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HomeMy WebLinkAboutPermit Plumbing 1991-9-20 ----- '(,,0 - )> ~ t1I ~-Q. ~ uJ :.1: o' a. Q - ~ 'I" z..-: () en T')r z - 'i'T", '" ~ ;' 13 'I'"" CD tJ ~. _'120 ,. ~ ~V)> D ??~ g 1i: ~l1~ro ~ iI:) [ ~ ~ ~ tf~ ~ 1 -.0 ~ ..N ~ - - - ~ST.) , .~-- -J[ . . I' 'l~S~ ~ VIC ::; ,,~ . '" L~ ..t; ;;; i~ 1.- ~ ::e: ": Ipl \ o '" '" 1..0 , - <<- ~ -, ~ ~ l- S ? \ 4lc~ o '" '" " 1::D r rot g g' CD a. ::J '0 :i' CJ} =r <0 CD 0 o z i o .., 3 '0 '" ::J '< ::J en ~ ~ :i.f- ':""'z. , -I:. 1I1 ., Iii ~I~J ~~ Il., MAP N _ --,.1l -j~ -?DJ'\ / .-t:l / MUST BE IN BLACK INK Permit No. ~ TV ~ - I r Twnshp, J f?' Range 0.2 Standard System M... Alternative System 0 (Specify Type).,,,, Job Location (Street Address) 1./ CI t.. dtL..<;A>r k21. Supdivision/Partition # I Parcel .!l>I'l\l,~5-11 Section 05, /:z., Tax Lot yt9lYU Lot Block DETA IL SYSTEM PLOT P CONSTRUCTED Scale --1- .. = ~. lCD' ll. I- "2 tt ..J ~ ~b; if. lii~ ~ J ..J.. ~ 2 .1 :1 5' 5 .- 'W' --;t" tt-'r ~ 15t:lOG1ILI.bN~ 7~"wJt IIB"t..)(61/"H /0' "-" ~v.:~ I; o!.I S Hc..sr: "'-- USE B~fCK INK ONLY ~" tl" FOR INSTALLER'S USE: Trench Depth ~ Gravel Depth Below Tile 'fo...l-c, Tank Capacity _ 15co Gi:\L Manufacturer W II.L"M~ l'''f~'I/ S1"ON€ Measured Distance from Well to Tank --.t!/.A. From Drainfield.1l[,+. Total Length of Lines.3tlo. COMPLET~ T.HE FOLLOWING IF A PUMP WAS USED.ON THIS INSTALLATION: I (installer's name) certify that a (Mfg,) (Model No,) , Pump and Mercury Jloat ~WitCh...(Mfgrlnd.NO,) have been installed with this sewage installation. Signature K '_~. e::.. - ,...,~ Date q -llo.q I FOR SANITARIAN'S USE ONLY: i!b-System Approved 0 System Disapproved 0 Needs Correction COMMENTS' .r _ {o/~te/~d . , Date Date - 1~:l..G-G'} System Capacity '1 ~ 0 gal./day Signature INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When signed tlyIlhe County Sanitarian, this certificate is evi. dence as per ORS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location. To request inspection, return all three (3) copies of this form to: Lane County Environmental Health Services, located in the basement of the Public Service Building, 125 E. 8th Avenue, Eugene, OR 97401.