HomeMy WebLinkAboutPermit Septic Tank 1981-5-26
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Permit No. it:. 99~ - ffJ Twnshp, ,.y Range f)S Section a-z.:z.
Standard System IB'Alternative System 0 (Specify Jypel hip. ' .-
JobLocationlStreetAddressl I;/,7 ./)",.,..!'. Sf. Sl)r,,,!/~'~W 0,.,.
S .~.~'.' '. /Partition # /L~C.- lrl Parcel '::L. Lot
form c55-11
Tax Lot .:l<.OI oj- 4' OJ
Bloc~ -
DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED
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!Title as shown on DEQ licensel
Telephone 7 <../ to - 'if 0 35'"
.nse No. ""( '7/~ </ i?
Bonding Company U.v,h,p P/lc.it,.t
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(Signature ollicenseel
If Installed By Owner-
Datp-
IStgnatureof Ownerl
Applicant's Name & Address
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USE BLACK INK ONLY
FOR INSTALLER'S USE: Trench Depth "'Z...'-I I ( ~ravel Depth Below Tilp (;, t<
Tank Capacity 11)00 Manufacturp. (J) (II a..,.. e/rr> &-~4" ::.P"'~
Measured Distance from Well to Tank From Drainfielrl Total Length of Lines,.,) 'Zr)
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I !installer's name', certify that a (MfgJ
and Mercury Float Switch (Mfg. and No.!
(Model No.! . Pump
have been installed with this sewage installation.
Signaturr
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FOR SAI\IITARIAN'S USE ONLY:
COMMENTS: _P,..:..., .~ ..\:,
i9 System Approved 0 System Disapproved
!">.)"H..... cr.te...;... (It......~....rJ.'f'~.,J. ..
o Needs Correction
System Capacity
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oal. / day Signatur~ ~ >r----rz::::sJ
Date
Date~- . fS'L
Corrected
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.
Return tnls form to: tlu'ldlng and :;anttalion U,v., Uept. 01 tnvlronmental Management, locateo In tne casement of the
Public Service Building, 125 E. 8th Avenue, Eugene 97401.
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FLOODPLAIN ~1AtlAGEMEJ~ OOtyNS N;~ R60U/~
Management/125 East~-Ave~tugene, uregon-
687-4357' .
By NLb.
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~ Permit Processing
. 0 Planning
~ bt\~h " Pub1 ic Works
~],iC [1'\1 Name ;J2,A. HA' "-' II
NO\] 12. Addr~s 'site -+\AaeOR. De..
\A~S;:):: '!2) . SFD AG W ADD. COMM.
. ;Approximate flood hazard study area, extra precautions may be appropriate to
~ ~~ssure that the building site will be reasonably safe from flooding.
~ Detail flood hazard study area.
~ Mobile home tie downs required'if -+he '3rcu,0 -+\..J r>>c.b,'/e .\10"'~ \-;.; plc\{@cI
o Substantial improvement. is belG01 ..\ I", base .(1co...,{ e1., vcr~\<, n.
o Site in regulatory f100dway channel, building prohibited unless it is demonstratl
that the cumu1ati,ye effect of proposEd de~elopment will not increase the base
flood at any poirit: . .
(3 . BASE FLOOD ELEVATION + l' = .444. d
,thise1j!vation requfred as check.ed below. .
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. ~ OTHER. -p".... ......"..u'-l~~t:> -'-r\.\A....- rl t-:l, 1="(,C>O~ -r-:>~ ~t..afI..-n=lJ~" 44'l'
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Date
To:
Permit No.
Partiti on No.
Subdivision No. .
'1'1S--8 (
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Certification at'or aboye
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CERTIFICATION OF ELEVATION
I ,Ge,.,a IrI k" 4-'.iLy . , a Registered Professional
LOTJc! ."') '..LI::Z..,re>',QI" in the State of Oregon, do hereby
certify to Lane counfy;. that the fo 11 owing e 1 eva ti on represent~} sur.,vey /
made by me or under my supervlslon.
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The foundation elevation (including basement slab) =
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The ground elevation that structure will be placed on" -1-1-7.7/
The first floor elevation = ~,~CJ.1t/ '(MSL).
The elevation of the top of floodproofing =
Other
Refer~nce Bench Mark No, .&;.}r'ft'J(Jr/ Soi...kp "'<L?:.~/
. Location ~:.<;f Pry€' Dr:' A. r. n": l/al"'6t:'>1'" Di""/Yp
/./.R7 #a,..,.~",.,. 0,-,.
Sig~ature $.-;Lf~/
Date /(/j/.f/ "" "7'
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Original to be certified and returned to
F1,00dp1ain Management,', .
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1st copy with application/inspection
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'~"',;;,j:'. :...." 2nd cop.y to app I kant ~'il>(.. " ,"
: ~ ";;,, :.',', ' ,,;3rd copy. to Floodplllfn Management .
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iowil ""r,~'. 'I; \f11~~tl:r~rli.~'J"~ii':~"~r.lG;~"<i~t '\. ".j' Illil~'h'fl"Il'l;f ':l~t:'.. ',i .' \1'" ".', ~. !.,\,,,:,~,,:":."
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P.EGISTERED
PROFE5SI0i'-lAL
LAND 5U:1V~YCiR
Lane County ~
OREGON
SEPTEMBER 23, 1~~7
GERALD 1<. ATTI
1121
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