HomeMy WebLinkAboutPermit Plumbing 1993-8-9
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SEWAGE. DISPOSAL SITE EVALUATION /
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Written Directions (!nt?L1.LJ'-"~ r~~, =--...-. e.~<f<'
TRS. TO
Subdivision:
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WATER SUPPLY /?a.,"'fllw I,,/~ OI'>""'{~1'"
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~ rA It ID '''' t. PROPOSED USE OF PROPERTY {?r'>' neVI n.<a-
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APPLlCANT'SNAMEANDADDRESS (A)/'NfI(. ~E'I~'.n--..
OWNER'S NAME AND ADDRESS e~-^, an..o.~~ 11 ""-
STRUCTURES NOW ON THE PROPERTY ~ / <;' f-MP
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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 certi~ that (~f nol the owner) '21 ~~~~riZed to act for the owner of record. and that said owner is a are and approves of this action. /
TEST HOLES READY ~ . ~L r <2. ~ ;r~ 14..>. Signature " . Date "'>/1- 7 91
. ** ***.. ........ ... ........... .......... ......... ... ........... OFFICE USE ONLY BELOW THIS LINE .......................... ............. ...:........
SITE MEETS STATE STANDARDS YES NO YES NO
Standard System ):( 0 Low Pressure Distribution 0 0
Sand Filter 1<e-rt6...ce~Gnb ft( 0 Holding Tank 0 0
1 Foot Capping r;;, - Other 0 0
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Partitioning #
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COMMENTS:.
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o Approximate
Study Area
o Detailed
Study Area
THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
ARE AT YO W ISK SITE IS PROVED. SEE REVERSE SIDE.
#.. . 'Dr '1 h~
I [7ATE
o Floodway
{/ AUTHORIZED SIGNATURE
LANE COUNTY ENVIRONMENTAL HEALTH,
C55-32
125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (687-4051)
I
LAND USE COMPLIANCE
.t\creage or Lot Sizo
(lOTAL)
Parcel #
) Completed
) Pending
FLOODPLAIN INFORMATION
. Allor part of this site may be in a flood hazard
area for which 100 year floocIlevels have not
been established. Extra precautions may be
appropriate to assure that the building site will
be reasonably safe from flooding.
All or part of this site may be in a flood hazard
area for which 100 year flood levels have been
established. A building elevation above the 100
year flood level may be required.
All or part of this site may be in a flood hazard
area in which a floodway has been designated.
Building may be prohibited subject to
demonstration that the cumulative effect of
proposed development will not increase the
100 year fl~ level at any point.
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. -MEMO'
TO: APPLICANT
FROM: LANE COUNTY ENVIRONMENTAL I:!EAL TH
SUBJECT: CONDITIONS OF SITE APPRO\tAL
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Any alteration of the natural conditions in the area approved for the on;site syste'in.or replacement area may void this approval.
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This approval is given on the basis that the lot 0; parcel described above will not be furih~"partitioned or subdivided and that conditions
on subject or adjacent properties have not been altered in any manner which would prohibit issuance of a permit in accordance with c
O.R.S. 454.605 through 454.755 and Administrative Rules of the Environmental Quality Commission. Any such subdivision,
partitioning or alteration may. void this report.
WARNING: This document is a technical report for on-site sewage disposal only. It may be converted to a permit only if, at the time of
application, the parcel has been found to be compatible with applica.ble LCDC-acknowledged local comprehensive land_
use plans.and implementing measures or the Statewide Planning Goals. The Statement of Compatibility may be made on
_ the attached forrl) or its equivalent. Authorized Agent approval is required before a construction permit can be issued. -
This report is valid until an on-site sewage system is installed pursuant to a construction permit obtained from Lane County, or until
earlier cancellatioii', pursuant to Commission rules. with written notice thereof by the Department of Environmental Quality to the
owners according to Department records or the County tax records. Subject to'the foregoing, this report runs with the land and will
automatically benefit subsequent owners.
'f' Only persons having a valid license issued by the Department of Environmental Quality under ORS 454.695 to install subsurface
.. sewage .disposal systems or an owner or contract purch'aser or his regular employees may install subsurface sewage disposal systems.
A gertificate olsatisfactory completion will not be issued if persons other than the above perform the installation.
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SEW AGE DISPOSAL
PLOT PLA1~ APPROVED
A permit is required
prior t. arli c.nstruction.
DATb-- -
B:~NMENiA.L HEALTH SERVicES
..'" HART 8TH AYENUF
.U""......III;. OREGON 87401
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Tax Ref'erence
SITE EVALlI,no:: ITD.D WORKSP.EET S. I . D
17./63 -.z.~ ,I Z-. !(,,(:Jo ~.!u:w,..:
A-rv"p~ ,./ Date: J~71t~)!~ ~~~:..,
Zoning: ~J~~~~ .parcel Size:
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Crd//-~h.atut
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Applicant
W~ter Supply: Wel1 Coanunlty PubliC'
Oept:h
Texture
soil ~~trix Color ~ Mottling (Notationl. 'Coarse Fragments, Hoots.
Struc~~e. Layer Limitinq Effective Soil Depth. etc.
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SISID1 SPECIFICATIONS
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Special Conditions
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< LANE
APPLICANT ALVERSON, WAYNE
ILl 1703221201600 SUBDIV
NEW BLDG TYPE USE R BDRMS
OWNER NME ANDERSON.. RON
CODE APPL NO ACTION DESCRIPTION
BF' (
BP
BP
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COUNTY DEPT ENV MGT RECEIPT I
ADDR 515 COLONIAL DR.,
930232 DATE 052793
SPI~INGf'IELD .
. LOT BLK
o UNITS 001 STORItS IBLDGS 001 PHONE 746 0082
FIDDR. 323~~ N.E. CADET. PORTLAND .
SQ FT UNIT COST VALUATION FEE DAYS
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PL . IFIX/f'ATH:
MECH
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SI LC 930232 SI
SDEQ FEE
SWR: FT. WTR:
~IECHAN I CAL FEE
STATE SURCHAI~GE
PLAN CHECK FEE'
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RAIN:
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25%
SI
160.N)
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EST. COMPLETION DATE
DEPOSIT JH('
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