HomeMy WebLinkAboutPermit Septic Tank 1984-7-20
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Lane Co~ty AuthonzatlOn ~'. ;:::::'i""f0';6 /'-6":;;
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S~B:H\IZ"ION/PARTl~f ab~_ Dplan Check Info Sheet
~~M~lO ~DD~~:!' ~~T ~ PROPOSED USE OF PROPERTY
,~~ ~~, ~1dentHI 0 Industnal
5~qu I CU~ o~ ~JY / .. /Ae I
. /~..& W..__..J? ~::'_'/~/....",../..4.../ (// _ 0 CommercHI 0 Pubhc
REC~S~/~~ _~ :~~~~~ ~~~~~~
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tb;~~~-B 0~2dd/ <;/ /
~orBED~\5116r~'1 #o~TATERSUPPL>~b ~~~~~~~
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I ~\VE CA~FULLY EX~~I~D ~T~E OOMP~TED APPL~~TI ~ FOR PERMIT and do hereby Cert~fy that all ~nformatlon hereon 15 ~~e and~arrect, and t~1t I
have the follOWIng legal nteresL.l.o the property owner of record o contract purchaser,Oauthorlzed agent Wlt'J eVldeo/"'E' of authorlty attached
I f_cthf'r cert1fy that any and all work performed shal be done 1n accordance "'lth the Ord1nances of Lane County 3"ld the La",s of the State of Oregon
p"'rta~nJ.ng to the work descr1bed 'lerf"ln and that NO OCCUPAt.CY wJ.11 be Made of any structure "'lthout the perm1SS~0'1 of the BU1ld1ng :J1v1s1on J fuy-
th( r certJ.fy that regJ.strat1on w1.th the BUJ.lder's Board 1.S 1n full force and effect as reqU1red by ORS 701 ass that 1f exenpt the baS1S lor exempt10n
J.S noted hereon, and that only subcontractors an mploye~s who are In COmpl1ance w1th ORS 701 055 1;1J.11 be used on thIS pro]C!ct I PAVE READ AND
CIIE~g;?;??' c:~~ j.//,h7~ /7 P~CA'-
-V - NA."l.E (please pnnf} - SIGNATURE
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DECLARED S VALUE
11 ~~'T~R1
f RFAD THIS SECTION
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l\ CI PLA~NING/ZONING
CAREFULLY
YOUR AUTHORIZATION HAS BEEN BASED ON THE FOLLOWING
l>lJ.l1lmurn Setbacks
Zone j:;,{-:lT
eL, frontj Ct-J '
rYJ W-'r:,Z
PartJ.tJ.on
#$- htJ-tf'c::. Parcel
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CONDITIONS I .
Parcel sJ.ze~~
rear :;;.0 f
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J.nterlor
CQ'1.1ENrS'
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1'"-\
'1 I~j-.FLOODPLAIN
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J ~J"fTATION S I # P Z --:/y t:: B P # Installatlon Record Issued' 0 Yes 0 No
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In flood hazard i'lrea? 0 No D YPs, SEE ATTACHED SHEET
Date
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~~~~ "---~- - ~-
rurAL VALUATION $
C0NSTRUCTIO~ AUTHORIZED BY THIS PE~~IT
--
Flxed Fee/ Floodplaln Fee $
/l Descrlptlon Sq r~ Unlt Cost Subsurface Fees $
L .4 / BUlldlng fee $
~YdA2.7~4. . ",ch/Plmbg Fee $
~p-- 4- /? L_) ::::: ~:::~a::: :$ <..c...~-
~~V'~ DEQ Surcha["ge )
/ . TOTAL FEE $$ ,C;:~(/V
0J ~~;f-",\. r Z-2r)-f!-d
.c- ~ERm.T A.':1PttQVED BY'SUILDI~: lFICIAL/DESIGt.EE -(pc:-- ORS 456 805 (1)) DATF' I
LANE COl'NT'( DEP' ~T. NT OF PUBLIC WORKS LAND MANAGEMENT DIVIS'ON, 687,4061, C 14 _ 25
12 EAST (lTH AIJE"lUC, EUGENE, OREGON 97401
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Vicinity Map
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LANE COUNTY
FLOOD PLAIN MANAGEMENT
687-4357
/J:- pc2-{} s;- _ TL /ytJtJ'I-/1/'7
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L/ Approxlmate
Study Area
I:)t-Detalled
Study Area
C/ Floodway
SI#
rFc?--/70
Allor part of thlS slte may be In a flood hazard area for WhlCh
100 year flood levels have not been establlshed Extra precautlons
may be approprlate to assure that the bUlldlng slte wlll be
reasonably safe from floodlng.
