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Home My WebLink AboutPermit Septic Tank 1990-9-7 if &;8 S/"Rp?&,,,cCZ!3L-,o SEWAGE DISPOSAL SITE EVALUATION SI N_ 9~~sh TRS.Tt/~-~,?-3~~2 ~7d7t:7 Job Location (! <.0).0 ;r;::L/.fl~ ~t.?r:J,)(;,~,,<~~ /)~e Wntten Directions ~7?4':?Y, 0,~_, ~~Ct!:; ~ ~/-'~/?'=L- ~~ z;-s-; ,~;LCr ~#.r?'7') ,r/j~ ~r/e- ' I nt Block '~ATERSUPPLY ~..t</~ APPLICANT'S NAME AND ADDRESS ~/7~..+:? ~kh.&>7'7~L/ ~..rPr:7 ~.PL~,C)&/J /~"7e- PhonJ4'.;/-/.3"~2. OWNER'S NAME AND ADDRESS ~..5'r ~/~e7/~ /-?..;,;::"'~MA:./ 97$/0/ ' Phone C'''''';'~n~ , r ~ STRUCTURES NOW ON THE PROPERTY ' \~ ,PROPOSED USE OF PROPERTY ~__ E77h~~ ~ SubdivIsion 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,r agent I further cert,iy thai (,I not Ihe ,wner) I am auth,nzed to act for the owner,f rec,rd and Ihal saId ,wner IS aware and apP?Jves of this action, TEST HOLES READY ~/C7/_ ~L- Slgnatur~~!A"l'''A<,{!//2A_'''//~.1 Date 9'/'7 ;;""J SITE MEETS STATE STANDARDS .. "".11 ** "" "" "" "" "" "".*...... * *.. "" ""*""....... *........ 11''''''''''' **.. *........ **.... OFFICE USE ONLY BELOW THIS LINE"" * ""*.... *.. "" ***.. """"*... **.... "" *.. *.. *......... *...* **............ * *.. NO YES NO o Low Pressure Dlstnbutlon ~ If ~ ~ Tank . ! s / d {/~ y y /' a I;f ! I V / /' I r /}L/// '[ A Iv ;/// / -' /P// /('(1 r j(/' / //0 ( JV/v v, . l - I ,- \ {l //' /' V,,-- Iv( ) /'./" rr(J1 I IV // THIS~A PRELIM ARY REPORT~t-I(CH DO S NOT EN~RE THE ISSUANCE OF A FUTURE BUlL NG PER T ANY PLANS 0 EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE Ii. 'OU WN RISK IF SITE I APPROVED, SEE REVERSE SIDE Standard System Sand Filter 1 Foot Cappmg Fill YES o o o \ / / I , AUTHORIZED SIGNATURE ZOning LAND USE COMPLIANCE A.creage or Lot SIZP ~TOTAL) o ApprOXimate Study Area o Detailed Study Area o Floodway OATE 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (687-4051) ~ CO~RONMENTAL HEALTH, Partltlonmg tf Parcel # / ) Completed ) I ) Pending COMMENTS - / . V . I J0,dc#~ ~ / /I///IIV' ~ ~ l!f -/ ~ , // FLOOD~LAI~ INFORMATION 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 bUlldmg 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 m whIch a ftoodway has been deSIgnated BUlldmg 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 RON MENTAL HEALTH SUBJECT CONDITIONS OF SITE APPROVAL lane county - Any alterallon of the natural conditions In the area approved for the on'slte system or replacement area may vo,d this approval This approval IS given on the baSIS that the lot or parcel described 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 A S 454605 through 454 755 and Admlnlstrat,ve Aules of the EnVironmental Quality Commlss'on Any such subdiVISion, partltlomng or alterallon may VOid this report WARNING This document IS a technical report for on,slte 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 Planning Goals The Statement of Compatibility may be made on the attached form or ItS eqUivalent AuthOrized Agent approval IS reqUIred before a construct, on permit can be Issued This report IS valid until an on'slte sewage system IS Installed pursuant to a construction permit obtained from Lane County, or until earlier cancellation, pursuant to Commission rules, w,th 