HomeMy WebLinkAboutPermit Septic Tank 1995-8-16
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REQUESa
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TOlMIISHP RANGE 5CCnCN V.Si:CT1ON TAX-LOT SlAlOMSlCN/Pot..RTTTJ:N LOT/PARCEL IlI..OCl(
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PRCIFClSkOUSE SEPf(;NSTAlLSD WIl.1ERNiT4ll..I:.D IIoQ.OFSTORlES NO OFEMPt..OyEES c:oNSfRUCTlONCOSTNALUE
-DESCRPllCNCF I'JO'CSEO WORK
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OJRECTlONS TOSffe. FROU NEAREST lMlH MERSe.... ~
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OWNERS NAME' ADDRESS
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~ MAIL PERMIT TO: kr7 AI: oC.tCI\I MCo-cS
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NAME I" I STREET
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I have carefully read BOTH sides of this application and hereby certify that all Informetlon Is true and correct
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READ CAREFULL VI Vour Authorization Is
FEES DUE:
APPROVED BY:
DATE
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(CALL FOR INSPECTIONS (SEE BACK OF FORM FOR
SEPTIC permits are. ~O~d__ for, ~ne year. _ AL~_ other permits expIre
LMD 040 Rev. 6/92
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INSTRUCTIONS) 687-4065
after 180 days unless Inspect/ons are
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VIOLATIONS
.:: smACKS AND onmR ..._._.......... OP APPROV ALMUST BB S1RJC1L Y OBSERVED. VlOLATION CAN REStn.TIN RBVOCAll0N opnus PERMIT.
CITATIONS MAY BB lSSUBD UNDER. nm PROVISIONS OP LANB COUNTY'S INPRACIlON ORDINANCE AND/OR. onmR RBMBDIRS AlLOWED BY LAW,
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A MINIMUM QP AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS
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Have the following information ready when you call: 687-4065
Permit number - Job address - Type of inspection requifed', \- 'When it will be ready' :
Your name and phone number - Any special directio~_tp.~~_s,~t1 ',' \~ ~';'...-\ \.
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PUBLlCOmClA.LRIGIITTOTRESPASSONPRIVATEPROPERTYORSns.oao.~ ... __." . \ .,
POWER TO ENTER UPON LAND. niB COMMISSION. AND ANY OP ITS MEMBERS. OPPICBRS AND BMA..OYBS.IN nm PBRPoRMANCB OP1lIBIR.PUNcnONS.MA Y f'
ENTER UPON ANY LAND AND MAKB BXAMlNATIONS AND SURVEYS AND PLACB AND MAINTAIN niB NHCBSSARY MONUMmITS AND MAR.KI!RS nmREON,
REQUIRED INSPECflONS
FOUNDATION INSPECflON: To be made after excavations for footings are complete and any iequir~ reinfo;bing stebJ'iS in pi."e.' " \ :", ..,
UNDERGROUND PIPING INSPECflON: To be made after all underground piping has been installed, prior to any backfill.
CONCRETE-SLAB OR-UNDER'A..00R INSPECnON:,To be niade 'afier'aJjin-slab'oiunder:lioor buildirIg seiYiceequiPmci.~ coridui~ pipmg,
accessories and other ancillary equipment items are in place but before shy concrete is placed; oLfl~r.shea~g installt4. including th.e ,s~bfloor.
ROUGH MECHANICAL INSPECflON: To be made after all ducting and gas piping has been'U;SJIl~ and prior to bbiJg 'covered!' \ '"
ROUG,H~P(:l!MJ;lIN9 IN~PECflON: To be 1IJ~: aft!'" '!.~p\~!>-ing rough-in';s'inplace, pi'iil,r,lp being,covered. ,': : ,". ,'.,,, ""~' '
FRAMING INSPECfION: To be made after the all framing, fIre blocking, bracing and roof are in place and all pipes, chimneys and vents are complete
and th",niugn"~lectriCaJ"pl,iunbing, and mechanical inspections have beeninade,and,,;ppn;-vfd,~-'\ i" .\.. ", \ ;Ii.... ','\0\';' i~" t:, "'
INSULATION INSPECflON: To be made after all insulation and vapor barnen; are in place, prior to covering.
