HomeMy WebLinkAboutPermit Septic Tank 1978-11-7
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~ I tf ,OZ-O'ZA 2, c.f H:: 2CejOB LOCATION
1/11
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PERMIT # '.:;7...71
5~; tL..~,:~'XL!:';
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.!:;a n 120
LANE COUNTY PERMIT
Acreage or Lot Si7~
Contractor's O.S. #
Partitioning #
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:lmJTIl'i' ::r. :nu.
Subdivision
Lot \i
om l1ill~ CL1.'2J:j~ spalct,\7IWW
Bloc~
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) Completed
APPLICANT'S NAME AND ADDRI'C::C::
OWNER'S NAME AND ADDRESC::
~C.ONTRAtTOR'S NAME AND ADDRESS
W""ail permit to (ll) Applicant ( ) Owner
74t-s);l' "
) Contractor.
) Prefer to pick up. Call
Phone
Phone_
Phone
(owner, etc.) when ready.
!... .i..~'j
L:.Yl'J.;.!W.:J...l,
STRUCTURES NOW ON THE PROPERTY
H&1~~;~ A~dj b~ f~: u,~u $40,447.00
THIS PERMIT IS FOR ---- -- -. ---.-,-- --.... --'____ _.. ___h.
.. ~.;..:. ,&-;:. .,LV A......,.,L...~ ..::.t,....;...l,VL) v~-m-w~ o.J.....;.&.~..:".l.
....,r..~ ("J
L~._J~
WATER SUPPLY.
UIIJ.!',' :.Yi.l.: t1.W,..il DIS'ffiIC't:
SEWAGE DISPOSAl
rill
3 II
'" SEDROOMS_;= PLUMBING CONNECTIONS__
Pil070SlliJ
S.1. #
THIS PROPERTY IS WITHIN ONE MILE OF THE CITY OF
l\A
oi&!I b>".
llli
I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: _owner of record;.
contract purchaser; _ potential buyer; _ realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of
record, and that said owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit. .
\<
. PLUMBING BY
Fee Paid c:: .) \
( v) NEW ADDRESS (
....
Signature "
, ; '"
Datp' \ '.~
- ". . '" \.
) FACILITY PERMIT TO TRANSPORTATION DEPT.__ (
) SPECIAL PMT. AREA. MIN. ELEVATION:__
. SANITATION
,
Minimum Septic Tank Capacity (Gallons)
Drainfield Required, Lineal Feet
~.1aximum Depth
BUILDING
__ Type of Construction
I Jse Classification
Group
.Fire Zone
Comments:
Comments:
. ,
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By: Date: - .., By: Date:
PLANNING REQUIREMENTS SATISFIED. By:_, ~,'~ , Date: ',\~, \.~. \ Date Issued~t>-):':'..
ZONE: ,-< j \, SETBACKS: FRONT ;,\ ~ SIDE F.ACING STREET (FRO!Y1 C/L) INT. SIDE YARD~ REAR' f
'-" , - ".~:, '-:') - .
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL'MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
.-
'./'/,/
(F ROM PILI
, .
~-- ~
PHONE: 687-4394
C55-13
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. PERMIT - WHITE; BUILDING - GREEN: PLUMBING - CANARY; SANITATION - GOLDENROD: OFFICE cOP..... _ WHITE
'""
.
000eJmbe.r 7~ I~? '1
Permit No.
.
2851- 7-7
CURB CUT
Dat'"
PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
WHEREAS, the attached application has been fully considered by the Board of County Com-
missioners of lane County, and it is the opinion and judgment of the Board that the said application
should be granted, and that a permit should be issued, now, therefore, it is hereby,
ORDERED, that a permit be and is hereby issued to ~}' <Kf, kf.'lL ; fd70
11 )l2.Sk _ ('.(.l Kl.:Uft-V"'l.lA..LJ ' Sorwn-x;; l ud Cha..S<'O'n for placing, building
or constructing the following facility; , l{) , U
;3R:P Qrktd:)~) kD AI(n}.~~ \ ~ne:n Wtj.:f( s lei' 9 ~~ 1
(~Hi D0L~ ,n.,,,'yo. \<'Wd, (), 0 ~ .
Vpon the righl-of-wayortOunty ~c No. \../ '-'""'()-. .. MJle Post
in strict conformity to the exhibits attached hereto, and subject to all terms, conditions, agreements,
stipulations and provisions contained in the appl ication and permit, the Rules and Regulations Gov-
erning Facilities to be Permitted upon County Road Rights-of-Way, as set forth by the lane Man-
ual 50.190(2) any amendments thereto, and any other applicable regulations, law or ordinance.
