HomeMy WebLinkAboutPermit Land Drainage Alteration 1999-05-25ffiis SrUe To Be Filld Out bl
This pormit is roquirod for irrry sito activity in the flood plain and ovorywhr-rrofifty (50) cubic yards of mar.rial or more and/or if a drainageway is aiie'ctea,
sito altoration consists of
within City limits and
Site Address
Fermit'Expiration Date:
Springfield, Oregon
Date of Application -* zf '? 2
Journal number applicable Land Use Appli
Tax Lot:o)43,E.
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No: /Z-og-zs-4{*Wtr uGB Tax Map
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Supplier: €*t €.V/t4) *e Supervisot s il€z{b foaruLt4P/<Projectil. sb Phone 3lS-/ 9os-
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GRADING, Quantity
EXCAVATION, Ouar ntity /&cteY Destination
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SITE PLAN Required Dafa:Ouantity of matqriali Propertv lines and descriotions, Tax mao andlot number, Site addrcss, Existing contour lines, Proposrid contour lines, Existin'g drainagie
W6ys, Proposed drainage ways, Significant tr.ees and fdliage; Ground c6ver, Soil tvpes,
B.uildinqs,'Septic syste irs, Sejwers, Areas subject to floodingj,. utilities, Areds subjri6t til land
slroes, Proposed srte tmprovements.
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DRAINAGE, POLLUTION AND EROSION CONTROL PLAN
ADDITIONAL INFORMATION,
REPLANTING PLAN
PHONE
COMPANY NAME
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COMPANY NAME:
De=r ,/u/ .ZLLLLS
C|TY &.2.€
PROJECT SUPERVISOR:&ss
ADDREi* /7Y?- D€,STATE &L
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PROJECT SUPERVISOR: 5
ADDRESS: t/ZSo !,tt . 5-n fVe-
A-2/SEMERGENCY PHONE:
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EXpiration Date:Registration Number
ADDRESS
/{2 FAx ?(s-31 7lSTATE
CONTRACTOR NAME:
PROJECT SUPERVISOR PHONE
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I undorstand that lor my succos:;rlrs rrray havo futuro plans for my property which maf bo anticipated or unanticipated at
this tim€. I understand that such luture plans may requira permits and developemont approvals from the City of Springfield
I understand that notwithstanding any approval of this Land and Drainage Alteration Pirrmit (LDAP), that at the time of
application of future permits or approvals the City may review and.recpnsider all actlons which I or my succassors have
und€rtakan p6rsuant to this LDAP. I undBrstsnd that thr Clty mly aa a condition of any future approval, requlre the
undoing, changing, or modification of any actions which I have und6rtaken as a result o! the City's approval of this LDAP.
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By signature, I state and agr€e, llrirl I have carefully examined the completed applicrtlon and do hereby certify that all
informntion horoin is truo nnd 61111rrrit, and I ftrrthor cor'tify that any.and all work Frerformarl shell be done in accordance
with tlrs Ordirrarrcos ol tlru City ol liprir\gtiol<J, applicablo Clty Standald spoclficutlona and Drawings, End tho laws ol tho
Stato of Orogon pertaining to th() work doscribed heroln.. lfurthor cortify that only contractors and employeos who are in
compliance wlth ORS 701.055 wrll bu used on tlrls prbJect. ,.
Th€ City may inspect the work sitr: tloscribed in this pclmit at.rny timo during a on! year period following the receipt by
the City of notice of complotion ol tlre described work and.specify. at the City's Sole desecration, any additional r€storation
work required to return the site to a standard acceptable to thb City. The p€rmitt€e will be notified in writing of any work
required and will havo thirty (30) days from the data of the notico to.comploto the Work. Work not completed at tho snd of
thd thirty days will be perfdrmed by the Citv and the coste will be bill€d td the permlttee.
requested at the proper time, that project address is readable from
th6 sito at all tim€s during construction.
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that all required
set of
Slgnaturc 2 r-?.
I further agree to
the street, and
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Property owne, Kentrrt /. i K*ce+ 1. Sio>r phone: %Zyfa$Address: 27fZ /occt.ST _5,- .. Cit
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MOBILE PHONE: S?.-
tr DRAINAGE, o storm, tr Dlteh, O Culvert, E Natural
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WETLANDS, Descripti
FEMA CommFLOOD PLAIN, Zone:
FLOODWAY, FEMA Cornmunity Panel No.:Date
s20.00
s30.00
$40.00
$40.00 For tho f ir:,t 1O,000 cubic yards, plus
$20.OO for each a(l(litional 10,O00 cubic yards or fraction thereof
S22O.OO For tho lir:;t l OO,OOl cubic yards, plus
S2O.OO for each additional 10,0O0 cubic yards or fraction theroof
$34O For the first 200,001 cubic yards, plus
$6.00 for each additional 10,000 cubic yards or fraction thereof.
$30.00
$30.O0 For the first 100 cubic yards, plus
$14.O0 for each additional 1O0 cubic yards or fraction thereof.
$156.00 For the f irst 1,000 cubic yards, plus
$12.00 for each additional 1,000 cubic yards or fraction thereof .
$264.OO For the first 1O,00O cubic yards, plus
$54.00 for each additional 1 0,000 cubic yards or fraction thereof
$750.00 For the first 100,001 cubic yards, plus
$30.OO for each additional 1 0,000 cubic yards or fraction thereof
Date:
Date
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100,oo1 TO 200,000
2OO,OO1 CUBIC YARDS OR MORE
Estimated Volqme
Received BY:
Grading Permit fee:
Received by:
Receipt No
Date:
PLAN CHECK FEES:
UP TO 1OO CUBIC YARDS
101 TO 1,OOO CUBIC YARDS
1,001 TO lO,OOO CUBIC YARDS
10,000 To r00,000 cuBlc YARDS
GRADING PERMIT FEES:
UP TO 1OO CUBIC YARDS
101 TO 1,OOO CUBIC YARDS
1,001 TO l O,OOO CUBIC YARDS
1o,ooo ro l oo,ooo cuBlc YARDS
10o,oo1 To 2oo,ooo
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Receipt N.,V4l7+
our", 5/25/11
Plan Check Fee: fi9
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Engineering
Maintenance:
Building:
Plannin
Date:
Date
Date:
Date:
Datelssued by
Date
Date
Permit Number
Date
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Date:
Engineering:
Building:
Maintenance:
Reqrrired Fihal lnspections.'
Planning:
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5 Land and Drainage. activity.as outlined in this permit has been completed in accordance withthe provrsrons of this permit.
hnmrl{tdr?J?igf"q,"r%?tityilJf&ffyt]i"ed in this permit has not been completed in accordance
tr Land and Drainage activity was performed prior to application for this permit.
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Accepted by Date
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1/6/1998
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Side To Be Fill By City Staff
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