HomeMy WebLinkAboutPermit Septic Tank 1975-7-8
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LANE COUNTY PERMIT Fe
. PERMIT NO. 1489-76,
,
CONSTRUCTION [ ]
MOBILE HOME [ ]
PLAN REVIEW [. ]
CHANGE OF OCCUPANCY [ ]
'\;
DOwner
ldoe:+ot"n .Q.11KI",';,...:an rnmn::anu
NAME
NAME
1::7J1l ~^II+h nll" C:1"I",ofnr!,f='';~lA l"'I".onnn Q71177
ADDRESS . -- 'CITY ... ., -~IP -CODE"
Dhnno 71l7_Q711
ADDRESS'- CITY
PHONE
.
D Contractor
ZIP CODE
. PHONE
O,S, Reg, #
Twn '0 Range ,,3-- Section "
5th addition to
Subdivision ~~~~~~~ =~~..'~ Lot Alii:
Tax Lot "~I'II'I
Code
CensOJs Tract
Block /11
Acreage. .
Width 1;0
'Access to Property (Road Namel:
l.f:u..hn... n~i\lo
Depth
1"7t:
Existing Structures on Property:
I\fnno
-.--.. -~
Directions to Property, Address: .- ?nl;? /.l..rhn.. nrjllo <:nr;nnf'i,,1t!,
- ~ - _......'~.'--;- _...~ '-.'
, .STRUCTURE (# BEDROOMS)
sa FT. VALUATION
(~fnC:T;'I' 1 ~i;hC:-IJv.T~r"Q'coIA'~nQ' ,.J','enne::l,1~C!"C'+om
11\ h.o.l'4...nnme
-~, ,,,j
P...; n\" ~nnrn"R 1
SEWAGE DISPOSAL:
PUBLIC I] SEPTIC TANK [] OTHER [']
BUILD IN".
,PLUMBING
3% SURCHARGF
MOBILE HOMe
WASTE DISPOSAl
.
PLAN REVIEW
1nn nn
PLUMBING INSTALLED BY:
OWNER [] OTHER I] NAMC
. WATER SUPPL Y: PROPOSED [ ]
EXISTING []
I ) PUBLIC
IX;]: COMMUNITY, NAME:
I ] PRIVATE WELL
I ] OTHER, SPECIFY:
TOTAL
1 nn nn
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN, SEPiiCTANKC'APACi'fY-:--'-.-.,. ._-".", ,,_'"__,_____Hu__'~"m'.
GALS qnn .MIN, DRAINFIELD 1l;n L1N. FT. MAX, TRENCH DEPTH ':In INCHES
J(,:l.pn rl.,..;;tinf;plrt A minimum nf 10n. -f'tJ.o.+ h;u..lt -FW'nm foha r'oh;.o", C:::+:HI In -Po.o+ oF""^1'I'I """'nrvun+lI 1';nnt'"
with All ~i=lrt~ nT ~Q"'J::t!:!r;l rlic.nn~~l. C!\le+om Mnh"'o I>U'\m13 n','ur-+ 10.1:\ in ~~~'!: ~....n", .......::c.::;;.I~iA
TYPE OF CONSTR UCTION
GROUP
FIRE ZONE
STAy"ioo' FROM ALL WELLS
USE 'CLASSI F.
SETBACKS, FT, FROM CTR, OF r/W:
FRONT 4; SIDE EXT.
l:;
FT. FROM PROP, LINE:
SIDE INT, REAR
I:
ZONF
D^"_MU
AUTHORIZED SIGNATURES:
Isl ,1 I' 1'11'1<:<:
ISSUANCE DATE:
--,
t:vocn!.l r.:tf\~" D t' /,.....
-0# .-.." --~-~';;;).
.1..1.. 0 '~'7c..
_.:;.,." .-:r. .-:-
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
IMPORTANT:
Call 687-4065 to sc~edule all required construction inspections. Call 687-4061 to schedule all required
septic system inspections. All construction shall comply with the Slate Buidling Code, D.E.Q, standards
for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy before being occupied.