LATH AND/OR GYPSUM BOARD INSPECflDN: To be made after all lathing and gypsum board, interior and exterior, is in place but before any
plastering is applied or before gypsum board joints and fastenen; are taped and rmislied".. '\"". \., r \. : ',,1: i r',
AilD,iTIONAL INSPECTIONS,MAY BE'REQUIRED::5uch .h'Uinot lliiiited -;;;:,c;..:; l'., ~ ",'. '.,' \\ ';'" , "'\' Y-I '-,
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BLOCK WALL: To be made after reinforcing is in place, but before any grout is poured. The inspection is required for each bOnd beaJD pour. There"
will be no approval until the plumbing and electrical inspections have been made and approved,
FINAL MECHANICAL INSPECflON: To be made just prior to the structure or remodeled area being occupied and prior to operating any equipment .-
FINAL PLUMBING INSPECflON: To be made just prior to the building, structure or remodeled area being occupied.
FINAL BUILDING INSPECflON: To be made after finish grading and the building, structure or remodeled area is completed and ready for occupancy.
MOBILE/MANUFAcruRED HOMES: An inspection is required after the mobile home is connected to an approved sewer or septic
system, prior to covering sewer or water lines, for setback requirements, blocking, tiedowns and plumbing connections.
Footings and piers to comply with Slate foundation requirements for mobile homes or as recommended by the manufacturer.
Minimum rmished floor elevation shall be certified when required by Floodplain Management
Tiedowns, if required, shall be installed and ready for inspection within 30 days after occupancy. Tiedowns shall be installed per enclosure.
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.
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APPROVED PLANS MUST BE ON TIlE JOB SITE AT All. TIMES DURING WORKING HOURS,
TIllS PERMIT WIll. EXPIRE IF WORK DOES NOT B~GI}" WITIIIN 180 DAYS, OR IF WORK IS S wrrc.u OR ABA"u,<"cu foR MORE TIlAN 180 DAYS,
SUSPENSION OR REVOCATION MAY OCCUR IF THIS PERMIT, W AS ISSUED ON TIlE BASIS OF INCOMPLETE OR ERRONEOUSJNFORMA TION,
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ANYONE PROCEEDING PAST THE POINT OF, REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
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Yoursignature on the front of this fonn verifIes the fo11owin~: ,I HAVE' CAREFULLY EXAMINED TIllS CO].fPLETED-APPUCATION,'and aD"
hereby certify that all information hereon is true and correct. and that I have a legal ~terest in the y....y.....) as owner of record or authorized agent ~
further certify that any and all work performed shall be done in accordance with the Ordinances of Lane County and the laws of the State of Oregon per.
taining to the work described herein. I further certify that ifl am not the owner of the r...r....~~J. my registration with the Builders Board is in full farce
and effect as required by ORS 701.055, and that if exempt the basis fo~exemp~n is noted h.ereon, and that only SUbcon, tractors and employees who
are in compliance with ORS 701.005 will be used on the job. ~..~ ~ 0 ~ ~~ 0
SUBSURFACE & ALTERNATIVE SEWAGE DISPOSAL Sysfti1lll>: ~ t!0b' ~ ~~.,
When subsurface construction is complete, the permit holder shall notify thc€i~ty Land ManagemllQi,Y' l}~ib1lut' . taIlation record
farm. An inspection will be made by a qualified sanitarian. If construction complies with all rules a ce r.1ca e Ofc~omoPf( eti wit' issued to the permit
holder, If construction does not comply with rules, the permit holder will be notifIed, and all correcti -shall Il'<>'.ha (\lr~rtificate of completion
will be issued. Failure to meet satisfactory completion within the allotted time constitutes a violation of ORS 454.605 t ^ and this rule.
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SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK DRAlNFIELD
From: Interior y....y.....; lines 10' 10'
Edge ofroad right-of-way 10' 10'
Building foundation 5' 10'
Wells or other water sources 50' 100'
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ro""',"SHIP / '7 I RANG; 0 ~r ..1 i,,~:>;ION .~ ./:::: ., TAX IA?.J .........-..OOUT ~~.. ( .I.=~~D ~~.S_E_ O.:.:_~~PERTY __ _
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SCBDIVISION/PARTITIDN (if..~P,PhC~~I":I.:: ;.' . ~ "Ie , '~" " :; I LOTmRCE~ I ~~K;" > .: : T tJ .S~;;'~~?~i,~ ~~ 0 Public,
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D"NE' AMEAND ADD~ / ./ _ /::? ~ /:;::? , I TELEPHO~:.JIUMBER I
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- ~VE CAREFO~L't EX~NE~"T~~~T:O .~P~L.I~AT;Ot~ FOR PERMIT, arId <.10 hcrclJy certify t:..h"at a~~ info~ti~n heceon is t~~e and correct, and that I I'
hay the following legal inteZ ~~~'-the property: OO'ol'ner of record; 0 CCint:.rdl:t- po.rchaser; authorized agent. . .
