EXISTING SINGLE FAMILY DWELLING
PROPOSED USE SEPTC NSTALLED
PRIVATE USE
WATER NT"lLED
CITY
M:l OF STORES
NO OFEMPtoYEES CClNSTRUCTIONCOSTNAWE
~Off>ROf>CSEDWCJAI(
REPAIR EXISTING SEPTIC
DlAf~ TOSfTE FRQ.l NEAFlEST MAIN HTERSECTlO'II
4LND STREET TO JASPER
DRIVE
"'<>'BE!lR:X>O
SYSTOl
ROAD, RIGHT TO 37TH,
ON CORNER OF 37TH AND CHEROKEE
APPLICANT NAME I ADDRESS
GARY PRIEBE,
PHONE
747-2029
SAME AS THE JOB ADDRESS ADOVE
CJWNERS NAME' ADDRESS
SAME AS THE ABOVE
PHONE
SAi~E
cafTRACTORINSTAUEf\'BUILOEA NAME CC81t
KEIH [:ORLEY
i MAIL PERMIT TO
MAIL PERMIT TO THE O~~ER AT THE JOB ADDRESS ABOVE
PHONE
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STREET
0lY
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PRMNAME
BOTH sides of this apY'}cJ'~(- and ,he~hat
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,
all Information is true and correct
I have carefully read
GARY PRIEBE
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. PLANN/NG/ZONING
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~ READ CAREFULL YI
~ONr-
"l,.Q00 PLAIN
Your Authorlzat,on Is Based On The Following Conditions r
MINIMUM
~ lEOAL LO"-" SETBACKS FROmLOlUNEl ~ ~ 'iiEiii""" ,$PAF\IAH
,
WPt,.ANOS
-';UI!IMqlI!l'"
NO PLAN")NG ACTION REQUIRED.
U-G-B SPRINGFIELD.
,
j SAN/TAT/ON
"'''' . 4/5/93
'~ 4 t. IItilr INSTALL DlaT. SY5T&:M PfCA I j' /' ......'C; '7
.; ""7~ "''T.J~.. 'P""j.PPAO'ltDP1.0T-PUNDATED ~-t~ '/~
.,J'-t \woo'" r--"'1 0 'Tl-tE SYSnM APPEARS 'To. BE wo.RKiNQ
~. ~'M ~. '''':Z~:ZZE LIN " D'" !rU,XTRN-o\liPTH RIIl:li1'.1F$YSTl!!iM:fAlt.S,VolJ-
.... # ~ , II:'" ..r\ Musr APPLY' FQR .. REPil,It\ P&;RMI'J
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ffiiMlN ~i /I ~~:J. --;;-/J ~S~~;~D PERaPER:t :UMe,ERK ~_ ,:,. I~~_ tJ. '^....,.
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,A..:~ -~u/'u.....J.. APPROIIIlO&.Y' ~ ~....u______
t SpILDING' ,- J)
APPROVED BY,
ROfiER HOLLIS
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FEES DUE $
APPROVED BY
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DA TE Lf-t. -'71
CALL FOR INSPECTIONS (SEE BACK OF FORM FOR IN!;TRUCTIONS) 687-4065
SEPTIC permIts srs good for one yesr ALL other permits exp/fe sfter 180 dsys unless tnspect/ons are
.
......
current
~
LMD 040 Rev 6/92
VIOLATIONS
SETBACKS AND ontBR CONDmONS OF Al'PROV ALMUST BE STR.Icn Y OBSERVED VIOLATION CAN RESULT IN REVOCATION OPTInS PERMIT
CITATIONS MAY BE ISSUED UNDER nIB PROVISIONS OP LANB COUNTY 5 lNFRACI10N ORDINANCB AND/OR OTIiERRBMEDIES AlLOWED BYLAW
A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS
Have the followmg mformauon ready when you call 687-4065
Penmt number - Job address - Type of mspectlon requITed When It will be ready
Your name and phone number - Any speCial dIrectlons to the site
PUBLIC OFFICIAL RIGIITTO TRESPASS ON PRIVATE PROPERTYORS ns.080
POWER TO Rm'ER UPON LAND TI-IE COMMISSION AND ANY OF ITS MEMBERS OFFICERS AND EMPLOYES IN TIlE PERFORMANCE OF 1HEIR PUNCI10NS MAY
ENreR UPON ANY LAND AND MAKBEXAMINATlONS AND SURYHYS ANDPLACB AND MAINTAIN TIIB NBCBSSARY MONUMENTS AND MARKERS ..~..
