HomeMy WebLinkAboutPermit Building 1975-11-18
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3073;.;75
LANE COUNTY PERMIT FOR:
PERMIT NO-
,
: CONSTRUCTION [x ]
MOBILE HOME [ ]
PLAN REVIEW [ ]
DOwner
ROR~RT N. HILL RUILD~R
NAME
5AM~'
NAME
870 w. CrNT~NNIAL
ADDRESS
SPRINGFllrLD
CITY
CHANGE OF OCCUPANCY [ ]
CJ7477 746-qq16
ZIP-CODE PHONE [
'1
o Contractor
ADD RESS
CITY
ZIP CODE
PHONE
OS Reg. # 81
Tw!", 18
Range 2
~~~R~~~G~tF~
Section
h .I.~x Lot 9-z,tJ ~
Code
Census Tract
SubdiVISion
Lot
18
Block 2
Acreagp
Width
80
Access to Pro perty (R oad Na me)
LAURtL STREET
Depth
100. 65
EXisting Structures on Property NONE
Directions to Property - Address
1060 LAUREL STREET
SPRtNGF'IELO
STRUCTURE (# BEDROOMS)
I}WELL I tJG
GARAGe
SO FT
1107 @ 21.80
506 @ 5~30
VALUATION
$24. 1 ~2 .60
2.681. iO
$~qO
INSTALL SE~ER DISPOSAL SYSTEM
-.-----~-~----_._--~---- ---
SEWAGE DISPOSAL PR I OR
PUBLIC [] SEPTIC TANK [ OTHER [ ]
BUILDING ~118.oo
PLUMBING . ~lLM
3% SURCHARGE - h-5h
MOBILE HOME
WASTE DISPOSAL In{'\ nn
PLAN REVIEW
PLUMBING INSTALLED BY
OWNER [] OTHER [] NAMF
WATER SUPPLY PROPOSED [ ]
EXISTING []
[ ] PUBLIC
[ ]( COMMUNITY - NAME
[ ] PRIVATE WELL
[ ] OTHER - SPECIFY
I.J/I_'_J\M~TT~ \>1J\T~n
TOTAL
~?i:\h-.~h
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN SEPTIC TANK CAPACITY ~
GALS 900 MIN DRAINFIELD ll=iO L1N FT MAX TRENCH DEPTH ~O INCHES
THE DRAINF"IELD MU5T 8E PLACED 10- F'i"!"T FROM PROPFRTV llN!=' ANn HOIJ~!='. R!='<;r;R"f:' AN
ARtA FOR RrPlACFM..NT OF' SrWF'R DISPOSAl SV~T.M.
TYPE OF CONSTRUCTION
t:;1\,
GROUP
R R..I FIRE ZONF
STAY 100' FROM ALL WELLS
USE CLASSIF
.'
-~~-
SETBACKS - FT FROM CTR OF r/W
FRONT 50 SIDE EXT
FT FROM PROP LINE
SIDE INT " REAR
,.,
~
.I
ZONI=
DI\
AUTHORIZED SIGNATURES
/s/ J 6 E. 80ss IHARBAUGH
GRAV /5AN I TA~ I AN
ISSUANCE DATE
11/. RhCl /" ^
,-,
BLDG PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT
Call 687-4065 to schedule all required construction Inspect'ons Call 687-4061 to schedule all required
septic system Inspect,ons All constructIOn shall comply with the State BUldllng Code, 0 E Q standards
for subsurface sewage d'sposal and the State Plumbing Code All bUildings require a certlf,cate of
occupancy before being occupied
(See Details on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
CL /lr;
C55 13
LANE COUNTY, DEPT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
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7<" tT SUBDIVrSION:
BUILDING PERMIT APPLICATION NO. 3~?3-7.s- LOT:
BU-! L~ ;NG' SITE EVALUAT ION
I
.f
( .t)."
() SITE I.NSPECTlON
PLANNING DIVISION Not
App 1 icab 1 e
1. Zoning Ordinance Compliance: Zone ~~ ()
2. Subdivision Ordinance Compliance ( )
3. Required Access ( )
4. Building Site (Area, Width, Frontage) ()
5. Other (see comments) ( )
COMMENTS:
S
TAX LOT
BLOCK :'
APPLICANT
DATE
No Yes
() (,} 6.