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 OAS 454 695 to Install subsurface sewage disposal systems or an owner or contract purchaser or h,s regular employees may Install subsurface sewage disposal systems A cert,flcate of satisfactory completion Will not be Issued If persons other than the above perform the Installallon ~.00 :.;- LSo "-,:> +: . vy "'", ~-'CV o ,Yv~, 2!:-- .I' "t/fl _ 7/' o . /' ~ . . . ~l_~_ ""'/"(7/ ----.c... I ( r\ r,,--~ - --=--- '- '-> , n~,:<> ~ ~, \j ~; ---l:o!: ;;;, ~) .' ---- v ql! l ~ \I , " '- I II' ,r I, : II, " I ,I I , , " . lid ~ 11\ Ji i APPLICANT WENDTLAND. BE~~~~DCOUNTY D~~~RE~MonG~p~EE~6Bl L~.?0~a~~NE?A6kEeBA790 TL~ 1703342200900 SUBDIV LOT BLK ~EW BLDC, TYf'E USE X BDRMS 0 UNI IS 001 STORJI::S ~BLDGS 001 PHONE 344 1352 OWNER NME WEND1LAND, BERNARD ADDR 2800 APPLE WOOD LN., EUGENE, OREGON CODE APPL NO ACTION DESCRIPTTON SQ FT UNIT COST VALUATION FEE DAYS .lP BP ~tlN' 3P BP 'L ~FlX/BATH MECH SUR -'CK SI LC 900~56 SI SDEQ FEE Hfl .;A TG, ~'LN SEQU TAKEN BY kLH RA SDS SW~ FT. WTR MECHANICAL FEE STATl SURCHARGE PLAN CHECK FEE 1 E"LE PCI< ISS EST. COMPLETION DATE FT. RAIN ~)% 160.00 / SI 1 OTR DEPOS 1 T l(l( ~ j 1 '1 I, e ( r1 , \ 160.00 15.00 . , Hli; 15 175.00 CK , . I ; i _ ~--:lUY?l~ ~ ~~//Mr~ ~~ (; , y ~ane ~~Uilty - r ( REQUEST FOR ASSISTANCE ~- -<. - - lAND MANAGEMENT DIVISION land Management D,y, 125 E. 8th Aye Eugene, OR 97401 , DirectIons to sIte from Courthouse ';=:;'/7 \~,d~ f' _*' I?~'~/ T-'\ &1- R'S~L-fd{('<.) -.::trJ //<-.1./) K;./I'j! 'I ~ ~ ?: J ~ // J.-('AI ~(~;/~~ ,~~ ,-' "','r J f Please complete all lines Inside whIte boxes, If possible. k,,^,~~ w~~'^^""'~ ';;;;; ~~ LV\. -&-- ~ y Vi,'ll" KJIJr.r;.~ti ~ ' r;'u.r CAAC.\ 6 r CITY' '-.:lo 0rrr n C-C-I f.s U e Y1 J f-(r;, V1 J OWNER OF PROPERTY (If nol same as above) 'I h l'li) dAle <<N 15J'L "MVNC Cf7 I{lJI ZIP k1.~~ )r.. vn f ZlI; Cr/ J1'l P OWNERS ADDRESS (II not same u above) C'UNI HAt..: I Un 4 .xd.A 27rJ LIcense. d ~r~ .... -"'1. """'i ~- :-. M.~ r~r . f .~ ~'i :7?L..i..'..........,. ,~C'l ,~ ) :i'~~ Reque~t for: _ 4 t. ~.: tl ~, .- "''-~~.J 1~.1 "'{ ,. ~ . MAP, PARCEL NUMBER (Found on tax maps in the A.s.essment & Taxstlon DepL) loL11P ~n~e JJn ~~t1on ~~x~ot ZONE FLOOD PLAIN Township n;;;- Seetlon 114 SectIon TalC Lot lownshlp "lrii"n"ge Section 1/4 ::><!cllon lilX Lot , . SITE ADDRESS i',,(/o'j- Ie' ~) lfi Jf) . MAIL PERMIT TO. NAtE: (jJ\ .'IL\. ''\'' AUUHt:~~ Cll' ZIP STAFF EVALUATION InformatIOn Request Only r=! COMMENTS / FOLLOW,UP PartitIOn I SubdiVision TRS Venhed Allowed Use r=!Ves =Ves Nor=! No= f land Management DIY staff can not be held responSible for evaluations or recommendations based on falso, Inaccurate or Incomplete Information ~ . , Existing Buildings or Improvements on Property c:::J House c:::J Barn - c:::J Garage c:::J Mobile Home ~ Shed SEPTIC INSTALLED c:::J Ves ~ Water DIstrict 1?tI ,. ^h'. ; ~ :I Arr rnt.. For Mobile Home Placement Only Brand Year Size No of Tip~outs No of Bedrmo License # ., , r lot & Block Uillfl I I ! I ) ;;'UUllntlill. TAX INFO _ CEZONE MORE INFO UGB: SPR HISTORY - - - - * HISTORY CODE P SITE INSPECTION -D C> , N lJl \) - -J , o w , \AI ..c. , (\J N , ..0 8 " rr< '- . , . , . HOLD SLIP APPLICATION # LOCATION 90 ~ ~J' /<1;Ltr-, 121 f Lane ii A /2/_..1' -; I' " j7r?