Special Provisions:
1. Driveway will be constructed in accordance with the attached driveway approach specifica-
tions (Drawing M9B-50).
2. Permittee will be responsible for the immediate removal of all mud, dirt and debris from the
roadway and right ,of way caused by his 0 peration, leaving the roadway and area in a neat,
acceptable condition.
3. Sidewalks will be constructed in accordance with the attached sidewalk
specifications and drawin9 M9S-49, The Standard Curb Type shall be
constructed unless otherwise specified.
This permit is revocable at any time, and will be strictly adhered to and no work other than
that specifically mentioned above is hereby authorized.
fore~~
Inspected and Approved
This permit shall be void unless the work herein contemplated shall
1 if-.
l
have been completed be-
19.+g.
Expires
19_.
Dat",
Approved by Board of County Commissioners
By
.01
~.~::;':; I~, (lAD
By
WHITE - OFFICE FilE
YEllOW - REAL ESTATE
PINK - PERMITTEE
ORANGE - BUILDING & SANITATION DEPT.
C74-129
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PERMIT #
T~S, TI
JOB LOCATION
LANE COUNTY PERMIT
Acreage or Lot Si7~
Contractor's O.S. #
Partitioning"
I Completed
Subd ivision
Lot
Block
APPLICANT'S NAME AND ADD RES!::
OWNER'S NAME AND ADDRES!::
CONTRACTOR'S NAME AND ADD RES.!::
.Mail permit to ( I Applicant ( ) Owner
STRUCTURES NOW 0"" THE PROPERTY
) Contractor I ) Prefer to pick up. Call
Phont
Phone
Phone
iowner t.e Wh~~fl ready
THIS PERMIT IS FOR
= Fr)POL' C
~ L \.. 'I '0
CL)" E l T h
WATER SUPPLY
SEWAGE DISPOSAl
S I .
THIS PROPERTY IS WITHIN ONE MI LE OF THE CITY OF
PLUMBING BY
I hereby certify that the above statements are true and accurate, and that I have the 10110Jlng leqal Interest In th~ property owner 01 lecord
contract purchaser, potential buyer; _ realtor or agent. I further certily that (,f not the owner) I "Ill authorized to Jct for th!' owner "I
record, and that said owner is aware and approves of thiS action. I hereby agree to comply wltl1 all applicable C )de' relatlra to th" permit
Fee Paid"
) NEW ADDRESS
. SANITATION
Signature
) FACILITY PERMIT TO TRANSPORT ATION DEPT
BUILDING
Oat!
I SPECIAL PMT AREA MIN ELEVATIOl'i
Minimum Septic Tank Capacity (Gallonsl
Drainfield Required Lineal Feet
~.1axlmum Depth
Type ot ConslIurtlon
lISt: llasSlfi( l or
Grc,,-,
F
7 ..,.
Comments:
Comn1Pnt~.
..
By Date: By 0,
PLANNING REQUIREMENTS SATISFIED. By' Date Ddtt Is>ued'
Z?NE~u ___ __h' _______SETBACKS. FRONT SIDE FACING STREET FROM C L) INT_ SIDE Y<l.RD REAR H Of\' P 1
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST BTH AVE., EUGENE, OREGON 97401 PHONt 6874394
POST THIS PERMIT ON MAIN BUILDING AT SITE
css 13
Bl.DG. Pt ~"1!T WH!TE BUILD1N~ GREEj\,j PL Jr~f:l N,
ANAf; y ,"'-NIT Tit.: '>j t.,
"'H
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,
.
.
.
SITE I NSPECTI ON
ApPROVED ~DISAPPRDVED L:::7 DATE
/(-7- 77 INSP[CTOR~rL..