( ) ( ~
( ) ( )
( ) (I)
( ) V)
CKID BY~ / / -/Cl. -?.s-
Setback~J~6m ell of road:
Front _~C/
Side Exterior
Setbacks from interior
Side
Rear
1 i nes :
S
S--
PLANNING DIVISIONAttlON PENDING: VESt ) NOt ) APPLlCATION#
BUtLDING INSPECTION DIVISION
Not
App 1 icab 1 e
( )
( I)
( )
( V
7. Plans Submitted
8. Soil Stability (footings)
9. Flood Plain
10. Other (see comments)
COMMENTS:
WATER POLUTION CONTROL
Not
App 1 icab 1 e
< )
( )
11. Meets Department of Environmental
Quality Standards.
12. Other (see comments)
COMMENTS:
No fie
()
() )
( ) ( )
( ) ( )
CKID
BYtf$~a1~./~G> '}J-
f DATE
..-
No Yes
() <pQ
( ) ( )
B~+
/J-It/-1S
DATE
CKID
TO APPLICANT:
~o~ Building I Site Inspection:
,R(.! Can be approved.
~ ( ) Cannot be approved at this time as indicated on item NO. above.
Jf~ Questions and further information on items 1 through 6 contact the LANE-
\~\I\~~ COUNTY PLANNING DIVISION. Questions an9 further information on items 7 I
\ through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION.
( ) Will be held in this office until you can resolve the problems indicated.
( ) Is being returned.
( ) Your bu i 1 d i n9 perm it app 1 i c~!X.9.!:l..Je~j_ue i ng ret\lrMd unger separ,i!te cover Il
DEPARTMENT OF ENV I RONMENTAL MANAGEMEN1'
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANNING DIVISION PHONE: 687-4186
C55-28
. ,"
. .
.
'. . Date
"
Noll.MR.Q
1 7, 1 9~ 5
Permit No.
3073-75
CURB CUT
PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
WHEREAS, the attached application has been fully considered by the Board of County Com-
missioners of lane County, and it is the opinion and judgment of the Board that the said application
should be granted, and that a permit should be issued, now, therefore, it is hereby.
ORDERED, that a permit be and is hereby issued to ROBERT N HILL
870 WEST CENTENNIAL SPRINGFIELD OREGON 97477
or constructing the following facility:
BUILDER
for placing, building
2ND ADDITION TO MEADOW GREEN ESTATES LOT 18 BLOCK 2
1060 LAUREL ST. SPRINGFIELD
OREGON 97477
upon the right-of-way of County Road No. , Mile Post
in strict conformity to the exhibits attached hereto, and subject to all terms, conditions, agreements,
stipulations and provisions contained in the appl ication and permit, the Rules and Regulations Gov-
erning Facilities to be Permitted upon County Road Rights-of-Way, as set forth by the lane Man-
ual 50.190(2) any amendments thereto, and any other applicable regulations, law or ordinance.
Special Provisions:
1.
Driveway will be constructed in accordance with the attached driveway approach specifica-
tions (Drawing M98-50).
Permittee will be responsible for the immediate removal of all mud, dirt and debris from the
roadway and right of way caused by his 0 peration, leaving the roadway and area in a neat,
acceptable condition.
2.
3.
SIDEWALKS WILL BE CONSTRUCTED IN ACCORDANCE WITH THE ATTACHED SIDEWALK
SPECIFICATIONS AND DRAWING M98-49. THE STANDARD CURB TYPE SHALL
BE CONSTRUCTED UNLESS OTHERWISE SPECIFIED.
This permit is revocable at any time, and will be strictly adhered to and no work other than
that specifically mentioned above is hereby authorized.
This permit shall be void unless the work herein contemplated shall have been completed be-
fore
NOVEMBER 17
, 19
76
Expires
, 19
Inspected and Approved
Approved by Board of County Commissioners
By
tk~
Director of PubliC Works
Date
By
WHITE - OFFICE FILE
GREEN - RESIDENT ENGINEER
PINK - PERMITTEE
BLUE - ROAD SUPERVISOR
ORANGE - BUILDING & SANITATION DEPT
YElLOW - REAL ESTATE
C98-79
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.",CON,STRUCTION [It] MOBILE HOME [,] . PLAN REVIEW [']
~" ;,' :~~l"~""'.' . _ '.: ~ i . '." -.l;-~'l';}"..,
;0 Owner'" .. "~8itA'F fit. Hlu_ ecHlttlfttR 8'10 W..C.I:tN'tI!JImGAi.
