HomeMy WebLinkAboutPermit Building 1981-8-26
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WORK. AUDTHORIZED BY P.ERMITc, Ie '
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DIRECTioNS TO SITE -~ ."~ - ----.
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PHONE NUMBER
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INTERIOR
5
REAR Z)
PHONE NUMBER
nPLUMBING FIXTURES
II
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5 ITE ADDRESS' .~~_.: ,,-C;:Sti.Ap-~) PERMIT NUMBER
FOUI;:Il'lATION I NSPECTION "OR M~)LE HOME SET UP INSPECTION IV" // ,
V Correction DisapproveB Date 7-3/-81 Inspector--y"",,-.c:....-I
LA I UNDER-"'tLOtRiNSPECTI~r<l h- - ~-~ ~ "P ~~ ~,..."P ,
Correction Disapproved Date Inspector
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UNDER ji~1 ~UMBING GROUNDWORK INSPECTION
Approved~ Correction Disapproved, Date
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nspec or, 10
ROUGH PLU~1BING INSPECTION
Approved ~ Correction
Disapproved
Date f'-~,.yl Inspector
Ie,J!.
FRAMING INSPECTION
Approved Correction
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INSULATION I VAPOR BARRIER
Approved ./ Correcti on
Disapproved Date Inspector
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Disapproved Date c;.I.s---X'/Inspector
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LATH I GYPSUM~OARD INSPECTION
Approved I~ Correction Disapproved
FINAL PLUMBING. INSPECTION
Approved V Correction
Disapproved
Da te/;;.'1 _ 1,bJ:!-1 nspector
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Date 7"-z/-R/lnspector
FINAL WASTE DISPOSAL SYSTEM INSPECTION
Approved >< Correction Disapproved Date ~/F:f Inspector f1)//
FINAL INSPEC/fION BUILDING / MOBILE HOME (1 ,--/?
Approved V Correction Disapproved Date 1~-I'1-8/Inspector YL<-f",---/
/P-'7-f?1 ~.(4/' ~ ~f', --.,-"~_.,,,,~~V Ck~
I tE.R{*Ict~ OfOCCUPANCY.u - . -- 7.. -, ~ "1UPO'RARY cfRfIFICArE OF OL'tGrANCY
Approved Correction Disapproved Date Inspector
Form C74,197
VICINITY MAP
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Installpc 'QClJes6j--{!p~"'.s"A/
ITitle as shown on DEQ ~censel
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Telephone
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ISignature01 Ownerl
Applicant's Name & Address
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J- c.. MUST BE IN BLACK INK form c55-11
Permit No. M.2.J - go ,L Twnshp. jog Range 00l.. Section ",6,. ~..;L Tax lot ~O::J,
Standard System ~ Alternative System 0 (Specify Type) F~u II L VI ~ T 12.. 13 UTI ~ A/
Job Location (Street Address) I:J. II DotJ I>\: e , <:::., /UAAf. FIEL I). t? 6'
Subdivision/Partition ,'I I Parcpl Lot Block
DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED
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USE BLACK INK ONLY
FOR INSTAllER'S USE: Trench Depth I 'if .f - 3o'! Gravel Depth Below Tilo fb'"
Tank Capacity /~t:J '1//1.. Manufacturer \AI IL l A ~ E'ri"E G-.e~V<"'7'"b A/ t:'
Measured Distance from Well to Tank From Drainfield . Total length of Lines_I.~'Y.> '
COMPLETE THE FOllOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's name) certify that a (Mfg!
and Mercury Float Switch IMfg, and No,)
(Model No,' Pump
have been installed with this sewage installation.
Signaturp
Datp
FOR SANITARIAN'S j.J~E ONlY,'..LJJ ~SysJem !lPPJoY9d 0_ Syst7l'.9isappro~d.l";: J}~,ecis ~rrection
COM M ENTS: ru/JJJJ 11./(, fKH:. m4tJ:b/ i cfkl;. UJx. C5)/ Jdffj atl'/! thJ7 ~ (4 ~,ac
~ "fJ System Corrected Dato\5",:&V'-Ob::> 8'/..
System Capacity-#"t) nal./day Signaturo ~ J?7.ilif Dato ~r 30 Er/
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian. this certificate is
evidence as per OAS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location.
Heturn thiS torm to: tJulldlng and SanitatIOn IJIV,. lJepl. 01 EnVIronmental Management, located In the oasement 01 the
Public Service Building, 125 E. 8th Avenue. Eugene 97401. '
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~NECOUNTY,OREGO~
DEPT. OF ENVIRONMENTAL II.""'GEMENT
CO~LC'Jt5CT!lOli\ll
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M(lJ)Ii'"U~1E
CONSTRU:TION PERMITS
& II~SPECTION DIV,
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. RIE-INBPIECTION REmUIREO Cf EA==' t=--
~hlClnlS 18i18l7-~~18i5 FOR APPROVAL INSPECTOR:4A 1~:... .
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JOB ADDRESS
DATE I 2 - {4- - <if /
BLDG. PERMIT: .I ::; '2... V ..... R' f
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, . ~ANECOUNTY,OREGO~
DEPT. OF ENVIRONMENTAL I\..AGEMENT
CORRECTION
.
NOTICE
CONSTRUCTION PERMITS
& INSPECTION DIV,
JOB ADDRESS /~ I r ~'?~ DATE Cj-/I-R/
TO: ~ BLDG, PERMIT: /322-8/
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~-INB'P~CTION REGUIREO (2. J ~ // ____
PhOi'11113l 1S18l7-4065 FOR APPROVAL 'INSPECTOR: ;~J.4_L~~