HomeMy WebLinkAboutPermit Plumbing 1975-11-5
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?:fi" -, . LANE C NTY !JUIWING PfR/,\lf OR MOBIL. .1OME USE PEllMlT' ':);','~:,
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. \.t'~,PROPE.RjY-.OWNl:R _______.m__ MAILING ADDRESS PHONE,-,.:.,
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'::{~.,CONTRACTOR MAILING ADDRESS PHONE
'.':" TED SOPTELEAN 5000 PRAIRIE ROAD JUI<CTION CITY OR.EGON 688-97')0:
I. .-..__..~-- .-.....-..... .
:/,:,:PROPERTY LOCATION - INCLUDE POST O~fICE
".J';,"" INLAND Dp I VE ,<ZQ65'~:J~'L!-~
'_~::>PROPER-TY LEGAL oE:scRlPiio"N-'=ME-TES" BOUNDS
:.<"". FILBERT CROVE LOT .56 [kOCK 2
"~,~TWP RANGE SECTION
'ii\) 18 03 28
},}i;;~l APPl,
];,:r~l--~I: NAME, .
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",:fh MAILING
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".,': ., ADDRESS
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.s ap
,;TAX LOT NO,
56
. .' CODE,
. ".:Ct,~SUS TRACT
1'1-183
EXfS,Tf!'iG STRUCTURES .ON PROPERTY"
. TEO SOPTELEAN
"
.,'.
!\!O~!F
LEGAL ACCESS TO' pROPERTY
SAME
I f~LAND v./AY'
PROPERTY SIZE - FT,
WIDTH'
DEPTH
AREA
,;"....FOR MOBILE HOME PERMITS ONLY..
.':~:~? No. of Bedrooms
,::,:".,;!:'.:;,. STRUCTURES TO BE BUILT THIS PERMIT"
;t'!""'.'(PERf<l T FOR HOB 1 LE I-IOME
,'.'
Connect to Existing Sewage System 0
'"TYPE CONSTRUCTION' ;,' SQ. FT. -1: BORMS
New System [
VALUATION
2
':;'iJY:l~':':'\;
;'::,rPE RM 1 T
:~:t~;?':~:l'Y:
TO INSTALL SEV/AGE Dis~OSAL SYSTEM
..-.,'
.:\~,~\:f'.<'
~, ,
: .;:,',:;:: SEW AGE DISPOSAL
''-I
.,--,.. PUBLIC 0 SEPTIC TANK
....,
" PLUMBING INSTAllED, BY
OWNER n OTHER: NAME
WATER SUPPLY,
I.
BUILDING
,
o
.$
OTHERD
".1"
FEES
,~:.".WASTE DISPOSAL
';',:}} PLUMBING
).:,PlAN REVIEW'
'.\~',?;; PARK TRAilER
,'/~V.,~',;;',' SURCHARGE
<t"TOTAl,
: .~~~.~:
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" .~'.. MIN. SEPTIC TANK CAPACITY
'<'y" WITH DIST, BOX, GAl. 'l5C;
~.:f.~r\.:,':
'\:)3':;';.'
~~.;~};}{ ~:.' , "
': ;:\;/~Y P Co F'-STRU (TU RE
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lnn.nn
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.PUBlIC n
o OTHER
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COUNTY BUILDING
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& SANIT /, TlON SPECIFICATIONS
DRA1N FIELD REQUIRED
tiN. FT 150
TRENCH WIDTH FT,
l DE;" TG)R SQ: FT.
:\00
';'.:.
OCCUPANCY'
'ZONE
. PUBLIC UTIt'. EASEMENT
".
,',,"
,;;,;,~-. BlDG~S-ETP.ACKS
~.t 11 c:'
..::.:,,~ FRONT .)
)::\/s/ J.. E, Boss
. FT, FROM CTR. OF ROAD RIGHT 'OF WAY ,
SIDE INT. .~) SlUE EXT..' )~O
---.-- ----------.,-..-..
AUTHORIZED SIGNATURE - DATE
BY HA~8AUGH '.
. REAR
.'('
USE CLASSIFICATION
!)l!r=
.::i
DATE
to';
5Hci~~/~;~I~A~I~N'.
11/5/75 DlM
IMPORTANT:
Call 687-4065 to schedule 011 required inspections. All canstrul
lion shall comply with Uniform Building Code, D.E.Q, standan
for subsurfClce' sewage disposal and county regulations coverin
plumbing. All buildings require a certificate of occupancy befa!
being occupied. ,.,;.;r.. .
(See Details on Reverse Side)
)~~f~!'