(See Deta[ls on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG, AT SITE)
C55.13
LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX; 135 EAST 6th, EUGENE, OREGON g~401
,
BUILDI't;\G SITE EVALUATION r-"
.. I
(~I{DING PERMIT APPLIC~;~ON
() SITE INSPECTION
;~..! ./
.,U",V
No.Li/i1 ~& .
. . j'
S
TAX LOT
T . R
SUBDIVISION:
LOT:
APPL I CANT
DATE
Not
A(?plicable
1 . Zon i ng 0 rd i nance Camp I i ance: Zone f} 1'1- - ( ),
2. Subdivision Ordinance Compl iance ~( )
3. Required Access ~~ ( )
4. Building Site (Area, Width, Frontage) ()
5. Other (see comments) ( )
COMMENTS: ~ ~~ '11
.11 . (,VWJAi~ ~ .~~, ~
PLANi~o/~O~NDI(~~~')~t;~~#
PLANNING DIVISION
BUILDING INSPECTION. DIVISION
Not
App 1 icabl e
( )
( )
( )
( )
7. Plans Submitted
8. Soil Stability (f66tings)
'9. Flood Plain
10. Other (see comments)
COMMENTS:
No Yes
T) TI 6.
( ) ( )
( ) ( )
( ) ( )
( ) ( )
No Yes'
T)TI
( ) ( )
( ) ( )
( ) ( )
BLOCK:
CK'D BY:~' z:.i> Gt.MU 7t,
Setbacks from cll of d:~<f: '-
Front tr.~
~,f"", Lll_. nn..
Setbacks from interior~ines:
Side S
~ Rear ~
.~~;;-:-
~~ /S7J.' [/
CK'D BY:...
DATE
-- ._,- ,". ....-..-.-- ...
WATER POLUTION CONTROL
11. Meets Department of Environmental
dUality Standards~
12. Other (see comments)
COMMENTS;,. . _.. ___
Not
App 1 i cab i e
( )
( )
. - -"' ~..... - ..- ---... .
No Yes
T) ThI
J
( ) ( )
CK'D B~hCft4ko-2,j.7("
{I DATE
TO APPLI CANT:
YRur~uiiaing ; Site inspection:
(cr-~afi be approved. . '. ,
~ () Cannot be approved at tnis time as indicated on item NO. above.
<::6V Ip./ Questions and further Information on items 1 through 6 contact ttie LANE-
U I /\ COUNTi,PLANNING DIVISION;, QUes.~I~~"ancl further information oni!ems 7
/\)0 thr,?ugli 12 contact the ,LANE,COUNT.Y-BU I LD I NG AND SAN ITATION 0 I V I S,I DN~
. I ( ) Will tie held in this office until you can resolve the problems indicated.
( ) Is being returned. ..
( ) Your buildin,,! permit application fee, isbeing ~~tu,=-n,~d under separi1te cover
-DEPARTMENT OF ENVIRONMENtAL MANAGEM~NI
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANNI~G DIVISION PHONE: 687-4186
C55-28
.
. ,,' bANE COUNTY, ENVIRONJou."TAL MANAGEMENT
Name and Address of Owner I J/U2.4. fJn ,', '_
)' 7 <;' S <) Ii-' ~'Yr~7/~
The building being constructed under tris permit w~ll
~AO./...... ~.
f'f'Y(I), Teiephone: '7l,c
PLOT PLAN
~,
7 '?"7 / /
be used for
c
t1A,... /-, Iv' .., .".:,~, ,.0.
Date this property was purchased / y {, -;
Do you now, or did you ever own p~op~rty adjacent to this tax lot? If so, please,
list those tax lot numbers or draw ~ose properties .on the plot plan below.
"<,.. J, dlui..!" l
Indicate on your drawing the location of all homes (including mobile homes) now on
the property, as well as the location ,of the net buildin~.