REMARK 5
FOUNDATION INSPECTION
APPROVEOIV~DISAPPROVEOL-I OATE/2-11-7.7 INSPECTOR ~
REMARKS ~ _ I'7k ?> ~ //-7_..,.., }It..-/' ,
r'~~, ~,____...:~n ~~~_~~ ~_ !-_ -_-0 ~
_n... --7J"-l..~ <<- ~~d"'_/p' .~A"~-:' .IJdb.- _' J j- U-7Tjlwte
.. . A ... ~ V ,-- 17
~""U~Q'k.. t!),<:::: ~ ~ .2. -3'-78' ~
FRAMING INS~ECT~ ~- - - -
ApPROVEO .G DISAPPROVEO L:::7 DATE/2-IJ-7"/ INSP[CTOR ~
REMARK S
LATH OR SHEET~PECTION r-- ~
ApPROVEO LLI DISAPPROVEO L-I DATE /2 -2-1- 71lNSPECTOR ~
REMARKS
FINAL INSPECTION
ApPROVEO ~ DISAPPROVEO Cl DATE 1- ~-'1tINSPECTORr:;d
REMARKS I~I ~A~if /JA'A' P - ~/"- ~.... ,,--r:- -2 /, ,r
2- ~//_---~.... /~~.&ry--.. r- .c'-. 7"'J ~~_'_ ~ ~
.L2/-'" ,..A-A d~,.-; ..::z - ?-7-!<' ~Ar::r-,
CERTIFICATE OF OCCUPANCY
READY TO Issue Cl NOT READY TO ISSUE Cl DATE
INSPECTOR
REMARK S
"';;.....-~ , ~,
.
.
Permit No ?p.,~)./ - 7-7
CURB CUT
"
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.;: Oat" ki/'\/ '('n" >\ i "?~I, It') " '1.
'l.
,.
PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
,',
WHEREAS:' the attached application has been fully considered by the Board of County Com-
missioners of lane County, and it is the opinion and judgment of the Board that the said application
should be granted, and that a permit should be issued, now, therefore, it is hereby.
ORDERED, that a permit be and is hereby issued to 12,"Ii I ~ f ~I I L 'II ~',7 ( I
( I \0 -,I r (I, \ { (I,..., ,'It1. I J ...., en I , ,.;. j;, ( I rI ()1..0 ~"I IY"\ for placing, building
or constructing the following facility; ~) '_:
';I,!, (vIr/I: III": ,: ' ,f(J . lIn, hl \ ,r. r ,,1',,"'1 ~J I'I-tl /: \,cJi' 9 t51( (v_ 1
, , . \. r - )
\1111 D! '(Lf,. L'l"'C .' u'cJ. Ul.r,/(~n . "
upon the r1gnt-of-way of County Road No." M,le Post ,
in strict conformity to the exhibits attached hereto, and subject to all terms, conditions, ,agreements,
stipulations and provisions contained in the application and permit, the Rules and Regulations Gov-
erning Facilities to be Permitted upon County Road Rights-of-Way, as set forth by the, lane Man-
ual 50.190(2) any amendments thereto, and any other applicable regulations, law or ordinance.
Special Provisions:"
/
1. Driveway will be constructed in accordance with the attached driveway apprqach specifica-
tions (Drawing M98-50). "-
2. Permittee will be responsible for the immediate removal of all mud, dirt and ,debris from the
roadway and right of way caused by his operation, leaving the roadway and area in a neat,
acceptable condition.
o
....,
.., ,,'
"
'I,' ,---
3. Sidewalks will be constructed in accordance with the attached sidewalk
specifications and drawing M98-49. The Standard Curb Type shall be
constructed unless otherwise specified.
.' .4,) ./
,,/
/'
"
-,
..
... -:"
, /'.' . cO"
f "
, ,
-.'
This permit is revocable at any time, and will be strictly adhered to and no work other than
that specifically mentioned above is hereby authorized.
This permit shall be void unless the work herein contemplated shall have been completed be,
fore' I '\ () I '( .,. L> Lt" '7 If
"
"/(,1
,19_.
, .....
Expires
19_.
Inspected and Approved
Approved by Board of County Commissioners
By
.-
( J.
\
II 1 I 'f t
Director of Public Works
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Oat"
By
WHITE - OFFICE FILE
YELLOW - REAL ESTATE
PINK - PERMITTEE
ORANGE - BUILDING & SANITATION DEPT.
>'
C74-129
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. '~~,., FII-= 0-1F7-77
MAP 18-0'2-(35-2-4 T,L. Zoo
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~
TO:
LANE COUNTY PLANNING
~ CONSTRUCTION PERMITS & INSPECTION
~cT?'
OTHER
FROM:
SURVEYORS OFFICE - FLOOD PLAIN MANAGEMENT
DEPARTMENT OF PUBLIC LANDS, PHONE: , 687 -4195
SUBJECT:
PARTITION NUMBER
SUBDIVISION
BUILDING PERMIT NUMBER '2..&~-,-,7
OTHER
RECOMMENDATION:
THE ABOVE SUBJECT IS IN A SPECIAL PERMIT AREA.
