HomeMy WebLinkAboutPermit Plumbing 1987-12-16
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~06 - S;:J,e-LL?
Lane County Authorization for:
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1::<' -/S'
FOR OFFICE USE ONLY
Seotic Svstem Verification
Application/~/,~~ ;7~
Perm~t # ~G?~/'-~ /'
WW:~SHIP
RANGE
18
02
I SECTION
05
I
j TAX LOT
201
L.OT/Pl.~t'r:::.. I
OOUT OF
PROpoSED USE OF PROPERTY
[jJ Residential D Industrial
o Commercial D Public.
S~BDIVISION/PARTITION (if applicable)
BLOCK
LOCATION ADDRESS
STREET
CI'!'Y
~
~
of 4?nd~ Hnl1Qp ;c: nn t-np lpft" h;:ann
ZIP
4982 Jasper Road, Springfield. Oregon
STRUCTURES CURRENTLY ON PROPERTY
Existin~ single familv dwelling
UIHL~TIONS TO SITE
Take Jasoer Road. off 42nd St.. gO annrox.
1/2 mil" nff
~i.dr .Qf r,,-Il.c1. hr,n'tT hl'l'~e J"1th rn~k ",~11
w~SCRIPTION OF PROPOSED WORK - Be SPECIFIC
DECLARED :;;: VALUE
~'9nt;i/'. c:.uc:d-am Verification
= OF BEDROOMS - I #- OF STORIES
na na
O~~'NER . S NAME AND ADDRESS
Lorraine~kin, same as the job address above
CJNTRACTOR'S NAME AND OSR ~
for Lo::tn
I It OF
EHPLOYECS
\~ATER SUPPLY
na
Well
o Proposed
rn Existing
TELEPHONE NUMBER
485-1234
TELEPHONE NUMBER
Bette Malcolm, 315 Coburg Road, Eugene, Oregon 97401
P:;~UT TO BE MAILED ro {NAME AND ADbkEss)
Same as the above
726-6691
Tt;I.J::;PHONE NUMBER
Same
I HAVE CAREFULLY EXAMINED THE CC>>1PLETED APPLICATION "'OR PERMIT, dfld ,]0 hcre!Jy certify t_hat all information hereon is true and correct, and that I
have the following legal interest in the property: Downer of record; 0 C~,I,';rd"t.. p'ln.:haser; (X\ authori zed agent.
I f'.:.rther certify that any and 411 work performed shall be done in .;.c<.:o;ad":l<;" Io'i th tho: nrdlllanC\:l~ of Lane COW'lty and the Laws of the State of Oregon
pertaining to the work described herein, and that NO OCCUPANCY will ~ :n.'Ide of ;;I;..,. 5'crllctm:e without the permission of the Building Division. I fur-
ther certify that registration with the Builder's Board is in full force and effect; as required by ORS 70t.OSS, that if 'exempt the basis for exemption
is noted hereon, and that only subcontractors .and employees who are in compliance with ORS 701.055 will be used on this project. I HAVE READ AND
CHECKED THIS APPLICATION THOROUGHLY.
Bette Malcolm
Drop Off
NAME (ploase print)
SIGNATURE
12-15-87
DATE
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION qAS BEEN BASED ON THE FOLLOWING CONDITIONS!
[] PLANNING/ZONING:
Zone
n~
Parti tion #
parce 1 #
parce 1 Si ze
Minimum Setbacks:
CL, front
CL, side
interior
rear
COM.'1ENTS: No nlRnninp" ;:artion rpnldrpn
Date:
12-15-87
~
c2A~ 50S:
~
')1.0
Installation Record Issued? 0 Yes 0 No
Maximum Depth
of Trenches
7-'~~J~~.
eat~ /J--/~::t_?~
[] SANITATION:
S. 1. .,
B. P. it
Installation
Specifications:
C~lENTS: ~ 0
Gallon
Tank
Lineal Feet
of n,:ainfjeld
[] PLANS EXAMINATION: Type
Group
Use
COMHENTS:
Calc:
n
~~O(i)BY BU~~F- - DESIGNEE (oer DRS 456.B05(1)) 12.-/'-L.7
LANE COUNTY DEPART E OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 ST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
C 14-25 R84-
..........