-- - -- - .., ,.. ...,- -- = .~ =.:.~ : ~ ~ ~ ~;~ ~ ~ ~ = = J.:. = ~ .:. =1= ~ ~. . ::: ::::: :: :: .:.:. ' .... -- -I::: --- --- -, .:._
----.------------------..-------.-------.--.------.-----.-------
.. '..." ,. :::::::::~:::::::::::. H-'l: C.;, ,:::,;::::: n. ~ ~~(!.:::::::::::::::: .::::::'
.- - _. - -.. - -' - - -. -. - ~- -- - - ,,- ~- .-. -- ... _. - -- -- .. -_ __ ._._ '_ __ ._. __ __ __ - _u .__ __ __
'h .,. -- . .. - -.. , ,..- .,,~ .:: .:. : : .::.. :: ~ ~ : ':" ..' - ;-: :::: ,;;; .:: J -:. -. .::.:..:. ::: - ,. ..
, -- -. .':::.:::::::::'::: ' '::'::::::::: ..,. .., ...,~ ,::: :::.~::: :: n ::.::: .:::::.::: ,\ ':::.~::: ::..:::" .::: '::':::=:::.
.----- - - -t~
C========_ -= . L == ==~: =t = = nL - .==~I===:_
~_~-...... - ==----~ -~~. .m~~i~~~j=- ... - _.-.. Co j= ~=~~~!i;~~~,,:_,
.,
~~~~~~~:::.::~~~~~~~~~~-~~~j~~~=~~~~~~~\~~~J~~~~:
'--" .'\
~~_.::::: ~ = =J = ~== ~ ~ ,__ ____ _ ___ ____________ _ __,
-.-. - -.
....." . ...., --
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.- - -....--:, - ...-
1\111: :: JIJlrlY
~I i~ If, 0. ~i la r I..L A),r 11,
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Name of Applicant
Address
Telephone
(if different from owner):
"
. ~-;.-, - ;","
"
.. ~",;,:". Appl ican t' s
,,,i)l~hC74_99
~"..._,.,
Interest: Buyer
D
Seller 0
Agen t W
Map/:r-3- /(-7.,-:1..,
Tax Lot ... <:;- () t)
Permit II
INSTALL:ER:
~-'- --
--~ ~.....:..'~, ~--
iE-/) S 6IT&t. ~A/'I
No. Living'Units Bedrooms
Baths
1~~-7~
IS with application, .'
PERMIT NO. ~. ~:;: ~;'.:;
PROPEK I Y, AUllRl:~~ L DT .., b Y3 t.- ~ d. d
2 D 61- I+-AR. Bo(l.. I) I:lY VI='
Ba~ement Water' Supp,l y
Yes No Pub Ii c V Other-Li st
PROPO~ SEWAGE DISPOSAL SYSTEM RECORD
Compl ete top part of fo,.., to signature ~nd submi t both Cl
INSTALLER'S NAME
Septic Tank:
Ft. f rom we 11
rLYD~ .'iHFt.f?Y
" . ,j FeeL[:om'
MAILING ,')--7S- J{..". ',4 ~, WEll
ADDRESS '.sfIUNC-P, eLcI '(jl~. '1,?u77 Lot Lil)e 10
/ ' , Front . . Side It) Rear
~ength of Lines-Ft., lT~ench I'Total Sq. ,I F~. Between IFiller):'IFiller Depth IFiller Below
.'732.7<13. 4. 5. 6. Wldth;L Ft.~~O() LInes' 10 Tvpe/~AboveTile1-inJrile 6 in.
~lot Pian (see instruCtions): , rloV
~1' ~ f~""
~v~~~r
I ~<:):\'Jt:
\~~ '\' "
\
Inside
Length
OWNER .
NAME
tl
'\
~
>-
ei
.Q...
'" .
~
,~
Concrete ~ No. Compartments
Steel 0
Ft.
, Diameter,
Gal. C~pac i ty
1000
Ti Ie Disposal Field:
Distribution Box: Yes V
Other Oistribution-Typ'e
V'
o i mens ions: '
Width
, Depth
No
Foundation
..
.;.;, .
r^' Ol3lk~ltiJr"'~
\ '
1t-- \ .
i? ~
:).5
.'
~~
. . _ ;:, "~'.l:,..
.......'.,.
~11
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y
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(
(iJ)
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~,
~
~
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--
~
cuN$
(!) yjOX
, _, RECE'~~
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-.-..--......,. '
-
~ . I NOViJ"11976
~/Ig \16
"\ '" J' !:M~g COUNTY
;f'/VmQNMgNfAL MGMT.