'THE ABOVE SUBJECT IS INCLUDED IN THE H.U,D, FLOOD INSURANCE AREA.
REMARKS ~ DU:>......'T 1Z.E...c.E.l"e:.. PE2M.\'T - '"'O~ 'e:.ulLT
A.l.1~ Oc..c..\.lP\E:I::> _ I=IU\<:::.HE:..O FLoo~ ~Ui::.\"{. /:a.~ ~\L.T
\c::. ~BL..'504 PtLlS (EL.E.,"", \'A.K~ of=- CC2o..rt" .....~~"
, ;
1=-U,.llS~ED ~L.DOR. TO . ~ 4~.0/C)'
DATE
~- 'Z.., -1&
BY
G::.m C.
_\0
TR~..T' ' ()
Written .1)irecti.ans
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1/1/ ~/A<-L dOSfl1
Job Locati~nia1...-1 -e/~c..I, ~ 7" V.,z J.JO~ Ii*!. "*1-s 't
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INFORMATION SHEET
) Building Permit
Acreage or Lot Size j 3 0 ')(. ,'2. +
.
Partitioning # ( ) Completed
( ) Pending
.PPLlCANT'SNAMEANDADDRESS~Ob.4!"",~ U. ,.,'1/ '"1-""-: I..J-- ~
OWNER'S NAME AND ADDRESS, if different from applicant's-1--. ~ ~ _
CONTRACTOR'S NAME AND ADDRESS ~o~~w H t"l / a~ !-.,
Mail permit or results of site feasibility study to ( ) Applicant ( ) Owner l'f.J,.Contractor.
( ) Prefer to pick up. Call (owner, etc.) when ready.
) Site Feasibility Study for Septic Tank.
Number of sites cd
. ~" ex'
. Lot C; Block /
Test holes will be ready
Subdivision---A1 '!" lJ. @cb.."""'.
~T:~4""
AlO
- W-t::.rJ C
~ . - ,.; Phonp
c..-.e-v'lv'-"~u ~I.iA.--....,
Contractors O. 's-; #
Phone9V'," "~I (.
Phonp
WA TER SUPPLY _~/I "I A. po' ~. ~
. f;t
SEWAGE DISPOSAL
s~..
l" 'hUMBINGBY_-\~.
. "" 1Q'1
,!,-.4-_ 't'
~ or
l73 e/ ~~r~-2n:::;' "It.l!....Bedl:=
- ,.. ,..... ( (existing or proposed well, etc. If public, name of Vleml~
(existing or proposed septic tank. etc.) S.I.", U 1/ ~
/c:7f
Address
STRUCTURES NOW ON THE PROPERTY
PROPOSED USE (this permit) Y-:S I J,.: ~' L ,.
I) NO",,=- <7I"b.MFe:P _
.stONlY BELOW~LII"C~.*.:-.." .J1*.............*~~..........
) Special Permit Area. ( Minimum Elevation: ~.
ori ...~ar ~
.'] (FROM PAO~INESI
---;;;.-~/' ~~C>
c- seE:. Permit Processing Section
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To:
)
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nivision
CS5.12
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MEMOR&D'UM
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,
TO
FROM
SUBJECT
JOHN SMEED
GEORGE CURRIN
SPECIAL PERl-1ITS
· , bn~ county
-
.1 ~.
DATE
MARCH 28, 1978
Mt. Vernon Estates Third Addition is located in the Coast Fork and Upper Wi11amette
Special Permit Area as designated in Chapter 11 of the Lane Code. 'L:~
The Lane Code in Chapter 11.510, requires this office'to'determine the minimum finished
floor elevation prior to the issuance of permits.
uu~ing the course of determining the finished floor elevation for Permits Number 466~78
and 467-78, it was found that the following permits were not referred to this office:
2857-77, 3464-77, 285-78 and 376-78, Permit Number 2857-77 is built and occupied, '
Permit Number 3464-77 is 80% finished, "Construction has not started on the others.
This office has checked the elevation on Permits Number~and 3464-77 and find'
that both are above the 100-year flood level, ~ .
This office would recommend that a review of your assessor's maps and subdivisions be
made to assure they have been stamped as special' permit areas.
If this office may assist you in identifying these special permit areas, please feel
free to call.