N:A.ME ADDRESS
~-..~';,_"'T'~_~'::
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;r~
LANE COUNTY PERMIT FORi )
'. .." \~
.....-;'1,0$.
. ,'_'1:;0,,_\, "" . \'1 ........1.,~
.PE'Riivll,;r~NO',307j"-1~!,. .
. '--.r'!-''''l:, ,'.,". I ;:~.r
. . , .J,;'f~'!"
CHANGE OF OCCUPANCY [ 1
q7~17 . '1~&.~ 16
Zlp"cbDE'" - P~ONE',.
SPR I NGF litL Ii
CITY
O.S. Reg. #
: .T~r i6
!i:~} . .
. (Subdivisian
S~
.NAME
[h'
ADDRESS.
CITY
ZIP COpE
PHONE',:
Range 2
,D(\Il~1
11
Section
"
~~
.< '.(f- -, ~/f'
Tax Lat
Cade
. ..Census' TraGt
Lat"
il
Blo.ck '
e.
. Acreag;'
Width
80
: Acce.ss to' Proper-tv (Raad Name)', LA~~IU. $i$!tE'f .
Depth. .. 'OOo&>
,ExistingStructures on Praperty:
pirectians to Property - Address:
Nt1\~t, . .
. .#.....
f~'~n~St~[~T
St:"n~QttgLI\)
, ..
STRUCTURE ('# BEDHOOMS)
,. . ..' ~iit.\, t~
: . _ P GADMH!it .
l'}~ ,:" ~;~~'~_::;:':"~'~
_' ,SQ.FT.
UO} , 2l.60
..41106, @ . fIi,,,~
.~. .
''';; ..
VALUATION
, $i4s 1~.~6t)
'~.4i81~~
4r'!:~.~~
,.
.,
~_l~~r.~~\L,,~J.tf~!i.J!t$~ts~,..$.YJi"..Il'~__, .
. -.- .-. '," .-"
SEWAGE DISPOSAL: Pl:ll~.
,.' P:UBLlC [,] SEPTIC TANK [] OTHER [ 1
iUa.~
~4,..QO
-. f~~ 1;E)
" ..
. .'
'. ~UILDING
PLUMBING
.3% SURCHARGF
\,' t, .
:.MOBILEHOMF
,',WASTEDISPOSAI'
. 'PLAN .REVIEW
pLlJIViBiNG INSTALLED BY:
OWNER [] OTHER [] NAMF
WATER SUPPLY: :PR"OPOSED [ ]
,EX'ISTING [.]
",l
100.00
[ ] PUBLIC
[ :]1. COMMUNITY.- NAME:
[ ] PRIVATE WE~L :
[ ] OTHER-SPECIFY'
\41fll AiMll''\M''#.' l.Jti'l'~~
" TOTAL
"-latii,:~fi"'"
CONSTRUCTION PERMITS.& INSpECTIONS AND WATER PQLLUTIONCONTROL SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY:" to,
GALS.. . 'gao MIN. DRAINFIELD 1~, L1N. FT. . MAX. TRENCH DEPTH WINCHES
1!"R$ O.~Hll"U~"'Gl MUlJ'f (Mi' PL:Ac''E'olQ'',mllV',''ft9tfj Ii'ROPE,ft'Vy....OO(f. liMfll' KeW\m. llistSlml1lVIZ Atf
. AA&AfI'.UB 8t!1PLA~itt4Il:N'l' 0' ~rm :&I&PciillM,9.1"f8"11f4.
T,YPE OF CONSTRUCTION
5C'3
GRO.UP t & J FIRE ZONF
STA Y100' FROM ALL WELLS
USE C LASSI F .
'. 'SETBACKS -FT. FROM CTR. OF r/W:
FRONT"~' SIDE Ex-f
FT, FROM PROP. LINE:
SIDE INT.!1lj'" REAR
~
ZONF
RA
~ .:
i,;' '.' AUTHORIZED SIGNATURES:
;'. Is/ .. J,.E....$$.!Hl\ftmaU_
"., \::. { .
