HomeMy WebLinkAboutPermit Septic Tank 1980-02-29r
POST THIS PERMIT ON MAIN BUILDING AT SITE
JOB ADDBESS: 3375 Uontebello, Sprtngfield CONSTRUCTION PEBMIT# rC-419-80
TRS, TL: 17-02-19.3.1[ l- 'l( 16 17 Subdivision: ontebello Acres (2nd Addttton) Lt 1 Block 5
This permit for the referenced proporty is hereby Approved Setbacks and other conditions of approval must bs strictly observed. Violation can
result in revocstion of this permit, citation under provisions of lane County's lntraction Ordinance, and/or other remedier allowed by law.
Applicant/Address: Sandra Shoemaker, 3375 Montebello, Springfield, dregon 97477
Owner/Address: Same
Contractor/Address: Same
Contractor's OS + na Total Construction Value: na
Construction approved by this permit Repair Septic Syttem (Emergency)
Water Supply: public
Telephone: 746-2203
Telephone: Same
Telephone: Sane
+ Bedrooms: na + Plumbing Fixtures: na + Employees: na
PLANNING DIVISION Zoning: na Partitioning + na Parcel +
Minimum required structural setbacks, from: centerline of road, front: na
side exterior: na ; interior property lines: na ;rear property line: na
Special lnstructions: na
For information call 687-4394, Susan KeLler
na Parcel Size: 91xl-13
; centerline of road,
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WATER POLLUTION
CONTROL DIVISION
Sitelnspection+rnalnstallationspecifications:Existing*,.,
na lineal feet of drainfield required; max. depth of trenches:ng
Special lnstructions: Probe to determine the Location of the exist ing septic system
Septic Tank
(refer to the attached copy of the orginal- permit). Connecting into box if
possibl-e, install as much additional line as space will allow in the front yard,
squeezing Lines in center if necessary. Lines in front yard should be set up
using serial dist. Tite line to new lines in front should be connected into the
Setbacks
I nGiio-r property I i nes
Edge of road right-of-way
rilding foundation
Wells, other water sources
box at a hieher
For informatio"n call
elevation than the o1d line
n 8:00 - 9:00 a.
10'
10'
5',
50'
Drainfield
-T0--
10'
10'
100'
s so that the new lines are utilized
betwee m.,
CONSTRUCTION
PE RMITS/INSPECTION
DIVISION
Take care not to disturb the existine svstem.
Type of Construction: na Group: Fire Zone: na Use Classification:na
lnstructions: na
For plans information call na between 8:00 a.m. and 9:00 a.m., na
For inspections (see back of this permit) call 687-4065 between 8:00 a.m. and 5:00 p.m.
Directions to Site: Hayden Bridge Road to 34th-on corner of 34th & Montebel-Lo.
Date lssuedi 2-29-go
DEPARTMENT OF ENVTRONMENTAL MANAGEMENT
By: Kathi wiederhold/mu
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FOR SANITARIAN'S USE ONLY: Efystem Approved fl system Disapproved tl Needs Correction
Hao<,t '6B,ocie i COMMENTS, ?ef&ir - QoeS rrot -r...erf Cqf('?n-t < T@.nd.a.e(S
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FOR INSTALLER'S USE: Trench Depth Filler Depth Below Tile
Subdivision Lot- Block
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Tank Capacity Manufacturer
[Vleasured distance to well from tank
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INSTALLATION RECORD AND CERTIF!CATE OF SATISFACTORY COMPLETION
When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat-
isfactory completion of a subsurface sewage disposal system at the above location.
Return this form to: Permit Processing Section, Department of Environmental [\4anagement,
Public Service Building, 125 East 8th Avenue, Eugene 97401
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Date:
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,,JOB ADDRESS
POST THIS PERMIT ON MAIN BUILDING AT SITE
CONSTRUCTI ON PE RIVI IT +I
Subdivision:TRS, TL
This permit for the referenced property is hereby Setbacks and other conditions of approval must be strictly observed
result in revocation of this permit, citation under provisions of Lane County's lnfraction Ordinance, and/or other remedies allowed by law.