Allor part of thlS slte may be In a flood hazard area for WhlCh
100 year flood levels have been establlshed A bUlldlng elevatlon
above the 100 year flood level may be requlred
Allor part of thlS slte may be In a flood hazard area In whlch a
floodway has been deslgnated BUlldlng may be prohlblted subJect
to demonstratlon that the cumulatlve effect of proposed develop-
ment wlll not lncrease the 100 year flood level at any pOlnt
. tjO :d.SITE FEAS~ILlTY REPORT FO UBSURFACE A~LTERJlATI ~ EWAGE D)8PoJJ>I9G0s I/,# g~ -/9 ~ ,
'l. ',tRS, TL/ tf-nZ-os /719-1/06 Job Location _ '?~~ ~ ~~hf CI. \ \'j
WrlttenD,r ons~~/ va7r_~~C2~/Y 4./~~.)
SubdivIsion ~..;:?~ ./!I 0. ~~ -. / ~ ~~u - ,
Lo< Block ~ /' ?r'r.../ "
APPLICANT'S NAME AND ADDRESS r ~ ~ ~J' d--~.4iY'~~.//-': Phone,?~?~/?
OWNER'S NAME AND ADDRESS, ~.KA~#a~' ;;?/~7' PhO~~
"""report~ I I Ap.,m" II;;,.{,'; /J:---'I,~~;)1" (O_~'~
STRUCTURES NOW ~~ ~YERTY~~~-1'_/....&-~~/~ PROPOSED USE OF ~RO~ERTY' ~
WATERSUPPLy~4~~~.J V WITHINONEMILEOFTHECITYOF .Rf#- (NO)~
. I hereby certify that the abov~ statements are true and accurate, and that I have the following leQaI 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 o~a,a~~ ~OV:}O~IS action - ~ .-
TEST HOLES READY ~~/L4r ' , Slgnatur~ /2f#~___;; /2 ~ Date, X ?'lj7 ?2,-
* * * * * * * * * * * ... * * * * * * * * * * * * * * * OFF;:ICE USE ONLY BELOW THIS LINE * * * * * * * * * * * * * * 'l!: * * * * * * *. * * * * *
SITE MEETS STATE STANDARDS YES NO
Septic Tankl Drain Field [B'" 0
::~;:~I~:nk ~ ~
Other " , 0 ~
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LA~ 1933YMPLlAN;;j /:
Zoning /r?~/ if.- /70/
Acreage or Lot 'Slze_4{ L/' a. (TOTAL)
./?7_/ /J C? () Completed
Partitioning #// /. U::7(/-~ <-
(Q..2endmg
Parcel #
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THIS IS A PRELIMINARY REPORT WHICI-l DOES NOT ENSURE THE ISSUANCE OF A FUTUR" BUILDING PERMIT ANY PLANS OR EXPENDI,
TURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK IF SITE IS APPROVED, SEE REVERSE SIDE
~ --d..-.______ If, /t - /?
-A~o'RIZED SIGNATUW DATE AUTHORIZED SIGNATURE
DIVISion of BUilding and SanltaKon 687-4061 Permit ProcesSing Section
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 125 EAST 8TH AVENUE, EUGENE, OREGON 97401
C55-32
OATE
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MEMO
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TO APPLICANT
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FROM', WATER POLLUTIO~'CONTROL DIVISION
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SUBJECT
CONDITIONS OF SITE APPROVAL
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OAR'Chapter 340"Dlvlslon 7, Sectlon, 72-015(6) ThlS report shall remaln'ln effec~ un-
tlll lssuance of a permlt to construct, unless In the meantlme condltlons on thlS or ad-
Jacent propertles have been altered In any manner WhlCh would prohlblt lssuance of a per-
mlt, In WhlCh case thlS evaluatlon report shall be.consldered null and vOld Technlcal
rule changes wlll not lhvalldate any evaluatloh report lssued pursuant to thlS sectlon
. - -
~
Before constructlon lS started brlng your approved Slte Feaslblllty Report to the Depart-
ment of Envlronmental Management and apply for a bUlldlng permlt Exact speclflcatlons
for the,sewage dlsposal syste~ wlll-appear on the permlt
I~ the property lS only a portlon of a tax lot, a partltlonlng or- subdlvlslon must be
approved before the permlt wlll be lssued Before a cosntructlon permlt may be lssued
~and Use Compllance m~st be approved
~ "', . .
