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HomeMy WebLinkAboutPermit Building 1990-4-23 'tra . 8PfG1'iJG'FI U[) Lane County Authorization ~~ for: FOR OFFICE USE ONLY Si3I7I..L(I <;~7;e;..,., ('TrYt Nt=u)<; .i~. R~. Application//-111 /__ ~/1 Perm~t i /.(/( C/ /4 /V - TOW~SHIP 17 ~ LOCATION ADDRESS 2- / 0 5 /-0 }.,// 00 D T 5eA!Ar.5 STRUCTURES CURRENTLY ON PROPERTY /'lOA.) t= DIRL~~lONS TO 51T~ U(J5 10 '~l 1?1/.rf-r . ) I_L!:>'Y _ ~I ()I!_ ~ESCRIPTION OF PROPOSED WORK - BE SPECIFTc }Jt;u J -:rliJ;yi8 T7tYrJ/{,,/ tfffi'/,08tJl!E . OF BEDROOMS I ; OF STORIES '1 · OF ENPLOYECS O;~"NER I S NAHE AND ADDRESS 25 J2- ) TAX LOT Dour OF o 47t:JV I LOT/PARCEL I Br.OCK CITY ZIP .:s P/?/~ Flr-(jJ PROFOSED USE OF PROPERTY ~Residential 0 Industrial o Corrunercial 0 Public. SECTION STREET q7477 1"i"'J l~( AI, ,-9& S 1_ L &rr1P-d . I DECLARED ~ VALUE Rpcoposed Existing TELEPHONE NUMBER 7~ WATER SUPPLY SJU/ n-f CDNTRACTOR'S NAME AND OSR' S::;?~7' _ - .I'..x'..." ",-21 HPL-M r35 &1J.srr; ~~ ,) :~-- ' : ,.m',"!l":', ) ""RNIT TO BE NAILED TO (NAME AND ADDRESS) A-rru/ -Do-u A/{ t:7dY{G ' ) c.rTlj /')F~;;J-f'u1if/~/C-(j) . :2/25 p/Pi7f ST.'\t1A7k4F/e(lJ /)J(, 97477 I TELEPHONE NUMBER 7~ - f20<7 I TELEPHONE NUMBER, 72t.> -3 ~ 2-:S I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION ~'OR PERMIT, and .10 he reLy cett.ify that all infol"'lllatioll hereoll is true and correct, lInd that I have the following legal interest in the property: Downer of record; 0 cont.ract. purchaser; Oauthori:z:ed agent. I f~rthcr certify that any and all work performed shall be done in accol'danc.. ....i th th.. Ordinances of Lane County and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will ht! made of any structure without the permission of the Building oivision. I fur- ther certify that registration with the Builder's Board is in full force nnd 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. 7JI-""",.a.(" j1=[= _~ NAME (pLease print) ~ ~,~, SIGNATURE ....-{""- / - 9tJ DATE READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION \IAS BEEN BASED ON THE FOLLOWING CONOITIONS! o PLANNING/ZONING, Zon. parti tion " Parcel #I Parcel Size Minimum Setbacks: CL, front eL, side interior rear COMHENTS: Date: n Installation Gallon Specifications: Tank Cfi:S'-L1Jj. ~ ~/ul.~ o PLANS EXAMINATION: Type Groun Lineal Feet of Dr:ainf.ield 'J Y 6 .Jey, I C:ls Installation Record Issued? 0 Yes 0 No Maximum Depth of Tr.?Chfr 121;>.1 (!,A..{'f<2c'/e)/ , Date: n o SANITATION: S. 1. i B. P. ij Use COMl'lENTS : Dale: n ~ PERNIT APPROVED BY- ;;UILD= OFFICIAL/DESIGNEE (oor ORS 456.805 (1)) cJ ;~~ 'J{) . 1ia.s .D"," LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061, -r/60 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 ~ :,::f.~'~~l,_1 SEE REVERSE FOR INSPECTION INFORMATION f',I._?';' QQ.t.. " .- . . , , ./ SETB.