Violation can
Applicant/Add ress:
Owner/Address:
Contractor/Address:
Contractor's OS +
Construction approved by this permit:
Water Supply
Total Construction Value
Telephone
Telephone
Telephone
I
C
+ Bedrooms:+ Plumbing Fixtures + Employees:
PLANNING DIVISION Zoning: Partitioning +
lVlinimum required structural setbacks, from:
side exterior: ; interior property lines:
Special lnstructions:
Parcel +t
centerline of road, front:
;rear property line:
Parcel Size
; centerline of road,
For information call 687-4394,Anv alteration ot the
naiural conditions tn
WATER POLLUTION
CONTROL DIVISION
site lnspection #
lineal feet of drainf
. lnstailation specif ications:
ield required; max. depth of trenches:
9pe9,rL_l$_tlygI,.11
;"
void this aPI
Setbacks
Inteiior property I ines
Edge of road right-of-way
Building foundation
Wells, other water sources
et $
tSeptic Tank
10'
10'
s',
50'
Drainf ield--T0--
10'
10'
1 00'
ltoarl llac
te+lr.mry.
r Eorr ltaal
ld
GCt
between 8:00 - 9:00 a.m,,
CONSTRUCTION
PERMITS/INSPECTION
DIVISION
Type of Construction
I nstructions:
Group:Fire Zone: Use Classification
For plans information call between 8:00 a.m. and 9:00 a.m.,
For inspections (see back of this'itrmit) call 687-4065 between 8:00 a.m. and 5ib0 p.m.
lane countyDirections to Site
Date lssued:
c55-1 3
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE / PUBLIC SEBVICE BUILDING
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
By:m!'- _==r
For information call
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C )NSTRUCTION [ ]
LANE COUNTY PERMIT FOR PERIVIIT NO
MOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
tr Owner
NA N/IE ADD R ESS C ITY ZIP CODE PHONE
D Contractor
NAIVIE
O.S. Reg. +
Tw
Subd ivision
Access to Property (Road Name)
Range-- Section ,.t,tr* b1 /O/7 9o6"
ADD R ESS CITY ZIP CODE
Census Tract
PHONE
Lot B lock Acreage width
Depth
Existing Structures on Property:
Directions to Property - Address
STRUCTURE (# BEDROOMS)SO. FT VALUATION
SEWAGE DISPOSAL:
PUBLIC[] SEPTICTANK[]
PLUIVIBING INSTALLED BY
orHER [ ]OWNER [ ] OTHER t ] NAIVI F
BUILDING
PLUIVIB ING
3% SURCHARGE
TVIOBILE HOt\4E-
WASTE DISPOSAL
PLAN REVIEW
TOTAL
WATER SUPPLY: PBOPOSED t ]
EXISTING I]
PUB LIC
COVIIVIUNITY. NAIVIE
PRIVATE WELL
OTHER SPECIFY
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
IVIIN. SEPTIC TANK CAPACITY
GALS.IVIIN. DRAINFIELD LIN. FT MAX. TRENCH DEPTH I NCH ES
STAY 1OO' FROIVIALL WELLS
TYPE OF CONSTRUCTION- GROUP FIRE ZONE USE CLASSIF
SETBACKS- FT. FROIVI CTR. OF rAtu
FBONT SIDE EXT
FT. FROIVI PROP. LINE:
SIDE INT.
-
REAR ZONE
AUTHORIZED SIGNATURES
/s/
ISSUANCE DATE
BLDG, PEBi,4IT - WHITE
OFFICE COPY - WHITE
COUNTY TAX _ PINK
PLUMBING - CANARY
BUILDING - GBEEN
SANITATION _ GOLDENROO
IMPORTANT
(POST THIS PERMIT ON MAIN BLDG. AT SITE
LANE COUNTY, DEPT, OF ENVIHONMENTAL i/4ANAGEi?4ENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
Call 687-4065 to schedule all required construction inspections. Call 687-4061 to schedule atl required
septic system inspections. All construction shall comply with the State Buidling Code, D.E.Q. stanilardsfor subsurlace sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy before being occupied.
(See Details on Reverse Side)
c55 -l 3
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SUBDIVISION:
AX Lor ,oza
LOT :_ BLOCK:_
BUILOING S ITE EVALUAT !ON
D{-'BUtLDfNG PERtllT APPLtCATION No. 8Sn-,7A
()SITE INSPECT!ON APPL I CANT
DATE
PLANNING DIVISION NOt
Appl icable
l. Zoning 0rdinance Cornpl iance: Zone.l$fifl( )
2. Subdivision Ordinance Compl iance ( )
3. Required Access ( )4. Building Site (Area, width, Frontage) ( )
5. Other (see cornments) ( )
cK,D sYdlQZSB4-No YesrI TX()0{()(rd()w
() ()
6 Setbacks-Tffi
Front
Side Ex
Setbacks frorn
Side
Rear
e7T-ofroa?