. (POST THIS PERMIT ON MAIN BLDG. AT SITE)
lAHE_ COUNTY, DE.PT. or ENVIRONMENTAL MANAGEMENT
COUIW\OU5~ ANNEX, 1:!~ EAST 6111. EuGENe O!lfGO~1 9/-401
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No.II/1f ~8.7!S'
BYIL~ING SITE EVALUATION
,
~BUrLDING PERMIT APPLICATION
() SITE INSPECTION
PLANNING DIVISION Not
API? 11 cab 1 e
1. Zoning Ordinance Compliance: Zone.l2l1d~~)
2. Subdivision Ordinance Compl iance ( )
3. Requ I red Access ( )
4. BUilding Site (Area, Width, Frontage) ()
5. Other (see comments) ( )
COMMENTS.
28 TAX LOT
T_ ")_R O.3s
SUBD,.ISION'
LOT:
APPLI CANT
DATE
No Yes
T)~. 6.
( ) ~
( ) f'"'-
( ).f'1""
( ) ( )
PLANNING DIVISION ACTION PENDING: YESl ) NDl ) APPLICATION#
BUILDING INSPECTION DIVISION
Not
Appl icable
( )
( )
( )
( )
7. Plans Submitted
8. Soil Stability (footings)
9. Flood Plain
10. Other (see comments)
COMMENTS:
WATER POLUTION CONTROL
Not
Appll cable
( )
( )
11. Meets Department of Environmental
Quality Standards.
12. Other (see comments)
COMMENTS,
BLOCK:
CK'D BY~ 1t:>-7-2-~
Setbacks from cll of road:
Front ~'
Side Exterior 4-0'
Setbacks from Interior lines:
Side ~,
Rear 7'AltE:.
f:rrP
( ) ( )
( ) ( ) CK'D
No Yes
T)TI
( ) ( )
Byn~'J-7{
~ATE
,"" '\~M
Ih- ZCj-7~-
DATE
TO APPLICANT:
~o~ BUIlding I Site InspectIon
L ~ Can be approved.
~:1~ ( ) Cannot be approved at this time as indicated on item NO. above.
\\.....:/ ~ Questions and further .nformation on items 1 through 6 contact the LANE-
COUNTY PLANNING DIVISION. Questions and further .nformation on Items 7
through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION.
( ) Will be held in this off.ce until you can resolve the problems Indicated.
( ) Is being returned.
( ) Your build,nq permit appllc!"!.l.9!'.Je<:;. is bein9 returned under seoarete cove.r>--
--DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687.4065
LANE COUNTY PLANNING DIVISION PHONE: 687-4186
C55-28
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LANE (
,NTY BUILDING PERI,II r OR MOBIL, rlOME USE PfllMIT
MH fl
MAIliNG ADDRESS
492 VIEs_",:_13Ro_AO\l".~____ EUGEN_E_S2!.<EG9_~_
MAlllNG ADDRESS
PERMIT NO
~
,l,' ) .-,
111\ I
__M!:I_S:!18- 7:i~, ' _
PHONE, r,
__ __3~j1-2.?57 '"
PHONE
688-97'50
eUllIJlrJG xx
',', PROPERTY. OWNeR ------
. ,
\" tG I~AYNARD
,----
\'11 ;ONTRACTOR
\ TED SOPTELEAN
I ---- - --- -- ----
I PROPERTY LOCATION - INCLUDE POST OFFICE
INLAtJD DRIVE 20~-:l5 11'lLMJO
~-------~--- -
'1 PROPERTY LEGAL DESCRIPTION -METES aOUND$
, FILBEfn GROVE LOT 56 HLOCK 2
:\ 'TWP RANGE Sf CTION
,;t~ 18 03 28
,
d,
1J 'l APPL
" ,
'l{..1o I NAM.E
~~4t\
~i'../ &
5000 PRAIRIE ~OAO
JUNCTION CITY OREGON
TED SOPTELCAN
rAx. LOT NO CODE CENSUS TRACT
56 11-183 "
EXISTI~G STRUCTURES ON PROPERTY
" .
~IONf
LEGAL ACCESS TO PROPERTY ,t
I h!LAND VIAY
PROPERTY SIZE - FT
WIDTH DEPTH ARE:A
SAME
':1 MAILING
,i ,.'
, ADDRESS
,',FOR MOelLE HOME PERMITS ONLY
I No of Bedrooms
>
STRUCTURES TO BE BUILT THIS PERMIT
Connect to EXistmg Sewage System n
TYPE CONSTRUCTIOI>J 50 FT -1: SDRMS
New System l
VALUATION
"'1/'
",', 'PER1;IT fOR HOBILE IIOME
2
: f',
l PERMIT TO INSTALL SE\/AGF DISPOSAL SYSTEM
~I"
"11\'
~
, .
