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HomeMy WebLinkAboutPermit Building 1992-05-27RESIDENTIAL PERMIT APPLICATTON lnspections: 726-3769 Oflice: 726-3759 SPNINGFIELED u4B JoEl NUMBE " ?2Q67-7- 225 Fif th Street Springfield, Oregon 97 47745\efr, LOCAI ION OF PR ASSESSORS MAP: t, TAX LOT: LOT: --* BLOCK suBDrvrsro N' Fare maeLe-,- tFr PHONE: "3 ?zqzrDB.E.ZIP:STATE 7?(9E'7e *l I. A u^t Cttt) /f). { /& t) OWNER: ADDRESS: .- CITY: REMODEL ADDITION DEMOLISH OTHER DESCRIBE WORK: NEW ou p RESS &_o_tl 6 r_ PHONEEXPI RESADD -t!-: ?3 - Z/?:,WCONTNACTON'S NAME .ENEFTAL: P. t/aurlrtflfr Loa{t e -e8 -F3 ?fl:813Jt)t-I,,MBING {o2MECHANICA ELECTRICAL: CONST. CONTRACTOR " FLOOD PLAIN:;;;,";,,.4N8;_ ,' OF BDRMS: - .1 -,_-J"'\ * Otr UNITS: RANGE: CONSTR. TYPE HEAT SOURCE: WATEN HEATER: _ OFFICE USE _ LAND USE: SECONDARY HEAT: SOUARE FOOTAGE: tl 6rr H'OCCY GF]OUP: r OF STORIES: OUAD AREA: # OF BLDGS Tenrporary Electric Site tnspection - To be matle af ter excavation, but Prior to setting {orms. To request an inspection, you must call 126-3769. This ls a24hour recording. All inspections requested before 7:00 a.m. will be made the same working cJay, ingpections requested after 7:00 a.m. will be made tne {oilowing work day. REQUIRED INSPECTIONS }< LJ Vf Rough Mechanical - Prior toE*,cover. -EA Rough Electrical - Prior to z,Gcover. V finat Ptumbing - when all J {plumbin0 work is comPlete. 'ls"Zf rinat Electricat - Wlren all .JA\r-'lecrrical work i s conrplete. XUnderslab Plumbing/ Electrical / Mechanical - Prior to cover. Fooling - After trenches are excavated. Foundation - After forms are erected but Prior to concrete placement. Underground Plumbing - Prior to lilling trench. Post and Beam - Prior to floor insulation or decking. Slorm Sewcr - Plior to filling l r enclt. Water Line - Prior to filling ,trench. Rough Plumbing - Prior to Electrical Service - Must be approved to obtain Perrnanent electrlcal power. Fireplace - Prior to facing materials and frarning lnsP. Framing - Prior to cover Wall/Ceiling lnsulation - Prior to cover. Drywall - Prior to taPing lnsert - After fireplace aPProval and installation of unit. Curbcut & APProach - Af ter forms are erected but Prior to placement of concrete. Sidewalk & DrivewaY - After excavation is contPlete, forms and sub-base malerial itl placc. Fence - When comPlete(l Trees - When all required rees are planted. Final Mechanical - When all mechanical work is corrtPlete. ,K JX { B x. B F ,x ,x 'lS/ri,.rt Buildinq - When all zlA\tequired insplctions have bcen approved and building is completed. )Kyi;|,l:m r] wood stove - Arter instaration. B Other MOBILE HOME INSPECTIONS Elocking and Set-Up - When all blocking is cornPlete. Plumbing Conneclions - When home has been connected to water and sewer. Eleclrical Connection - Whcn blocking, set-up, ancl plutrtbing inspections have ltr:ctr aJrprovctl and tlrc lrorno is conn0cte(l to tlle service panel. Final - After all requircd inspections are apProvecl and porches, skirting, clecks, and venting irave been installed. R7 Floor lnsulalion - Prior to JAdecxing. Sanitarv Sewer - Prior to f illing rrencn. To Ary7O P9 * 6mtA*--3 's -.