HomeMy WebLinkAboutPermit Septic Tank 1994-11-28SEWAGE DISPOSAL SITE EVALUATION
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Written Directions +
Subdivision:Po l',lr'to,..
-".8 7_Brock-WATER SUPPLY U
APPLICANT'S NAME AND ADD
OWNER'S NAME AND
STRUCTURES NOWON THE Nc.,r^'e-PROPOSED USE OF PROPERTY
Phon e 12Q -132L
Ptrone-?YG:1-83?
E-- !-
I herebv certifu that the
ts ieartorLragent.
above statements are true and accurate, and that I have the following legal interest in the property:
-owner
of record;-contract purchaser;
-potential
buyer;
I further certify that (if not the owner) I am authorized to act for the owner of record, and that said owner is approves of this action.
-EST HOLES q Signat
.. i * rtr *r*** * * * * **r******i *** * **** t***** * * *i*r***.* * oFFlcE usE oNLY BELOWTHIS
SITE MEETS STATE STANDARDS
Standard System
Sand Filter
1 Foot Capping Fill
NO
tr
tr
n
YESNO
n
n
tr
YESXn
u
Low Pressure Distribution
Holding Tank
Other
LAND USE COMPLIANCE
Zoning Acreage or Lot Size CIOTAL)
Partitioning #-Parcel ) Completed
) Pending
COMMENTS:
FLOODPLAI N I NFORMATI ON
THIS IS A PREL]MINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
AR RI
tr Approximate
Study Area
tr Detailed
Study Area
tr Floodway
All or part of this site may be in a flood hazard
area for which 100 year flood levels have not
been established. Extra precautions may be
appropriate to assure that the building site will
be reasonably safe from flooding.
All or part of this site may be in a flood hazard
area for which '100 year flood levels have been
established. A building elevation above the 100
year flood level may be required.
All or part of this site may be in a flood hazard
area in which a floodway has been designated.
Building may be prohibited subject to
demonstration that the cumulative effect of
proposed development will not increase the
100 year flood level at any point.
E IS APPROVED, SEE REVERSE SIDE.
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LANE COUNTY
c55-32
ENVIRoNMENTAL HEALTH, 125 EAST 8TH AVENUE, EUGENE, oREGoN 9740t (687-4051)
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