HomeMy WebLinkAboutPermit Plumbing 1992-1-22
SEWAGE DISPOSAL SITE EVALUATION
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SubdiVISion'
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Written Directions
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APPLICANT'S NAME AND ADDRESS d I'C tl 4: I) e h '^ u 11\.+
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OWNER'S NAME AND ADDRESS Oor-of),,, 1=. VI10v v-e....
STRUCTURES NOW ON THE PROPERTY V) GVl .e
Lot
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Phone
PROPOSED USE OF PROPERTY ~ I"1YJc ~u/41li.;. Vt"\ ~ c!-eI.1(e.
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I hereby certify that the above statements are true and accurate, and that I have the follOWing legal Interest In the property owner of record, ,contract purchaser, . ^ potential buyer,
,
realtor or agent I further certify that (If not the owner) I am authorized to act for the owner of record, and that said owner IS aware and approves rf this action '2. '3
,l TEST HOLES READY 'Y.e~. Slgnature_ 1 /cZ;t;,j/ -fl1 I)wf- DatI" ~ ..0 d: q I
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * OFFICE USE ONLY BELOW THIS LINE * * * * * * * * * * * *!' * * * * * * * * * * *
*. * * * * * * *.. * * * * * * * * * * * *...
SITE MEETS STATE STANDARDS YES NO YES NO
Standard System 'p( 0 Low Pressure Distribution 0 0
Sand Filter D- O Holding 'rank 0, 0 ZOning
,
1 Foot Capping Fill 0 0- Other 0 0 Partitioning #
LAND USE COMPLIANCE
Acreage or Lot Size
, .
(TOTAL)
Parcel # ' ( ) Completed
( ) Pending
COMMENTS: 068- .s;;4-?;;nk~L.O
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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.
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~ AU'fHORiZED SI~RE
LANE COUNTY ENVIRONMENTAL HEALTH, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (687-4051)
C55-32
o Floodway
1-2-2--92-
DATE
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
appropnate 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 ENVI RONMENT AL HEALTH
SUBJECT: CONDITIONS OF SITE APPROVAL
lane county
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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 given on the baSIS that the lot or parcel descnbed 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. 454 605 through 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 technrcal 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 Implementing measures or the Statewide Plannrng 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 report IS valid until an on-site sewage system IS Installed pursuant to a 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
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SEWAGE mSPOSftl
PLOT PLAN APPROVED - Iv'-
. A pe~m!t is required
pnor to st.::rlmg construction.
DATE /-'2-'2...... -92- 30'
BY .~~---
Environmental Health Servi
125 East 8th Avenue
Eugene, Oregon 97401 .
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SITE EVALUATION FIELD WORKSP.EET
Tax Reference
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Landscape Notes
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SYSTlli SPECIFICATIONS
:ype System:
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SpeC1al Cond1tions
pr...or PLAN ON P.EVERSE SIDE
HOLD SLIP
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APPLICATION # c( 1- _l:? r
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NAME
ADDRESS
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The Lane County Building and Sanitation DivIsion cannot proceed wIth processing your application because:
1. ~ Incomplete application (items deficient).
o Address and/or directions to application site.
o Proposed number of bedrooms In dwelling.
I!I. Approvable plot plan (see -~. i:I ~). f""fO'-"'~{.,:", 6..10 <..J)
o Notification of date test holes will be ready
2. 0 Verification of existmg system required (see attachment)
3. 0 Two test holes (2'x4'x5' deep) reqUired for expansion or repair of existing sewage disposal
system m the area of the proposed drainfields.
4 ~ Other: ;2t..J- ~ 4. ffi/ Ad- -'~ f!6<,v fu
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If no response has been received in regards to this matter by
the application will be denied
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LANE COUNTY ENVIRONMENTAL HEALTH SERVICES
Courthouse-Public Service Bldg. /125 E. 8th Ave. / Eugene, OR 97401 / 687-4501
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W 3 LANE COUNTY DEPT fNV Me. T RECEIPT :g. 9f03:~9 DA T E:. 12239'1
APPLICANT MOORE, DOROTHY ADDR 492 E. 13TH AVE., EUe.ENE. OREGON
~, ~ rTL=ll' 1703224:~0~600 SUBDIV LOT !ILK: J \
l~lNEW BLOC. TYP~ USE X BDRMS 0 UNITS 001 STORIES IBLDGS 001 PHONE 484 67994-
OWNER NME MOORE, DOROTHY ADDR 492 f. 13TH AVE., EUGENE, OREGON
CODE APPL NO ACTtON DESCRIPTION SQ FT UNIf COST VALUATION rEE DArS
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MECHANICAL FEE
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PLAN CHECK FEE
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The Lane County BUilding and Sanitation DIvIsion cannot proceed with processing your application because
/
1 [EI Incomplete application (Items deficient)
o Address and/or directions to application site.
o Proposed number of bedrooms In dwelling.
[:KJ Approvable plot plan (see attachment)
o Notification of date test holes Will be ready.
2 0 Venflcatlon of eXisting system reqUired (see attachment),
3 0 Two test holes (2'x4'x5' deep) reqUired for expansion or repair of eXisting sewage disposal
system In the area of the proposed dralnflelds
4 D. Other ~']tL dA-"1" 1. .:;(h~ /ti,.,/-.-'~ /Jar,v. ~.<.L- ..1
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If no response has been received In tards to this matter by
the application Will be denied
LANE COUNTY ENVIRONMENTAL HEALTH SERVICES
Courthouse-Public Service Bldg / 125 E. 8th Ave, / Eugene, OR 97401 / 687-4501
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