\CKS ....:-<0 OTHER CO::OITIO::S OF' APPROV,\L ~lUST BE STRICTLY OBSERVED. VIOLATIO~ 0.:-1 RESULT IN REVQ- C;'71 0:1 or TillS PERmT, CIT.\T10:1 UND~R PROVISIONS Of LA:>;E COl'::TY'3 INFRACTION OROl::';NCE, AND/OR OTHER REMEDIES ALLOWED ay LAW. ~ READY FOR n:SPCCTION. CAL:" 687--1065. A ~IINnlU:'\ OF ,\T LEAST 2-1 !lOURS ,\OVAI:CE NOTICE FOR INSPEC- TlOCl kE:QI,;t:~T:; ;-,UST BE GIVe.;, J-li.l'lC the lollowing info!':natiofl ready: permit number, job address, type of inspection, when it will be ready, your name and phone nu:nber, and any special directions to site. BUILDING DIVISION: REQUIRED 1::SPECTIO:1S: 1. Foundation Inspection: To be made after trenches are excavated and forms erected and when all matCrldlS lor the toundation are delivered on the job. Where concrete from ~ centr~l mixing plant (co~~only termed -transit mixed-) is to be used, materials need not be on the job. 2, Concrete Slab ~ Under-Floor Inspection: TO be made after all in-sl~b or under-floor building serv~~e e~uipment, condult, plplng accessories, and other ancillary equipment items are in place but before any concrete is poured or floor sheathing installed, including the subfloor. 3. ~raminq , Insulation Insyections: To be made after the roof, all framing, fire blocking, and raClng are In ?lace anc all plpes, 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 Gvpsum Board Inspection: To be made after all lathing and gypsum board, ;nterior ~e^terIOr, ~s In-prace but before 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-wbrk~~.done on any par~-of~ t~e 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 befo~e any grout is poured. This rnspect~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~: To be made after completion of masonry (if applicable) and when installation is cO::lplete. Installa tion shall be in accordance ....ith an appro...ed, nationally recogni zed 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-5eptic 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. J. ~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. Swimminq Pool: Below grade when steel is in place and before concrete is poured. Above grade wnen pool-rs-installed. APPROVED PLANS ~lUST BE O:-J THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WITHIN 180 DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS. SUSPENSION OR REVOCATION }~Y OCCUR IF THIS PE~~IT WAS ISSUED ON THE BASIS Of INCOMPLETE OR ERRONEOUS INFORHATlON. ANYONE PROCEEDING Pi\5T THE POll:'!' or REQUI RED INSPECTIONS WILL 00 50 AT THEIR OWN RISK. SUBSURFACE AND ALTERNATIVE ~ 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 Corr~"llunity Development by submitting the installation record form. The Department shall inspect the construction to d(Herminl;! if it complies ....ith the rull;!s contained in this division. If the construction does comply with such rules, the Department shall issue a 