"
\ ;\
" ,
"
FEES
PLUMBING INSTALLED BY
OWt-lER n OTHER NAME
WATER SUPPLY,
'1 SEWAGE DISPOSAL
, PUBLIC 0 SEPTIC TANK 0
,
BUILDING $
, WASTE DISPOSAL
I,:PLUMBING
PLAN REVIEW
,\/ PARK TRAILER
OTHERO
lnn nn
h,nn
PUBLIC 0
o O1HER
, ,<
"
,n,no
.12
LJ3~_.JL__
COUNTY BUILDING
','I
"~~ SURCHARGE
"
j TOTAL
, ,
& SANITATION SPECIFICA TIOI~S
MIN SEPTIC TANK CAPACITY
WITH DJST BOX GAL /j()
DRAIN FiElD REQUIRED
lIN FT 1::;0 TRENOl WIDTH FT
)[)[Ol<DRSQ FT
~()O
I'
".
,(,
(,
,
"
1'\'1,
., '
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,.....JJ'
{~/; ~
, "
l'---~-
~ TYPE OF STRUCTURE
{ hlH'1
" ,
OCCUPANCY
I
ZONE
PUBLIC UTll EA~EMENT
,</s/ J. [,
FT FROM CTR or ROAD RIGHT OF WAY
~ 'to
SIDE 11'11 ~~ SlOE EXT
~------ -
AUTHORIZED SIGNATURE - DATE
Boss BY rlARBAUGH
REAR
USE CLASSIFICATION
/1 rll~
,,', BLOG SET~ACKS
I ~ 1.1'- 1
,FRONT .J
DATE
SHOOK/SAN!TARIAN
11/5/75
OLM
1 BLOG PERMlT - WHITE
'OFfiCE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY"""'"
BUILDING - GREEN
SANITATION - GOLDENROD
H"'j"" L '
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IMPORTANT
Call 687-4065 to schedule all required InspectIons All constl u(
hon sholl comply with Uniform Budding Code, DE Q stender(!
for subsurface sewage disposal and county regulations covenn
plumbing All buildings require 0 certificate of occupancy befol
being occupied
(See Details on Reverse Side)
-,
I,'
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. "ltl~{~I"/
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,~
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(POST THIS PERMIT ON MAIN BLDG AT SITE)
LANE COUNTY. D(PT or ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX lJr EAST 61h EUGENE OREGot~ 97.cOl
"I ,.. .
-- ---.---..-.--
1
,
.
,
SLAB f'LOOR
PLUMBING GROUNDWORK
ApPROVED / / DISAPPROVED / / DATE
INSPECTOR
REMARKS
----- ..., -,,-."-
G~S PIPING GROUN~/ORK
APPROVED / / DISAPPROVEO / / DATE
INSPECTOR
REMARKS
ROUGH PLUMBING
ApPROVED / / DISAPPROVED / / DATE
INSPECTOR
REMARKS
ROUGH GAS PIPING
ApPROVED / / DISAPPROVED / / DATE
INSPECTOR
REMARKS
FINAL PLUMBING
ApPROVED [I..---7~-DISAPPROVED C1 DATE.<:./_/:;1_ll)/{
INSPEC~~_n~o
~ /
REMARKS
FINAL GAS PIPING
ApPROVED / / DISAPPROVED / / DATE
INSPECTOR
REMARKS
CFRTIFICATE OF OCCUP~NCY
RfAOY Tn ISSlJf / / NOT RrAOY TO ISSUE / I DATE
INSPECTOR
REMARK";
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NOTE
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NO PERMIT
-.L BE ISSUED UNTIL THIS APPLICP
/l7 t/;;iffF 75"
lN HAS BEEN APPROVED
,
APPLICATION FOR
t=J
CONSTRUCTION c:::::::::J MOBILE HOME DZr PLAN REVUW c:::::::::J CHAl;Gr: OF OCCUPANCY c=J
.A /'^AYNA~P ,-/or).. Wp.JT (JP,oftD WAy _
OWNER (; eN I; "IF;."'/!. /VIA YNA~ ~ ~lf(YeN do "7'1 Q J .3 Lf 32),;) 7
Name Address City 'np Phone
S cJpTI!I-E.Af\/ .!:JU 00 PI<lt-1 ~/~ p.J) J(//'I(J-I.t.'!fI?7 1/1(1 ~ r !-r7S"O
Address City' lip Phone
I~IJ
Name
~TRACTOR
Existing Structures on Property
/'
cen7Tract
"," :7 'ro,,,,, ~~" / """~""" _
_/her~h/lA/
/ 0-..-1 ,-
/
Below fo r Of f ice Use On! yX:XXXXXXYYVVVYYVY,:VYVYYV~. vV'n~XXXXXXXXXXXXXXXX1Xxxxx.xx.'O{XXXXX:XXXXXXXXXXXXXXX}Q(XXXXXXAXXXXXXXXX:XXXX
m 4 Sq Ft /1 jBedrooms Valuation-
. ( ~ )
~/7n /J j;/J' /tJ ~ .5 II' ,/
/
Existing Sewage D1sposal System ~
Publec c::::::J /
Community ~
/
PLUMBING I
Ins talled by Owner c::::::J Other c:::::::::J Name
PLUMBING FEES
# of Fixtrs Sewage
Connection
{
Twp I J? Range 6.::5 Sec tion -.2 J Tax Lot c ~ 6
,- ST/1 /
Subd'V1s1On_rIt.. 13f-ftl. TC;~O/l/! Lot--"sO
Code
/ I-I'll
o S
R1G II
ACCESS TO PROPERTY (Road Name)
Property Location - Address/Directions
;<;oJII~
J AI /.. A/l/JJ
/J~/v?
