HomeMy WebLinkAboutPermit Building 1980-10-2
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Application forf\lll'T,r"oJ /1::;i=1'i."'({>~';j 1<:/4,1'-1'
Structures now on the property J H{A;O:; P. Wl'il-J
mri1p~W.~41tiiI<!Iat\!9Bip~f:tYl; /F(l ;jl<!~jft.~:~r~jf I 0 i~ii!ffii~f~Wj]
Affidavit: I, J101A-k?v I N i1:~()O-- K/2cwrV
, pl~ase!iprcj"t,)
If this application is for an agricultural building it will be used for purposes allowed by the State Building Code and
Lane County Code Chapter 10 (zoning) and for no other purpose. I have the following legal interest in the property:
'><' owner of record~ contract purchaser; lessee; holder of an exclusive option to purchase~
duly auth~~>>J act for, th:2wner. ~~hy.s. I<nOw~edgeab~of this appl ication.
Signature/Address ~ /t:.J//,/ ,.".. P<:lZluL-- '?t! 7V/I/ (zio)C;17L/CY
, Telephon~7':i7, I,,: ?, or 7"/7. Ij, ,,;,-::;> Date q.4.-Yo
When pennit is ready notify.: M Appl icant ~ Owner {} Contractor
Owner.r]1AI2III/J R. f$.eni"'I6,J .r-<. (ZiD) ((7LW/ Phonc7LI-I 1~,s2-
Contractor (zio) Phone
,
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DEPARTlIEtIT OF EINlROW1EiITAL lIAIIAGEMEI.
PSU. 125 EAST 8TH AVEilUE
EUGEIIE. OREGON 97401
/{,
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Ct !~t6jJ&i
. hereby certify that this information is true and accurate,
Contractor's 05R#
Plumbin9 by
.i~"::;"8"f:r:ijR":t''t~:~l
i$~~)'f~~;:~~:::::~ :.~A ~~
[diMl
,COstl
&>d- 'Tt)~40 ~v
Parcel d~+-
into 11::\/ re~r~1
<./ I
~'
DO NOT WRITE BELOW THIS LINE
If Commercial: il;6fjstOr.fi~I '. :~f~em~y,,? . _
Residential: i(p(b!!l~. ~ /./~/.:Z1;t~~t!f7-C.
51 test holes ready
, """'~~'
IFee';;
Code'
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Va 1 u"a t i on
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Total Valuation: $
l~~~;li~j:~~;i! :: :
Subtotal
g 1~~~~~l-I~_
Received by
.4% State surcharge
Water Supply P-rllj),\[Cl1t~ G ~ Plans check fee
Proposed _' Existing ~ C-.':' ,;.:. .~"'I.."'~""'J
Year Installed
PERMIT PROCESS lUG.
Minimum setbacks:
Zon ~~ Part. #
P?/"'f I -/
It, fro'l?Ji' V0 It, side
Parcel i
COllll\[~nts
To th! typed on permi t
I
CP&I Type ")JV Group 1:'-'3 Fi re Zone
To be typed on permi t
By (l(lrT'1f .
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Jl.(. :"';I.l:::;37-i'\(:
~A~TitinedtkTIim
-=
-Fee
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S
$
I.... ..
'$
"
each $ .
each $
$
$
=
Use Classification
Date ~('J
:5 Pc / giJ;j7;rr;...::J
For plans information call (area
-t>Directions to site J)O(~'-_ll--4
! (~J\l/=l";r-\l.-! Al?I==A
Plans to: CPSI
C/ ;;)'0 ~PC
-,I /" J~_
By ~~U
I
Date
inspector)
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Phone
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t
set(s)
set(s)
Date
Requ ired
Hold 51;p
tr'l prr
Date
r .....",... 1 ro ~........
Da te to
'f<l)/J,'J::- r<OI,,,,^J
(please'print)
If this application is for an agricultural building it will be used for purposes allowed by the State Building Code and
Lane County Code Chapter 10 (zoning) and for no other purpose. I have the following legal interest in the property:
'../ owner of record; contract purchaser; lessee; holder of an exclusive option "to purchase;
duly authorized to act for the_owner, who is knowledgeable of tllis application.