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 certific~te. Failure to meet the requirements for satisfactory completion ....ithin a reasonable time constitutes a vio- lation of ORS ~54.605 to 454.745 anu this rule. Setbacks - Subsurface Interior property lines Edge of road rIGht-of-way Buildinq foundation ~clls, other ~ater sources S.;:....aqc Disposa~ SePtic Tank 10' 10' S' SO' Drainfield From: 10' 10' 10' 100' . , , , . . '. :2r/?O 5 tOW? l1)U~ ~ , .,' " .. .' ,. /. . ,- , ',,". ',- C'I',; l~'{'l.:h'~'''ff'.v.,~'''''U:I.li~I'''~i: r , (''i:':.' {.., "t:11/,,:'i-<.;fr;.. 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", "'1 ,;I~L",~:"\--""7. , i ie',. 0' ~ ~oi(: ""~ t:~' :~:;;", )"'~' ' ~ .,~~;[;" " ,:' V~~"l.;~~~ ,~. ".,,'~\ ~:,')".~~~,( ..)," ';,:,:: :", ~ is!:' ~ ': ': J~~l ....;' 'w' ~1P~ .. ~t>" ,:=--, =:-~~;---~-'~'-"1'~ t)Ji\l ~~Ir ,~ \",(', \'" ~"",' Ir) Q \..~~ \ " ,.\\~ " c: ~c. 0.;:' :,' ...... "'l~ """~ _:;"<~ ~~, . ,,' ,.,', ' 1jJ \. " -~~:'::~1) ,v: l~ ,\. . ,,' [ i'~:,\'" ," ~?.'f-:\.i " , 1 J ,;'!,..:. '__ '\ , :."..."( ~~.. >:. ;li'~~ .,1 '.' '.o;~" I,'".,.,.., 05~ -'." , ~ oJ ~ \\ , ~ ('l N ....... ,--'-h" .. ~, I:. ".' 2'f' ..~ D, t:., \ GARfl(.;.1=-. ' " - -oy__ _ 7"i:'!...s...-: , ::\ \;::".:' " " \ : ~~' ~: ' '1 ,;",~,y~~ ,,'; I '''i:':\)~ tt ',: I ~ I '. "':"', ;:. I~ I~~;:.</~';'~,l .. ,'i:'~':~\'1 'J ,.. ,,"',' '....~," I..'!'...-- 'I "';"1,:1, .'. \}!>.;; '''" ~:;: ;,,~. I '. .' , ..... ~.y If; ~Vj j 6M'D'Nn " .1 ". '.1 :,~::.. :/~:::" ..~,. ;,"1" 'i' , , .":: j.' ~ft~~~,,\ ,: :::~;'~f~~~f; ..<,' -, i:., .' , ',' ~~ .t..:'. '., ,I' '! . ;'; AIJt:'" '<.", l.< hi!i;:;- , ..., .. Oi. :.) .. ~. 87, -'.-./ '! ,~.' ~,., 1-"', . . ~:'." .....', I " " '.,;t. -. ..... . , ~: ;, r; ~ i . "'-:i. . '_b'1:50-.,_>/-"rc..o: SEWAGE DISPOSAL SITE EVALUATION ~<":I S.I.#'%J-/b'/' TRS,TI 17-03-25.1.2 TL~ 4700 Lomond Terrace. ~priahfield, OreGon Go to HI,-Y # 126 east to I;ohawk off ra;r,p. turn left to Job Location Written'Directions Subdivision: _ 19th.. th~n rioht on Lemond. ~~r!~.~~ to lot ~14 WATER SUPPLY city Of Sprinqfield , Lot BIoc~ . "':"" . I . APPLICANT'SNAMEANDADDRESS.ll9""~,l"'Je'" Hoare. P_O_ Box 11641. Veneta. Orecon OWNER'SNAMEANDADDRES" ?~,!l'e a~ the2bove STRUCTURES NOWON THE PROPERTY' "0 ",yist:ina stnnctur~",' 97487 . Phone. 935-2901 . Phone. Same Res'idence' PROPOSED USE OF PROPERTY. , " ". . . .' . . I hereby certify that the above ~~~:.~:are true and accurate, and that I have the following legal Interest in the property: xx.x.owner of recOrd; _contract purchaser; ~tential buyer; -"Gattor or agent. I further certify thai (if !lot the owner) I am aUthorized to act for the owner of recoid. and that said owner is aware and approves of this action. ~. . . . , TEST HOLES READY . ~~a'11.').f'~ ,~,_ ' " ' , Sigriatur~':J.,>,;,;,. ,,//':' )}/''';/~(:'',Dat~' ,,' , ...................... ................... ..:;........ OFFICE USE ONLY BELOW THIS L1~E"""'" ~........ ....... ....... ..................' I' SITE MEETS STATE STANDARDS YES NO, YES NO LAND USE COMPLIANCE , Standard System ~..;-- '0 Low Pressure Distribution 0 0 j' I " Zo~ing Acreage or Lot Size. (TOTAL) Sand Filter o '0' HO,lding Tank 0 0 I ! 1 Foo,t Capping Fill 0 0, Other 0 0 Partitioning # . _Parcel I. I' I Completed Pending .-/ , ',0, " :' ] J:' /1'/ ~ :i:' - /: COMMENT~' " ~ _ /j',,':"..., !"o?..." , /; ~f.. .___'!(-!;; /'/- ~,.);'.9 __ . :-:-__- A 0/./.': _- ; ~ :. _-_Y_~,,,- ( j;/~ .f.~ - />, 4"- PE f~.-<-1... h'( r.41/iA~'-x t'\. .:/~ = ~J .(; A;;; ~.t;::~~,/;'~-,~C~, .../:/'.'~.,7~,,?/. . t ...; /.. / . " . -..../.:- . . .~- .~~.(./('=' ...L..~.;/:"~~.' />,..,...".7//;/'//..;,/,1/_, _-/""}//H ~<: .- ,- .. . r ~~ - -. I ~:/~'r: j.j /.:.)/, I, - /'A.~ _ /L.,,~ /) /. ~ . .,..... ,I, ,. . 'FLOODPLAIN INFORMATION " All ~r part of this s~e may be in a flood hazard area for which 100 year flood levels have not been established. Extra precautions may be appropriate to assure that the building site will be reasonabfy safe trom flooding. All or part of this site may be In a flood hazard area for which 100 year flood levels have been established. A building elevation above the 100 . year flood level may be required. All or part of this site may be in a flood hazard area in which a floodway has been designated. Building may be prohibited subject to demonstration that the cumulative effect 01 proposed development will not increase the 100 year flood level at any point o Approximate Study Area, o Detailed Study Area THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE BUILDING PERMIT. ANY PlANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK. IF SITE IS APPROVED, SEE REVERSE SIDE. '. / y-p // - .{/ -r7 ,f DATE . o Floodway ,/, -:7"-:--, '..-' ..L J ~ ..----;.:, // ~ .....---- AUTHORIZEoSIGW,riJRE:,' LANt COUNTY ENVIRONMENTAL HEALTH, , .C5S-32 -' 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (687-4051) ". ...: !. ' .. ... 1, ,'.., ..r... ,....,.. . ..' .:.< ~'. . . I' . .~ '. ....._:' .:. . .,' .'. ~:'.:.:.. .. : . .....-.. .... ..,.....'.. ~:. " .... ," I -Y6/5 -_..J>'1r:c...u, SEWAGE DISPOSAL SITE EVALUATION S.I.# %J-/6';7 TRS,T' 17-03-25.1.2 TL" 4700' Job Location Written'Directions Lomond Terrace. spriabfie1d, Orecon Go to' H",-v *126 east to r;ohaw!: off ra;r,,,. turn left to Subdivision: 1qr.~_ the~ riaht on Lomo~d Terrace to lot #14 WATERSUPPLY citv Of Sorinqfie1d , L"t . BlocI< , APPLICANT'S NAME AND ADDRESS Donald OWNER'S NAME AND ADORES!=' Same E STRUCTURES NOW ON THE PROPERTY, '\! n Tee Moore. P.O. Box 1641. Veneta. Ore con 97487 t!;e above Phone 935-2901 Phone Same evistina stnrctures , ,PROPOSED USE OF PROPERTY Residence I hereby certify that the above ...........~_..