I
ter i or
i nter ior nes:
C
COililENTS:
FTANI]NG TTtrPITcAraoN#
BUILDING INSPECTION DIVISION
Plans Submitted
Soil Stabil ity (footings)
Flood Plain
0ther (see conments)
Not
I icable No
7
8
9
0
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fr'()
()
r)()
()
()CK!D BY:{-o
COHMENTS:
I,ATER POLUTION CONTROL NOt
I l. l'leets Department of Environmental
Qual i ty Standards.
12. 0ther (see comments)
No Yesr)rI
DATE
CO}IMENTS:
Aool icable
() ()()CK'D BY
TO APPLICANT:
Your Building / Site lnspection:
(4 can be approved.( ) Cannot be approved at this time as indicated on item N0
Questions and further information on items I through 5
above.
contact the LANE-
C0UNTY PLANNTNG DlVlSl0N" Questions and further information on it eilfi
c55-28
()
()
Your bui ldin
ems i nd i cated.UU
through l2 contact the
Will be held in this of
LANE COUNTY BUILDING AND SAN TAT ON DIVISION.
fice unti you can reso vet Prt)ls being returned.
rmit a I ication fee is b
G
135 Sixth Avenue East Eugene Oregon 97401
PHSNE: 687-4065
LANE CoUNTY PLANNING DlVlSloN PHoNE:. 587-4186
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LAI'E COUNTY ENVIRONMENTA! I'IANAGEIGNT
Name and Address of Owner
Telephone:
The building belng.constructed under this permlt w111 be used for
PLOT PLAN
Date this property was p urchased
Do you now, or did you ever own property adjacent to thls tax 1ot? If so, please
llst those tax lot numbers or draw those properties on'the plot plan below.
Indicate on your drawing the location of all homes (including mobl1e homes) now on
the property, as well as the locatj-on of the new building.
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Address
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LANE COUNTY PERMIT FOR:PERTVIIT NO
CONSTRUCTION [ ] IV]OBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
NATVIE ADD R ESS CITY ZIP CODE PHONE
NAIVIE ADD R ESS CITY ZIP CODE
Census Tract
PHONE
O.S. Reg. +
Twp Range- Section Tax Lot-- Code
B lock AcreageSubd ivision Lot
Access to Property (Road'Name)
Width
Depth
Existing Structures on Property:
Directions to Property - Address
STRUCTURE (# BEDROOTVIS)SO. FT VALUATION
SEWAGE D ISPOSAL:
PUBLIC [ ] SEPTICTANK [ ] OTHER [ ]
PLUMBING INSTALLED BY:
OWNER[] OTHER[] NAM F
BUILDING
PLU I\48ING
WATER SUPPLY: PROPOSED t ]
EXISTING t ]
PUB LIC
COMIVIUNITY. NAIVIE
3% SURCHARGE
IVIOB ILE HON4E
WASTE DISPOSAL
PLAN REVIEW
TOTAL
PRIVATE WELL
OTHER . SPECIFY
CONSTRUCTlON PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
IVIIN. SEPTIC TANK CAPACITY
GALS.t\4IN. DRAINFIELD-- LIN. FT MAX. TRENCH DEPT I NCH ES
S TAY lOO' FROIVIALL WELLS
TYPE OF CONSTRUCTION GROUP FIRE ZON USE CLASSIF
SETBACKS - FT. FROM CTR. OF rAV:FT. FROIVI PROP. LINE
SIDE INTFRONTSIDE EXT.R EAR ZON E
AUTHORIZED SIGNATURES ISSUANCE DATE
lsl
BLDG. PERMIT - WHITE
OFFICE COPY _ WHITE
COUNTY TAX - PINK
PLUMBING _ CANAFY
BUILDING - GREEN
SANITATION _ GOLDENBOD
IMPORTANT
POST THIS PERMIT ON MAIN BLDG. AT SITE
LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
Call 687-4065 to schedule all required construction inspections. Call 687-4061 to schedule all required
septii sysiem inspections. All construction shall comply with the State Buidling Code, D.E.Q. standards
ioi suOdurtace sdwage disposal and the State Plumbing Code. All buildings require a certilicate ot
occupancy belore being occuPied.