-RrDut 4A-- Masonry - Steel location, bond bearns, grouting.r fl tl tl n Lot far;es Lot sq. ftg. L<.rl.c@vcrage Topography _ r.i' . ..Io/al nelgnt Lot Type \< - lnterior Setbacks PL.HSE GAR/OHa Ze?o X"ornu, ACC 'S THE PROPOSED WORK IN THE -'rl|STOR|CAL DISTRICT, OR ON 1/r7 THE IJISTORICAL REGISTEF.? fV -- lf ycs, this application rrtusl ttc signcd an<J approved by tlre Historical Coordir-rator prior to permit issuance. APPROVED: N .2.Qo dc Panhandle Cul-de-sac !i E 6 sv' ru ?, BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on tlte express condition that the said construction shall, in all respects, conform to the Ordinance adoptecJ by tlre City of Springfield, including the Developrnent Code. tegulating the construction ancl ttse of builclings, and may be suspended or revoked at any tirlle upon violation of any provisions of said ot'dinances. [) l;t L t: ti 2 /.oo 6o ;ffi2 Plan Check Fee: Date Paid Receipt Nuttrber: Recei (A) X $iSO. FT.VALUE s??_5f ?AH Total Value Building Perntit Fee State Surcharge Total Fee 6"s13 Staa -/5,{o 32*so BUTLDING PERMIT ITEM SQ. FT. Main Garage Carport /#s dn4 Systems Developtnent Charge is due on all undevelopcd properties wi thin thc City limits whiclt are [.:cinq itnprovctl. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ,UA ADDITIONAL COMMENTS \u ITEM Fix t u res Residcntial Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home PLUMBING PERMIT FEE /obf'(c) ,@f FT. FT. 9oo Plumbing Permit State Surcharge Total Charge MECHANICAL PERMIT Fu rnace Exhaust Hood Vent Fan ll" - 3 Wood Stove/ lnsert/Fireplace Unit Dryer Vcnt -3_L9:(D) N? rc3 ..M Co t-- 4-;o Meclranical Perrnit lssuance State Surcharge Total Permit 2Z?: */_o_P/./1 By signature, I state arrtl agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I {ut'ther ccrtif y that any ar-rtJ all work perfortncd shall bc donc in ;rccclrdance with the Ordinances of tlte City of Springficld, and the Laws of the State of Orcgorr pcrtaining to the worl< rlcscril>ed hcrein, and that NO OCCUPANCY will be tn;Iclc of atny structure witlroul pertrtission of the Building Safety Division. I further certify that only contractors and etnployees who are in compliance witlt ORS 701.055 will be used on tl.tis prolect. I f urther agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will rentairr ,<- /7aDate on the sit Signature "ru;w (. cluring const tio MTSCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk ----- ft Curbcut --- ft Detnolition Stalc Sttrcltarllc Total Misccll;-tttcous Pcrttti ts (E) AMOUNT RECEIVED RECEIVED NY VN LIDATION IIECEIPI' NUMTIT-II q7/,' DNTE PAII.)*v7? TOTAL AMOUNT DUE (excluding elcctrical) (A, B, C, D, ancl E Combined)5z?,13 ; ,- FT. C'TY OF SITIIINGFIELC) Jr Air 225 FIFTB STREET SPRINGFTELD ORBGON INSPECTI0N REQITESTz 726-3769 OFPICE: 726-3759 ELECTRICAL PERHTT APPLICATION City Job Number il;t1 1 0N 0r 5 t f.