Signature/Address---)'J;&,~f"',''''_/''':'-,~/ 'N,: -;; ,.
. / . 'I' .r. _'
Telephone ---'~l" I.~",,,,,,,,
When permit is ready notify: i\J'Applic~nt 1~/'Owner
-, ..-,
Owner ~-1}^I)lIrt.l}"J R'"";llll,\ J
Contract~~
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.
DEPARTliENT OF EI;'1IROW1EiHAL IlANAI;EflE.
PSG, 125 EAST GTH AVENUE
EUGEnE, DREGOiI 97401
Job Address .< ~ }1/:::L> nnl/)~ \/'0,
'Township, Range. Secti~;-n. Tax lot I --,~-...
Subdivision ". _.'1 ,,'
Application for" A t""~rrl rt"'\ ICr-r>.rt;'"h"'''...J l~ft-lf-l-
. .,_ .._. /.._ _ _ .n .., "
Structures now on the property I-I.). >::.. 1::- ~ I (,,~I
Proposed use of pro'perty: iiI Residential I I,::i Co~ercial
.' ~ \
Affidavit: i. j,{,iLfO",,,j
1:-"'1 !,,:,/...;^ Ji::::"
J.::L-oJ '-'1 I
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J 'j \ City
- ~Jt~r"l",",)
Lot
Block
CI Industrial
CI Public
. hereby certify that this information is true and accurate,
or '
Date
,/
.' ~ ;T)
/~/ Contractor
(zio)
(z;o)
Phone -j..,
11 ,/
Phone
Contractor's OSR#
Plumbing by
Application # ~
"f' '1J:: ,?17- 7\t'..
- -,,-.-,
Assigned Numbers
=
(zio)
I . .~/;
,- ~?-
UU I1U-1 WR.III:. tH,LUW "I-titS LH'lt
If Commercial: # of stories
Residential: ! of bedrooms ';;..:)
51 test holes ready
. # of employees
" -
~, ~1~''''1r?'?1',-':,''',. - (1"'1,,.
# of units
SOS: I~I Existin9, BP N
.-:..,
I_I Proposed, SI N
.,
'r. .... ('r"-
Fee
Code
Sq. Ft. or
N of Sites
Unit
Cost
Oescriotion
Valuation
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CI Cash
CI Check #
Received by
Total Valuation: S
Plumbing fixtures at S
Sewer/water conn. at S
Subtota 1
4% State surcharge
Plans check fee
I ) ~ I
Water Supply 1'- f ; ; .\.~q
Proposed \ -
Year Installed
, ';,' ). j~" \
;.", - I "C;.r. .. I
. l....L _''':' ....
E;isting y" Change. of. Occupancy
. ('. '
TOTAL '
....!
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each
each
Fee
S
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$
$
$
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$
PERI11T PROCESSINIi,
!.1inimum setbacks:
Zone//.//-
t, front.,!
c.
1., side
Part. N
Parcel #
Parcel Size
into p. rear
Comments
To be typed on. permit
By
. '" :, ~
Date ' '; .'t". j i' ,
I
WATER POLLUTION CONTROL
Installation specific'ations: ~LSL..~ gal. ~ank; ft, of drainfield; max. depth of trenches:
To be typed on permi t a 1< . t.- D...[tl <t &..L.:..{ ~ - l<,c.a..1c..0--
n~ SJ';:J'L ~'\.-~ r(....lI...J..J'-- tc:<a.J~ <eD. .~;.k ~()6ak& ,~~ o.."-u- cP ..fVLoI)o;,z)
Cl.C'~' L.'"-l~ . D. 1.10 C"l<L",<s< .cJjn"""g,11I,f.iLb''/u--\ dt ~f<;t~ ,><-~')q,-J, QL~> '<;k~
yv C'- ~u 1'<<..o'Y'...L1 ...f. r.-:<>!J),.-- aJ~L.c- ~ '
; Telephone (0::;;'; 1--:'>'15 <." By r I\{ Lt 5"-'
.Oirectionstosite ~}I"')("-,"I 1.1. l___:' "~ I.'r\ -I." 1-.