-" are true and accurate, and that I have the following legal interest in the property: xxx..owner of record; _contract purchaser, nntential buyer. _reattor or agent. I further certify thai (if not the owner) I am authorized to act for the owner of record. and that said owner is aware and approves of this action. . TEST HOLES READY '~~a'11"'hU '/ Si9natur~I)()J-,::=:;.'~' "L/'; ";"/" --i...:'- ,Oat". ................... ...... .......... ... ... ... ..:.~ .... .... OFFICE USE ONLY BELOW THIS LINE ... ............. ......... ..... .... ........ ........ SITE MEETS STATE STANDARDS YES Nq YES NO Standard System '/ 0 Low Pressure Distribution 0 0 LAND USE COMPLIANCE lQ / Zonin,:, Acreage or Lot ~l...... 'TOTAL) Sand Filter 0 0; Holdin9 Tank 0, 0 1 Foo,t Capping Fill 0 0, Other 0 0 Partitioning I Parcel I ! ) Completed ) Pending .-/, ' '., -=-,,' /': COMMENT!=:' -::-,,-, o' ,f..." .-........... ./.;':n"'__ ....-.../i.'fi...............t;:.-1......~C '//- ~_ P? !~A_ /;'{ r:LZ1/iA_;'J.~ , ~/ .....Y- _ ~.,....( j! V_. ,J i"- A :./}/",/1/I'..: ~,,:::-r-- ,..-, //"A "';"A- 7 A ,r, : ,~' j' .-;/J_~ /.,~~ ~. .j ;~, , I "'./>:.'f:'- i! /.;~:'~. ~L.~~ /"~/,,,,,,,,,- /) I."" . ,/: YF AG ,- /; :../,~-,,,:t .,/ -7" /." r:-. ". .... "/ / ,-.:... ' "....,..!.!........_..-/,. ~J.....-'-'~ / " ., ~, ,;',.{ , , .' " '. './ . - -- .z!rf .': -- . i FLOODPLAIN INFORMATION o Approximate Study Area o Detailed Study Area ' THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK. IF SITE IS APPROVED, SEE REVERSE SIDE. , / ,yP //- 4/d/ DATE - , o Roadway ,-,~-:-""".... ~.. ~ ,"'----;:. p..... ----. ____ ' , AUTHORIzeD SIGNATURE" ' LANE COUNTY ENVIRONMENTAL HEALTH. C55-32 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (687-4051) Allor part of this site may be in a flood hazard area for which' 00 year flood levels have not been established. Extra precautions may be appropriate to assure that the building site will be reasonabty safe from flooding. Allor part of this site may be in a flood hazard area for which' 00 year flood levels have been established. A building elevation above the '00 . year flood level may be required. All or part of this site may be in a flood hazard area in which a floodway has been designated. Building may be prohibited subject to demonstration that the cumulative effect of proposed development will not increase the '00 year flood level at any point. 'VGt$-S;JruJ. SEWAGE DISPOSAL SITE EVALUATION (tG IO~/3 S.I.# ?f/~/ TRS, Tl 17-03-25.1. 2 TLN 4700 Job Location Written Directions Lomond Terrace. Sprinqfield, Oreqon Go to Hwv #126 east to Mohawk off ramp, turn left to LOI Block APPLICANT'S NAME AND ADDRESS Donald Lee Moore. P.O. Box OWNER'SNAMEANDADDRES~ Same as the above 19th. then riaht on Lomond Terrace to lot #14 ~TERSUPPLY City Of Sprinqfield #641. Veneta. Oreqon 97487 Phone 935-2901 Subdivision: STRUCTURES NOW ON THE PROPERTY No existinq structures PROPOSED USE OF PROPERTY Phone Same Residence I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: xxx...owner of record; _contract purchaser; -potential buyer; _realtor or agent. I turther ce,rt~fy that (if n?t the owner) I am authorized to act for the owner of record, and that said owner:TI~s a,,!ion, . . .