HomeMy WebLinkAboutPermit Plumbing 1976-6-15
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7[,-45:
Kosciol'!k
Surname
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03
Ri'lnge
')2.2 700
Section fax Lot
1-\'2
lode
Census Tract
6-15-76
I Owner
Kosciolek
Owners Consent
Yes X No
Receipt No.
Date
REQUEST FOR SITE FEASIBILITY STUDY
THIS IS A PRELIMINARY
BUILDING PERMIT. ANY
ARE AT YOUR OWN RISK:
REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE
PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
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Name
and
Address
Frank A ano Toula h.~osciolek
Eugene, Or. 97401
No. Acres
TOTAL
$
$
$
75.00
No. Sites
5:5 Me~ewether Street
Telephone No. IAPPlicants Interest in Property I Proposed Use of Property
3[.3-li9;, owner dwe 11 i ng
Property Size ILegal Access - Road Name Ispecial Permit Area I Urbanizing
. L4 tlcr'!5 S(1uth 21'1d and Ash Str. Yes X No YesX No
Existing Structures I Is Property Within One Mile of a City?
sn,all I:ouse What City? Springfipl-j Yes); No
Proposed Water Supply Other
Publ ic X District Sprinq Well Specifv
Area
Property Location: (Directions) ['lain Street in Springfield to South 2nd
out South 2nd to property located on the corner of Ash
NOT APPROVED XXX
APPROVED
Tr0 arE' of the test r.oles c~nnot be ap~roved for sewage disposal sY5em,
juc to :-eavy clay soil I-lith; 'I l~" of ground surface.
Greenway Conditional Use perm-;t '15 required; 'ontact the Lilne County
Planning Dept.
BEFORE CONSTRUCTION IS STARTED bring this form to the Department of Environmental
Management and make application for a building permit. If the property is a por-
tion only of a tax lot, a metes and bounds description of the parcel must be fur-
nished. Exact specifications for the sewage disposal system will appear on the
building permit. Two sets of building plans and a plot plan will be required.
LANE COUNTY DEPT, OF ENVIRONMENTAL MANAGEMENT
135 EAST SIXTH AVENUE, EUGENE, OREGON 97401
G. W. Gray 'jec
Authorized Signature
June 2..: 1':176
Date
C55-32
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3/74
.c-lUEST FOR SITE FEASIBILITY STUDY
--
S.I.#?C- ,41-5;:5
For Offico/l.~
Use Only U~ /7-0.2
i~eceived by' Code C.T. Number
v
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE BUILDING
PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK.
~
Speci~l Permit Area
Yes No
Urbanizinq Area
PERM IT .
PLEASE PRINT
--i
If Subdivision - Name: Lot #
Block #
1~
Township
en
Range
02,20 5700 I3IlS"
Section Tax Lot No.
Kosciolek
Owner of Property
Yes x
Owner' 5
No
Consent
""
Frank A. &Toula H. Kosc.i.olelc No. of Sites
Name
.<;25, Merewethp.r st No. of Acres
Mail ing Address E:
Euq:mene, Oregon'?r~O~--1. '. I C
343-1798 ~~4&e-~ ~(
Telephone # Signature of Appl icant -o-ate a
1
$ 75.00
V>
Total
~k
$
$ /i<(70l)///
--i
r
small house
Existing Structurey'on Property
Proposed Water Supply
Publ ic X District:
Spring Well Other (Specify):
""
-2L- Seller
Proposed Use
of Property: ~",,"u:::leo "'''''mo
App I icant I s Interest
in Property: Other (Spe
Rea I tor
_"'it ?"'r~ so. 2nd & Ash St.
Property Size Lega~I,ACcess - Road Name
~s Property Within 0 e M'I.le of City?
es -L.. What City? rinqfield
No
M~in ~~rep~ in ~nrinafield to So. 2nd -
...QJ.!S.
located on the corner of Ash - between Oak
3RQ :Il~u Ash. Annrox matelv .84 acre. dimensions - 295.02 x 169.3x219.82x
, --, -,? /'. / /' (county road lipe unmarlcea as to
When Will Test Holes Be Rea y? u..;//'v --? (&> dimensions on title Co map)
MARK TEST HOLES WITH OUR FLA S I (Date) . .
Location of Test Holes on Prop
I
/
"ion of any landmarks and relationship of t~st holes to
\ raw djagram of property
hese andmarks:
~
',.
~
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c:::ve
--..
MAKE CHECK PAYABL TO: ENVIRONMENTAL. MANAGEMENT
MAIL TO: LANE COUNTY DEPARTMENT OF ENVIRONMENTAL
C55-5S
-.
Phon e: 687-4065"
MANAGEMENT, 135 E. 6th Ave., Eugene. Ore.