QAAVJS~N.'1Att.AN
ISSUANCE DATE:
'1 tAS!1&i . .€:LA
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. BLDG. PERMIT - WHITE ..1
OFFICE coPY - WHITE
. COUNTY TAX ~ PINK
PLUMBING - CANARY
. BUilDING - GREEN
SANITATION - GOLDENROD
. IMPORTANT: .
. . .
, Call.687-4065 to schedule all required.construction in's'pections. Call 687-4061. to schedule.all required
septic system inspections. All constructionshall comply' with the'State Buidlirig'Code, D.E.O. standards
for'subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of."
occupancy before being occupied.
i
C
(See Det,!i Is on Rliverse Side).
C'SS-.13
(POST THIS PERMIT ON MAIN SLDG, AT SITE)
LANE COiJNTY. DEPT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EP\ST 6th,. EUGENE, OREGON ~?401
1 ',.,'.
'-'.1 IL
\,.;,..\.,.. /.....
) 1
SLAB FLOOR
PLUMBING GROUNDWORK
ApPROVED /
/ DISAPPROVED /
REMARKS
GAS PIPING GROUNDWORK
ApPROV[-D /
/ DISAPPROVED /
REMARKS
ROUGH PLUMBING
ApPROVED ~ /
DISAPPROVED
REMARKS
ROUGH GAS PIPING
ApPROVED /
/ DISAPPROVED /
REMARKS
FINAL PLUMBING
ApPROVED /
/ DISAPPROVED /
REMARKS
FINAL GAS PIPING
ApPROVED /
/ DISAPPROVED /
REMARKS
CERTIFICATE OF OCCUPANCY
/ DATE
/ DATE
/
DAT#- ~75
/
/ DATE
/ DATE
/ DATE
READY TO ISSUE /
/ NOT READY TO ISSUE /
/ DA TE
REMARKS
INSPECTOR
INSPECTOR
INSPEC~~
(/
INSPECTOR
INSPECTOR
INSPECTOR
INSPECTOR
.
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Permit No.
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CURB CUT
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, PERMIT
IN THI; iiOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
V'
WHEREAS,-rthe attached application has been fully considered by the Board of County Com-
missione~s of lane Cql.mty, and it is the opinion and judgment of the Board that the said application
should be grant~d, and that a permit should be issued, now, therefore, it is hereby. .
/1 . .....,.
ORDEREDj that a permit be and is hereby issued to lhl'lli:F\'f n hu.,t, ~~'iHl~li:h
f" .'
i.J 10 lAt(~a.'V t~q>I'rl4f'#~ii tAl.
or constructing the following
':
~.,4.G ,tlt'.",... i. "i' 'lj, il'k.t.,,~~,::,,; "'.. ':~:". 7'G
...'~~T~;f,'" ,4-lJlUW '4'~"~'4l V411 !~~r.",i ~;Jl; '.f, V
facility:
~ ".
for placing, building
~ll'a)~fP~flltl~~ 1'0' M,'o!lt(1ow GI~-t3ti€ ~;l!::fArtlSi
,. i!cI,"i' \;}:,~; ;~. ,'a ",", ~,I
~~~ ~ ~~ \w Lfit... ~.lNt <;~ l'r"
1of.~ ~~~\~ t~". !.l'kik$-1l'H,~i{:1
O~t;t,.I):i, ',n-;:t?
p.
\;.
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upon the right-of-:way of County Roa'd No. , Mile P~st ,
in strict confbrmity'to the exhibits attached hereto, and subject to all terms, conditions, agreements,
stipulations and provisions contained in the appl ication and permit, the Rules and Regulations Gov-
erning Facilities to be Permitted upon County Road Rights-of-Way, as set forth by the lane Man-
ual 50.190(2) any amendm~nts thereto, and any other applicable regulations, law or ordinance.
.. . if::
Specia I Pn,:{';is'ions:
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1. Driveway will be constructed in accordance ',with', the atta,ched driveway approach specifica-
. tions (Drawing M98-50). ';, , .
2. Permittee wi.ll be respo;nsible for the immediate removal of all mud, dirt and debris 'from the
roadway and right of way caused by his operation, leaving the roadway and area in a neat,.
acceptable condition.
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~~U:u~\tlALf':Hi W'~u. :j~t <;OWEl~::\;j:fl:n~~ !h 'Iii
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Inspected and Approved
Approved by Board of County Commissioners
By
Date
~' /
;. .~ .. . ,
By Director of Public Works
~,. . .
