HomeMy WebLinkAboutPermit Plumbing 1990-11-26 (2)
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""" SEWAGE DISPOSAL SITE EVALUATION S.LH 9c:/-Z7'9
TRS,Tl /703-22',/2 #/?6P4 Job Location U{ 7 /Z.u/7~ ....J?c , C#~?/?:,p~ /"?",,::>.p:
Written Directions ~77, H~-- ~ h9,"';_/-~~d N~~~
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Lot Block WATERSUPPLY~'" ~-
APPLICANT'SNAMEANDADDRES~~..#~ 7:;/;rr,,:" ,/~.c;:;Sr- .6f7~/.P ,/.-9Y', G~/, Phone6"'d'9-/,h?.-?
OWNER'SNAMEANDADDRESS~//~t97~ /?~ ~.flJ 9;:i~/.J?..
STRUCTURES NOW ON THE PROPERTY,@ . t;- /2,;-.d:!P7 ~ ~ PROPOSED USE OF PROPERTY.
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Subdivision:
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Phone~ .;'>--,' ~"-
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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 r r. . ......ntract purchaser; -potential buyer;
_realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of record. and that said owner is awar a yeS of this action.
.ESTHOLESREADY~ /:.~// - Signatur ~ I / Oat.. /D - /1-7d
................................................................................ "'.. "'.......... OFFICE USE ONLY BELOW THIS LINE ...!~.......................... .....................
.........
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SITE MEETS STATE STANDARDS YES NO YES Nol
Standard System ~ 0 Low Pressure Distribution 0 0
Sand Filter CI Holding Tank 0 0
1 Foot Capping Fill fJ 0 Other 0 0
Zonin,:,
Partitioning #
LAND USE COMPLIANCE I
'creage or Lot Sizo77-S' 7'> L ~TAL)
Parcel # A
~
COMMENTS: a/'5- -,5/P//--r?
AD..o~lIt3;;{ -fdr SU.b5 U~
,,-jf..<; oac;~p ."fd,..- One dwell/n4.
c;:pp~~ pk~ pfa.4,
se~e.
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I Completed
Pending
o Approximate
Study Area
FLoqOPLAIN INFORMATION
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 ~ OWN RISK. IF SITE IS APPROVED. SEE REVERSE SIDE.
'/'Y~ 1//~J90
( / AUTHORIZED SIGNATURE DATE .
LAN[ COUNTY ENVIRONMENTAL HEALTH, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (687-4051)
C~2
o Floodway
All or part of this site may be in a flood hazard
area for which 100 year flood levels 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 f100dway has been designated.
Building may be prohibited subject to
demonS1ration that the cumulative effect of
proposed development will not increase the
100 year flood level at any point.
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MEMO
TO: APPLICANT
FROM: LANE COUNTY ENVIRONMENTAL HEALTH
SUBJECT: CONDITIONS OF SITE APPROVAL
lani county
-
.
Any alteration of the natural conditions in the area approved for the on-site system or replacement area may void this approval.
This approval is given on the basis that the lot or parcel described above will not be further 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
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 applicable 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 form 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 cancellation, 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.
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 purchaser or his regular employees may install subsurface sewage disposal systems.
A certificate of satisfaciory completion will not be issued if persons other than the above perform the installation.
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Soil Macrix talar ~ Hottli~q (NoCation), \Coarse Fragment-sI Root-s,
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REQUEST FOR ASSISTANCE
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Land Management Div. 125 E. 8th Ave. Eugene, OR 97401
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tAHO MAllAC[M(NI Ol'o1SlQH
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((~ ~ ~:. For Mobile Home
(J,;' ~~ ~ )Iacement Only
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('rYJlI ~") <(<;;I 1- , No. of lip,auts
- zip No. of Bedrme
license #
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Please complete all lines inside white boxes, if possible.
vaun N1!1.l-~i. 7 ~ I,~ ~ Al .'s-r-p
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tUVN A6uHCSS 11
e:J 'I I! /\f 0 IL
CITY (j
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OWNER OF PROPIiATY (il nol ..me" n .bovel I
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OWNERS AODl'lESS (if not ume as .bovel (
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MAP, PARCEL NUMBER
(Found on tall m.p' In the Auu.sment &; T.ulion Oept.)
fo!nlp 4 ~ 1f4L~on ~.k~
Township R;;;g;'" Seclion 1/4 Seclion T.. lol
lownshlp -,r.;;g;- ~eellon 114 ~ctIO" fax lOI
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Existing Bul/dlngs or
Improvements on
Property ~
CJ Houso
CJ Barn .
C:J Garage
C:J Mobile. Home
C:J Shed
SEPTIC INSTALLED
C:J Ves
J:!SLNo
Water District II
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Directions to site
from Courthouse
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PERMIT TO:
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Lot & Block
Land Man:Jgcmcnt Div. staff can
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