GMC:gc
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JOB LOCATION
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?'57-r
SPi,!L;G"T,L;) PERMIT #" I
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/11/
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13U x l24
. LANE COUNTY PERMIT
Acreage or Lot Si70
Contractor's O,S, #
Partitioning #.
!-IT.' r.::::n:,c.:, ESTATtS
Subdivision
Lot 9
870 tfCST CfittmmIAL SPRIEGFIELD
Bloc~
OREGON
1
) Completed
3rd ADD:
THIS PERMIT IS FOR
STRUCTURES NOW ON THE PROPERTY__
B~bfHG ll~~ ~3 ~f:
!tOBERT 11. IlILL
L. BERG
APl'LlCAlf1
) Contractor,
NONE.
) Prefer to pick up. Call
Phone
Phon.
Phono
(owner, etc.) when ready,
746-9916
APPLICANT'S NAME AND ADORE""
OWNER'S NAME AND ADORES"
CONTRACTOR'S NAME AND ADDRESS
. Mail permit to (X ) Applicant ( ) Owner
VALm. $40,447.00
3 II
:: SEDROOMS__:: PLUMBING CONNECTIOf\JS_
WATER SUPPLY
r~&~L! LV LdOL~L ~B~auli ULb~U~AL ~I~L~~
flILLAl:1ET'i:E HATER DISTRICT:
SEWAGE DISPOSAl
flA
PROPOSED
u:I. th S? /
I
. SANITATION '
. {.j17O Minimum Septic Tank Capacity. (Gallonsl
J'5ff)' Drainfield Required - Lineal Feet
.~ ,)'. Maximum Depth , "
Comments: "t-...:"i:.0.tL AA.~&;i. ..........:~ ~-0 A"~r.'l/rw.t->V
-: ':;C<L ;t~~ ,t:/f~ _ 1.!f""Y-- --;'r ~ th~. vf;-~(L ~'I~
..-:- ,"'"-'.,/. ---. r , ,1" - (i"~"
A..r ,~'.J:' /'". A...-1\...o'i 'rj./ :1~"",~{.. ~c....- cc.;- (-1/'1- t-f../r/?e, d:.r~,-, ~~1.':'....~o4t CA'tvfA.'
- '.'; )/ut; c":: .'~ . J~/......:.tf-~ It A1.lA.AAt__ A~I2'fM&t.<;J.:..~i (!!/-r:/...(--. y;~v",,-
-. r~ , .. '1 /' / II
'."" '-<~--"" ~--4' ~.~ J~ ('
By: ~<,:;;' _...c,{."v.A ~ T Dat~ 19G-:;"~:;: - By< <. f?J..,-?<) 6,,, ~ Date: /1- 3 - 77
PLANNiNG'REq'lJ1REMENTS SATISFIED. BV.~_ ''\r~~"..... ~u... . p DatJ03\ \~~-l, \'\ 'II \ Date Issued:l\hrJ, 7/7'1
, ZONE~.~,.,\^, SETBACKS: FRONT~\~';- SIDE FACING STREET _, (FROM C/L) INT. SIDE YARDt~ REARi"f.' (FRO'M PILl'
~~VOQ~ ~='<'-.<?~ ....~
LANE COUNTY DEPARTMENT OF ENVIRONMENT'AL.: MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401 PHONE: 687-4394
BUILDING
L::;.i) Type of Construction 7 - T Group
.II , 4 ~ ' Use Classification
~;,;~~
~~~~
J
Fire Zone
C55-13
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. PERMIT - WHITE; BUILDING - GREEN; PLUMBING - CANARY; SANITATION - GOLDENROD; OFFICE COpy _ WHITE
~
~
.
.
,
SLAB FLOOR
PLUMBING GROUNDWORK
,
ApPROVEO / ~i DISAPPROVED L:::7
DAT~ ~;I;I--~~INSP[CTOR
.....-.-
REMARK~;
GAS PIPING GROUNDWORK
ApPROVEO /. / DI SAPPROVEO L:::7 DATE
REMARK~>
INSPECTOR
ROUGH PLUMBING
ApPROV[O ~ O,SAPPRovm Cl DA[[//-';;/-77' IN"PUWR
ReMARKS
ROUGH GA:, PIPING
^PPROVEO L:::7 01 ~APPROV[D Cl DA r[
RCMARKS
FINAl.. PUJM[l1 NG
ApPROVED Cl DISAPPROVEO / / DATE
R[MAf<K'~ ..,1 A~
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J N~~ Pf.I,", ior~
INSP[(TOR
7< -9- 7R I? Ii.
