HomeMy WebLinkAboutPermit Septic Tank 1974-5-10
,,~:.~. I HI.fIUEST FUH , i IE IIISI'EC 11011 . S. I, /I 7'1-;)'1$ 2-
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For Off'icc f7 41/l;/ d2/>l? . I
, Us.c. 'On I y~ Yes 110
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THIS IS A PHELIMII/AI\Y RErOn WHICJ?pj 0 !:SAWT IIISURE THE ISSUAUCE OF A FUTUHE BUILDING
PlAUS OR EXPENDITURES MADE IN, ~Ehl CE UPOU THIS REPORT ARE AT YOUR OWN RISK,..
. . 3rJ,~- PLEA S EP R IN T 8110(1-:25-;2,,)
If Subdivision - Name: Mf '/'"'-1-/7.<:>1'" B/k2. ((- 11.)81Ii/(g''1,/Olot t/
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Range ,Section Tax Lot No. Owner of Property Owner's Consent
PERMIT .
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Block 1/
/85 R.
Township
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Ri-<.Ir..",_ F,')( No, of Sites l.a
Name
ll'f-R r;/IZ-dI-IMdfrLl- LdhfL No. of Acres 4--
Ma i I ing Address .
~b"',',u"F.'a./'/ Total
i / /7...-'/'. ' . Cas h
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Telephone 1/ Signature of Appl icant Date ./-
$ '"?7S,CQ
$
$ :-52S, 0,-,
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Owner Seller
Proposed Use
of Property: /?a..S,'dd-ffl-/CV/
Applicant's Interest Buyer
in Property: Other (Specify):
Rea I tor
Property Size
Legal Access - Road Name
Existing Structures on Property
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~s Property Within One Mile of
es v What City? ~.;:,/
No . /
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Property Locat ion (0 i rect ions): L./ 2.!!d. e/- iTa"'l,z.r If /.
Sau;/ ,C)~} S"A"';"'f<03')-i+,'f1~ .duu~~ I.t;.JP'A()
City 7
Proposed Water Supply
Publ ic V District:
Spring Well
Other (Speci fy):
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When Will Test Holes Be Ready?
MARK TEST HOLES WITH OUR FLAGS
(Date)
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Location of Test Holes on Property:
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Draw diagram of property showing location of any landmarks and relationship of tcst holes to
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these landmarks:
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MAKE CflECK PAYABLE TO: HEALTH AND SANITATION
MAIL TO: LANE COUNTY BUILDING AND SANITATION DIVISION, 135 E, 6 th Ave,. Eugene, Oregon 97401
C55-55,
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LAND DEVELOPMENT RECORD
Da te /f) k.... T I
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Development Name
....
Twp~RangeJ- Sec.~Tax Lot
Lot Size General Location
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f,op6rpj .
3~ Owner or Developer
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111 r!~,~t'" 1:3101"
Census Tract
Acreage Involved
1.
Soils in Area (General)
7J"'~PDr'"
a)
b)
c)
d)
Topsoil Type & Depth
Depth to Impervious Layer
Water Table nOflQ. -l'o'MlJ.
1..0"""
-In
no 11 ~
/..,,1. '"
cd )..,..7 6'D " Subsoil
Type
Mottling
Suitability for Subsurface Sewage Disposal
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,;;,' I,;/",!) .L~C6"
,
e) Fill Feasibility
2. Topography
a) Slopes G~ Ii'", ,,,j/., f-fa f
1
b) Slide Area s A..,.,
c) Soil Scientist Repor t' Requested? AA
d) Geologist Repor t ...-, J'l
3. Drainage
a) Flood Plain
b) Winter ProblEms
Ye.:>
rtLJ
c) Distance to Bodies of Water
cv:k. .-013/7 -:t L..:.. ~ hI..4<,'
, ;:
8 ? /6 (;.f{ t
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4. Problems in Area
a) Previous Site Inspections
b) Neighboring Dwellings
a.LIa.::. At' .s:.. ~ . .
c) Environmental Survey? ~~"
,
d) Health Hazard Area? ~
S. Proposed Water source~~/private)
a) Projected Plans for Public Water
b) Problems With This Source If Anv
6. Projected Plans for Public Sewers
a) Distance to Sewers --!: ~
Distance to City Limits ..l ~
7. In Urban Service Area?
a) Within Fire Protection District?
b) Health Hazards in Area?
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MSS-60
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BUILilNG ~ITE EVALUATION
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( )
( )
( )
. Building Permit Appl ication No.
Site Inspection
7'1 - :S~2.
