HomeMy WebLinkAboutPermit Septic Tank 1993-6-4
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· REQUEST
FOR:
SEPTIC SYSTEM VERIFICATION
'18' "''''''02 "c'''b6:r~r '"''f1.4'r'''''''''''
LOC:fJIOO ADDRESS
1085 DONDEA STREET, SPRINGFIELD, OREGON
6TRUCTlJRES NOW CI\I PROPERTY
LOT/PAACELl!l.OC:K
97478
EXISTING SINGLE FAMILY DWELLING
PAoPosEoUSE SEPTCNST.-t.La) WA~NSTA.U.ED N:>,OFSTOkail>
JRIVATE...j!SE \'IlLLArlETTE
ClESCRPTlC.Ha'PFlClPC6EDWORK
SEPTIC SYSTEM VERIFICATION
DlAECTlONS TO SITE FROM NEAREST WAIN MERSECTM:N
SOUTH ON DONDEA, FIRST CUL-DE-SAC ON THE LEFT.
NO OfEMA.OY'l;I;$ cx:NSTRUCTIONCXlISTNAl..l.E
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AP1>UCANT NAME" ADDRESS
ROBERT ADAMS. SAME AS THE JOB ADDRESS ABOVE
OWNERS NAME. ADDRE.55
SAME AS THE ABOVE
CCNTRACfORfNST ALLEI'lI BUILDER NAUE
'''''"'726-9375
PHONE
SAr'E
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· MAIL PERMIT TO:
MAIL PERMIT TO THE OWNER AT THE JOB ADDRESS ABOVE
~ NAMI: STREliT OTY ZIP
I hava carafully read BOTH sldas of this appllca~ jOd~ramCartlf~ all Information Is true and corract
ROBERT D. ADAr'S 4J1I1M..1/L/'.../1:...<.//2~ , _ S--2-R-2S'
PRNTHAME (f!:,~IUI'. UAII:
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FEES DUE: $
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.. CALL FOR INSPECTIONS (SEE BACK OF FORM FOR INSTRUCTIONS) 687-4065 )
, SEPTIC pa,mlts a,e good fo, one yea,. ALL othe, pe,mlts expl,e efte, 180 deys unless Inspections e,e CUffent.
~D 040 Rev, 6/92
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VIOLA nONS
SBTDACKS AND onmR. ..................... OF APPROVAl. MUST DB smCl1. Y OBSERVED. VIOLATION CAN RESULT IN RBVOCA1l0N OPnDS PERMIT.
CITATIONS MAY DB 15SUBD UNDER nm PROVISIONS OF LANE COUNI'Y'S lNPRAcnON ORDINANCB AND/OR 0'1HBR RBMBDIBS AlLOWBD BY LAW.
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A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPEcrION REQUESTS
Have the following information ready when you call: 687-4065
Permit number - Job address - Type of inspection required When it will be ready
Your name and phone nwnber - Any special directions to the site
PUBLIC OFFICIAL RIGIITTOTRESPASS ON PRIVATE PROPERTYORS 115._
POWER TO BN'J'ER UPON LAND. nm COMMISSION, AND ANY OF rrs MEMBERS, OPPICERS AND EMPLOYES, IN' TIm PBRPORMANCB OP1HBIRPUNC'nONS,MA Y
BN'J'ER UPON ANYLANO AND MAKBBXAMINATlONS AND SURVEYS AND PLA.CB AND MAINTAIN nm NBCBSSARY MONUMBNTS AND MARKERS nmRBON.
REQUIRED INSPECTIONS
FOUNDATION INSPECTION: To be made after excavations for footings ore complete and any required reinforcing steel is in pl""e.
UNDERGROUND PIPING INSPECTION: To be made after all underground piping has been installed, prior to any backfill,
CONCRETE SLAB OR UNDER-FLOOR INSPECTION: To be made after all in-slab or under-floor building service equipmen~ condui~ piping
accessories and other ancill8ty equipment items ore in pl""e but before any concrete is placed or floor sheathing installed, including the subfloor.
ROUGH MECHANICAL INSPECTION: To be made after all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPECTION: To be made after all plwnbing rough-in is in place, prior to being covered.
FRAMING INSPECTION: To be made after the all framing, fire blocking, bracing and roof ore in pl""e and all pipes. chimneys and vents are complete
and the rough electrical, plwnbing, and mechanical inspections have been made and approved.
INSULATION INSPECTION: To be made after all insulation and vapor barriers ore in place, prior to covering.
LATH AND/OR GYPSUM BOARD INSPECTION: To be made after all lathing and gypsum board, interior and exterior, is in pl""e but before any
plastering is applied or before gypswn board joints and fasteners ore taped and finished.
ADDITIONAL INSPECfIONS MAYBE REQUIRED, such as but not limited to:
BLOCK WALL: To be made after reinforcing is in pi"".. but before any grout is poured. The inspection is required for e""h bond beam pour. There
will be no approval until the plwnbing and electrical inspections have been made and approved.
FINAL MECHANICAL INSPECTION: To be made just prior to the strucrure Or remodeled orea being occupied and prior to operating anyequipmenL
FINAL PLUMBING INSPECTION: To be mada just prior to the building, structure or remodeled area being occupied.