~
FINAL GAS PIPING
ApPROVCD Cl DISAPPRoveo Cl DATf.
REMARKS
Cf~RTIF ICATE OF OCCUPANCY
READY TO IS~U[ / / NOT READY TO ISSUE / . / DATC
Hr.M^RK~;
INSPEcrOf;
R~
/P ;61
INSPECTOR
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Written Directions
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Job LocationLa.L1
INFORMATION SHEET
) Building Permit "0 ~ ,... ""-- ) Site Feasibility Study for Septic Tank. Number of sit~" ~ cB.
Acreage or Lot Size.J...L .. - 'T" Test holes will be ready 0
Partitioni~g # ( ) Completed Subdivision-->>-' '!" tJ e ~-. Iii ~ 'MQ. . ,1... Lot C; Bloc~ I
. ( ) Pending .
APPLICANT'S NAME AND ADDRESS~b.4!-~ U, 1.,'1' ~K-; 1-k....t.J~ 1310, Phone9t11.9#/ t..
OWNER'S NAME AND ADDRESS, if different from applicant's --.J.., ~ ~ "\ {'"'.....::; ....J.- C Phono
CONTRACTOR'S NAME AND ADDRESS ""Ota.~~ ~ --\_~ .,.,~ ~ 1..>>. _../ - Phono
Mail permit or results of site feasibility study to ( ) Applicant ( ) Owner l'fJ.,contracfor. C----6'V"co.~~ntr-actos..rsA 0 .uf......... . #
( ) Prefer to pick up. Call. (owner. etc.) when ready. :)~ O. Is-)
STRUCTURES NOW ON THE PROPERTY , 6 r/<'
GC< \Q,
PROPOSED USE (this permit) 1>- '15 I J,. ....' c.,. /./3 O:i:-f C<r-~ 04 fl3
WATER SUPPLY -WI "1 #It.,.( ~"i.. .....~:Q..f - ,; "-"C
SEWAGE DISPOSAL S'bl ~~ "1-r _("_
I ~I J.
PLUMBINGBY ~ ",e-~~__ ~i
(/)PROPERTYISWITHINONEMI~EOFCITy(J;"P~~t ~ 1,1 )
*************+*****************************t)FFICE SE ONLY BELOW THIS LINE *********...*****<HH-.".lt******.*.*****..."..
~j! PPnrtYmq
(existing or proposed well: etc. If public, name lP!em/ .A,..J
(exIsting or proposed septic tank, etc.) S.1. 4= '/,gv
/c;7f
.
Address
'-L.. ) Ne~ss^ecessary ( ) Facili~y Permit Necessary ( ) Special Permit Area.
ZON~' ~ SETBA~KS: Front' Side Facing Street'
(FROM CENTERLINE OF ROAOJ
To: Planning/Building Inspector nitac.i.!:'n/Surveyor.
Your assistance wil e ap eciated. ~ ~
Respon<o' 0 )
I /~ .'
By
Minimum Elevation:
Interior Side Yard Rear
(FROM PROPERTY LINES)
/'
Permit Processing Section
f)ivision
C55-12
DEP .RTMENT OF ENVIRONMENTAL MANAGEMENT
Permit Processing Section
125 East Bth Avenue
\ 68 7 -4394
~/ "
~TRS, TI 18.0.:5- 13
Plot Plan
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Job location (Street, mile pqst) 1111 D~)(.( E.. Q,,;z~L)E.. ~ ~puJnO~ ~ IA . .
SUbdivision~~ add dt~, ).... A0 )J01..l"v ) \JOn-'lf\yl.(c;}ri1'Iislo, ~ Block 1
FOR SANITARIAN'S USE ONLY: ~ystem Approved D System Disapproved D Needs Correction
COMMENTS:
Signature: ~ ~
FOR INS~AllER'S USE: Trench D~Pth ::<1") r -Filler Depth Below t/ie' r:, /(
Tank Capacity /lJtJ() Manufacturooc p@xTcz_ r-: /0." C;~ ~
Measured distance to well from tank --- ,from drainfielrl -'
Date:..2 -,,2-7.1
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INSTAllATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION
When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat,
isfactory completion of a subsurface sewage disposal system at the above location.
i~
N
Return this form to: Permit Processing Section, Department of Environmental Management,
Public Service Building, 125 East Bth Avenue, Eugene 97401 C55,11