(o' JOB DES(N,IPTION a Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for 180 days. 2. CONTRAC:TOR INSTALI,ATION ONLY Electrical Contractor Address Ci ty Phone Supervisor License Ntimber Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician Ovners Name Address PEE SCHEDULE BBLOI' Nev Residential-Single or MuIti-Family per dwelling unit. Service fncluded: Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Each Manuf'd Home or Modular Dvelling Service or Feeder s 40.00 Services or Feeders Installation, Alterations or Relocation: 200 amps or Less 201 amps to 400 amps -401 amps to 600 amps _601 amps to 1000 amps_ 0ver 1000 amps/volts Reconnect Only C. Temporary Services or'Feeders Insta1lation, Alteration or Relocation .? $ 1s.00 4s.oo ee ilBtr aEoF not included) 40.00 40. oo 20. o0 Sum B $ so. $ 60. $100. $130. 00 00 00 00 00 00 40.00 55.00 80.00 $300 $40 200 amps or less $ 201 amps to 400 amps _ $ 0ver 401 to 500 amps _ $ Over 600 amps or 1000 volts s 4 Ci ty OIJNER INSTALI.ATION The installation is being made on property I own vhich is not intended for sale, lease or rent. 0vners Signature: D. Branch Circuits Nev, Alteratlon or Extension Per Pane1 One Circuit S 35.00 Each Additional Circuit or vith Service or Feeder Permit $ ?.00 ,Ynone k--tffi E Miscellaneous (Service/feeder -Each installation Ptrmp or irrigation $ Sign/Outline Lighting- $ Limited Energy/Res $ Limited Energy/Comm $ SUBTOTAL OP ABOVE 5Z State Surcharge TOTALPT RECEIVED BY: 5 t4 IAGAL DESCRIPTIONtf z^ ^Z /,2- OZ4ao <,/n C,ITY OF SPR OREGO'V BACKFLOW PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION SPBII{GFIELD Offi ce: INSPECTION LINE: 7?6-3759 726-37 69225 Fifth Street Springfield, 0regon 97 477 Job Locati on : Assessors t"laP ll: ekda-/e 4r)4;Tax Lot #:D 0wner:{;€ Addres s :t{; r dtlL- State t LiCity:p:47{7 7 Backflow Permit'is $15.00 + $0.75 State Surcharge I 6-r) Phone #:Qz {'3-zrf Srate, CfL 7i p , q 7,//l I 2142_Uete'- FOR OFFICE USE Contractor: Addres s :Po C'ity :VU.etd- Construction Contractors Registratjon ll:I 3'72 Expires:4,3a -q) By sign'ing th'is pcrmit/lppl ication, I agrce to cal I for an inspection once the backf'low prevcntlon Oevict nas Uoon installed and is vis'ible for inspect'ion (726-3769). I atso state that aii info.rotion on this application/permit is correct. ature Total Amount Collected: ? 15,1{ Job #:Date of Appl i cati on:, / (.qt Rece i pt ii Issued By: 5/ I 1n r Phone #: {4 225 North Fifth Street Springfield, Oregon 97477 FENCE PERHIT APPLTCATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION SP'tII{GFIELO 0ffice: INSPECTION LTNE: 7 26-37 59 726-37 69 CITY OF SPR OREGON Job Location: AssessorsMap#t /703 ZZ y'Z"Tax Lot *: Z{O1) Ovner:SCtrk">*So G-{l-,, Q-\i +R Phone #: Value of Fence | 220 () a 4) Con t rac t or / Ins taf Ier : Fence Permit is $5.00 State:Or zipl \trr..K;, ( tS /az,r;z:e< r Address: Ci ty Sr:\,\\State: Construction Contractors Registration *: \ Phone #: zip: _Expi res : By signing t-his permit/appl.ication, I agree to caII for an inspection once my fence has been constructed (126-3769). I also stated that all information on this application/permit is correct and that I vas provided r,rith the Springfield Development code requirements for fence standards. /, \ ure Da te FOR OFFICE USE Date of Application:fr 6 Receipt +_fuOZ?- Tota1 Amount Collected {o- JoB *: 7Zttr., Issued By: z1 --s.d//fu- Checked for Delinqueneies:Checked for Historical Sta ttts: 77 Address'"\5O \.