~.~ ~~~~~.~~~~~. ~.~~~... ~ r....... OFFICE USE ONLY :~~;;~~ L~E~"'"'''''''' ..~~~:~:...... ........... SITE MEETS STATE STANDARDS YES NO YES NO ~ LAND USE COMPLIANCE Standard System 0 Low Pressure Distribution 0 0 Sand Filter 0 0 Holding Tank 0 0 Zoninn Acreage or Lot Size ITQTAL) 1 Foot Capping Fill 0 0 Other 0 0 Partitioning #. Parcel # ) Completed ) Pending FLOODPLAIN INFORMATION o Approximate Study Area o Detailed Study Area THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE BUILDING PERMIT, ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK. IF SITE IS APPROVED, SEE REVERSE SIDE, t?<7 ~ ~A4- _ //-~~ __ '-j(UTflORlZlill8fGNA~ DATE - , LANE COUNTY ENVIRONMENT~EALTH, 125 EAST 8TH AVENUE, EUGENE. OREGON 97401 C55-32 o Floodway (687-4051) -- All or part of this site may be in a flood hazard area for which 100 year flood levels have not . been established. Extra precautions may be appropriate to assure that the building site will be reasonably safe from flooding. All or part of this site may be in a flood hazard area for which 100 year flood levels have been established. A building elevation above the 100 year flood level may be required. All or part of this site may be in a flood hazard area in which a f100dway has been designated. Building may be prohibited subject to demonstration that the cumulative effect of proposed development will not increase the 100 year flood level at any point. - . MEMO TO: APPLICANT FROM: LANE COUNTY ENVIRONMENTAL HEALTH SUBJECT: CONDITIONS OF SITE APPROVAL klne county .. . Any alteration of the natural conditions in the area approved for the on-site system or replacement area may void this approval, This approval is 9iven on the basis that the lot or parcel described above will not be further partitioned or subdivided and that conditions on subject or adjacent properties have not been altered in any manner which would prohibit issuance of a permit in accordance with O.R,S. 454,605throu9h 454.755 and Administrative Rules of the Environmental Quality Commission. Any such subdivision, partitioning or alteration may void this report. WARNING: This document is a technical report for on-site sewage disposal only, It may be converted to a permit only if, at the time of application, the parcel has been found to be compatible with applicable LCDC-acknowledged local comprehensive land use plans and implementin9 measures or the Statewide Plannin9 Goals, The Statement of Compatibility. may be made on the attached form or its equivalent. Authorized Agent approval is