HomeMy WebLinkAboutPermit Septic Tank 1991-9-6
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Permit No.-L") j:::J -9/ Twnshp. /A Range C'\.<" _Section 02.3'3 Tax Lot '7700
Standard SystemEl Alternati~ ?'yst~mnc::.(~?$Cify Typ~). .. see~~,or~......el ~&,;..~
Job Location (Street Address) /g819~.;v.o;.... ~.;::-=='~;:>"- SP~ /....r- /'--e/./
Supdivision/Partition #, .~ V'd a.Ll .c; t' 6 .....7"G-;,".rparcel ' Lot.:JJ /? Slock:<: '
DETAIL SYSTEM PLOT PLAN AS CO~STRUCTED
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. . . . USE BLACK INK ONLY. ~/
FOR INSTALLER'S USE: Trench Depth r:')(.j" -,.;.<.. Gr~vel Depth Below Tile G
Tank Capacity /tJOfJ Manufacturer uhl! a.rna.N,o G~.,;J.",S'Ilfj~p A
Measured Distance from Well to Tank - From Drainfield -' Total Length of Lines~
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's name) certify that a (Mfg.) (Model No.) . Pump
and Mercury Float Switch (Mfg. and No.) have been installed with this sewage installation.
., ., ;:,: I..'"' Signatur" Date '
c;; \ ).}-.l-LLi...:21 I'. -' -
.,,"y tJV'" <ro.,.1 R SANITA~IAN'S S<E ONLY: .~Syst7 APprovep~stem 9isapw>ved . 0 Needs" co~.r r~J ion
6'1'/ tt'd1 /:"1 C~'OENTS: . ., j'~'!,~l.y-'" 'P > .A<2. A~~. ~ ' AA.;~6'"
- Sr;-~~/t,li!'. \/ ';""" ,/ /1"", "J~.J!.. ~
~~' '-!-' On v f:..: r:". ' q $ystef!k..Corrected Date.... __ ~
8 (. Ie. . V ign ~y:St~m Capacity If,,S7J , gal./day Signature ~ r.t,,~ Date c.; -ef'.~9.L /
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, . '" 14?J!'" I~' /ALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When SI ned by the County Sanitarian. this certificate is evi,
v ... 'Q~nce as per GRS 454,665 of satIsfactory completIon of a subsurface sewage disposal system at the above location, .
~ Ao request inspection, return all three (3) copies of this form to: Lane County Environmental Health Services, located~in the basement of th~
Public Service Building, 125 E. 8th Avenue, Eugene, OR 97401.
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SPJIlNGFIELD
225 FIITH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726~3769 City Job Number
OFFICE: 726-3759
1. LOCATION rtf, INSTAJM.'[~N 1\0 .n ,
~8() pO/? A,2,lt'J lYU j lS,.-/
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. 1(\1'\ -\011 D~CRIPTIO~ ~ /1
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Pe,rmi ts are non-tran f rable and expire
if'work is not starte within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Heritaqe Elect
Address 855 West 24th Avenue
Ci ty
Euqene
Phone 344-1500
Supervisor License Number 9455
Expiration Date
10/1/
Constr Contr.. Number 63137.
Expiration Date
12/27/ .
Signature of Supervising Electrician
~L/ W,. ~ f{;-S'
. Owners ~m~\O, VTl\IlO~A\ I f\b. Qh1L'QQD.
Address44-fL ~ ~()i. \-\N\ \11 ) \TI ~8
City f'" 'Y'~~ PhonePA-4~t6) \
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OVNER INSTALLATION
The installation is being made on
property I own which 'is not intended
for sale, lease or rent.
Owners Signature:
----------- -----------------
DATE: fi-2/<.9 /
RECEIPT jt: 7L/2S-~
RECEIVED BY: //~~~--"".---5'\
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3. COMPLETE FEE SCHEDULE BELOV
A. New Residential-Single or
Multi-Family per dwelling uni t.
Service Included:
It ems Cost Sum
1000 sq. ft. .or less $ 85.00
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Manuf'd Home or
Modular' Dwelling A 8:Q
Service or Feeder $ 40.00
B. Services. or Feeders
Installation, Alterations or
Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnec.t Only
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
Installation, Alteration or .Relocation
200 amps or less
201 ~mps to 400 amps
. Over 401 to 600 amps
Over 600 amps or 1000 volts
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see "B" above
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
$ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20.00
Limited,Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE <(<I\C:O
5% State Surcharge .~()()
TOTAL 'i<.4.cx..J