\" \ Ci ty:(o-\\ I REAUEST FOR:INSTALL SEPTIC SYSTEI"'i FT, 150 N. 7lao STREET, spRrNGFrELD, oREGoN 97478c NAME certlfyI have carefully read BOTH sldes of thls JOANN CL I FT PNT{T ls trueL -J and OATE READ CAREFULLYI Your Authorlzatlon ls Based On The Foilowt Condltlons FEES DUE: S APPROVED BY:DATE at2 CALL FOB INSPECTIONS (SEE BACK OF FOBM FOR INSTRUCTIONS) sEPTlc permlls are good for one year. ALL other permlirc expire atter loo days 687-4065 unlegs inspections are current. t ,rurru, o- VIOLATIONS SETBACKS AND OTHER CON'DMONS OP APPROVAL MUST BB STAICTLY OBSERVBD. VIOLATION CAN RETII,JLT IN RBVOCATION OF THIS PERMIT. CTTATIONS MAY BE ISSI,'BD I,'NDER TIIE PR.OVISIONS OF LANE COI,'NTY'S INFRACTION ORDINANE ANDr'OR OTHBR RBMEDIES AIIOWED BY LAW A MINIMUM OF AT LEAST 24 HOTIRS ADVANCE NOTICE MUST BE GTVEN FOR INSPECTION REQUESTS Ilave the following information ready when you call: 6874M5 Permitnumber - Job address - Type of inspection required - When it will be ready Your name and phone number - Any special directions to the site powERroBN'ERrpoNLAND. "*""iffi,:1?.R51Boi#3FIlffifiB'J*::S#1"lffiiffi[8ffi?fitfi'*?*"'**oFr]rEIRptNcrIoNs,MAyENTERI.JPON ANYLAND AND MATGEXAMINATIONS AND SI'RVEYS AND PI-AG ANDMAINTAINTHB NECESSARY MONT'MEXTITS ANDMARXERS THERBON. REQURED INSPECTIONS FOTINDATION INSPECTION: To be made after excavations for footings are complete and my required reinforcing steel is in place. UNDERGROLTND PIPING INSPECTION: To be made after all underground piping has been instaUed, pnor to any backfill. CONCRETE SLAB OR LTNDER-FLOOR INSPECTION: To be made after all in-slab or under-floor building sewice equipment, conduit, piping accessories and other ancillary equipment items are in place but before any concrete is placed or floor sheathing installed, including the subfloor. ROUGH MECHANICAL INSPECTION: To be made after all ducting and gas piping has been installed and prior to being covered. ROUGH PLUMBING INSPECTION: To be made after all plumbing rough-in is in place, prior to being covered. FRAMING INSPECTION: To be made after the all framing, fire blocking, bracing and roof are in place and all pipes, chimneys and vents are comPlete and the rough electrical, plumbing, and mechanical inspections have been made and approved. INSULATION INSPECTION: To be made after all insulation and vapor barriers are in place, prior to covering. LATH AND/OR GYPSUM BOARD INSPECTION: To be made after all lathing and gypzum board, interior and exterior, is in place but before any plastering is applied or before gypsum boardjoints and fasteners are taped and finished. ADDITIONAL INSPECTIONS MAY BE REQUIRED, zuch as but not limited to; BLOCK WALL: To be made after reinforcing is in place, but before any grout is poured The inspection is requied for each bond beam pour. There will be no approval until the plumbing and electrical inspections have been made and approved. FINAL MECHANICAL INSPECTION: To be made just prior to the struchJre or remodeled area being occupied and prior to operating any equipmenr FINAL PLUMBING INSPECTION: To be made just prior to the building, strucure or remodeled area being occupied FINAL BUILDING INSPECTION: To be made after