HomeMy WebLinkAboutPermit Septic Tank 1990-7-25
,
REQUEST
FOR:
SEPTIC SYSTEM VE~IFICATION
~ TOWNSHIP
18 RANG' 02
SECTlON 0 - '" BU;TlON
J.L.'1
'AXLO' 300
auBDlVISION I PNlTlTKIN
LOr I PARQI,. ROCK
.
LOCATlOi Ai....
U ::> COLE ';:AY,
SPRINGFIELD, O~EGO~
97~78
STRUCTURES NOW ON l'ftOPIIITT
E:: I 5T I NG S I :',GLE
PROPOSED un:
alPllC ..TALLlO
F Ai-' I L Y
.AlUl "TAWO
D\'JELL I ~G
JIIO.OIBlOfUi3
MO.OIEllPLDYUB
COIGTRUCnotf CCUIVAWI
P~IVATE USE
~IIIP11ONOI'''''OPOIImWORll
SEPTIC SYSTEM VERIFICATION
Il1O. 01' UDIlOOlll
OIucnOHB w ~fI 'ROIl coy,.~ou..
I-Iv::> TO ~LND ST.,
TO JASPER ROAD,
TO DIXIE DRIVE TO COLE ~AY TO SITE
A'PUCANT NAIIE . ADDRnB
JACK GIS(;;-:~L,
,""0'"
7if6-7oB
OWNEI'lB NAIll. AODR."
~O~ SIX3Y, SA~E AS THE JOB ADDRESS ABOVE
....ON.
NONE GIVEN
CONTRACTOR N.....E 0SIl UCIEN.. I PHON I
~A NA NA
~ MAIL tfl1e'/f"l~~Q~ jJ :.; Et.L EST ATE, 1216 MOHAV:K '3L VD" S PR I N G FIELD, OR E Gor< 971:,77
: NAM' &ODRIISII-
I have carefully read BOTH sides of this apPllc~td )le!e!ly ~rtffY th,t l!~ \flformatlon Is true end correct
JACK GISCf-:EL .A I/f ~.A,uf---b
PRM'N....,lI. .....';:;:;7 DAT&
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FEES DUE: $
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APPROVED BY:
~.~~-
DATE 7~2-. r-F~
(CALL FOR INSPECTIONS (SEE BACK OF FORM FOR~STRUCTIONS) 687-4065
SEPTIC permits are good for one yaar. ALL other permits expire after 180 days unless Inspections ara
currenf. J
.
VIOLATIONS
.
SBTBACKS AND onmR _.................. OF APPROV ALMUST BE STRIC'It. Y OBSERVED. VIOLATION CAN RESULT IN REVOCATION OPnDS PERMIT.
CITATIONS MAY DB ISSUED UNDER nm PROVISIONS OF LANB COUlfiY'S 1NPRAC110N ORDINANCl AND/OR. OTIIBR RBMBDIES ALLOWIID BY LAW.
.
A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS
Have the following infonnation ready when you call: 687-4065
Permit number - lob address - Type of inspection required When it will be ready
Your name and phone nwnber - Any special directions to the site
. PUBLIC OFFICIAL RIGIIT TO TRESPASS ON PRIVATE PROPERTY ORB ns.oso
POWER TO BNTER UPON LAND. 1HB COMMISSION, AND ANY OP ITS MEMBERS, OFPICERS AND BMPLOYBS, IN nm PBRPORMANCB OP THBlRPUNC110NS, MAY
ENTER UPON ANY LAND AND MAKE EXAMINATIONS AND SURVBYS AND PLACB AND MAINTAIN nm NBCBSSARY MON1JMBNJ"S AND MARKERS ..~,:..
REQUIRED INSPEcnONS
FOUNDATION INSPEcnON: To be made after excavations for footings are complete and any required reinforcing steel is in place.
UNDERGROUND PIPING INSPEcnON: To be made after all underground piping has been installed. prior to any backfill,
CONCRETE SLAB OR UNDER-FLOOR INSPEcnON: To be made after all in-slab or under-floor building service equipment. conduit. piping
accessories and other ancillary equipment items are in place but before any concrete is placed or floor sheathing installed, including the subfloor.
ROUGH MECHANICAL INSPEcnON: To be made after all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPEcnON: To be made after aU plumbing rough-in is in place, prior to being covered.
FRAMING INSPEcnON: To be made after the all framing, fire blocking, bracing and roof are in place and all pipes. chimneys and vents are complete
and the rough electrical. plumbing. and mechanical inspections have been made and approved.