(See Details on Beverse Side)
n Contractor
tltltltl
F
SITE INSPECTION
Appnoveo
Rruaaxs
D r snppnoveo Dar e I ruseecton
FOUNDATION I NS t0N
AppRoveo
Reuanx s
Dr sappRoveo D Dar NSPE OR
./,\ _/-\(i:--t-
FRAMING INSPECTION
Appnov e o
Reuanxs
DrsappRoveo -t?? I NSPEcToRrtoor, /- I
LATH OR SHEETROCK
Ap pnov r o
Rr xr Rr< s
I NSPECT I ON
Dr sappRovEo Dar e I Hseecton
FINAL INSPECTION
AppRoveo Drsrppaovro D oort/- 2-!'7? tNspe cron
Re tqa nr s
M
CERTIFICATE OF OCCUPANCY
Reeov ro lssuE
Rruanr s
Nor Reaov ro I ssue Dare I ruspecron
D
,kizfl,
I
((PERMTT + /& ZZ
NO PERMIT I{I.- BE ISSI]ED I]NTIL TIIIS APPLIC.ATION HAS BEEN APPROVED
APPLICATION FOR:
cousrnucrrou l>4l MOBILE TIOME PLAN REVIEW C}IAi'IGE OF OCCUPANCY
3
zLp Phoneess
CONTRACTOR
Name
O. S. REG. iI
Twp.Section
Subdivis
ACCESS TO PROPERTY (Road Nane)
Exlsting Structures on Property:
Property Locatlon - Address/Directlons:
B1 Pro
(*
Sq. Ft.
Existlng S Dlsposal System E[. or New system Requlred f-l
Public
Comunity
Other
perty Acrease---------w fi*lflpepr{.A:
F}. Name of conmunity or PublLc systen ? ,,.
Address
Tax Lot
Phone
Census Tract
DISPOSAI
Slte Inspec tlon /l
I^IATER SIIPPLY
Well
B1dg.
Plunblng
3Z Surcharge
l{aste Dlsp.
Plan Review
Moblle llone
TOTAL
Use
Sprlng 0ther
PLI]MB
/a # of Fixtures
t
tlon
Signature of Appl
Fee Recelved By
Water
Connection
FACILIIY PERMIT
YES
Date:
CASH
CHECK
NO NO
ao,la
M1n.Tank Requ ired - Lineal
FLre Zone Use ClassiflcatlonUpeof Constructlon
Bldg Setbacks - from Center
Front aO ---:lde rnt
of Road Righs t of Way:
Side Exter Rear ,€i+t
DATE:DATE:DATE
c55-12 LAI{E COT]NTY OF ENVIRONMENTAL
O--O
NOTE:
Du City ZLP
,-?/.fl
'%""*'r=
I
DEPARTI]ENT OF ENV I RONI.IENTAL I1ANAGEMENT
PSB, I25 EAST BTH AVENUE
EUGENE, OREGON 9740I
C/?2 ?Job Address
Appl ication for
Structures now,on the ope rty
.ifi *$Hq$Hil.:.:.gs€,,,,,fi #,,:::g*sgryful:,r
f,ffidav'i!: l, AL
7./7fe
€/t
-o
51a
.U',uU:Xi;-f
/_/ rftiiHltilsiir
that this information is true and accurate.
/ /,:tiElE!!4rE$n:ili':'eTri'uirdilt$;lid'.{*-I;i:i:i
, hereby certify
lf this applicati
Lane County Code
_ V.z bwner of- duly auth
5 i gna ture/Addres s
ffion is for an agricultural building it will be used for purposes allowed by the State Building Code and
Chapter 10 (zoning) and for no other purpose. I have the following lega1 interest in the property:
record;contract purchaser;I essee;holder of an exclusive option to purchase;
ori zed the owner, who is now able of th"is applica t'ion
,* L"
or "6
Da te
21,l
Telephone *" .241
When permit is noti fy
Owner
Con trac tor
A oro't L/X 0wner .t /_/ Contractor !y: /_/ nail-\,#on"Efi.7s6 Yz1
(zip)Phone
Contractor's 0SR#Plumbing by
If Commercial
Res identi al :
# of employees _i#ii:i:s#ii ji,Hnif ,tr
,*#*tll:i,:' //txisting, BP #
17 Proposed, SI #SI test holes ready
:::t.Ee:::.