finish gading and the building, stnrcnre or rernodeled area is completed and ready for occupancy. MOBILEMANUFACTURED HOMES: An inspection is required after the mobile home is connected to m approved sewer or septic system, prior to covering sewer or water lines, for setback requirements, blocking, tiedowns and plumbing connections. Footings and piers to comply with State foundation requirerne,mts for mobile homes or as recollmended by the manufacfurer. Minimum finished floor elevation shall be certified when required by Floodplain Management Tiedowns, if required, shall be installed and ready for inspection within 30 days after occupancy. Tiedowns shall be installed per enclozure. APPROVAL REQIIRED No work shall be done on any part of the building or structure beyond the point indicated in each successive inspection without flrst obtaining the approval of the building official. Such approval shall be given only after an inspection shall have been made of each successive step in the construction as indicated by each of Ore irspections required' APPROVED PI.ANS MUST BE ON THE JOB SITE AT ALL TMES DIJRING WORKING HOURS. THIS PERMT WILL E)(PIRE IF WORK DOES NOT BEGIN WTT}IIN I8O DAYS, OR IF WORK IS STOPPED OR ABANDONED FOR MORE TTIAN I8O DAYS. SUSPENSION OR REVOCATION MAY OCCIJR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION. ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK. Your signature on the front of this form verifies the following: I HAVE CAREFULLY EXAMINED THIS COMPLETED APPLICATION, and do hereby iertify that all information hereon is true and correct, and that I have a legal interest in the property as owner of record or authorized agent. I further certify that any and all work performed shall be done in accordance with the Ordinances of Lane County and the L"ryt ff E State of Oregon per- taining to the work described herein. I further certiS that if I am not the owner of the property, my registration with the Builders Board is in full force and effect as required by ORS 701.055, and ttrat if exempt the basis for the exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.005 will be used on the job. SUBSURFACE & ALTERNATIVE SEWAGE DISPOSAL SYSTEMS: When subsurface construction is complete, the permit holder shall notify the County Land Management Division by slbmitting the installation record form. An inspection will be made by a qualified sanitarian. If construction complies with all rules a certificate of completion will be issued to the permit holder. If constftlction does not comply with rules, the permit holder will be notified, and all corrections shall be made before a certificate of completion will be issued. Failure !o meet satisfactory completion within the allotted time constitutes a violation of ORS 454.605 to 454.745 and this rule. SUBSURFACE SEWAGE DISPOSAL SETBACKS SEPTIC TANK DRAINFIELD From: Interior property lines l0' l0' Edge of road right-of-way l0' 10' Building foundation 5' 10' Wells or other water sources 50' 100' {r, a @ Or(o !n u, rcl (o-Jq = {N h a,FC)-{!F 2, .r,!7o mq Bj o (D -o E. (D 6- o o 6AI c,(D o6lh FI EB sD gr 9l}89Pgti >ro6 AeGro ErssNt E$ I /s nc(o I t /, a Lovo, E er.l.t = tf,O s il {t \ o t/ st *.q Iv\- I \, u o i\(f rrrl rrl a C UI I(f,t -, a - ' - ll u t- t\ --d ' '' ':i;' ,.j l- - --l -El -]I Re.7 VALK R.V.' PARKING -0' lt: ED l.