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NO'r APPROVED )<_
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(-tw.-- At'--t~:7 ~_ 9t"-f./' 7.xt~
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;t':BUll~ f~G's I,;E EVAL~U~i'I~~::' ,<_;~,:' .'. '.'!::~{~j' ~ . , I e\'~3 ~ ci2~a !AX LO~ 76~ <,~
. . "to' ",", "':" ~,.!j. _,'" ~~1;: 11(:,' ,SUBDIVIS.'UI~: . ,_;
t,;( ) '. BUILDING' PERMIT APPt'lCATION NO. . .7&-'t5S ' LOT: BLOCK:;
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~,(>r"'~;~.i:r} I Nsi,'ECT 'ION " ,--. ]. ;~, '. APPLI CANT I:',
,.., ./. I ~ " 4"". ,. DATE
{-PLANNING DIVISION Not~,.;~::
;". " ~pJicilble. No Yes
~;I. Ziming Ordinance Compl i;ahce:Zone.2a.. l.).. ", () TI 6.
; 2. Subdivision Ordinance Compl iance ,. () ;" ( ) ( )
:3. Required Access ,~.. - ';;;:- (~). .;~: ( ) ( )
,,4. Building Site (Area, WI.dth, Fro~tage) (,) - (),,()
i;" 5.' Other (see comments..V')1 . (') ()\).. ( )
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COMMENTS: '.,6..'''' f6 i<'~w"--'I( C..,..~.:.)~. i"'MC:;NAL..
'.....- ,~~.,r1'-' i~ ~et~LJ\,R"t;.~"r\~
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CK'D BX:....J \aA'b- (1-,(..,
Setbacks frbm ell of, ~oad:
Front k-J~
Side Exterior "
Setbacks froinS'interi or, 'IIi ries: \)'" "j
S ide I ~
Rear 'V
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::",PLANNING DIVISION ACTION PENDING: YESl
- ,
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) NO(' ) APPLlCATlON# /
Not" /
APD 1 ic~b Ie' No Yes
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( ) '. () ( ) CK' D BY:
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,I BUILDING
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INSPECTION DiVisiON
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; 7. Plans Submitted
.: '8. Soil Stability (footings)
:9. Flood Plain
.'j O. Other (see comments)
i" COMMENTS;> " '. -\-
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DATE
"WATER POLUTION CONTROL
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Not!
App I ic~b I'e
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/
,/
No Yes
f)D
( ) ( )
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.11. Meets Department of
Quality Standards.
. 12. Other (see comments)
,
,
CK'D BJ-411.~
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(p -:23-16
DATE
,.:.
" COMMENTS:
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c'TO APPLI CANT:
Your Building I Site Inspection:'
.- . I () Can be approved;C// J
,,-\.1.'<J (>d-cannot be approved at th i s timE.! as i nd i cated on i tern NO,:::J, above.
I. '1., pO Questions and further informati on on items 1 through 6 contact the LANE-
~ J\ COUNTY PLANNING DIVISION, Questions and further information on items 7
/j/lA
. through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION.
( ) Will be held in'this office until you can resolve the problems indicated.
( ) Is being returned. ~ .
( ) Your building ~ermit ap.~~!12~.f~~J.~_~einq returned und~r seD~~te cover.
vEPARTMENT OF ENVIRONMENTAL MANAGEMENT
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANN.lNG DIVISION PHONE: 687-4186
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C55-28
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LOCATION:
I K RANGE
TWP.
ZONING:
SITE EVALUATION WORKSHEET
/) '\ SECTION:<'. 2...
SIZE OF PROPERTY:
PROPOSED USE:
# it! 1ff'~JU--
AMOUNT USABLE AREA:
WATER SUPPLY:
COMMUNITY ~
PUBLIC 0
IF SITE MEETS STANDARDS FILL OUT:
Type of structure and approximate sewage flow: Single Family
Mul ti~family gpd Industrial
Commercial gpd Institutional
MINIMUM DESIGN REQUIREMENTS:
Distribution Method:
Length of disposal trench required
Curtain drain required:
Other:
Equal D
Yes D
Serial 0
No D
TAX LOT #
7&'0
~7f-..t:?
INDIVIDUAL ~.
gpd
gpd
gpd
/150 gal.
SPECIAL SITE CONSIDERATIONS OR VARIANCE OPTIONS OR OTHER ALTERNATIVES:
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NAME:
o ~______
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C74-l26
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DATE OF EVALUATION:
f ~;l~,?~
in.
in.
I L E
PROFILE
Inch
'I
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I PREDICTED WATER
I
in. Inch
in. ,
~ ('.
12
#1 TEST
PERCHED WATER
Predicted
Observed
Date
SATURATED ZONE
Predicted
Observed
Date
# 2
S T
H 0 L E
PROFILE
.se.