WHITE- OFFICE FILE
GREEN - RESIDENT ENGINEER
PINK _. PERMITTEE .
BLUE - ROAD SUPERVISOR .
ORANGE - BUILDING..& SANITATION DEPT.'
.. YELLOW - REAL ESTATE
C98-79
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LANE COUNTY PERMIT FOR:
PERMIT NO. ':;~.l~;<h&j
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CONSTRUCTION [s
MOBI LE HOME [] PLAN REVIEW [] CHANGE OF OCCUPANCY [ ]
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p 9wner
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ADDRESS
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~i!iiUNC1" h':1.0
CITY
~;; ,',l.r ~;~,1
ZIP CODE
11,~f-?" tl:;\.{;'j
PHONE
.[
'0 Contractor
NAME
C;:1'11tt .' ..
NAME
\ ,
ADDRESS
CIT.Y
ZIP CODE
PHONE
O.S. Reg, # gB
.Twr
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Range 2
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:Subdivision . ~i~~~g~f:~ Lot
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Access to Property (R61~)-Name)' t.AtHf~~:;';'t\~{;~\.
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Existing Structurleslo~ope~~l,""- ~lJR.. \ ~'-t~:-_ \~~~t>,,~~:~~~,~)'~~:\\-0'S i\ '-:\,
\ .... ... .' \ . - \' ~' ,- ,,\\ ~ - ".~ \ . \
Directions to Property - Addre~s: tOOG ~}HIJWt~ ~iTr~r.T\ G~~,ft'n}t ~t:i.v \
"\ " t \. ~
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,~Y~~'fJ '~~) ~~..~\}~~ .~\\).) i\ \.1)
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Section
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Tax Lot
Code
Census Tract
t,~:
Block
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Acreagp
Width
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"~ Depth
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'STRUCTURE (# BEDROOMS)
CUi":..' ~'\{';>
SEWAGE DISPOSAL: fti'H{ffi"i
PUBLIC [] SEPTICTANK [
OTHER [ ]
f:'
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'.I\.'~ --\ ,~~y~~,~-L "\--~\:~... ~~~i,~~h
PLUMBING\INSTALLED BY: - '\
OWNER [] OTHER [] NAMF
VALUATION
t'f,i: }~'/ '1 32' . ~l:'
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t~k~ll ~.,1 ~\.'~)f\
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[ ] PUBLIC
[ JJCOMMUNITY - NAME:
[ ] PR IVATE WELL
[ ] OTHER - SPECIFY'
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BUILDING
.PLUMBING
3% SURCHARGF
, MOBILE HOMF
WASTE DISPOSAl
PLAN REVIEW
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WATER SUPPLY: PROPOSED [ ]
EXISTING []
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TOTAL
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CONSTRUCTI.o.~ PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFl.CATIOI\JS
MIN. SEPTIC:\lIoANK CAPAClf-Y-;. ~ fi.e,' _' "" ,_,
GALS ;,ll'~~ MIN. DfrAlNEIELD ~'l~ L'IN. F1.:r.. MAX. TRENCH DEPTH"'3~" i'NCHES
, mr: OflA lNV H~"'U ~U$'f)&t:..P.lA<<:tfJ; IL~n:'r~n~~,'GS-\:~~hr U~E, .h~ii~ \IlO.t)~t,,~~!.:or,(!,Htr, ~r
1W~~Ji. ~Ult ft~111i.Atttt{m;. Of' $f.WU'-I $Jif,Ft1$AL t.1'i't\;tM.
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. TYPE OF CONSTRUCTIQ)N.
, p
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GROUP
1, .r. ~
FIRE ZONF
STAY 100' FROM ALL WELLS
USE CLASSI F. (
.~~\ .>, \'. ," .~.
-1"1 .... ,
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~,
:' \0
i"t,
r
SETBACKS - FT. FROM CTR. OF r!W:
..u
FRONT ~l' SIDE EXT.
1
FT. FROM PROP. LINE:
SIDE INT. ,';\ REAR
:;
ZONE=
;,,:f~"\
AUTHORIZED SIGNATURES:
,) t. 1'n.M .,.'."" "'f>~~~"':l
/s/ ^}4~,.~ tl""", .Ij ,'I~'";!JI"',,,,,,I, ;
(,i;.!" " ,f" ".'J. ~ '<,l>....,i'"' (' f\C~
-tn. '1""- .~ t' ....~ ~-~, il~". _t-,:. H' \-l V .-~~
ISSUANCE DATE:
Hi t.i~l!';^') . t: ~ i.