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H AP.-tJ (fR P R !'1fT
Date NUll :1- 7 6 S i qnature -A .JIpA~"'rt.P -X"A1A;;7-.vv
CERTIFICATE OF SATISFACTORY COMPLETION /
For Sanitarian Use Only:' Datell~-7j;"
In accordance with 1973 Oregon Laws Chapter 835. Section 214 this certificate is issued
as evidence of satisfactory completion of a subsurface sewage disposal system at the above
location.' ,
~Approved: System Installation conforms to current standards
c==J Disapproved: Does not conform to current standards
Remarks:
C55-11
Y<7,~
Sanitarian's Signature ~
LANE COUNTy(f
: ,":' . STATE OF OREGON 'DEPARTMENT OF ENV I RONMENTAL QUALITY
,'. ,: NOTE:
,.:.
NO PERMI1
l
~LL BE ISSUED UNTIL THIS APPLICh.LON HAS BEEN APPROVED
(E:t~y /76
"
APPLICATION FOR:
CONSTRUCTION 'c===J
MOBILE. HOME [:8;]
PLAN REVIEW c===J
CHANGE OF OCCUPANCY L:=J
t=J
OWNER 'lAuJ.iJr...JI2-w.o~ l':.A
. Name
f(}a....-.!J., ~7'
. Address
Sa..A
"
8,';'] 1// ... 'J V till
~tY. Zip
9'7~ 7 7
Phone
'/C,;7F.h;
c===J. CONTRACTOR
· e ~
~ .".l
Name
.'
A~dress
City
Zip-
PhoI).e
O,S, REG, II
ACCESS TO PROPERTY (Roa?'Name)
~l:e_ .~ Section II
nd'E.t / h f'}o' r r:,. rriLltot '-I r;;.
/fa ..../v....v
'n....,') t<=}.
Tax Lot 7,0;' f'l (')
. Block --:5
Code
Census Tract
Width~ePth~
Property Acre~ge
~J""
~~ist'ing Str!lctures on Property:
, ,
Property Location - Address/Dir~c~ions:, d (') G ~
/Ia v hLJ....
. r .
p 'lLL,,' '"
<C:;-:> ""/'45' tlt>/(
~elOW fo Of f ic e D.S e onl vxxxxxx. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX~XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
. ~fU-.f,d--{]S, Sq, Ft,' , ("B~~mS ) ,Valuation.
-. \ -~
." . .
,
SEWAGE DISPOSAL:
Site Inspection
II~
I
Existing
Required ~
c:::::::::r "E5. c===J NO c===J YES ~~
'Signature of APr{Y'?Lt: a~ (jJ,,/?/,~:#, " /r
Fee Received ~I/ ~~ Date: b ~S' /--t::>
Min~ Septic T~~ Capa:ity _ q tJO Drainfield. Req.Uired - Lineal Feet I' /S-()" _ Maximum DePth, _1' 0 _
4 ,d:., /~ ~. 'lA.-..'-.'.', ~ -'f /00 A~ k ~~,
1:jJ.-!~~ ~ ~()I'7A~a:5~~dJ5~~ dtr4, A~
TOTAL
tB-rJ, (T()
Other
or Public System
WATER SUPPLY:
Well
Spring
FEES:
PLUMBING:
Installed by Owner c===J
Bldg,
Plumbing
3 % Surch~rge
Waste Disp.
Plan Review
PLUMBING FEES:
II of
Water
Connection
/UO,(',3-0
PLANS FURNISHED_
FACILITY PERMIT
Mobile Home
q ,CASH
Type of Construction
Group
Fire Zone
Use Classification
Bldg Setbacks - from Center of
Front L,?~""'- Side Int.
Road"Right of Way:
~ Side~
Rear
,~
Zone
,/?~ -/11/1-,
PIANNING:
J /lAeP.
..
DATE: >>;J}.ATION' " .-,_DA/~:?/
2t../'~""'J 7c~ ~/, ~ I y
, tf,t' LANE COUNT; ~PARTME~Ta ENVIRONMENTAL
BUILDING:
DATE:
C55-12
MANAGEMENT