I :.:.rther certify that any and all work performed shall be done in accol-da:1Cf; i..ith ct.:! Ord' an 5 of Lane County and the Laws of the State ot Oregon .
pertaining to the work described herein. .and that NO OCCUPANCY will be .::lade of ar'J' structure wi t the permission of the Building Oivision. I fur-
ther certify that registration with the Builder's ,Board is in full fa 'e and feet as"re'iuire ORS"OL05S, that if "exempt the basis for exemption
is noted hereon, and that only subcontractors and "employees who are 'n complia ce with'O~;7 .0 will ~ use~ 'on thi~_p~oject. I HAVE READ AND
CHEC~~~~/d
- '-NAME Iplease print' J DATE
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READ THIS SECTION CAREFULLY., YOURJ~THORIZAtfON qAS BEEN ftASED ON THE FOLLOWING CONDITIONSl
o PLANNING/ZONING: Zon~ -%/./{fi! Partition # Parcel # ~a"rcel Size
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.~ # Date, - /t::7P~~iA~j
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SANITATION: S. I. # 'B. 'P. # Installation Re~rd Issued? 0 Yes ONO
Installation Gallon Lineal Fect kaximum Depth
specificatiO:,;:.1 . Tan~ ,~_." .of Orainfleld ,: ./!. of -Trenches ~"
Coo.'lENTS, ._/kJ)-.~----R').\.~"~~~ f--A"Y.-' f ~ .
dt /A,,;.,;!';C..' /, Pya..".. ~aJ..!. ~ ~ Date, la-Itf... ~
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COM.'lENTS, ~ /4:?'
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Date:
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~"t: AI'PRovtO BTBU~ OFF.(CIAL/OE-rlGNEE (cer ORS 456.805 (1)) eATF.'. -
LANE COUNTY ~ARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
ITY'OF SP INGFIELD .
EVELOP EN .SERVICES DEPARTMENT
25 FIF. . TREET
PRINGFl ,OREGON 97477
HONE: (503) 726..3759
. SPRINGFIELD
EHPORARY USE - EMERGENCY HEDICAL HARDSHIP APPLICATION
OCATION OF PROPERTY _J <;( q bl2n:71 vJ1l/~ /JJ2'5;CR/ /'K}P~
ESCRIPTION OF PROPOSAL ---;;. ,/JlI/;'}/J ;:I,,ClJ/?/,,j .""'" / 1'!2/JLJI:L -I-RI9//d2
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,PPLICANT NAME
,DDRESS
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IN THIS APPLICATION IS
IIINER NAME
lDDRESS
:HE UNDERSIGNED ACKNOIILEDGES THAT THE INFORMATION
:ORRECT AND ACCURATE, . //l
IPPLICANT SIGNATURE L'/~~ 1J1}m/'YJ
[F THE APPLICANT IS O~~D;.fHAN THE OIlNER, THE O\INER HEREBY GRANTS PERMISSION
'OR THE APPLICANT TO AtVfN~TH :R BE?tF,
)IINER SIGNATURE ~ /<f~
'LEASE ATTACH THE PHONE NUMBER AND SIGNATURE OF ANY ADDITIONAL
?ROPERTY OIlNER,
OVER
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w: 2 2 3 LANE COUNTY DEPT 'ENV MGT RECEIPT 0 273895 DATE 081595
AF'I'."L.ICANT r~ENNER, JIM ADDR 184 GI,EENVAU: ST., SPRINGFIEL.D, (}f~E .
e TL.~' 170323330B900 SLiBDIV . _ LOT BLI<
'I~NEW BL.DG TYPE USE R BDRMS 0 UNITS 001 STORIES OBL.DGS 001 PHONE 726 iB6~!;
I. ,.. OWNEf~ NME I:~ENNEF~, .JIM ADDF~ I 04 Cf~E':[NVAL.E: ST., SPFnNGFIEL.D, 01'([ . ,..
. CODE APPL NO ACTION DESCI:nF:'THlN S(~ FT UNIT COST VALUp,TIDr" FEE DAye
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