/'AU~ /)ouj~1 1 p/KJ U~n~ ~ ~- /i- ) . .. -",P. 0 ('/..... ~ -/ / NAME d-- ,jr' ADDRESS 97$/n / ZIP CODE The Lane County BUlldlng and Sanltatlon Dlvlslon cannot proceed wlth processlng your appllcatlon because ' ,// 1. ~ Incomplete appllcatlon (ltems deflclent). Address and/or dlrectlons to appllcatlon slte - Proposed number of bedrooms ln dwelllng - Approvable plot plan (see attachment). ,2U Notlflcatlon of date test holes wlll be ready. Verlflcatlon of eXlstlng system requlred (see attachment). 2 D D Two test holes (2'x4'x5' deep) requlred for expanslon or repalr of eXlstlng sewage dlsposal system ln the area of the proposed dralnflelds 3 4 D Other , 1><1' ~,___ SIGNATURE - . v (/ . J?. ~ to 9, 1JfJJh.., OFFICE HOURS 0/-/0,-10 DATE hf'7- 37 JJ from to PHONE If no response has been recelved ln regards to thlS matter by the appllcatlon wlll be denled ()tJ':I.:JI ;' (9 ?o, LANE COUNTY ENVIRONMENTAL HEALTH SERVICES Courthouse-PubllC Servlce Bldg / 125 E. 8th Ave. / Eugene, OR 97401 / 687-4051 I' ~_ CANCELLATION .~~y REFUND AUTHORIZA TION ~ NAME 'K_.n~.t0A-f2.D WEt-JDTLAt0D TRSfTI.# /I-03-3l./--Z"Z-Qro PLEA8E PRNT ADDRESS "2600 ,A-PPLEw60D Lt-J.il'"S8, 8JG~rVtT I oR q,yO( Ia APPLICANT 0 OWNER 0 CONTRACTOR REASON FOR CANCELLATION 'L:> W t LL 0 t:- !+oOt.., f.J6 UP TO SPf2-t f.J6 A ELO <:"EwE--R SIGNATUR" ,--z:,.~/J"Ul/A.A/ .// /'/VlAd.L,.:::M/ DATE '1/;;..0/90 Fees paid for waste disposal systems (SIte Inspections andlor applications to Install the septc tank and dr8Jnf,eld) are ordinarily nonrefundable Refund may be on building, planning, or plumbing portions according to the amount of the permit/application processed -, .... PERMIT # q 0 - "2.Sio . FEES PAID fwO,DO /5,00 %REFUND % Flood Plain Fee % Building PermIt Fee % Mobile Home Fee % Plumbing Permit Fee % Mechanical Permit Fee % Plan Check Fee % State Surcharge 100 % Septic Disposal Fee % Site Inspection Fee 100 % DEQ Surcharge % Land Use Application % Planning Director % RecordIng Fees % Partitiona % Coplea & Ordinances % Surveyors Less Processing Fee $--------------------- $--------------------- $--------------------- $--------------------- $--------------------- $--------------------- $--------------------- /&'0,00 $ --------------------- $ --------------------- $ ____L?~~S)___________ $ --------------------- $ $ $ $ $ -------------~-------- $_____-2S~~~~-______ I REFUNDED$___L~~~_Q12_________ .:J1)~fo ~~~AL AMOUNT TO BE SIgnature ~_ TO DEPARTMENT OF FINA~6E Building Permit Refund State Surcharge Refund Septic Disposal Refund DEQ Surcharge Site Inspection Refund Land Use Appllcallon Planning Director Recording Fees Partitions Copies & Ordinances TOTAL AMOUNT REFUNDED PLEASE MAKE CHECK PAYABlE TO n::.tA $ $ $ $ /S: ~ $ 11:.0. z $ $ $ $ $ $/7S:~ 24-0674/Accl 42120/Prog 020 Recelpt# 24-0674/Acct 42123/Prog 020 Recelpt# 24-0427/Acct 42133/Prog 240 Recelpt# _ . 24-0427/Acct 42123/Prog 240 Recelpt# ...1'7..:1" ~ 24-0427/Acct 42134/Prog 240 Recelpt# ;;;,>9.32<1 24-0674/Acct 46202/Prog 010 Recelpt# 24-0674/Acct 42150/Prog 010 Recelpt# 24-1870/Acct 46211/Prog 110 Recelpt# 24-0674/Accl 46202/Prog 010 Recelpt# 24-1870/Acct 44419/Prog 110 Recelpt# NAME BER.t-JA~D VuEAJbTLA-i0b ADDRF"" 2800 ApPLEWOOD uJ, #5"6 I EuGf3JG1 or<. C17YO/ M14-48