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SETBACKS ';~O 07!!SR CC::OITIO':S OF ';PPRO'l,\L ~:us'!' BE STRIC':':',' O'::5ER'-'ED. VIOLATIO~l CA:l RESULT I~ REVO-
c;,;'IO:l OF ,HIS p,::mI" CI",-Tro:; U::DSR PROVISIO:lS OF L\~E ':O~:;TY'" I"FR,\CTIO~ O!l.DI:;';::CE, ;,~;D/OR OTHER
RE~lEDIES ALLO',.;ED BY LA\~.
,,'HEN RE.~DY fOR I:;SP!:C,IO:l, C\:':' 687-4065. ",'1I~I;'lU:'1 OF ;,T LEi,ST 24 1I0URS "DV,\::~E :lOTICE_FOR INSPEC-
;hO:<HEQLt:~'i'S ;,,-';';'1' iJ~ GiVE::. ;Ia'/e the :-ollo,....illg ir.:o~:nat.ion ~eady: rer~it number, _ j'ob address, type
of inspection, when It w-lll be rendy, your ;lame a;ld ?~,or,e :lu::-,oer, a;ld any sjlccial'Clrcctions to slte.-
BUILDI:lG DIVISION:
REQUIRED r::SPECTIOClS:
1. .Foundiltion Inspection: JO be maue afte-r trenches arc ,exc_lvated i1nd forms et;ected and when all
r.,ater-lals for t~e toundatlon are delivered on the Job_ ,';here CO:1crete from a central mix-lng
plant (com:nonly termed "transit mixed") is to be used, materials need not be on the job.
2. Concrete Slab or Under-?loor Insnection: To be made after ayl in-slab or under-floor building
serVl~e esuipment, conauit, p-lp-lng accessories, and other ancillary equipment items are in
place but before any concrete is poured or floor sheathing installed, including the subfloor.
3. Framing ~ Insulation Insoections: To be made after the roof, all framing, fire blocking, and
braci:1g are in ?idCe and all. ?-lpes, fireplaces, chimneys, and vents are complete and all rough
electrical and plumbing are approved. All wall insulation and vapor barrier are in place.
4. Lath and/or Gvosum Board Insoection: To be made after all lathing and gypsum board, ;,nterior
ano-extcrIOr;-rs-Tn-pIaCe but betore any plastering is applied and before gypsum board joints
and fasteners are taped and finished.
5. Final Insoection: To be made after the building is complete and before occupancy.
APPROVAL REQUIRED. ~o work shall be done on any part of the building or structure beyond the point
. indicated in each successive inspection without first obtaining the approval of the building official.
Such approval shall be given only after an inspection shall have been made of each successive step
in the construction as indicated by each of the inspections required.
NOTE: All building permits require inspections for the work i1uthorized, such as but not limited to:
A. Block \~all: To be made after reinforcing is i:1 place, but before any grout is poured. This
~nspe~t~on is required for each. bond beam pour. There will be no approval until the plumbing
and electrical inspections have been made and approved.
B. Wood Stove: To be made after completion of masonry (if applicable) and when installation is
complete. Installation shall be in accordance with an apprOved, nationally recognized testing
agency and the manufacturer's installation instructions.
C. ~obile Home: An inspection is required after the mobile home is connected to an approved
sewer or septic system for setback requirements, blocking, footing connection, tiedowns,
skirting, and plumbing connections_
1. .Footings and piers to comply with State foundation requirements for mobile homes or as
recommended by the manufacturer.
2, ~obile home minimum finish floor elevation shall be certified when required by a flood-
plain management letter.
3. .'lobile home tiedowns, when required, and skirting shall be installed and ready for inspec-
tion within at least 30 days after occupancy. Tiedowns and skirting shall be installed
per enclosure.
