HomeMy WebLinkAboutPermit Septic Tank 1995-11-20
225 FIFTH STREET ;
SPRINGFIELD, OREGON 97477
ENGINEERING DIVISION"
OFFICE TELEPHONE (5031 726,3753
INSPECTION LINE (503) 726,3769
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DATE ISSUED: /t,2tJ -t(5' PERMIT NUMBER:
SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
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o Plans attached (Plans must meet City of Springfield Code Chapter'X Article V showing existing and proposed site conditions:)
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LOCATION OF WORK,
SITE ADDRESS: ?Ja...IC;- HAVoei-I f;f. ed, TAX MAP:
CITY: f7fi.t1.t'f1IEE1//)'~TATE: t5tZ- ZIP: t?7qT1 TAX LOT:
SUBDIVISION:
OWNER: "P~..HlA KA /111'
ADDRESS: U/~ f!I).-Wg;.J N
CONTRACTOR:
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CITY: ~;./fj/:iPfP'"
ADDRESS:
PHONE: ~ ~2/1
,STA;rE: --'2l! ZIP: 9147'1
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PHONE:
APPROVED BY:
~L006.l.PLAIr:i':, -&5
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WETLANDS BY: h0
a--€NGINEERING BY: ~
DRAINAGE: A..}., hd_
GRADING: 0 IL
, SLOPE: (!J.'t2-,
SOIL CONDITIONS: S-n::.tP,
. DATE: '. f.f / 'UJ li.C'COMMENTS:':'t.,
D'A -tE: \ Ii'! U; /1 c: COMM'~f..{fs~;"~~
DATE: /;-;-7-95 COMMEt:J;-"S;V
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COMMENTS: -r-7 , /
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CONDITIONS:
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 5 OF THE CITY CODE, CONTRACTOR TO COMPLY WITH MUTCD
( MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES 1 AND THE OREGON SUPPLlMENTS,
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REVISIONS 9/6/95
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~ORM # 128
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FEES:
.
fLAI\I ~"'~~K FEES'
o UP TO 100 CUBIC yARDS''''''','''''''''''''''''''''''''':'
6-'101 TO 1,000 CUBIC YARDS """,,,,,,,,,,,,,__,,,__,,,,
o 1,001 TO 10,OOO'CUBIC yARDS""",,,,,,,,,,,,,,,,,,,,
o 10,000 TO 100,000 CUBIC YARDS"",,,__,,,,,,,,,,,,,
o 100,001 TO 200,000 ",,,,,,,:,, ,,,,,,,,,,,,,,,,,,,,-,,,,,,,,
::. - . '~... .... ,
o 200,001 CUBIC YARDS OR,MORE "",,"'"
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GRADING PFRM'T F~~1>;.
o UP TO 100 CUBIC YARDS ":"",,,,,,,,,,,,,,,,,,,,,,,,,,,,
~1 TO 1,000 CUBIC YARDS """":":""''''''''''''''
o 1,001 TO ,10,000 CUBIC yARDS""""""""",,,,,,,,
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o
10,000 TO 100,000 CUBIC yARDS'",,,,,''''''''''''''''
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100,001 TO 200,000 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,__,,,,,
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E.STIMATEI2 'vOtUME'OF "I,LL:"
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$20,00
$30,00
$40,00
$40,00 For the first 10,000 cubic yards, plus
$20.00 for each additional 10,000 cubic yards or fraction thereof.
$220,00 For the first 100,001 cubic yards, plus
$20.00 for each addttjon_a~ 1 O;OOO'cubic ,yards or fraction thereof.
$340 For the first 200,001 cUbic;yards:plus
$6.00 for each additional 10,000 cubic yards or fraction thereof,
$30,00
$30,00 For the first 100 cubic yards, plus
$14.00 for each additional 100 cubic yards or fraction the~~of.
$156,00 For the first 1,OOO,cubic yards, plus '
$ 1,2,00 far,each additional ,1 ,000 c'ubic ,yards,ar fraction thereof.
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$264,00 For thidirst 10,000 cubic yards,'plus ,,', ". ,
$54.00 for each additioriall0!OOO cubic Ya.r9s;;or~fraction~thereof.
$750,00 For the first 100,001 cubic yards, plus '
30.00 for each additional 10,000 cubic yards or fraction thereof
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A final inspection 'will be required after work is completed. Please call the Inspection Line at (503) 726-3769 and allow two business
days advance notice of the date Y,?u wish inspection. . . .
o Engineering Final Site inspection by:
o Planning Final inspection by:
o Building Final inspection by:'
PLAN CHECK FEE:
GRADING PERMIT FEE:
TOTAL DUE:
PAID WI APPLICATION
BALANCE DUE
'?r'I, () 0
iJ:..f.o ()
71://0
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$
$
$
$
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RECEIPT'NO,
REOUIRED INSPECTIONS:,
COMMENTS:
CHEC~ N9,
CHECK NO,
:!
'27/7/
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RECEIPT NO, .
RECEIPT NO,"
/9/7.6
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DATE: ,
DATE
RECEIPT NO,
CHECK NO,
Date'
, Date:
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Date:
v'ALlDATION: ' ,',-
, ,.j signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information
. rein is true and correc( and I furthor certify that any and all work performed shall be done in accordance with the Ordinances of the
y of Springfield, and and the laws of the State of Oregon pertaining to the work described herein. I furthor certify that only
contractors and employees who are in compliance with ORS 701,055 will be used on this project. .
1 furthor agree to ensure that all required inspections are requested at the proper time, that project address is readable from the street,
and the approved set or-plans will remain on the site at all times during construction.
Signatur~
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