v',. - . {\,
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'Plans ~o:
Date
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CI SIFO
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CPSI set( s)
~rc ===== set(s)
Date
(("\f1I[llntp(j
Date
Requ ired
Hold Sl;p
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Plan
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Job Location
Permit /I
Permit Ii" ^
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lane county
Water Pollution Control Division
Environmental ManaQement Department
125 East 8th Avenue
Eugene, OreQon 97401
LOCATION:
Twp.rr RanQPO<-
(Comp le te
Subdivision Name: -
Section 15 Tax Lot # [4/02-
the foUowi!!.gLi[~pp.1ica9le)_
-- --- -[ot-# -8loek #~-----",.
[i]
system located on this property has ever failed by discharQing sewage upon
the ground surface or into public waters, by clogging or backing up, or in
any other manner.
~ I have information that the existing subsurface sewage disposal sys-
tem located on this property has failed in the past by discharging sewage
upon the ground surface or into public waters, by clogging or backing up, or
in some other manner, and that:.
D The system has not been repaired.
I have no information that the existing subsurface sewage disposal
D The system has been repaired and has operated
since the repair without other failures,
Date(s) repaired ,
continuously
I have had personal knowledge of the performance of the existing
subsurface sewage disposal system located on this property for20
years and months,
The existing sewage disposal system consists of:
a) Septic tank has a~t?ot) gallon capacity.
b) Number of drainlines ~ .
c) Length of drainlines~'! ~..u..
d) Distribution box? VeSJU~~ No
- ,
The existing septic system was installed
under Lane County Building Permit #
This system last served a dwelling having ~ bedrooms (include all
rooms which could be used as a bedroom, though actually used for other
purposes such as for a den or a sewing room) OR, if for commercial use, this
system last served an establishment having employees, and gallons/
day sewage flow. This system was last used on~7.ZV //S~ (Date).
/
In case of an addition, the new portion will be,ll?'.> feet away from the
existing drainfield. ~
APPLlCANT:~d&/M~ ~.d' ~ '(//4/ BI!<<:E.E;;owAf
PROPERTY OWNER: [XjVes D No ,
DATE: q,C:J..s;.o
(Date) ,
C74-156
WATER POLLUTION CONTROL OIVISION I
125 EAST BTH AVENUE I PUBLIC SERVICE BUILDING
ENVIRONMENTAL MANAGEMENT DEPARTMENT
EUGENE. OREGON 97401 I 15031687.4061
Water PQ11ution Control Divisi~ 125.East 8th / Public serviC~lding / Eugene. Ore. 687-4061
~ RECORD OF EXISTING SYSTEM
DIAGRAM
~l~ j4 ~ ~ ~ccili ~~
W S42(l~ 0JI..9.9- }-<> ~ y ~y
s1uu.U ~ fut.~. ~~t ~
cvJ ~~ ~ ~~ ~~ ~
Sr ~\:cLUJ-;b, ~~ ~~ ~ ~ '
~~ ~ JL 8~ \J-v ~St C'- ~cu-v ~
~
or .2-'1. _yO
TWP. Ii RANGE 03
SUBDIVISION/PARTITION
ZONING DESIGNATION ~C;-r
OWNER Ml.e.VVJ ~rJ ADDRESS 135 V~ j.~ ' 7~
EXISTING DWELLING NUMBER OF BEDROOMS :J, PHONE rr- "7<17; 1l_C; 2.