Predicted
Observed
Date
12,
in.
in.
SATURATED ZONE
24 _ ~ f Predicted
I Observed
(, ~lIfiJ ~ ~te
36 _
36 -
in
in
24 . :!CAj
Restrictive Layer
Impervious La~r 17
Mottling {L'
in,
in,
in,
Restrictive Layer
Impervious Layer
Mottling /'?
in'
/::L. in
in
48 -
48 -
60
60 -
SITE DOES
o DOES NOT
ADMINISTRATIVE RULES
~ MEET MINIMUM STANDARDS.
REOUIRE A MINIMUM DEPTH OF:
- -
ON YOUR PROPERTY THE DEPTH
~:
0 36 inches to an impermeable layer /~ inches
0 30 inches to a restrictive layer inche s
0 60 inches to a permanent water table inches
0 24 inches to a temporarily perched water table / )~inches
OTHER REASONS FOR DENIAL
PLOT ~:
Stream
Drainage or
pond
It'............,'.
Road,
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Test Hole aD
~ % Slope
Cut Bank
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Fence
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RECEIPT No, ?qqi7 TWP, If RANGE.4BSEC'a2...2.
^IV\ TAX COT NO, 7/Y'.> ~ODE..L2.-oG-
REQUEST FOR SITE I NSPECT ION DATE-5' -7 /~ 7/
.
BY fi's::./ ()L FJ( Fr'At'UKMA IL I NG ADDRESS5"25" filI7Pr 4lcmt'!f::: No, 3;L~ _/ '? <7 f
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BY-MaS1f.4 f-I.-OOls ez.tc.,Lh JP..,oe,
Foul !~-(1' .".- _ . I ;-/
OWNER OF' PROPERTY-A::'/),<;'('j/yt;j(l SIZE oF' PROP..94(1,,CiI/'1!;LEGAL ACCESS? /')fJ. L/'UC/ $/,'".
CONSENT OF' OWNER? Is PROPERTY CONTIGUOUS TO ANY CITY LIMIT?
EXISTING STRUCTURES ON PROPERTY ()L D .silACK
SOURCE OF WATER SUPPLY: PUBLIC
SPRING
WELL: DR I LLE~I VEN
DUG
DESCRIPTiON OF SITE (DIRECTIONS? LANDMARKS, HOUSE OR BOX NO" IF ANY): 0tI7$O,2AJ.f:>
6772:"=:eJ -#LJ 6PE..ltUr;~)f.L/:;:,./ oR:- Jeff.
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PROPOSED USE OF SITE (E,G" NUMBER OF' DWELLINGS, COMMERCIAL OR INDUSTRIAL USE, SUBDIVISION):
&-
CJ
ttl7l/,t}e bu ),C7 / / A Ie..
--'APPROVl:.LJ
COUNTY PL'NNlNG DEPAHTMENT FEE:
LAN~ ' ," No, OF SITES I .;Q
~ ~ ~ _...>.Cl r:>
/?/~ No. OF ACRES
t:.. f) BY _ ,. ("';;5'7 TOTAL- ,$ <- CJC'?
RESULTS OF INVESTIGATiON: $~~ ~ ~~
,~
URBANIZING AREA.
SPECIAL PERMIT AREA.
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0-1\.. s~ - .:3 U. r.pa.c e Se. wQ.(fe.>
of AeCLJY e~y 58;/ an}
e.~"1
17 ~I-
.be <</'/riJuefJ ..pf) ( fhe IhS;.alr~.
d,SftlSQ1 sysfem .6~c.o..ut;;e-
/;dJ WQle r fat!~
f'\.
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE BUILDING
PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK:
BEFORE CONSTRUCTION IS STARTED BRING THIS FORM TO THE BUILDING AND SANITATION DIVISION AND
MAKE APPLICATION FOR A BUILDING PERMIT. iF THE PROPERTY IS A PORTION ONLY OF A TAX LOT, A
METES AND BOUNDS DESCRIPTION OF niE PARCEL MUST BE FURNISHED, EXACT SPECIFICATIONS FOR THE
SEWAGE DISPOSAL SYSTEM WILL APPEAR ON THE BUILDING PERMIT, Two SETS OF THE BUILDING PLANS
AND PLOT PLAN WILL BE REQUIRED,
~~(JN:
BUILDING ~TOR
ANITATION DIVISION: ~ )(,;~ ~ ,
~-'.:W/G~~
SAN I TAR I AN'
,
)22 ~ f\
V
DATE
THIS REPORT IS NOT COMPLETE WITHOUT THE SIGNATURES OF THE BUiLDING INSPECTOR AND SANITARIAN.
<:~ron-07