HomeMy WebLinkAboutPermit Septic Tank 1992-1-28
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REQUEST
FOR:
SEPTIC SYSTEM VERIFICATION
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~ TOWNSHIP RANGE SECTION 114 SECTION TAX LOT IUIClIIISIOfIII PAAlITlON
18 02 05.1.4 10,400
,03A998"j'A's PER ROAD, S?R I NGF I ELD, OR EGON 97478
STRJCTUREI NOW ON PROPERTY
EXISTING SINGLE FAMILY DWELLING
PflOPOSED use . sum; INSTALLitl WATER IilI.TALUoD NO. DI' STORlD NO. OF EllJlLOnE3
PRIVATE USE
El€SCAlPllON Of' P'fIOPOalD WOAK
SEPTIC SYSTEM VERIFICATION
LOT I PARCEL al,(II(;K
COHITRUCTlON COBTIYAWI
NO.OlI'IIWRDOIaI
DIRECTIONS TO IlU 'ROM COUIHMOUB; 2
NAIN STREET TO ND STRE.I"",
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APPUCANT NAME . "DDRESS
JOHN M. ZYBACH, SAME AS THE JOB ADDRESS ABOVE
OWNERS NAMIl: . ADOREsa
SAME AS THE ABOVE
..0.. 741-7167
"HONI
:;S\I\t.1E
CONTIlACTOR NAME
I\! A
) MAIL PERMIT TO:
MAIL PERMIT TO THE OWNER AT THE JOB ADDRESS ABOVE
) NAME
I hovo corolully rood BOTH sldea 01 this a
JOHN M. ZYBACH
08" UCEHS. ,
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PHONI
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"ODRISS
"""NAME
Information la true and correct
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FEES DUE: $
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READ CAREFULL VI Your Authorization 10 Baaed On The Following Conditions
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APPROVED BY:
DA TE /- 2..f? __7'?
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CALL FOR INSPECTIONS (SEE BACK OF FORM F(jR INSTRUCTIONS) 687-4065
~ SEPTIC permits are good for one year. ALL other permits expire after 180 days unless Inspections
p
are current.
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VIOLATIONS
SBTBACKS AND 01HER __......._.J OP APl'ROV AI. MUSTBR snucn.. Y OBSBRVFD. VIOLATION CAN RBSUL TIN RBVQC,\T10N OFTIm PBR.\A:rr.
CITATIONS MAY BB ISSUED UNDER nIB PROVlSIONS OF LANB COUNTY'S lNPRAcnON ORDINANCB AND/OR 01HER RBMEDIES AlLOWED BY LAW.
,
A MINIMUM OF AT LEAST 24 HOURS ADY ANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS
Have the following infonnation ready when you call: 687-4065
Permit number - Job address - Type of inspection required When it will be ready
Yournarne and phone munber - Any special directions to the site
PUBLIC OFFICIAL IUGIITTO TIlESPASS ON PRIVATE PROPERTY ORS 215.0lIO
POWER TO BNI"BR UPON LAND. TIm COMMISSION, AND ANY OF ITS MEMBERS, OPPlCBRS AND EMPLOYES, lNTIlBPERPORMANCB OPnmIR FUNcnONS, MAY
ENn:R UPON ANY LAND AND MAKE EXAMINATIONS AND SURVEYS AND PLACB AND MAINTAIN nm NECESSARY MONUMBNTS AND MARKERS "~'"
REQUIRED INSPEcrIONS
FOUNDATION INSPEcrION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
UNDERGROUND PIPING INSPEcrION: To be made after all underground piping has been inslalled, prior to any backfill.
CONCRETE SLAB OR UNDER-FLOOR INSPEcrION: To be made after all in-slab or under-flocr building service equipmen~ condui~ 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 INSPEcrION: To be made after all ducling and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPEcrION: To be made after all plumbing rough-in is in place, prior to being covered.
FRAMING INSPEcrION: To be made after lbe all framing, fire blocking, bracing and roof are in place and all pipes, chimneys and vents are complete
and lbc rough electrical, plumbing, and mechanical inspections have been made and approved.
INSULATION INSPEcrION: To be made after all insulation and vapor barriers are in place, prior to covering.
LATH AND/OR GYPSUM BOARD INSPEcrION: 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 JNSPECfIONS MAY BE REQUIRED, such as but not limited to:
BLOCK WALL: To be made afler reinforcing is in place, but before any grout is pomcd. The inspection is required for each bond beam pour. There
will be no approval untillbe plumbing and electrical inspections have been made and approved.