8sdH $SSE i*:fiEi*flfrr'
:$g...,i:!:Htri:::'::uH::: '!.t iilit:i
.#;.1[f,....$,fttgi:. .$g+ti Va'l uati on Fee
Total Va,luation $
$
$
$
$
at
at
each
each/7 .ifif;S:ft:liii,iliia.
- :ii:::::il:i:r:rllril:::rr:i::::l
t.ifih€cki.iii1f,
$_
$
$
Received by.
Water Supply
Propos ed
Year Instal led
a
Existing _
4% State surcharge
Plans check fee
Change of 0ccupancy
Su btota I
TOTAL v?,s7m
$
PERMIT PROCESSING
Minimum setbacks:
Comments
Tonerl-, front
Part. #Parcel #_ Parcel Size.
intt, side
To be typed on permit
By Da te
Group Fire Zone Use Classification
To be typed on permi t
By Da te
For plans information area tns pec tor )r(ne
Di ions to site
- Dl.-./ / SIFO
/-/ CPs.I
/-/ NPC
17 Planning
, Public works
/l Elevation l-l nla
/-/ Address
/7 FacilitY Permit
/ / Environmental HeaIth
CP& I
I,JPC
set(s)
set(s)
Da te
Req u i red
Hold Slip
to PCC
Da te
Compl eted
Date to
PCC
FoRINF0RI'1ATloNaboutprogressofyourappl.icationca.ll
c.7 4-L7 L
Permit Control Center 687-HELP (687-4357)
/
$
rea r_
CP& I
^ orpRRtriENT 0F ENVIR0NT4ENTAL r,rANAGEr"rENT
PSB, '] 25 EAST 8TH AVENUE
EUGENE, OREGON 9740I Appl ication #
Job Address Ci ty.Assigned Numbers
Township, Range, Section, Tax Lot
Subdivision
Appl ication for
Structures now on the properfy
Proposed use of property: / /'Residential /_/ Commercial /_/ Industrial ! Rubtic
(please print)If t-his appl ication is for an agricultural building it will be used for purposes allowed by the State Building Code and
Lane County Code Chapter i0 (zoning) and for no other lrurpose. I have the following 1ega1 interest in the property:
owner of record; contract purchaser; lessee; holder of an exclusive option to purchase;
- -artV
authorized tolct-ilor the owner, whc i: [r-*,l1eTgeab1e of thE appl.i cation.
3i gnature/Address ( zi p)
Te1 ephone 0r Da te
Lot 81 ock _
Affidavit: I, --- , hereby certify that this information is true and accurate.
-
l,Jhen permit is ready notify: /l Appl icant
Owner
/-/ ]wner , Contractor ry
(zip)
/ / nail /.2|.phone
Pnone
PhoneContrac tor (z p)
Contractor's 0SR#P1 umbing by
SI test holes ready
Descri pti on
# of units
SDS: / / Existing, BP #
/_/ Proposed, SI #
9t'^-6r'-
Fee
Fee
Code
Sq. Ft. or
# of Sites
Uni t
Cos t Val uati on
$
Total Val uati on:
Plumbing fixtures at
Sewer/water conn. at
4% State surcharge
Plans check fee
Change of Occupancy
each $---
each $
$
$
/-/ Cash
/ / Check #
$
Subtota l
TOTAL
$
Received by=---$
l,Jater Supply
$
$
Proposed _
Year Installed $
PERMIT PROCESSING ZONC
Minimum setbacks: t, front
Part. #Parce l #Parcel S i ze
Comments
By Da te
I.IATER POLLUT ION CONTROL
I tank;ft. of drainfield;max. depth of trenchesInstal Iation specifications :
To be typed on
,1:
ans lo
Tel hone
set Da te
Requ i red
Hold Slip
to PCC
Da te
Compl eted
Date to
PCC
By
tions to si te
/-/ slF0 CP& I
WPC
(s)
(s)
/_/ CP&l
/_ / ,ulPC
/-/ Plan ng
c Works
Add res s
/-/ Publ
/-/levation /_/ n/a
vironmental Hea
oa 4
cd/u ,?6 'h 4duilo*7ak
ill bo* q{a
(tne-e at-a- Ltfr
/ Faci 1 i ty Permi t
l/w)
Ll th
'-Luruz ru fu,r*
'crh wai 'Q,a-
h/4fuL &
#/ f<t'tl bb
FOR INF0RIIATI0N about progress of your app)ic
fu-annoM u4fu
Center 687-HELP rc87-4357)
If Commercial: # of stories # of employees
Residentia'l: # of bedrooms
Existing _