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
Call 687\,~065 ;'0 schedule all.}equired construction inspections. Call 687-4061 to s~hedul~ all~reqUired/."
IMPORTANT'.. septic sys'iem friS'pections'. All construction'shall comply with the State,Buidllng Code"D.E.O..standards
. for subsurface sewage disp6~al and the State Plumbing Code. All buildings require' a cer.tificate of:
" occupancy~be!ore being occupied, "_~" . \, - ..., ,~.'!!.(~< '\- I \,'.'.
...).. (" .',', ~, 'i- "\ _ \, (See Detai!s on Reverse Side)'j" /.'i;;.> .' -'f
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(POST THIS PERMIT ON MAIN BLDG, AT SITE)
LANE COUNTY, DEPT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
C55.13,
, .
SITE INSPECTION
ApPROVED / / DISAPPROVED / / DATE
INSPECTOR
REMARKS
FOUNDATION INSPECTION @)
ApPROVED / vI' DISAPP~OVED / ~ DATE/:Z"/~ "'7($.... INSPECTOR' _,(
REMARKS t7 /( ~ :dit/t!-;t;t./Jk~, ;;~~r' Y) r;;L J;) ->9r.r!r P ~ J ~
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I! ~t tIJf't-i4-lJ!... .-"UHLiJ..,lt./'If.L/l O~/ 4'( o/f.1''Cf'fL- /~_z"! ~7!/1! !,'
FRAMING INSPECTION ;r
ApPROVED / / DISAPPROVED / / DATE ~)
/7 '1 '1' If /
REMARKS V~ 4{ia.r-t:~~.t!t./;..{f_iL' 1- $"--,?r/ ~:t
a' ;f
INSPECTOR
,f
LATH OR SHEETROCK INSPECTION
ApPROVED / 'x / DISAPPROVED /
/ DATE / ~..</~~
"
INSPECTOR~~
""""""-
REMARKS
FINAL INSPECTION
. -/
ApPROVED / ~ BJ~A~PROVED /
/!"
[} /,..) Jf..
/ DATE Pf'....(j/ / ~
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IA
INSPEC
REMARKS
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- " . ,
CERTIFICATE OF OCCUPANCY
READY TO ISSUE / I NOT READY TO ISSUE I I DATE
INSPECTOR
REMARKS
-/
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t:) ,,I 1/.
AI 11/1/./ //!A71
t/V L/l /' v -Po
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PRC
INSTALLER: Complete top part ot
'ED SEWAGE DISPOSAL SYSTEM RECOr
Jrm to signature and submit bott.
INSTALLER'S NAME
Perreo
No. Liring Units
Septic Tank:
Ft. from well
PROPERTY ADDRESS
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. ,
-
Jpies with application.
PERMIT NO. 3073-75 ~ 'GG
Bedrooms
3
1060 Laurel St. Spfd.
BaZhs Basement Water S~pply
Yes No X Pub 1 i c Other-Li st
Steel
o
Concrete KJ No. Compartments 1
Inside
Lenqth
OWNER
NAME
Dimensions: ft.
8 Width 4f Diameter
Gal. Capacity
1000
Depth 5
Tile Disposal Field:
Distribution Box: Yes X
Other Distribution-Type
No
Robert N. Hill, Bldr.
MA IL ING 870 W. Centennial
ADDRESS
Feet from
WEll
Lot Li ne
Front 100+
Ft. Between
Li nes 10
Springfield, OR 97477
Length of Lines-Ft. Trench Total Sq.
1.8'2.703. 4. 5. 6. ,Width2 Ft. 100
Plot Plan (see instructions):
Foundat ion 10 ·
Side 10' Rear 10'
IFiller Filler Depth IFiller Below
Type ItR Above Tile2 in.lTile 6 in.
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Date 1 f.. ?f.. S i q!'ature ~:t/l \f:.q fV\.~
CERTIFICATE OF SATISFACTORY COMPLETION
For Sanitarian Use Only:
In accordance with 1973 Oregon Laws Chapter 835, Section 214 this certificate
as evidence of satisfactory completion of a subsurface sewage disposal system
location.
