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HomeMy WebLinkAboutPermit Land Drainage Alteration 2002-9-19 \ ~ ., CORRECTIVE APPLICATION . SPRINGFIE8 City of Springfield Development Services Department 225 Fifth Street Springfield, Oregon 97477 Phone: (541)726-3759 Fax: (541)726-3689 Type I Land and Drainage Alteration APPLICATION Date of Application 0, . ,e, Property Owner ~ame: f\" ,,: r\;' Jer, . b~J ~ a. City: Sf'-' '^'JIJ."I~' State: 1<... Property Add~ bM:l \Jf>_'C<;; ("'0 Subdivision' ~ .5"ln!'li2>^ Lot_ Assessor's Map - BstWl.e.s . Reouired Information Address:~Pl)::> ~IA' 1 ~ J . Zip: ~Phone: +to:Jf?SC ~ Springfield, Oregon Tax Lot 1. FILL, Quantity Supplier 2. GRADING, Quantitv 3. EXCA V A TING, Quantity Destination Supplier: Project Supervisor Address Phone 4. PLOT PLAN (3 sets) with the following applicable data: property lines, north arrow, tax map and lot number, site address, existing and proposed contour lines, existing and proposed drainage ways, significant vegetation, ground cover, soil types, buildings. septic systems, sewers, areas subject to flooding, utilities, areas subject to land slides, proposed site improvements including stockpile location. . Source Location Material Additional Information Reauired if checked .,j D CROSS SECTIONS D SOIL & GEOLOGY PLAN D DRAINAGE, POLLUTION AND EROSION CONTROL PLAN D REPLANTING PLAN D RESTORATION PLAN CONSULTANT COMPANY NAME: PROJECT SUPERVISOR: ADDRESS: PHONE CITY: STATE: ZIP: CONTRACTOR NAME: PROJECT SUPERVISOR: REGISTRATION NUMBER: ADDRESS: MOBILE PHONE: PHONE: PHONE: EXPIRATION: CITY: STATE: EMERGENCY PHONE: ZIP: -- o Journal Number related to this LDAP o DRAINAGE 0 Storm Pipe 0 Ditch 0 Culvert 0 Natural o WETLAND Description o FLOOD PLAIN Zone: FEMA Community Panel No.: o FLOODW A Y FEMA Community Panel No.: Date: . -----------------.----------- --------- --- ---------------------------------------- CITY OF SPRINGFIELO 225 FIFTH STREET SPRINGFIELD, DR 97477 (541) 726-3753 , ----- ------------_._--------------------- ---------------------------------------- WELCOME TO DEVELOPMENT SERVICES RND PUBLIC WORKS ---------------------------------------- ---------------------------------------- REG-RECEIPT: 0.1-00 10659 C: SEP 18 2002 CASHIER 10:003 4:43 pm A:SEP 18 2002 .---------------------------------------- ---------------------------------------- 1257 CORRECTIVE ACTION LoAP CORRECTIVE 1039 BUILDING REINSPECTI JOB#:02-01000-01 TOTAL DUE RECEIVED FROM: DAVID LUCE CHECK: fOl AL TnMREfj $500.00 $45.00 $545,00 $545,00 CHANGE OUE $,), [,G $~:'i 00 THRNK VOU!!!!!! ---------------------------------------- ---------------------------------------- ---------------------------------------- ---------------------------------------- ---------------------------------------- ---------------------------------------- , I '/-----...../_...---. -- '-_.~-- i ; ",. . " .~ ./ The stop work order will be lid once all conditions are met to t.satisfaction of the City Engineer. I understand that I, or my successors, may have future plans for my property which mayor may not be anticipated at this time. I understand that such future plans may require permits and development approvals from the City of Springfield. I understand that notwithstanding any approval of this Land and Drainage Alteration Permit (LDAP), that at the time of application of future permits or approval the City may review and reconsider all actions which I or my successors have undertaken pursuant to this LDAP, I understand that the City may as a condition of any future approval, require the undoing, changing, or modification of any action which I have undertaken as a result of the City's approval of this LDAP. By Signature, I state and agree that I have carefully examined the complete application and do hereby certify that all information herein is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield, applicable City Standard Specification and Drawings. And the laws of the State of Oregon pertaining to the work described herein, I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. The City may inspect the work site described in this permit at any time during a one-year period following the receipt by the City of notice of completion of the described work and specify, at the City's sole discretion, any additional restoration work required to return the site to a standard acceptable to the City. The permittee will be notified in writing of any work required and will have thirty (30) days from the data of the notice to complete the work. Work not completed, at the end.of the thirty days will be performed by the City and the costs will be billed to the permittee. I have read and understand the statements above, and I further agree to ensure that all requires inspections are requested at the proper time, that the project placard is readable from the street, and the approved permit and set of plans will remain on the site at all times during construction and until removed by the City. Sign"D0~AJQiucp-- ' Date: q ( t o,g '02 ~ I . '(