FINAL BUILDING INSPECTION: To be mad" after finish grading and the building, structure or remodeled area is completed and ready for occupancy,
MOBILE/MANUFACTURED HOMES: An inspection is required after the mobile home is connected to an approved sewer or septic
system, prior to covering sewer or water lines, for setback requirements, blocking, tiedowns and plumbing connections.
Footings and piers to comply with State fmmdation requirements for mobile homes or as recommended by the manufacturer.
Minimum fmished floor elevation shall be certified when required by Floodplain Management
Tiedowns, if required, shall be installed and ready for inspection within 30 days after occupancy. Tiedowns shall be installed per enclosure,
APPROVAL REQUIRED
No work shall be done on any part of the building or structure beyond the point indicated in each successive inspection without fIrst obtaining the
approval of the building official. Such approval shall be given only after an inspection shall have been made of each successive step in the construction
as indicated by each of the inspections 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 " va GD OR ABANDONED FOR MORE TIlAN 180 DAYS,
SUSPENSION OR REVOCA nON MAY OCCUR IF TIIIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOU~ INFORMA nON,
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK,
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Your signarura on tha front of this form verifies the following: I HAVE CAREFULLY EXAMINED THIS COMPLETED APPUCA TION, and do
hereby certify that all information hereon is true and correct. and that I have a legal interest in the !"n't"..../ as owner of record or authorized agent. I
lurther certify that any and all work performed shall be done in accordance with the Ordinances of Lane County and the laws of the State of Oregon per-
taining to the work described herein. I further certify that if I am not the owner of the ..._......" my registration with the Builders Board is in lull force
and effact as required by ORS 701,055, and that if exempt the basis for the exemption is noted hereon. and that only subeontractors and employees who
are in compliance with ORS 701.005 will be used on the job.
SUBSURFACE & ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
When subsurface construction is complete. the permit holder shall notify the County Land Management Division by submitting the installation record
form. An inspection will be made by a qualified sanitarian. If construction complies with all rules a certificate of completion will be issued to the permit
holder. If construction does not comply with rules, the permit holder will be notified, and all corrections shall be made before a certificate of completion
will be issued. failure toJneet satisfactory completion within the allotted time constirutes a violation of ORS 454,605 to 454.745 and this rule,
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From: Interior y'"y"" lines 10'
Edge of road right-of-way 10'
Building foundation 5'
Wells or other water sources SO'
DRAlNFIELD
10'
lO'
lO'
100'
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'I-. r Please complete all lines InsIde whIte boxes, If possIble.
- fhx E/LT /)#'/7 ,/9/J/7/7J, \ <5'-..28-73
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CITY ZIP .
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OWNER OF PROPERTY (It not urn. .. above)
PHONE
. ~xlstlng Buildings or
Improvements on
Property
c;a::House
c:J Barn
c:J Garage
c:J Mobile. Home
c:J Shed
..u:- SEPTIC INSTALLED
~Yes
c:J No ~ tz:,
w~~ ~IS)rlct f!.
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OWNERS ADDRESS (If not ..me .. .boWl)
ZIP
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.. 'ZDlrectlons to site from
>'>' nearest main Intersect/on
S64-rH on
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MAP, PARCEL NUMBER
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Township ~ &Kllon 1/4 IhcUon Ta Lot
lownanlp ~ tieClIon l'4 _lion To: LoI
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X SITE ADDRESS /05(< ./)Q/?.!'}~4 ~ T c.S~/2/d7C~EL..p OA..
ZIP4' /L,I" IK
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^- MAIL PERMIT TO: .
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Land Management Dlv. slall can
nol be held responsible for
evaluations or recommendetions
based on false, inaccurale or
LMe ..." 2/92 incomplete Information
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1'114-68 02/92
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.w: ~) 3 LANE COUNTY DEPT ENV MGT RECEIPT ::"88293 DATE 0:>:,e>::
APPLICANT ADAMS, ROBERT ADDR 1085 DONDEA ST., SPRINGFIELD, OREGON
TLO 1802061311400 SUBDIV LOT BLK
. NI::W BLDG TYPE' USE 1'( BDF(MS 0 UNITS 001, STORIES '~BLDGS 001 PHONE: 726 n.;
~~~~ OWNER NME ADAMS, ROBERT ADDR 1085 DONDEA ST., SPRINGFIELD, OREG~~
. CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE D1~ylS
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W: 5 3'4'j LANE COUNTY DEPT ENV MGT RECEIPT ~ .188293 DATE 05~.>~
APPLICANT ADAMS., ROBERT ADDR 1085 DONDEA ST., SPRIN'GnELD, OREG, I
TL~ 1802061311400 SUBDIV LOT BLK
NEW BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES ~BLDGS 001 PHONE 726 92.>
OWNER NME ADAMS, ROBERT AD DR 1085 DONDEA ST., SPRINGFIELD, OREjfl.~
CODE APPL NO ACTION DESCRIPTION SQ FT UNH COST VALUATION FEEV Dm.\s
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