REQUIRED INSPECl10NS
FOUNDATION INSPECl10N To be made after excavalIOns for footmgs are complete and any requITed remforcmg steel IS m place
UNDERGROUND PIPING INSPECl10N To be made after all underground plpmg has been mstalled, pnor to any backfill
CONCRETE SLAB OR UNDER-FLOOR INSPECl10N To be made after all m-slab or under-floor bUlldmg semce equlpmen~ conduI~ plpmg
accessones and other anCillary eqUIpment Items are 10 place but before any concrete 15 placed or floor sheatlung Installed, mcludmg the subfloor
ROUGH MECHANICAL INSPECl10N To be made after all ductmg and gas plpmg has been mstalled and pnor to bemg covered
ROUGH PLUMBING INSPECl10N To be made after all plumbmg rough-m IS m place, pnor to bemg covered
FRAMING INSPECl10N To be made after the all frammg, fITe blockmg, bracmg and roof are m place and all pipeS, chunneys and vents are complete
and Lh~ rough electrical, plumbmg, and mecharucallIlSpecuons have been made and approved
INSULA nON INSPECl10N To be made after all UlSUlalIon and vapor bamer.; are m place, pnor to covenng
LATH AND/OR GYPSUM BOARD INSPECl10N To be made after a1llathmg and gypsum board, mtenor and extenor, IS m place but before any
plastcrmg IS applIed or before gypsum board Jomts and fasteners are taped and flIllShed
ADDITIONAL INSPECflONS MAY BE REQUIRED, such as but not hrmted to,
BLOCK WALL To be made after reInforcmg IS m place. but before any grout 15 poured The lIlSpecuon 15 requIred for each bond beam pour There
wIll be no approval untIl the plumbmg and electncallIlSpecl10ns have been made and approved
FINAL MECHANICAL INSPECl10N To be made Just pnor to the sttucture or remodeled area bemg OCCUpied and pnor to operalIng anyeqUlpment
FINAL PLUMBING INSPECl10N To be made Just pnor to the bUlldmg, structure or remodeled area bemg occupied
FINAL BUILDING INSPECl10N To be made after firush gradmg and the buIldmg, structure or remodeled area IS completed and ready for occupancy
MOBILE/MANUFACTURED HOMES An mspectlOn IS reqUITed after the mobIle home IS connected to an approved sewer or sepuc
system, pnor to covenng sewer or water Imes, for setback requrrements, blockmg. uedowns and plumbmg connectIons
Footmgs and pIers to comply WIth State foundatIon requrrernents for mobIle homes or as recommended by the manufacturer
Mmunum funshed floor elevauon shall be cerllfied when reqUIred by Floodplam Management
T ledowns, If requITed, shall be UlStalled and ready for mspeCl10n Wlthm 30 days after occupancy Tledowns shall be mstalled per enclosure
APPROVAL REQUIRED
No work shall be done on any part of the bwldmg or structure beyond the pomt mdIcated m each succeSSIve lIlSpecl10n WIthOUt fIrst obtammg the
approval of the bulldmg offICIal Such approval shall be gIvcn only after an lIlSpecuon shall have becn made of each succeSSIve step m the construction
as mdIcated by each of the mspecuons requITed
APPROVED PLANS MUST BE ON TIlE JOB SITE AT ALL TIMES DURING WORKING HOURS
TIllS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WTI1!IN 180 DAYS, OR IF WORK IS STOPPED OR ABANDONED FOR MORE TIlAN 180 DAYS
SUSPENSION OR REVOCA nON MAY OCCUR IF TIllS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMA nON
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK
Your signature on the front of t1us form verifies the followmg I HAVE CAREFULLY EXAMINED TillS COMPLETED APPLICATION, and do
hereby certify that all mformatlon hereon 15 true and correct, and that I have a legal mterest In the property as owner of record or authonzed agent I
further certify that any and all work performed shall be done m accordance With the Ordmances of Lane County and the laws of the State of Oregon per.