IF NO DWELLING EXISTS, LAST KNOWN NUMBER OF BEDROOMS SERVED(FROM A&T RECORD)
PREVIOUS SITE INSPECTIONS OR PERMITS ~
SEPTIC TANK SIZE / cbO GALLON CONCRETE [] METAL 0 FIBERGLASS [] OTHER 0
LAST KNOWN PUMPING DATE W;"~\u:-.... ~ Z ~s
CONDITION OF SEPTIC TANK: SATISFACTORY ~
DISTRIBUTION METHOD: EQUAL [J
CONDITION OF DIST/DROP BOXES: SATISFACTORY []
NUMBER OF LINES
LENGTH EACH LINE 1) ft. 2)
5) ft. 6)
CONDIDTION OF FIELD: SATISFACTORY
COMMENTS lvtc.~ f.-. Q...oudL ~..:..Jl..J.).
SECTI ON
I~
TAX LOT <tiOL
PARCEL LOT
BLOCK
UNSATI SFACTORY
SERIAL OTHER
UNSATISFACTORY
o
o (SEE COMMENTS)
[J
ft. 3)
ft.
[]
ft, 4)
ft,
UNSATISFACTORY
[]
FINDINGS
1) This system is in compliance with provisions of Oregon Administrative Rules, chapter 340,
division 7 and is sized to accept a sewage flow of up to ~ gallons per day.
2) This system is not in compliance with one or more provisions of Oregon Administrative Rules
chapter 340, division 7. IL AI _.' ~1I. _ - '
~ J~ "l,2Jj',X\l
Ullltu
M74-176
~!bNIIIUKt
.
.
HOLD
.
SLIP
bne county
-
I-\Cv" oj tv' DroLlJ VI
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APPLICATION # -:2531- y~)
LOCATION ntit.dv'I..I5\\...Q Yo/(U
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NAME
c
( J.,.l.j)o.,r..Jl.. _
U
of2.
jQ/r^'1 (. J .
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Zr'P CODE
ADDRESS
The Lane County Water Pollution Control Division cannot proceed with
processing your application because:
1. D Incomplete application (items deficient).
r=:J Address and/or directions to application site.
o Proposed number of bedrooms in dwe 11 i ng.
c::JApprovable plot plan (see attachment).
E::J Notification of date test holes will be ready.
~
2.0
3. D
Verification of existing system required (memorandum
explaining this procedure attached).
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. 13 Other:
1'(}
~(o\Jtv d;,,1 V~'/,9"'-' bo-x..
CclLCOVr1
SIGNATURE
<{ _ goO
OFFICE HOURS
AGt (SOh q - 29 -Y,o
DATE
t{-l?f\ -::J.r~ ft/-.7 3 CI5 "-
PHONE
If the necessary corrections are not made within 30
application will be denied,
days, the
~25
BUILDING & SANITATION / ENVIRONMENTAL MANAGEMENT DEPARTMENT
East 8th Avenue / Public Service Building / Eugene, Oregon 97401 / (503)687-4061
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".I'1.PPLICANT BROWN, M
TI.O 1703150004102
" NEI.) BLDG TYPE
-.CODE AF'PL NO
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LANE COUi'dy DEPT ENV MGT RECEIPT ~'253'7EI0 DATE 09~)98~ n
BRUCE ('1.DDR 135 DEAOMOI-lD FERRY RD., EUGENE, OREG e
SUBDrv . LOT BLK
, USE R NO BORMS 03 NO UNIJS 001 NO STORIES NOBLDGS 001
. ACTION DESCIUPTION SQ FT UNIT COST VAL.UATION FEE DAYS.
ADD TO EXISTING
DWELLINGI BEDROOM
WITH BATHf~[)OM
:~60
,38.10
1:5716
.
.
L.C 253780 F~MA
NO. FIXTURES:
3
NO..
CONNECTORS:
MECHANICAL. FEE
STATE SURCHARGE
PL.AN'CHECI< FEE
ADEQ. .
13716
15.00 EACH '"
68.00
15.00
'.
I' .! ~
.
4%
5(-)%
3.32
41.50
40.00
e~
SDSC CERi'. OF
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BY CAD
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SDS ' sr
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COMPLETI ON DATE
pel<
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ISS
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TOTAL FEE~"*
167.82
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EST.
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