D. swimmin9 pool: Below grade when steel is in place and before concrete is poured. Above grade
wnen pool-rs-installed.
,WPROVED PLAl'lS :.IUST BE 0:-< THE JOB SITE AT ALL THtES DURI!':G WORKING HOURS. ~HIS PER."1IT WILL EXPIRE
IF \-I'ORK DOES NOT BEGIN WITHIN 180 DAYS, OR IF WORK IS St:SPENDED OR ABANDONED fOR :.IORE THAN 180 DAYS.
i~~~i~~~~gN ~R REVOCATION ;.tAY OCCUR IF TIllS PER-'llT WAS ISSUED 0:-< THE l!ASIS ,OF INCOMPLET.E._O.R, ERRONEQUS
ANYONE PROCEEDING P;\ST THE POItlT or REQUIRED INSPECTImlS WILL DO SO AT THEIR OWN RISK.
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
1. Permits shall be effective for one year from the date of issuance.
2. Upon completing the construction for which a permit has been issued, the permit holder shall
notify the Lane County Department of Planning and Co~~unity Development by submitting the
installation record form. The Department shall inspect the construction to determine if it
complies with the rules contained in this division. If the construction does comply with such
rules, the Department shall issue a certificate of satrsfactory completion to the permit, ~older.
If the--constructiOrr doe'~ not compl~' with such -rules, the Dep~rtr:ient' shall notify the. permit
holder anu shall require satisfactory completion before issuing the certific~tc. Failure to
meet the requirements for satisfactory completion w-lthin a reasonable time constitutes a vio-
Hlationo'f elRS 01501,605 to 45L7-l5 and this rule.
setbacks - Subsurface
S'l'..a'le Disposal
Septic Tank
10'
10'
5'
50'
10'
10'
10'
100'
Drainfield
F~o~:
Interior propert, lines
Ed'-je of road rHirlt-of-way
BuilJinq founr-atio;)
Wells. other water sources
.
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Lane
...fh~(JV "' 0<67--_1
~unty Authorization. for:
J! 11 L!-/(/ ,9 7
'..'
FOR OFFICE USE ONLY
SEPTIC INSPECTION .FOR LOAN REVIEW
Application/ fq ~~. ~ 7
permi t I / q(.:;JC7 - ~ .
WWf-,;SHIP
18
I RANGE
02
SECTION
05
J TAX LOT UOUT OF
201
LOT/PARCEL I BUXlt
PRO~OSED USE OY PROPERTY
[!] Residenti,al 0 Industrial
o Coaunercial 0 Public,
S~801VlSlON/PARTlTION l1t .ppl~c4bleJ
LOCATION ADDRESS STREET
4982 Jasper Rd., Springfield 97478
SrRUC1\IRES C'lili.~LY ~ PROPe:R~
SFD W' ...
Ul~~~lUN~ 1V ~~+~
CITY
ZIP
]
Take Jasott Rd. - off 42nd St., - go approx. 1. 2 ml off of 42nd - Hs on L (brown hs. with flock
.,.i.'t " , ,.., '. I :', ,
w<lll) " .
i)r;SCRlPTlON OF PROPOSED WORK .. BE SPECIFIC OF;CLAREO ~ VALUE
S[PTIC INSPECTION FO~ LOAN REVIEW
l' OF' ~TORIES .
~---
OollER' 5 NAME AND ADDRBSS t!tf7 I t/ .
AKIN, Lorr~l~ 4982.Jasper Rd..
COW~'S [~..J>~J'
( /7/ /rLCo L- /11
P:;Ktll T ro tI~ - l~U ~ lNlWUO AHg ADDIUf;S"
'3/ 0 ("0 uu /,(1 R t7
II OF B.:...................
'.1' OF EMPLOYtES
WATER SUPpLY
o Proposed
Pl.'Existing
TELEPHONE NUMBER
4fJ5 1214 ',c,n
-
Springfield 97478
TELEPHONE NUKBER
726 6691
E'OC/.?J/4..,o
OY.p~.