lammg to the work descnbed herem I further cerufy that If I am not the owner of the t"~r-.~j. my reg15tratlOn WIth the Bmlders Board IS m full force
and effect as reqwred by ORS 701 055, and that If exempt the basIS for the exempuon 15 noted hereon, and that only subcontractors and employees who
are In comphance WIth ORS 701 005 will be used on the Job
SUBSURFACE & AL TERNA TlVE SEW AGE DISPOSAL SYSTEMS
When subsurface construcUon IS complete. the pemut holder shall notIfy the County Land Management DIVISion by subnuttlng the lIlStallatlOn record
form An Irnpecl10n will be made by a qualIfied sarutanan If construcUon complIes with all rules a certifIcate of compleuon w1l1 be 15sued to the permit
holder If constructlOn does not comply WIth rules, the pemut holder w1l1 be nOl1fied. and all correctlons shall be made before a certIficate of completion
WIll be ISSUed FaIlure to meet sausfactory completIon wlthm the allotted tune constitutes a vlOlauon of ORS 454 605 to 454 745 and thIS rule
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From InterIOr property Imes 10'
Edge of road nght-of-way JO'
BUlldmg foundatlon 5'
Wells or other water sources 50'
DRAINFIELD
10'
10'
10'
100'
.5aLtr!t
,- . J ~REPr'RED ~l' 1
'>IICE
0 l DATE )
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REQUEST FOR ASSISTANCE
land Management Dlv 125 E 8th Ave Eugane, OR 97401
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PleasyomPlete a/1 lines insIde whIte boxes, if possIble.
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CITY //~/L ZIP
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OWNER OF PROPERTY (It not um. .. .boy.) P"UNt;
OWNERS ADDRESS (II not ..me .. abon)
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ZIP
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Request for: O~~
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MAP, PARCEL NUMBER
(Found on tu mapa In the Aa....m.nl .. T...tlon Depl)
/<.; '7~ Illffl1/ f~ 2
fown-nip ~ ~uon 114 s.cUon ... tOI
If c);:: 06<1, Z ,<?,-PCM
Township Rang. Seello" 1/4 Seellon Tax Lot
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FLOOD PLAIN
lown.nlp ~ lieCtlon 114 t1ec(lon IU LOt
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SITE ADDRESS // . :..;.. .. ~ 1'/1' /J / (_ /__
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LAIC) MANAGEllEHT DIVISION
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Ex/sting Bulld/ngs or
Improvemen,s on
Property
5ilI House
c::J Barn
c::J Garage
c::J Mobile Home
c::J Shed
SEPTIC INSTALLED
tmIYes
c::J No
Water District
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D/rectlons '0 slle from
nearest main Intersection
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STAFF EVALUATION
Information Request Only eI
TRS Verified elVes Noel
Allowed Use =Ves No =
Partition / Subdivision Lot & Block
COMMENTS / FOLLOW-UP
.
Land Management DIY staff can
not ba held responsible for
evaluations or recommendations
based on false, Inaccurata or
lMD 149 2192 Incomplete mformatlon
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M14-68 02/92
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For Mobile Home
Placeman' Only
Brand
Year
Size
No of Bedrrns
LIcense #
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Dls'ance from Mobile
Home to.
Water
Sewer/SeptIC
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rll'!' TU 1802061202800 SUBDJV Lor ilLK .4'
NEW [<LV(; TYf'F USL b: BDF,MS 0 UN] TS 001 S FORJ L,; ~BLDGS 001 I-'IHJNI: 747 20:"-'
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