SEWAGE DISPOSAL
S1te Inspection #
or New System Required c::z:J
WATER SUPPLY
Well
Spring
Other
Name of Community or Pub11c System
-
FEES
Bldg
Waste Disp
Plumbing
j07J-072
L/.., I'J n
'1 Wa ter
....J.--- Connect1on
,
:;
Plan Review
TOTAL
,3./? (') ()
, / :::L- CJ CASH
/ ~ L/ / d... o::;:j-arECB
tJr,s}:)pJ,SHED
Iftp/YES c:::::::::J NO c::::::J YES ~
Signature of APp~nt ~~intf!Jh"~
Fee Received By a "JtG-1- DateLA ....7-': -7 s--
3
FACILITY PERMIT
Mobile Home
1% Surc'barge
Min Septic Tank Capacity
7 STJ
Dra1nfield Required - L1neal Feet
JSf)
Maximum Depth
Type of Constructl.on M H
Group
I
Fire Zone
Use Class1ficat1on
Bldg Setbacks - from Center of Road R1ght of Way
Front 4~ Side Int ---.S' S1de Exterwr 40'
Rear:J_~_.P() r;- Zone RA -hid
P~l!'ING
cJ.!;(,T /n-2..Z-?c::'
DATE
}!TION () DATE,r- /J ~LDING. / /J/ DATE .
} -20-7n /ff.:f~M.//<J-7.7
( . , '-' I
D P THENT OF ENVIRONHENTAL ~NAGEHENT '
C55 12
LANE COUNTY
INSTALLER
PROPO
Complete top part of fo,m
SEWAGE DISPOSAL SYSTEM RECORD
to signature and submIt both c~~,es with applica.ion,
PERM IT NO. MH '548~ 7'5
\1
\
INSTALLER'S NAME
PROPERTY ADDRE~~
205l1:i ~5i-
'l'NLANO WAY
Baths Basement Water Supply
Yes No Publ'cVOther-L,st
SHOOK
'lED SOJOIIiI-Et:rJ-...r
No. LIvIng Units Bedrooms
Septic Tank:
Ft. from well Steel D Concrete ~r No. Compartments
Inside DImensIons: Ft. Tile Disposal Field'
Lenqth WIdth Diameter Depth Distribution Box: Yes ~ No
OWNER GMAYN. Other Distribution-Type
NAME l'E-O-&Of>-T-EI:E-AN- 1/' '~ 'Aft< D
J.{q'-.. weST 8JQ, Of.f) W(\Y Feet from
HAILING _,?OOO...J:lRA'IR I E-RoAO WEll Foundation
ADDRESS /;../J rrl1- N r; Lot Line () / 0
tJUNC-NON_C I.T.Y_OREGON Front / Side 0 Rear I
Length of LInes-Ft. I Trench I Total S9'0 I Ft. Between_IFlller..kIFiller Depth IFiller Below
:1l2.7f13. 4. 5. 6, Width2.. Ft. 3 U Lines t7 Tvpe I 2. Above Tde::2-,nJrde h In.
'lot Plan (see instructions): ..
I
u~~/
~/
u,
Gal. Capacity
/000
Jlo..[~
,.........
.i7::2 .'
\l II
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IIANE COUNTY
$1ill\l~NM[NTAL MGMT.
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Oat e /\I (j V f(' - 7 l; S I H!' a t u re J-fLM....0.Iv .A ..n-n::t2f t7.Ah'"
CERTIFICATE OF SATISFACTORY COMPLETION ,
For Sanitarian Use Only: Date' 1/-/0-7.;-
In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certIficate IS Issued
as eVidence of satIsfactory completion of a subsurface sewage disposal system at the above
location.
~Approved: System Installation conforms to current standards
c==J Disapproved: Does not conform to current standards
Remarks'
""
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Sanl~ian s Slgnatur
LANE COUNTY
STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY
C55-11