required before a construction permit can be issued" This reportis valid until an on-site sewage system is installed pursuant to il construction permit obtained from Lane County, or until earlier cancellation, pursuant to Commission rules, with written notice thereof by the Department of Environmental Quality to the owners according to Department records or the County tax records, Subject to the foregoing, this report runs with the land and will automatically benefit subsequent owners, Only persons having a valid license issued by the Department of Environmental Quality under ORS 454,695 to install subsurface sewage disposal systems or an owner or contract purchaser or his regular employees may install subsurface sewage disposal systems. A certificate of satisfactory completion will not be issued if persons other than the above perform the installation. . -- ......... .. . ...... ......;:"}~.. Existing Buildings or Improvements on Property / CJ House W'A()V CJ Barn V CJ Garage CJ Mobile. Home CJ Shed SEPTIC INSTALLED CJ Yes CJNo Water District SppJO/(.,.fr'r-~j !J:tiJ.1~ ~ , i~j;~7d all ;n[ Fide j:1;eo ;;s, 'DO, 'P>o)( 6L/-/ 'J;"F7;LLf A . 0 p.~ CITY if possible. {.i3 51. Cf.Ql "1'H'cJNt: q7Lf'l7 ZIP OWNER OF PROPERTY (II not ..me .. above) PHONe OWNERS ADDRESS (II nol ..m. a. above) ZIP l.V"',nJolt,,;IUI1 Llc.n.. . ~ ............... ,,:'::'::.::::.:.,:~::::<.:.:::=::: .".... ~ . . MAP, PARCEL NUMBER (F~Und on to m.- In It,. A.....m.nt . Taxation ~ T!~ZjP 12n~ M- 1'4 L:u?-- lax lo?#O TownshIp "'iia;;;;- SecUon 114 BIIellon To Lol lown.fllp Ran. l:ieCll0n 1,. _cuon .ax LOI \ . . Directions to site from Courthouse {;fo 1b l'J.b C/-lS+ 1'0 l"1oHt1.w/( Cl-M Rm,p fUR ~ ./.trf+-ro It(~ t4~ d -th....N 'A. I'<h-/-It ~ N to No W rf -ro J.,<:rt-/y SITE ADDRESSlofl,!, Bt...oc(,,\ 3. jG;4r!j,t,'oW 14 t:..oCK AO'h1oIVQ-1-eRRoC e..- , 'i. , MAIL PERMIT TO: f -:JJoMIJL( "AM~ ~ ItL 1'-'.0, :ua:>X n"""l} ENE t A Il100RE L..~-e. btlJ (lJA.. OJ7C('X7 ..i,' ZIP . ..... ...... ..... ...................... .. .... . ....... ..:..... :.":'::'''';'.':''':'::'.: .... ........... ....w....,..... ................:.::,....;-::,.:...: . Land Management Dlv. staff can not be held responsible for evaluations or recommendations based on false, Inaccurate or Incomplete Informetlon ZIP .. ., ~".: For Mobile Home Placement Only Brand Year Size No. of Tip-outs No. of Bedrmc License # i . ,-- " -L-t~ ~, \ ,--- . . . I . . . .' . . j, . .8 ;" J 8 . .~ f . w .~ ". w ".!' . .':. ~ B ~ . . ,1, t . .f . go . .! 0 I'~ . .~ .. .... - -- ___. ___ ____ u u ., - - -- __.. __..0 ____ . . "J I . I..:ANE COUNTY DEPT ENV MGT RECEIPT ::: 880167 DATE 101388. APF~ICANT MOORE, DONALD ADDR PO BOX :::641, VENETA" OREGON TLO 1703251204700 SUBDIV LOT BLK ~EW BL.DG TYPE USE X BDF(MS 0 UNITS, 001 STORIES '~BL.D~S 001 PHONE ';>35 2901 .' OWNER NME MOORE, DONALD I ' 'ADDR PO BOX 0641, VENETA, OREGON, , CODE APPL. NO ACTION DESCRIPTION SQ FT UNIT COST VAL.UATION FEE DAYS~ RP ~P BP ''<F' 'P ,. ~ 1 "'L' ~'FIX/f.'ATH: -'1ECH sur~ ...f'CK ~I SDI~Q . . "~~ iD .