HomeMy WebLinkAboutPermit Plumbing 1979-4-4
~.
~ '
TRS, TL_I<;I - c.::) - f'\<::;' TlJJ 0,:);
Plat Plan
~
--f>
"
-:r-
~
~\r 1
~~~ PJ. ~ l( u,fdsY-..C.
/I-v~ l,J U ",.
~
~.
~.
'~'
~ .
'~
~. ~i\
4,~
~~
~CI
co
...
~
c:
>
lD
.
t-
{'.
Job location (Street, mi Ie post)
Subdivision.
=
l/ 7:tU
eJ
; Sprln~(;",(J
lot
Block'
.:s;:/~r
FOR SANITARIAN'S USE ON l Y: isJ System Approved D System Disapproved 0 Needs Correction
COMMENTS:
FOR INSTAllER'S USE: Trench Depth
Tank Capacity Manufacturp'
Measured distance to well from tan~
Scale:
Signature: 0 ~
Filler Depth Below Ti
Date: <f..J'-7 '7
j ~.
~, ,,~
N. "1:
<{-; ~ -
N
from drainfielri
.
fff,rt:r "7
u.A$f'J':f{ Rp,",O
...,...... l' ..1t~LC TI?l!,'
"T<J r - ,,., r4{ """'JV "" rf~< 'Q
,
q" r ".J I"f' ",,..qr
. L'.' u). f"r .
0\[ ,~ frl>r,
"fd /Or , J ,rro"K
~,
,,";~'.
L.r; ~/J .
,.
,.
~,'?
.-'I' L~I\,T 'Z.~ fori
/.I <19 L to 1+" lVt c-
>..,
<::
.~
'"
~
.
-
'"
....
tf:~ ~~ ~
-?,{) <~ ~
R ,~'<). (, ',~
\ - 'r. '/ .. ~
0.., 61..... ,.,. . ~<J'
<~;':-"oA)' '\
,,<:. . 0..... /1")
,'<>~
INSTAllATION RECORD AND CERTIFICATE OF SATISFACTORl( MP.,!:-'i::&~~
When signed by the County Sanitarian, this certificate is evidence as per OR~ 11:'665 of s
isfactory completion of a subsurface sewage disposal system at the above 10~0l ~
Return this form to: Permit Processing Section, Department of Environmental Management,
Public Service Building, 125 East 8th Avenue, Eugene 97401
C55,ll