HomeMy WebLinkAboutPermit Septic Tank 1978-7-27
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Surname
t! :1 H ~7r'l .-n4
wp, Range Section Tax Lot Code
I Date I OWner
7-?7-7c Si:m2
:',7:
Census Tract
Receipt No.
Owners Consent
Yes No
REQUEST FOR SITE FEASIBILITY STUOY
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE
8UILDING PERMIT. ANY PLANS DR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
ARE AT YOUR OWN RISK:
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1i'~S Curtis
1
No. Sites
2,11
No. Acres
TOTAL
$ 70;. nn
Name
and
Addr<> 0 0
i'~ariBn t. neach
$
Eu~~ne. Or:. 97401
$ -.. ~'l
1:1 _ \,
Telephone No. Applicants Interest in Property lProposed Use of Property
(R5-00r;4 Ol-mer Ham?
Property Size Legal Access - Road Name ISpecial Permit Area I Urbanizing
2. 31 acres GaFic F!.?rm Road 3535'" Yes X No Yes ~ No
Existing Structures I Is Property Within One Mile of a City?
r~one What City? SDrinClfi:1d Yes)( No
Proposed Water Supply Other
Public )( District SorinQ Well Soecifv
Area
Prooertv Location: (Oirections) S. E. corner of nead~onrls F~rrv Rno rR~p FRrrr ~o&d.
APPROVED XXX
NOT APPROVED
t\!Jproved for subsurface se~!a~e disposal for one dwell ing providecl the dr~inffel c' is
locaten 2Qot of the stB~ed mobile how.e site.
OAR Chapter 340 Divlsion 7 Section 72-020 (6).
This report shall remain in effect until issuance of a permit to construct,
unless in the meantime conditions on this or adjacent properties have been
altered in any manner which would prohibit issuance of a permit in which
case this evaluation report shall be considered null and void. Technical
rule changes will not invalidate any evaluation report issued pursuant to
this section.
8EFORE CONSTRUCTION IS STARTED bring this form to the Oepartment of Environmental
Management and make application for a building permit. If the property is a por-
tion only of a tax lot, a metes and bounds description of the parcel must be fur-
nished. Exact specifications for the sewage disposal system will appear on the
building permit. Two sets of building plans and a plot plan will be required.
LANE COUNTY DEPT. OF ENVIRONMENTAL MANAGEMENT
135 EAST SIXTH AVENUE, EUGENE, OREGON 97401
J01n Crllic!:s'lcn:'
Authorized Signature
L-S-/G
s;
C55-32 B
Date