C(7C/O I
. TI:;LEPHOHf; NWtBJ;;R
1 HAVE CAREFULLY EXAKIMED THe COMPLETED APPLl~Tl N fOR PERKlT, 6r,d Jo hore~y cartify that all intol~tion hereon i. true and correct, and that 1
have the followln9 189&1 inter.at in the property: O'ofner oC record, 0 c(.Illt'ra.;t pUl:cha&ec, Oauthorized agent.
I r~rth.r certIfy that any and all work performed. h 11 be done in .c~uldancu ~lth thd Ordinancd~ at Lana County and the Lawa ot the State of Oregon
pertaining to the work deacribed hereIn, and that NO OCCUPAUCY will btI lftadc of anr atructure without the p4t('1Jlhdon of the Building Dlvhion. J fur-
ther certify that r891atr6tlon with the Builder'. Board la in full force and effect .s required by ORS 701.055, that if.exe~pt the baaia for ._emption
is noted hereon, and that only aubcontracton and employ... who ara in compliance with ORB 'ol.OSS vUl btI uucl on thh proj.ct. 1 HAVE READ AHD
CI\E.CUD TlIIB ..,LICA"'" """"""""".. '/. ,--DO'-"l'" ' , Clt:-
I prt~nine A~jn 1\ ;::11.V ~
NAME {ploaao printl
SICNATURE
</ / I ::{ / S7
DATt:'
..
.
READ THIS SECTION CAREfUL~Y. YOUR AUTHORIZATION ~AS BEEN BASED ON THE FOLLOWING CONDITIONSl
o PLANNING/ZONING: Z<>ne
Part! tion .
Parcel'
par:cel Size
Minimum SetJ)acka I eL, front
CL, side
interior
rear
COKHENTS I
, SEPTIC INSPECTION FOR LOA~ REVIEW
NO SPECIAL PLANtlING ACTION REfJUm[O
Date, 4-13-87
"
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Gall,,!,
'T~
Lineal Feet
of Dralntield
lnstalh,tion .Rocord luued? 0 Ye. 0 No
...ximUlll Depth
of 1'nnch..
o SANiTATION: S. 1. .
Installation
Speciticatio...
CQIItENTS. ..7f... I
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S, P. .
d
v
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~t., H_ fr. P 7 .11..,
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o PLANS EXAIIINATION I Type
Group
u..
CClD12NTB,
Date:
n
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"'--PERK1lf"APPROVED BY BUlLDING OFtICIAL/DESIGNEE Coer ORS 456 .80S (1)) DATE i,...' .'
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
tj'H.J ~H_ q {I .{o<.<'r? 125 EAST 8TH AVENUE. EUGENE. OREGON 97401
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AF"I '[f'AN'!' AI('I",. I ()I"I"' TN[" -~D'" "")"' J^ '"I","'e, r"r. \"F"I"]'>I('I"IE'I D OI"'I"('()'1
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,Lj:, I B02050000201 SUBD I V 'LOT I1LI(,
NEW BLDGTYPE USE R DDRMS 0 UNITS 001 STORIES tBLDCS 001 PHONE,485 1234 III
NME AKIN, LORRAINE AbDR 49B2 JASPER RD.. SPRINGFIELD, OREGON
r~PPL NO ,~CTION DESCIUpTION SQ n UNIT COST VALU(c,TION FEE IhWS.
.OWNEr;:
CODE
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PI.J,N CHECK FEE
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EST. COMPLETION DATE
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ACTIVITY INFORMA TION SHEET
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L..OIO.."..""'.Mr..... n.",<;1QOf
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Please complete all Items above dolled line
FILLING OUT * LINES WILL GET YOU INFORMATION ONLY
*DATE Sf';;- f:LZ..
*PERSON ~ (
MAKING ,Q A V
REQUEST c/o
ADDRESS V J
ACTUAL
PROPERTY
OWNER
/fJ(J-;./
, '1V'.>J€A If c:R
)
CITY
TELEPHONE (BUS!