FINAL MECHANICAL'INSPEcrION: To be made justpYioito lIle _sttucnire or remOOcled area being occupied and prior to operating anyequipmenL
FINAL PLUMBING INSPEcrION: To be made just prior to lbe building, slrUcture or icmodeled area being occupied
FINAL BUILDING INSPEcrION: To be made after fmish grading and lbe bullding, slrUcture or remodeled area is completed and ready for occupancy.
MOBILEjMANUFACfURED HOMES: An inspection is required after lbe mobile home is conneCted 10 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 fOlmdation 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 inslalled 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 WffiIIN 180 DA YS,.OR IF WORK IS STOPPED OR ABANDONED FOR MORE TIlAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF TIllS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION,
ANYONE PROCEEDJNG PAST THE POINT OF REQUIRED JNSPECfIONS WILL DO SO AT THEIR OWN RISK,
Your signature on lbc front of this form verifies lbc following: I HAVE CAREFULLY EXAMINED THIS COMPLETED APPUCATION, and do
hereby certify that all information hereon is true and correct, and that I have a legal interest in the y....t....nJ as owner of record or authorized agent. I
furlbcr certify lbat any and all work performed shall be done in accordance wilb the Ordinances of Lane County and lbc laws of lbe State of Oregon per-
taining to lbe work described herein. I further certify that if I am notlbe owner of lbe property, my registration wilb lbe Builders Board is in full force
and effect as required by ORS 701.055, and lbat if exempllbc basis for lbe exemption is noted hereon, and lbat only subcontractors and employees who
arc in compliance wilb ORS 701.005 will be used on lbc job.
SUBSURFACE & ALTERNATIVE SEW AGE DISPOSAL SYSTEMS:
When subsurface construction is complete. the pennit holder shall notify the County Land Management Division by submitting the installation record
fonn. An inspection will be made by a qualified sanitarian. If construction complies with all rules a certificate of completion will be issued to the pennit
holder. If consb'Uction 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 to meet satisfactory completion within the allotted time constitutes a ,violation ofORS 454.605 to 454.745 and this rule.
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From: Interior yovy...j lines to'
Edge of road righl-of-way 10'
Building foundation 5'
Wells or other water sources 50'
DRAJNFlELD
to'
10'
10'
100'
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YOU" 9;'~~fI 1)1
CITY
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lATE
,.,sr39'2~ 7'11-7/01
PHONE
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ZIP
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Existing Buildings or
Improvements on
Property
~ House
a Barn
c::J Garage
c::J Mobile. Home
c::J Shed
SEPTIC INSTALLED
c::J Yes
9'=' :ater District
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Please complete all lines Inside white boxes, if possible.
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SA~
OWNER OF PROPERTY (If not same .. above)
PHONE
OWNERS ADDRESS (if not ...IM .. abovel
ZIP
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INSTALLER/BUILDER. COHTRACTOA
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UCENSE .
DIrectIons to site
from CQurthouse I _
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'!-!mill
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MAP, PARCEL NUMBER
(Fo.od on ta m... In'he "'HZi:T/~ oWO
If: ~ ~ I lIon -1..101
TOWMhlp ~ Seellon 114 s.cUon Tax Lot
lownsnlp ~ 'IK'iIOn 1/4 tieCuon '0 LOt
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SITE ADDRESS 31f? ,--mf'J::rr rt:!
~tOJ'1I11'/J 1.0 tJ ~
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ZIP
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MAIL PERMIT TO:
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:~::.~('fl'lI1(.-hf?i:>> I ()17 .
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ZIP
For Mobile Home/
Placeme~nlY
Brand
Year /
Size 2\
No. of TJl1-Outs
No. oJ..S~r=
License #
Land Management Dlv. staff can
not be held responsible for
evaluations or recommendations
based on fals8. Inaccurate or
Incomplete Information
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. ~F'prr~ANT ZYBACH, JOHN LANE COUNTY D~bbRE~~9SG~A~r.~pra;., ~sp~1~~~rEe~:Eo2H!a~
l ,I iTL~ 1802061410400 SUBDIV . LOT BLI(, I i
.,tNEW BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES '~BLDGS 001 PHONE 741 7161"
. OWNER NME ZYBACH, JOH~ ADDR 3998 JASPER RD., SPRINGFIELD, OREGO.
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST. VALUATION FEE DA"S
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LC 21492 SDSV
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