HomeMy WebLinkAboutPermit Septic Tank 1971-2-17
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TWP.17 RA,NGE 03 SE~. 24
TAX LOT NO. 4uu COPE-
DATE 2/11111 ~
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OUT
REQUEST FOR SITE INSPECTION
BY~hwlrt2. Jeff
MA I LING ADDRESS '284 Parker
TEL. No. 747-5432
Springfield, Oregon
OWNER OF PROPERTY Lenu Palluck
CONSENT OF OWNER? Yell
EXISTING STRUCTURES ON PROPERTY
SIZE OF PROP. 1 Acre
Is PROPERTY CONTIGUOUS TO
None
LEGAL ACCESS?
ANY CITY LIMIT?
7
No
SOURCE OF WATER SUPPLY: PUBL I C X
SPRING
WELL: DRILLED
DRIVEN
DUG
DESCRIPTION OF SITE (DIRECTIONS, LANDMARKS, HOUSE OR BOX NO., IF ANY): Down Mohawk Blvd. to
19th street (left) out 19th to 21st turn left and go out 21st to end of road.
PROPOSED USE OF SITE (E.G., NUMBER OF DWELLINGS, COMMERCIAL OR INDUSTRIAL USE, SUBDIVISION):
Future Dwelling
L::7 URBANIZING AREA.
~ SPECIAL PERMIT AREA.
JH/gf
FEE:
No. OF SITES $
No. OF ACRES
TOTAL- ~
5.00
5.00
v:J:1' c(/l/u:fY...4-/ _~'Z~
RESULTS OF INVESTIGAJlON: " ~ .c. ~ ' ~ ~ _
, . '.j.? - [;,,--,,- A /7 " ' - ~t-c./---' ~ ~l.--t!-C-rz...-r
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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 THE PARCEL MUST BE FURNISHED, EXACT SPECIFICATIONS FOR THE
SEWAGE DISPOSAL SYSTEM WILL APPEAR ON THE'BUILDING PERMIT. Two Sr.TS OF THE BUILDING PLANS
AND PLOT PLAN WILL BE REQUIRED.
LANrarouNTY BUILD).NG ~ SANITATIO: DIVI~~ . ~ /
~~~~~( ~~(J-k#~
'. BUILDI~'CTOR . - SANjJ/ARIAN
THIS REPORT IS NOT COMPLETE WITHOUT THE SIGNATURES OF THE BUILDING INS~ECTOR AND SANITARIAN.
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DATE
"~091.01
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