STATE
ZIP
ADDRESS tf'2f :?-
CI~~ < [.;.peR
TELEPHO~E (BUS)
STATE
ZIP
(HOME)
(HOMEI
* PROPERTY ADDRESS
OR
MAP & PARCEL NUMBER (Found on tax maps in the Assessment & Taxation Dept.)
STAFF WILL
LD R /U F-/o
Zo,{ed
Township
tJJ-
Range
fb -()() r20/
DETERMINE _
It
Section
Tax Lot
Flood Plain
Township
Range
Section
Tax Lol
Zoned
Flood Plain
Township
Range
Section
Tax Lot
Zoned
Flood Plain
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
ACRES
*REQUEST(descrlbe what you want to do)
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Directions to site
....................Staff Use On~....................
Comments:
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Land Management Division, Public Works Department 125 E. 8th Ave., Eugene, OR 97401 phone 687-4061
'.-
. RUR.ADDRESS1NG .
CHEC....ED APR I 4
Lane County Authorization for:
SEPTIC INSPECTION FOR LOAN REVIEW
.11% ~-/4 P7
FOR OFFICE USE ONLY
Application/ I.'et,}~ ~7
Permi t it c;+...:;JV -d) ,
"""';SHIP 18 '" I RANGE 02
S~8DIVISION/PARTITION {if applicable)
SECTION
05
I TAX LOT ODUT OF
201
LOT/PARCEl. I BLOCK
PROpOSED USE OF PROPERTY
[] Residential 0 Industrial
o Corrunercial D Public.
LOCATION ADDRESS STREET
4982 Jasper Rd., Springfield
STRUCTURES C~TLY ON PROPERTY
SFD W'
'UIRJ::;c.::TION::i 1'0- SITE:
Take Jasper Rd. - off 42nd St., - go approx. 1.2 m; off of 42nd - Hs on L (brown hs. with Rock
CITY
ZIP
97478
wall )
~~SCRIPTION OF PROPOSED WORK - BE SPECIFIC
SEPTIC INSPECTION FOR LOAN REVIEW
DECLARED S VALUE
'" OF BEDROOMS I fj: OF
o;mER I 5 NAME AND ADDRESS
AKIN, Lorraine
CONTRACTOR'S NAME AND OSR #
STORIES
I "OF EMPLOYEES
WATER SUPPLY
o proposed
Wxisting
TELEPHONE NUMBER
485 1234 ?hn
TELEPHONE NUMBER
726 6691
4982 Jasper Rd., Springfield 97478
P:=;Rr>llT TO BE MAILED TO (NAME AND ADDRESS)
TELEPHONE NUMBER
I HAVE: CAREFULLY EXAMINED THE COMPLETED APPLI!N FOR PERMIT. <HId ,]0 hereby certify t.hat all infortllation hereon is true and correct, /lnd that I
have the following legal interest in the property: owner of rCCOt"dl Ocontcdct.- pllcchaser;Oauthorized agent.
I f-,;,rther certify that any and all work performed sti 11 be done in act:l,)t(lanr.e wi th the Ordinances of Lane County and the Laws of the State of Oregon
pertaining to the work described herein, and that NO OCCUPANCY will be madco of ar.1' st.cucture 'without. the permission of the Building Division. I fur-
ther certify that registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if "exempt the basis for exemption
is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. I HAVE READ AND
CHECKED THIS APPLICATION THOROUGHLY. ...J r 0 Ir-I A t". /'1 J ...
I nrriline Akin 1\ ;::[ \)V'-~ l.tAi'-
NAME (please print)
SIGNATURE
LfI/3/n
DATE'
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION HAS BEEN BASED ON THE FOLLOWING CONDITIONS!
o PLANNING/ZONING: Zone
partition 11
Parcel 11
Parcel Size
Minimum Setbacks: CL, front
eL, side
interior
rear
o SANITATION:
S. 1. #
B. P. #
~
" --,...