~ III 'SWF! : FT. WTR: MECHANICAL FEE STATE SUF(CHARGE . PL.AN CHECK FEE, 1 FT. F(AIN: FT . , 9 e! L.C 880167 SI 150.00 150.00 15-')0 " ;; ... .~ . '. I'q~ .~ . 5% e:ATG: .,E.QU: , r "T!-!KEN APF' 1 BY RtH r~A FP SDS SI ' PCK O)'H- ISS 3 DEPOSIT Hi 1-.. I . 165.00 CI< l ~ .~ 2 EST, COMPLETION DATE . . o j .i Tu Rotero."" I, -0 J - J.... 2.- tr1~ D , . SITE EV ALUATIOII F1lJ.D WORK.Sl\EET , L./l7tHJ . Aater: Dote: ,1/- 'Iff ~- ,- (/ IT - /07 i Applicant . D.ptll Tex~ure Soil Maerix Color And MOttlinq (Notation). 'Coarse Fraqments. Roots, ~ L=uro. Layo:,Llm::;;;z:.Oi1 DO:;;~' ~ _ {, '1 I '~ 1/1 ~ ;t:;-tfJrj bl ' v 'O~38" .J ffr(' r. SJ~ riQr.JIJY s .L PAt 1 PAt 2 cJ -.J..t./ SI'L M~ V1;L/, MAl 2.L{r(,'If' ~P..a~1': ,~ ~ /~,n-. '-'~ / I j ~ /., AA..,'i' a'fri/I;; 111:',. (f '/1',) / PAt 3 ,PAt 4 , , I j :capo HA f- Other Site ~'tes LMA'LlR./I I'JI../ ~ ~J~" . lopo.t Gl'olllldwa.... SISml Sl'ECIFICl.TIOlIS , # I.JO /u-v{ 4{nJ ~,' , 1YPo Sy.tell: /J Dl:USII nOlI ~ IA1t1al ~..;...#t % . ". Sys~em S1z.1na: \ r;::) I" 11~ s- Max. Capeh Absorption FacUity Un) ~ V (I Repla_e.t r.- Sy.tecI SUing 00 /150 g. Hax, Depth Ab.orption Facility (lnl' ~ ~ 'Z :":7:}i~:t:~'Vth':J~, ~t:t/f:, r'A" I, '7r . I /'01 . tf .- 1/ . ~ /, N h oM.D A 'v {5 M fA t: . \ .~~ :-:,=-+, ~() ( IY PUlr4S APP~C:")~D , ',. r"'-" A building permlI IS , __,' " prior to starting con,~)p /I-~-~- -- DATE -, tf-v:. tA BY B1ilTdi;j-~"fSJn;' a'tion ulvi,',.. 125 ["'8th l1ve./Pub. SejIJ, CI'" cug~"'\ v'- :.1 ~/"",l iS031 (87-4061 1- -7..i2CS+__ -1,6, - - f./~t-::L'-_ ,~ ftl?@~ 1~_ 2C 132 ~. ~ - ~ ~~~ t il f\ ~-o -, 'lV I _ "'N~",,( _ _ _ . tc~~ ((E~6;ff(-4~<fr --I:;J: ',,~- (d' \, ", , , 1 '"\,- . e- . . . . "i 1 . I .' i " '. . rr. 1 ~ . . . . 11 i . . . . rf r . . . . 1'1'1 . . . . 'I r . . LANE COUNTY DEPT ENV MGT RECEIPT 0 120190 DATE 042390 APPLIBANT SMITH. NA ADDR 2105 LOMOND TERRACE, SPRINGFIELD TL'::, 1703251204700 SLJBDIV " LOT' ElLK. . "::"J <'I D"' 'I'Y"::"E:' U"I::' I" '<Df""<-', LJ"T....'" 00'" <':"")C'I'"'..' '"BII)-'" 0'0' F'I"CI N I::' 741. ,"';'69 . 'I: 1... v J.: .., b.. .':)._ \ L \ d ,j l. 1'(.__ I..).. I ,j I t " 1:_ S If . _. lr u I 1 _ I ~.) ..... OWNER NME SMITH. 'NA ADDR 2105 LOMOND TERRACE, SPRINGFIELD . CODE:.. I<\PF'L NO M:.TIClN DESCIUF'TIDN SQ FT UNIT COST VALUATION FEE 31'" l'W, Ell'" .:<F' 1'1' Jill=' ." " .. '1 ~ "; nAy,te ,'"" ' .~ .:'L '~'FIX/BIHH: MECH "',If" ...'.'" . ,:'CK SDS LC 120190 SDSS .,bE[1 SI,m : FT . ~ITf( , ME:CHM~ 1: CAL FEE , STATE SURCHARGE I::'U\N CHECK FEE FT. F:,UN: FT . ~)% 2~j%' .. II' . .:A"f'[' : -. , rr SEQU: . .TAI<EN AF'P 1 BY f'B f(A FP sns SI F'C1< OTH ISS 3 DEPDS I T *,), . 2 ~) 0.00 F'(j . EST. COMPLET1:DN nATE .' .