Pre-Permit Investigation
LANE COUNTY PLANNING DEPARTMENT
NOT
ao;;l icable
I.
Zoning Ordinance CompJi~~
(Zone ~)
Subdivision Ordinance Compiiance
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
2.
3.
4.
5.
Required Access
Building Site (Area, Width,
Frontage, Setback)
Other (see comments)
COMMENTS:
NO
YES
(}
( )
,
( )
; )
, \
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T'" 02s 06'
CENSUS TRACT
f1f; Uerfl(M l?- 2 (L..- b-J z) B-3
APPLICANT: 0_1 lLO'-/D' Q 'Z.saJ
N/\ME F/x I,;) 0 ~ ' ,
ADDRESS
t
TAX LOT
I
PHONE
DATE
CI-/l,-7Y
NAME
DATE
4- 17-71
'"YVl'9---,
BUILDING INSPECTION SECTION NOT NO YES NAME ~
-, -
app 1 i,cab I e
6. Plans Subm i tted <p ( ) ( )
7, Soil Stabi I ity (foot i ngs) ( ) ( ) ( ) '1
8. Flood Plain ( ) ( ) ( ) e(Jt~
9, Other (see Comments) ( ) ( ) ( ) .6-/3 '7Lf
-
COMMENTS: ,
.
'-.
NOT NO YES
ao;;~ i~able (1~('f~~
() ( ,) ( ,)
() () ()
() () ()
SANITATION SECTION
10. Sewage Disposal
II. Usable Area
12, Water Supply
13, Other (see Comments)
NAME
DATE
./ ---- /
.._ __ _~.. A.A
,_ , ., . _._n
COMMENTS:
TO APPLI CANT:
Building Permit / Site Inspection:
Can be app roved. tI /, L
Cannot be approved at this time as indicated on item NO.""" DIS above.
Questions and further information on items I through 5 contact the Lane-
COUNTY PLANNING DEPARTMENT. Questions and further information on itemS 6
through 13 contact the Lane County BuildinQ and Sanitation Division,
Will be held in this office until you can resolve the problems indicated.
Is being returned.
Your building permit appl ication fee is being returned under separate ~over.
5/(S~t J:f
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( )
( )
( )
LANE COUNTY PLANNING DEPARTMENT
135 Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342-1311 EXT. 231
C55-28
LANE COUNTY BUILDING & SANITATION DIVISION
135 Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342-1311 EXT.411
. .
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~ Twp, Section
" liurname Range Tax Lot Code
Receipt No. Date I Owner
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Census Tract
Owners Consent
Yes; . No
REQUEST FOR SITE FEASIBILITY STUDY
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
ARE AT YOUR OWN RISK:
Name .'!:!~~~:: I;:
and
Address '. t:.~ ~:l:.;' t:':. \\ ;. ~'if~~
."l~),'Jil!l;':~ lc.i~ :!j:l~n
$
No. Sites
$
No. Acres
TOTAL $
'. .
..
Proposed Water Supply
Publ ic .;;; District
Sprinq
in Property I proP,~~~~\~S~i~f Property
Name ISpecial )ermit Area I Urbanizing
Yes No Yes No
Is Property Within One Mile of a City?
What City? ~:)rrllt~Yj(~ld Yes; No
Other
Specify
Area
Telephone No.
':". ': .:.; L~f:; ~
Applicants Interest
Property Size
Legal Access - Road
Existing Structures
Well
"
Property Location:
(Directions) Gi: t.:!.. :'~)Il ~;~:i;"rtt!~i1: ell ,"1''::::1
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APPROVED NOT APPROVED
'.::';." ~:o".-',Il~ 1:-. y~ '.';ncf~ i ,-,.it! lc~ 1 0\7 l..l~ocl( ~ t:(n:l;'J~; i;:. '-_;'::."~;v:' ','I"
-:. ::~j ..:)' !:l::J!lt'j';'!t;~~ BC:--!'T~; ":!G:~:-:n,'l ~cccu:H.: \':il~'~;{: ,;-'~:..~l '..t, ::'1:: i .'
r '.
I:.::., ::":'.;:.,.~:,j:I,I.l,.u! 12 uf block ~ ,md lots '5 <.Jr..! ?oS O~';h..I,
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BEFORE CONSTRUCTION IS STARTED bring this form to the Department of Enyironmental
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/pl,an will be required.
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LANE COUNTY DEPT. OF ENVIRONMENTAL MANAGEMENT
135 EAST SIXTH AVENUE, EUGENE, OREGON 97401
Autho~ized Signature
~
C55-32
Date