Installation Record Issued? DYes 0 No
Lineal Feet Maximum Depth
o;'~;;:iel~ ~ _~;::nChe,&~~
fl Ute: #-ll~P? /~
COMNENTS:
SEPTIC INSPECTION FOR LOAN REVIEW
NO SPECIAL
PLANNING ACTION REQUIRED
4-13-87
Date:
Installation
Specifications:
Gallon
Tank
COMMENTS: ~ ~ .~7/
Il_ r ,
/~ At,;" ~~
<;J) 5.
o PLANS EXAMINATION: Type
Group
Use
COW1ENTS :
Date:
n
~(J Ah.~ -_ /! ,) U____/Gf?7
-PERMI~APPROVED BY'BUILDIN~ICIAi~ESIGNEE (oer ORS 456.805(1)) ;' - ~~ATE G7 ~
LANE COUNTY DEPA~}MENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION r 1l._?~ 11A4.
.
.
SETB,\CKS ASO OTHER CO:;DITIO~S OF APPRO'l,\L XUST BE STRICTLY OBSERVED. VIOLATION eM! RESULT IN REVQ-
C;.:;IO:J or TillS PERm;', CITATrO:: UNDER PROVISIONS or LAl>;E COl.i::T\":; INFRACTION OROI::;'~CE, AND/OR OTHER
RE~IEOIES ALLOWED BY LAW.
\<OMEN READY FOR I::SPCCi'ION. CALL 681-";065. A :1lNH\U~1 or AT LEAST 2.; "OURS ADVA::CE NOTICE FOR INSPEC-
T10:-l I\t;QJ.;t;::>r::;; :,1,;::>. Ul:: GIVt;N. Have tne tollowing information ready: permit number, job address, type
of inspection, when it will be ready. your name and phone number, and any s?eci~l directions to site.
BUILDING DIVISION:
REQUIRED INSPECTIONS:
1.
Foundation Inspection: To be made after trenches are excavated and forms erected and when all
rnatcrldlS ~or tne toundation are delivered on the job. Where concrete from a central mixing
plant (co~~only termed -transit mixed-) is to be used, materials need not. be on the job.
Concrete Slab or Under-Floor Inspection: To be made after all in-slab or under-floor building
serV1=e e~ment, conou1t, plp1ng accessories, and other ancillary equipment items are in
place but beiore any concrete is poured or Cloor sheathing installed, including the subfloor.
~raming , Insulation Inspections: To be made after the roof, all framing, fire bloc~ing, and
raClng are 1n piace ana all p1pes, fireplaces, chimneys, and vents are complete and all rough
electrical and plumbing are approved. All wall insulation and vapor barrier arc in place.
2,
),
4.
Lath and/or Gvpsurn Board Inspection: To be made after all lathing and gypsum board, ~.nterior
anaeXECrIOr, 1S 1n""""PI'iCe but before any plast.ering is applied and before gypsum board joints
and fasteners are taped and finished.
5. Final Insoection: To be made after the building is complete and before occupancy.
APPROVAL REQUIRED. No work shall be done on any part of the building or structure beyond the point
indicated in each successive inspection without first obtaining the approval of the building official.
Such approval shall be given only after an inspection shall have been made of each successive step
in the construction as indicated by each of the inspections required.
NOTE: All building permits require inspections for the work authorized, such as but not limited to:
A. Block Wall: To be made after reinforcing is in place, but before any grout is poured. This
InSPectiOn is required for each bond beam pour. There will be no approval until the plumbing
and electrical inspections have been made and approved. '
B. Wood Stove: To be made after COmpletion of masonry (if applicable) and when installation is
com?l~ Installation shall be in accordance with an approved, nationally recognized testing
agency and the manufacturer's installation instructions.
C. Mobile Home: An inspection is required after the mobile home is connected to an approved
sewer or-5Cptic system for setback requirements, blocking, footing connection, tiedowns,
skirting, and plumbing connections.
1. Footings and piers to comply with State foundation requirements for mobile homes or as
recommended by the manufacturer.
2. Mobile home minimum finish floor elevation shall be certified when required by a flood-
plain management letter.
