HomeMy WebLinkAboutPermit Septic Tank 2004-04-2704/29/0{ TEtr 0E:35 FAX 541 083 3991 LANE CO LAND MG}INT @ ooa
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SAI{ITATION AUTIIORIZATION NOTICE
FOR SP037418
Permit SubType: AUTHSffE AppHcrtion Date: t0/Og/2003
Proposed ectivtty: AUTr{0RIZATION wrT}I FIELD vIsIT
Job Addrecs: 2532 GRAND VISTA DR SpR
Applicant:
HEAD ED
2532 GRAI{D VISTA DR
SPRINGFIELD OR
97471
Parcel #: t7 -O3-Z+3 l-01400
Discussion:
No evidence of failure.
Setbacks met.
Sand filter treatement if failure
occurs.
Inspectlon By: jm
Inspcctor Signeturo:
Ownerl
KELLEY JOHN L
2532 GRAI{D VISTA DR
SPRINGFIELD OR 97477
Authorized?: Y
Y: Yes
N-No
Inspecfion I)ate: }4/lg/ZA04
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Permit No. *J ,C 3 '-c)5^ Twnshp.' ? Range o'3 Section J Tax Lot 6 c, 7/j,
Standard System B Alternative S u (s
Job Location (Street Address)
Supdivision/Partition #Parcel Lot Block
DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED
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USE BLACK INK ONLY
Tile L,(FOR INSTALLER'S USE: Trench Depth L(Gravel
Tank Capacity /0 ocs Manufacturer IS
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION
I (installer's name)certify that a (Mfg.)(Model No )Pump
D and Mercury Float Switch (Mfg. and No.)have been installed with this sewage installation
Signature Date
FOR SANITAR 'S USE m System Needs orrection
l.huvJu- R^-,r/Qr
\COMMENTS:
System Capacity
Date
Dategal./day Signature
INSTALLATION RECORD & CERTIFICATE OF SATISFACTOBY ION When signed by the Counly Sanilarian. this certiflcate is evi-
dence as per ORS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above locatron
To request inspection, return all three (3) copies of this form to: Lane County Environmental Health Services. located in the basement of the
Public Service Building, 125 E. 8th Avenue, Eugene. OR 97401.
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Permit xo. Q/ 83 -?-f Twnshp.
Job Location (Street Address)
Standard System E( Alternative Spegify6t Type)
/ ? Range Section aq Tax Lot ."S9i):\o3
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Block _
DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED
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USE BLACK INK ONLY
L(ravel Below Tile Z,(FOR INSTALLER'S USE Trench Depth
Tank Capacity /6 or>Manufacturer
and Mercury Float Switch (Mfg. and No.)
c2 Deoth
s7-o
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION
I (installer's name)certify that a (Mfg.)
Total Length of Lines / Sa
(Model No.)
have been installed with this sewage installation
Pump
F
Signature Date
lJ4^$r,o E^'.4,\COMMENTS
FOR SANITAR 'S USE m System Needs
Date
System Capacity gal./day Signature oate 7 -/3 -Al
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COM N When signed by the County Sanitarian. this certiricale is evi-
dence as per ORS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location
To request inspection, relurn all three (3) copies of this form to: Lane County Envrronmental Health Services. located in the basement of the
Public Service Building, 125 E 8th Avenue, Eugene, OR 97401.
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PLO'T PLAN APPROVED
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prior lo starting
DATE
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04/29/04 TEIT 08:35 FAX 541 682 Jggl LANE CO LAND UGUNT & oor
ffi Land nlanagement Division
Lane County Courthouse
125 East 8th Avenue
Eugene, OR gZ4Ol
EA)( h (541) 6g2 -3947
FAX
Meacage lio:\n^Seg-
Work
Locatioa:
Telephone
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Message
Sent By:
Location: Ianc Countv PSB
Telephone
Nuniber:(,8L'5t tq
Number
of It(Be:
Rclurn
Originats To;
Special
InstructioaJ
It{eseage:
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cover sheet )
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Sent By:
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