HomeMy WebLinkAboutPermit Plumbing 1994-2-21
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VICINITY MAP
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LA,'r.. \;UUI~ I Y
I::IW1RONMENTAL HEALI h
"I HAVE PERSONALLY H~SPECTED THE SYSTEM
SHOWN HEREON AND CERilFY THAT IT IS
CONSTRUCTED IN FUll CG:APll.t.:-'~E WIT~
THE PROVISIONS OF OAR 340 D!ViS.ON 7L
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-, r _ c..f MUST BE IN BLACK INK
Permit No. 45'"'1 9 Twnshp.) 7 Range 03-
Standard System ~ Alternative System 0 (Specify Type)
Job Location (Street Addressl Z. ~ ~L.h.:J
Supdivision/Partition # --,-,^b~ ~~ Parcel
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DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED
... form c55-11
Section.:z.3.# Tax Lot /Ck:>
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Scale
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USE BLACK INK ONLY
FOR INSTALLER'S USE: Trench Depth "2.4- ... Gravel Depth Below Tile C. ...
Tank Capacity Manufacturer
Measured Distance from Well to Tank From Drainfield Total Length of Lines_~'
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's name) certify that a (Mfg.) (Model No.) Pump
and Mercury Float Switch (Mfg. and No.) have been installed with this sewage installation.
Signature Datp
FOR SANITARIAN~U~ ONLY: rK,Sys\llm Approved
COMMENTS: L--X.r .str a.A 0:a.J:::.. _
r'/:---"" .")c~_J~.Y oAIC
,h!c.,~ ..;W[~I?
System Capacity gal./day Signature
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INSTAllATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this certificate is evi-
dence as per GAS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location.
To request inspection, relurn alllhree (3) copies of this form to: Lane County Environmental Heallh Services, located in the basement of the
Public Service Building, 125 E. 8th Avenue, Eugene. OR 97401.
o System Disapproved
o Needs Correction
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SP:~_ELD
Th following project as submitted has I~O 'e,Howlng
zo~ing, and does not require SP6\,.,':IC I~ilct ;.ISQ
approval.
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPEctION REQUEST:
OFPICB: 726-3759
97477 Zonino LDQ
0'&4-37693- \Io-qy
. Iwlhorized Slgn"ur"'" A \,.~
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1. .LOCATION OF INSTALLATIONj _
.:,)0n \....\.r"A\N'~<..t. ~ A.
. LEGAL DESCRIPTION
n D';2.,';:l:1.,Li4
OO"lO()
JOB DESCRIPTION
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Permits are non-transferable and expire
if york is not started yithin 180 days
of issuance or if york is suspended for
180 days.
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2. CONTRAC'rOR INSTALLATION ONLY
,
Electrical ContractornTY(1N .1.rTRTr
Address
1130 BAILEY HILL RD #24
City I'IIGENE Phone 144-~1q~_
Supervisor License Number
36145
Expiration Date
10/1/95 ..
Constr Contr. Number
..
'..:,..
fifiAq4
Expi'ration Date
~ .!2..1L!ll'
Si.~ ture of Supervising Electrician
i{)< uP !GJ~ .
ovnerJXame~()\-'P^+' Ck>A fA cP ('j'J:f(2 D.
Address ~S::lD 1r-lA) f'\ \AP~+-, Lh^^ 0
City~ Phone
OVNER INSTALLATION
The. installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Ovners Signature:
---------------~,-----------------
DATE: Z, -( (0 -q'-j
RECEIPT t: . () '1(n!
RECEIVED BY: (1A. ,~
ELECTRICAL PERMIT APPLICATION
'City Job Number
~vnr~'(~ FEE SCHEDULE BELOV
CjL..jf) \1"1
Nev Residential-Single or
Multi-Family per dve1ling unit.
Service Included:
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dllelling
Service or Feeder
B. Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
Items
Cost
Sum
$ 85.00
$ 15.00
$ 40.00
$ 50.00 ..so..Oo
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or'Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
$ 40.00
$ 55.00
$ 80.00
see tlBn
above
Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit $ 35,00
Each Additional
Circuit or \lith Service
or Feeder Permi t .., $ 2.00 J!::J..!..v
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
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