J. Mobile home tiedowns, when required, and skirting shall be installed and ready for inspec-
tion within at least. 30 days after occupancy. Tiedowns and skirting shall be installed
per enclosure.
D. swimmin9 Pool: Below grade when steel is in place and before concrete is poured. Above grade
wnen pool-rs-installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WOR~ING HOURS. THIS PERMIT WILL EXPIRE
IF WORK DOES NOT BEGIN WITHIN ISO DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS.
SUSPENSION OR REVOCATION HAY OCCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
ANYONE PROCEEDING PAST THE POIl1T or REQUIRED INSPECTIONS WILL DO SO AT TIlEIR OWN RISK.
SUBSURFACE ~ ALTERNATIVE ~ DISPOSAL ~:
1. Permits shall be effective for one year from the date of issuance.
2. Upon completing the construction for which a permit has been issued, the permit holder shall
notify the Lane County Department of Planning and Community Development by submitting the
installation record form. The Department shall inspect the construction to determine if it
complies with the rules contained in this division. If the construction docs comply with such
rules, the Department shall issue 1:1 certificate of satisfactory completion to the permit, holder.
If 'the construction docs not comply with such rules; 'the Department shall notify the permit
holder and shall require satisfactory completion before issuing the certificate. Failure to
meet the requirements for satisfactory completion within a reasonable time constitutes a vio-
lation of ORS 454.605 to 454.745 and this rule.
Setback~ - Subsurface
From:
Sewaqe Disposal
Sept.ic ~
10'
10'
5'
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Drainfield
10'
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I~tcrior property lines
Edge Ot road riGht-of-way
BuildinQ foundation
~ells. other ~ater sources
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. W: ~) , U\NE COUNTY DEPT ENV MGT F:ECEIPT '~123687 DATE 0413<1.
APPLICANT AKIN, LORRAINE ADDR 4982 JASPER RD., SPRINGFIELD
TLI 1802050000201 SUBDIV 'LOT BLK
."I"'J "il 1)(" 'r Y I:' 1'" II <'I" I" r.iD' 1"'1" ,(.) IJ\1 'I' T S' '.'" < "~'rIll:;' 'I' E'S' ""'Iii D(' S' ")0' 1:'I-IONlo ,')"l'" 1 ';''',4.
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OWNER NME AKIN, LORRAINE' AD DR 4982 JASPER RD., SPRINGFIELD
. CODE APPL NO r;CTION DE:.SCr~1PTION SQ FT ,UNIT COST VALUATION FEE
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COMF'LI::TIClN DroTE
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ACTIVITY INFORMA TION SHEET
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Please complete all Items above dotted line
FILLING OUT * LINES WILL GET YOU INFORMATION ONLY
*DATE '-f '-/.3) ~7
* PERSON d \ ACTUAL \ 6<
MAKING fl J.- 0 PROPERTY
REOUEST f'rl1//1L.,...,9"'t-! ( . OWNER P
ADDRESS L/ q If:;), ~~-1 e; ADDRESS ~
CITY ~ (f--r;;;TE O/C- ZIP q 7t.(l ~ITY
TELEPHONE lBUSl.JJ-y-s- I;}) L/_lHOMEI..:] ~ i, Ie, ~ TELEPHONE lBUS)
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* PROPERTY ADDRESS ~ _ .
OR
MAP & PARCEL NUMBER (Found on tax maps in the Assessment & Taxation Depl.)
ST
()!r 20 ( 11
Section Tax Lot
D
STATE
ZIP
(HOMEI
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T6w~shlp Range
Township Range
Township Range
Section
Tax Lot
Zoned
Flood Plain
Section
Tax Lot
Zoned
Flood Plain
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
ACRES
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9 -qt;..;, +~__L ,Q."" t l~~~ ,
*REQUEST(descrlbe what you want to do)
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Directions to site ~_
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....................5taff Use On~....................
Comments:
Land Management Division, Public Works Department 125 E. 8th Ave., Eugene, OR 97401 phone 687-4061
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