INSULA nON INSPEcnON: To be made after all insulation and vapor barriers are in place. prior to covering.
LATH AND/OR GYPSUM BOARD INSPEcnON: To be made after all lathing and gypsum board. interior and exterior, is in place but before any
plastering is applied or before gypsum board joints and fasteners are taped and fmished.
ADDITIONAL INSPECfIONS MAYBE REQUIRED, such as but not limited to:
BLOCK WALL: To be made after reinforcing is in 'place, but before any 8rou1 is poured. The inspection is required for each bond ~ pour, There
will be no approval until the plumbing and el"!'lricai inspections haveJ~e,e)1_made,and approved,
FINAL MECHANICAL INSPEcnON: To be made just prior to the sb'UCture or re;modeled area being occupied and prior to operating any equipment
FINAL PLUMBING INSPEcnON: To be made just prior to the building. structure or remodeled area being occupied.
FINAL BUILDING INSPEcnON: To be made after ftnish grading and the building, structure or remodeled area is completed and ready for occupancy.
MOBILE/MANUFACfURED 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 fotmdation requirements for mobile homes or as recommended by the manufacturer.
Minimum ftnished floor elevation shall be cenified 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 fust 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 AU. TIMES DURING WORKING HOURS.
TIllS PERMIT WiU. EXPIRE IF WORK DOES NOT BEGIN wrhi1N 180 DAYS. OR if WORK IS STOPPED OR ABANDONED FOR MORE TIlAN' 180 DAYS,
SUSPENSION OR REVOCATION MA Y ~~UR IF TIllS P_E~ WAS ISSUED ON TIlE BASI~ OF INCOMP~~ OR ERRONEOUS INFO~ATION:,
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
Your signature on the front of this fom verifies the following: I HAVE CAREFULLY EXAMINED TillS COMPLETED APPUCATION, and do
hereby certify that all information hereon is true and correct, and that I have a legal interest in the property as owner of record or authorized agent. I
further cenify that any and al\ 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 funher certify that if I am not the owner of the propeny, my registration with the Builders Board is in full force
and effect as required by ORS 701.055, and that if exempt the basis for the exemption is noted hereon, and that only subcontractors and employees who
are in compliance with ORS 701.005 will be used on the job.
SUBSURFACE & ALTERNATIVE SEW AGE 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 wUI be notifie4, and all corrections shall be made before a certificate of completion
will be issued. Failure to meet satisfactory completion within the allotted time constitutes a violation of ORS 454.605 to 454.745 and this rule.
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From: Interior r'"r--, lines 10'
Edge of road right-of-way 10'
Building foundation 5'
Wells or other water sources 50'
DRAINFIELD
10'
10'
10'
100'
i: ,,' <:.,:~
if possible.
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Please complete aU lines inside white boxes,
J4-dt ~/<.f'O/&L
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RON ..,0 }(/3y'
OWNER OF PROPERTY (It not ..me .. .bove)
! ()?:-? r; l E: u.A Y
OWNERS ADDRESS (It no, _me .. .bon)
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977'77
ExIstIng BuildIngs or
Improvements on
Property
~use
l=:J Barn
l=:J Garage
l=:J Mobile, Home
l=:J Shed
9EPTIC INSTALLED
lZfYes
l=:J No
Water District
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MAP, PARCEL NUMBER
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MAIL PERMIT TO:
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Placement Only
Brand
Year
Size
No. of Tip-outo
No. of Bedrmo
Ucense #
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Land Management Dlv. staff can
not be held responsible for
evaluations or recommendations
based on false. Inaccurate or
Incomplete Information
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~l ~. 5 LANE COUNTY DEPT ENV MGT RECEIPT A ?34790 DATE 07?09~
. AF'PLICANT BIXBY, RON ADDR 1075 COLE WY., SI"RtNGFIELD, o,(EGof;l .
TU, 1802052400~i00 SUBDIV' LOT --._BLK "
NEW BLDG TYPE USE R BDRMS, 0 UNITS 001 STORIES '~BLDGS 001 PHONE 746 -'1.613 "
. OWNE,(/NME BIXBY. RON AD DR 1075 COLE WY., SP,(INGFIELD, OREGON .
CODE ' APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DAYS
BP , . 6~ft
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BP
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LC 234790 SDSV
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CATG: PLN RA
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rAI(EN BY RLH .
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