HomeMy WebLinkAboutPermit Land Drainage Alteration 2008-5-7
City of Spnngfield
Public Works Engmeenng
225 Fifth Street
Spnngfield, Oregon 97477
Phone (541) 736-1037
(541) 726-5931
Fax (541)736-1021
s~ 'lINGFIELD
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Land and Drainage Alteration Permit Application
PERMIT NUMBER~ ,.. 000(,1
BUILDING PERMIT
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Site Address fC --r a I
Subdwlslon ~OtA.tJ'\~~ ~ Lot QS
Spnngfield, Oregon
Assessor's Map 1'+ t>l. 3'" '\3 Tax Lot 621ot>
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ApplIcant Name Address
CIty Sf(L\N~~ State ~
Owner Name ?Or "L.. \~ 't L Address
State ZIp Phone
\rV~ddress p.. (J 'E,u(\' i a-~
State ~ ZIp '11 '1), Phone
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Zip en t..fT\ Phone
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CIty
Contractor Name \-tt:I '-'\. S ~ CcvI MJD
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Mobile Phone S"'\ L.\.. r J.-55'1
CIty
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ReqUired InformatJon
Excavatlon, Quantity \~ \ t'-ll ~ lA.l/V1
Imported Fill, Quannty + t-.J 'U t-J 'e.....
Total
Destmanon KLL ~c.t\:-'U>('\\J;'V ~l1
&L '2-M I'D. tV <0 -1\1 s" l"E:.
SIze ofproJect area (sg ft) \ ~O
Area of chsturbance (sg ft)
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31"0 --.-- A8-03^6~dd"'-
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03UUn:l:lO
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DescnptlOn of Work S \ ~ G0-- ~ ~ \ L-\, \) vJ ~ rJ ~
For this LDAP to be in effect the city inspector must sign offin the box directly below.
By SIgnature, I state I have authonty to SIgn thIS appbcatlOD as vested ill me as the property owner or as
delegated to me by the property owner, that I am the responsIble party and wIll be held accountable for thIS
applIcatIOn, and agree I have carefully exanuned the complete applIcatlOD and do hereby certify all mformatlOD
herem IS true and correct Cl. cy
SIgnature of owner or owners representatIve LfY- Date ~..... ').--0 ~
Issued By
Fee
ReceIpt Number
Incomplete applIcatIOns will not be accepted for submittal.
March 2005
Land & DraInage AIterahon PermIt
I
Contents: At a mIrumum, the LDAP plan (two sets need to be provIded) shall address the follow factors
Please use the check boxes below to assure that you have addressed all of the below mformatlOn on your plans
tt Site 10catJon and VlCIDIty map
tt A SIte development drawmg contaInIng the followmg
a) Soil types and areas subject to floodmg or landslIdes (mclude 100 year floodplam boundanes)
b) EXIStmg and proposed contour lmes
c) Property lmes, easements and north arrow
d) Buildmg pad floor elevatIons and retaInIng walls
e) FoundatIon type and foundatlon drams
f) IdentIfy threatened or endangered specIes habItat (If applIcable)
g) Surface draInage patterns, npanan areas, top of bank and wetlands
h) EXIstIng vegetatIon type & trees over 5 mches m DBH and greater
rt Delmeate areas where ground cleanng or ground dIsturbmg actIVItIes are prorubIted such as but not lImIted to
conservatIon zones, wetlands, publIc or prIvate draInage easements, open waterways, natural resource SItes, buffer
areas, roadsIde ditches, water features and other protected areas
tt IdentIfY measures wruch WIll be 1.ID.plemented to phYSICally protect areas where ground dIsturbance IS prorubIted
tt Show measures for preventIng, and/or controllmg erosIOn, sed1.ID.entatIon and other pollutants mto the CIty'S
stormwater system and related natural resources
rt VegetatIon speCIficatIons for temporary and permanent stablltzatIon (mclude a plantIng plan)
tt Access for all velncles mcludmg
a) Areas where a constructIon entrance/eXIt WIll be constructed.
b) LocatIon ofverucle's wheel wash area (ilapplIcable)
tt All storm draInage facilItIes, such as but not 11.ID.lted to catch basIns, curb mlets, ditches, and outfalls
tt DISpOSal locatIOns and methods of contamment for the followmg
a) Debns and Garbage
b) Stockpiles
c) Concrete Wash Out
tt If a geotechnIcal report IS attached, reference It on the SIte plan
Unless the follOWing mformation is to be prOVIded by tbe contractor please indIcate them on the LDAP. If
the information IS to be provided by the contractor mdlcate that m a note on the plans.
tt ConstructIon Schedule
a) Haul routes
b) Schedule constructIon
March 2005