~ Approved: System Installation conforms to current standards
I (Disapproved: Does not conform to current standards
Remarks:
/,_ o~ 71
Date: "t)' ~
is issued
at the above
4~"
San i t"ar i an I 5 S i gnat yffi
LANE COUNTY V
STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY
C55-11
NOTE: NO PERMIT ~
BE ISSUED UNTIL THIS APPLICAl
PERMiT ~" ~ J,\ <:;
HAS BEEN APPROVED
~ .
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APPLICATION FOR:
CONSTRUCTION ~ MOBILE HOME I I . PLAN REVIEW CHANGE OF OCCUPANCY I l
OWNER&;/7/. /1.11/ ~~~L~~,!'it'J y. t,,~0' JAYu~-~.d/ ~
o Name - Address Clty (/ Zlp / / Phone
CONTRACTOdd'JJ.1/~ ~7~ .:;,<J clltrrlV124 &t~ 7~~'-97/~
J Name Address City Zlp Phone
O.S. R1G. # ~J'
~ 11 TwPdf~ Range::t Sectlon ~0
.n sf(d'lV~!ll~'/~!JuS'+- [d-~ . Lot J,.p
ACCESS TO PROPERTY (Road Name) dt2t:t'd_~ ~~,t-i-
EXlstlng Structures on Property: <77/l}1,l~ -
Property Location - Address/Duect:ons:_ltJ<::o ~~L
Tax Lot
Code
Census Tract
Block
62.,
Property Acreage
'0-" . '"
Wldth~Depth~
J~zI:
r
A
1r7rtf' ~
lfelow fo r Off lce Us e Onl yXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
- ~~ "'-~~'-'- '\
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'--- - ~.
.b--::~. ~ -€-
\\Dr\t. ~) ~\, F~ms
~'j(";L~ ~"\( r'\ ~), ~~,,~C-'\
- 7
/
/
Existlng Sewage Dlsposal System 1/
~ Name of Communlty or PubllC System
/
Valuation 6<c:::>
~\-\ I \~~.
:;) <O?l l . 60
--
.
-
.--..... . S.
SEWAGE DISPOSAL:"......) . "\
Slte Inspectlon # ~ ' r~~
~
~~ln.P'\K~'
or New System Requlred ~
WATER SUPPLY:
Well Spnng (Other Communlty I
~-\.."-~'-Q "-~p \. ~D. ~'9.V-
FEES: '""PLUMBING:
':2. <;1 \ ( c. oc:::;, Installed by Owner I
..,)~ lfldg. \.. ~
I .~ Waste Disp. ~ ()() .00
\~lumblng S\..\.C)()
PubllC
PLUMBING FEES:
\D pi),\ ~ of Flxtur s
'-.-/ .
Name
Plan Revlew
Sewage ~
Connection
/-
Water ~
Connection
./
PLAN7ED
l.\. .~l() I [". I YES I \ NO I l YES I I NO
~l' .~ S,_,"," uf AP"~%_ ~ i't~ I ,,'))-
, ) ~ ~'\ Fee Received By: ~:~ .~\\~~
Min. Septic Tank Capacfty C[.fYf) ~JlnfJld Requued - .Jlneal Feet (,"\0 Maxlmum Depth. .~ M
:M.i/ d~u~'~~X~ ~ (f#-.A~ ~-~~ ~
~ .. t ' /' 1/ '1 orr~ / '/ Vr
..AA4A.(J-. a-- /~ ~(JI'f ~tI~~ C:1Ilt ,r~ r .
f/ -,- - /
1% Surcharge
Mobile Home
TOTAL
Type of Construction
,/
,.I) j;V Group / ~ Fue Zone
,
Use Classlflcatlon
B1dg Setbacks - from Center of Road Rlght of Way:
Front~;'"? Side Int. ::;;-- Slde Extenor
Rear ~
Zone tR;:7l
C 55.12
DATE: ~ SANITATION: DATE:. QU!IDINGi} . d"J../J DATE: '
//-/3 -/~ ~).~ 1/,.. 1.:J-7rfJD~t:J(I;J"'l7-7!J
LANE COUNTY- D;;ARTMENT ~ ENV;RONMENTAL ~NAGEMENT I ..
PI.A~
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