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HomeMy WebLinkAboutPermit Plumbing 1981-6-18 r VICINITY MAP ~ / ~' ~. < Ci .u 3o.5.fer .Ed: a-0. - N JAc<scr I "XCAV/,TlNG SERVICE 375.JO v,:, \lL.';..CE C;;:;:EK ROAD SPRINGFIELD, OREGO,~ 97477 .Installer~~~ C ~ !Title 8S shown on D~censel 7~7- d:<'7tf...s- Telephone License No. I t, I ~ I.) BJrding Company ~~ ~ ,fJ,(h~ e~Lh->.JDate~-/e.81 lSignatureol Licensee) If Installed By Owner- Dat" - lSignature of Owner) _ ...1 Applicant's Name & ~r~s ~11.L' -WI" . ;;it 4J.{:K; ;r , ..f-(J:'d--~ //l(), , ~ J6\'S-+: ~ :#50D MUST.BE IN BLACK INK oZ. :3 form c55-11 Permit No. /LilY-XL Twnshp, /Y Range t?e:. Section () ,,') Tax ~ot, ~ /~6'd Standard System]:8'. Alternative Syst~m 0 JSpecif.\( Typel p~ ~ - d~)!.':U1r. '!;ff~1 Job Location (Street Address) ::;i:r C1'/~..,) ~Ar,O,op .t!'Ann/. ,~/?P/Ar:~;- ([~ 971/?) Subdivision/Partition # 1) Parce' . _fot 8W1ll0c1' , DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED IHc~1 €) ~ (31 []-t'(:\I\/< 11' Q) \301- .. ~ L-J.jll'_'>D~-IEI-> "'--34'-7 "-l " ii' I ;..- .... _ I LA - t.! \Q ~ ~ Well;; oh ~ Il e;j h bc~~ frofe>-"f' , ~~ >. -1-' ~ ~ ~ ~ Scale - " - , .. ~ I /\ \.:~_..!~r'<'1 ,./Q-';,./.... /"Y ~p , ~ "1 V. ~"'/)' ~~; ~ (~ .. _ 1- J;-.. c!"" ;./.>~ rJ -...J ,:" c" .:q, /!" ~ '\'J~\ v c ";>~ !:; >..... .............\ '(""~ v .a . ,,"\oJ ~ - "\., '/).~4- .... ~ *//' ~ /'7-,' <:l.... 0; 1'lJ" t;) c:t ..J.. USE JlLACJ, INK ONLY FOR INSTALLER~S U~I;: ~::rTrench Depth 30' . Grav:1 Depth Below Til" TankCapacltY~JAf.I Manufacturer .A~-r-.:l d... ":J-'" ~i'-'.A!'I.J Measured Distance from Well to Tan~ From Drainfielrl ,Total Length of Line< /50' COMPLETE THE FOllOWING tF A PUMP WAS USED ON THIS INSTALLATION: I !installer's namp, certify that a IMfg) and Mercury Float Switch IMfg. and No.1 ~!I IModel No.1 Pump have been installed with this sewage installation. Signature r)atp FOR SANITARIAN'S USE ONLY: COM ENT~: J o Needs Correction Dat" . System Capacity 'J,['J:) Date~ INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this clI'rtificate is evidence as per ORS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location. Heturn tnls torm to: !:lUIIOmg ano ~anltatlon UIV., Uept. ot tnvlronmental Management, 10cateO In tne oasement ot me Public Service Building, 125 E. 8th Avenue, Eugene 97401. .