,Only, persons havlng.a valld llcense lssued by thp Department of Envlronmental Quallty
under ORS 454,695 to lnstall subsurface sewage dlsposal systems or an owner or contract
purchaser or hlS regular employees may lnstall subsurface sewage dlsposal systems A
certlflcate of satlsfactory completlon wlll not be lssued If persons other than the above
perform the lnstallatlon
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T R S Ir-O'l.._~OS- T L
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Page of
#2 TEST HOLE
#1 TEST HOLE
ROOT DEPTH
Major 1 n
M1nor ")0 1n
RestnctlVe flIV1n
Manu NG
Gray J '
Rust-----A V.
Mn
WATER TABLE'
permanent-1JtL1n
Temporary >In
Observed ,1n
Slope % h1'A.r
Depth oflJilr 'fe 1 n
#3 TEST HOLE
COLOR &
IN TEXTURE
S,'L
1n
1n 0_
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COLOR &
ROOT DEPTH IN TEXTURE
Major 1n
M1nor In
Res tn ct 1 ve 1n
ManU NG
Gray 1n
Rust In
Mn 1n
WATER TABLE
Permanent 1n
Temporary 1 n
Observed 1n
Slope %
Depth of TH 1n
ABREVIATIONS
NOTES
Structure
Sbk-Subangular Blocky
Gr-Granular
SG-S1ngle
M-MasslVe
Pores
~ew
2 - moderate
3 - many
Textures
SlCL - S llty clay loam
S11 - Sllt loam
SlC - Sllty Clay
CL - Clay loam
C Clay
L - Loam
S L - Sandy Loam
L S - Loamy sand
S - Sand
STRUCTURE
& PORES
.5 hie.
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GIL
STRUCTURE
& PORES
ROOT DEPTH
Major In
Mlnor In
Restrlctlve 1n
ManU NG
Gray 1 n
Rust In
_Mn In
WATER TABLE
Permanent In
Temporary 1n
Observed ,In
Slope % ~
Depth of Wi ", 1 n
#4 TEST HOLE
ROOT DEPTH
Major 1 n
M1nor In
Restr1ct1ve In
ManU NG
Gray 1 n
Rus t 1 n
Mn 1n
WATEi<YAHLE
Permanent In
Temporary 1n
Observed 1n
Slope % 1n
Depth of TH In
~
COLOR I STRUCTU~
IN TEXTURE & PORES
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COLOR I STRUCTURE
IN TEXTURE & PORES
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Page of
1"'1 SubdlV / S I s(',,;l.-/9'Lot#
T R S -I~FJ2...-Qr_ T L .L~Part ~~_____Parcel# Blk #
Zonlnq us, ___ u_ Parcel SlZe _Water Supply Wel~bllc
Ddlly Waste Lenqth of Dlst ~
Flow _J"~_Q'D Llnes /~_ft2jJ.!i..O.9. Method ~ Max Depth _~.z:...1...nches
SITE DESCRIPTION
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ACTIVITY INFORMATION SHEET
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COMPLETE THIS SECTION INCOMPLETE FORMS WILL BE REJECTED'
Verna. )J f( eec e.
PERSON MAKiNG REQUEST
PO, 867C /ff'-</
'MAILING ADDRESS
q" /2 Jd I
'i/ CITY
Kodflt>uT-<f- Vema /U t<ee.ec-:-
i PROPERTY OWNER
f {) i3Ci~ /g'.y
MAiL1NG ADDRESS
()/2
sTAtE
97</77
ZI P CODE
-5~ tld,
T CITY
0{2
STATE
977-'77
ZIP CODE
7<;~~7/
BUS-INES-S--T-ELEPHO~# HOME TELEPHONE # BUSINESS TELEPHONE #
2 PROPERTY ADDRESS non e.. \( e + r o("n l?,r 0 f 4::J.n d Sf-
(IF DIFFERENT FROM MAILING AD~RESS)
7-$/6 - D"'r 7 /
HOME TELEPHONE #
q... ~a=,oer f.2d~'
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3 MAP & PARCEL NUMBER
(REQUIRED INFORHATlON)
(from tax maps 1n Department of Assessment and Taxat10n
or from tax statement)
/'1 02 oS
TOWNSHIP RANGE SECTION
:(.y - c&9oo
TAX LDT(S) DR PARCEL #
.I?f-/~
ZONING
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL #
ZONING
TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL # ZONING
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP -</, "-/ ACRES
4 SUBDIVISION (If appllcable)
5 REQUEST ('tate exactly what you plan to do)
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'6 DIRECTIONS TO SITE c..c.)(''"ner o-P ~.Dd_'3t a.nd :5CL:,:,'(?er ~;'f
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ZONE/LAND USE
BY DATE
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TIME IN OUT
NUMBER
DATE
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LAND MANAGEMENT DIVISION / 125 E 8th AVE, EUGENE, OR 97401 / 687-4061
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