<fnl{ II Rwl - a.F -- a-l- i.,'.',: , ' ,;.ti,,,:'. ';,rt{t+i$$ 6.tr t; '',,,' :,i t,,,,1,..it.,/ri,.,\ r.tri\. l,tr.i !. .-) ir) .1or) _ _-<D !ir i:1' lq h. ":+-:trl': 'i' 5r_0, o(o(o f^ u,j (o'qo- '::.'... ' r' VI ,., ,i:ry:' A I t I I ].!..|.i!.. r',!|'.|:,] l o @ 95 c\,\ I N O',1 ',o" W .' .,. ,, ,.i 120.00' -?t- Ert I! I IL l I I t I 'i Exlstlng Bulldlngs or lmprovements on Property E House r JlE Bam NAt'E Garage lvE trlobile. HoireE Shed SEPTIC INSTALLEDtlll yes Etlo Water District / Please complete all llnes lnslde whlte boxes, lf posslble. Sofr.uut C\{} lsa lt aama I Fd \ -l zl? 'IIo=-T- zlP TE6tr_ YOI'E I{I[E -\ Dlrectlons to slte lrom B'ir\",U. -f ':",-l tU(,.," I.lJ;- r +#/dffi{uq#=c-Jl*t#L, ffiEiFffiriiEiffi..E*-i-- ffi- Ei Eiffi rTil'Eiffi -tilEi- on#PARCEL NUMBERMAP, (Found , Moblle Home ent Only License No. ol Size I MAIL PERMIT TO:$ from to: Water Sewa/Septic Land Managemont Dav. 3tatt can not be held responsible lor evaluations or recommondations based on false, anaccurato or 11s- z,s2 incomplete ln Iill4-68 02/92 il ule1i*r,i:i.f,,it(.i,i{ii Tiihh,,,$:i:.,,,r',ii,i'jtliihlii:rr_:flfi1t,:,r1,1i*,ffrItt I {.lt-]il1'Y !::. r'.- !.1 !'! !::- I i-r i..ihi , ...!Lli-ll',1 1.1 r... I .t. L! i't irl '? t.!i.,I:[ 1' i 'i i:"i-t-J.l !, f.r '..' -{1 t.l t.t t:'l.- t: r'r,.,l ut,ll:1 ii {ri} i r*il) It Iil:iiN s(t fi. t'l i:'i:: l::'I t.-- 1..- it'F i., t-. JF:ll :!"'i' i., t.J ,:r ii:t.iliE: rti:iFil... Nil fii:i ri f' 3 E atI li,!. t &.t I t',t .t. r.... t .t i-.. t--. !-t t: (., l" !.. t.. t.. i' l::. l::. t,.. i:rY !:;:1...l'i r:i i'. ir, i::i.ii4i::'1..i:.1' I Lii.l iiA'! il:i.i i.i l:i E I' J., il l^Jfi t, t7-O3-L7-4 z SEWAGE DISPOSAL SITE EVALUATION Job Written Directions Subdivision fr<n o*LL Lot / Btock ./ APPLICANT'S NAME AND ADD /6b s.r ?a -oogo TRS, SUppw Cc, rnntu,ni&+.l OWNER'S NAME AND STRUCTURES NOW ON THE PROPERTY .2? S 1,/zt ,t tr e P PROPOSED USE OF PROPERTY record: contractpurchaser;_potentialbuyer;I hereby certity that the above statements are true and accurate, and that I have the following legal -realtor or agent. I further certify that (if not the owner) I am authorized to act tor the owner of TESTHOLESRE^DY </- 7- 9A sig * rtrt *rt*r**t1***t*ttrtrrrr*rt ***rrr*rrr***.* oFFlcE usE oNLy BELowTHls LINE' aetion oarc 7- ? -74, SITE MEETS STATE STANDARDS Standard System Sand Filter 1 Foot Capping Fill 3e-v!'a Low Pressure Distribution Holding Tank srntr S@llge'fisruh LAND USE COMPLIANCE Zoning Acreage or Lot Size-OOTAL) Partitioning #-Parcel ) Completed ) Pending coM O KD/+^) Gtaaurt+ BovNA Atzy oF ,f?errrlC-piett FLOODPLAI N INFORHATION EtFil. f"*a tr r one Itttayt - Con*rt o YES n -E.- NO tr tr trx. NO E- -fr- YES -fl- C ,c.n -71- Z €ol 4 be tr Approximate Study Area All or part of this site may be in a flood hazard area lor which 100 year flood lovels have not been established. Extra precautions may be appropriato to assure that the building site will be reasonably sale lrom flooding. All or part ol this site may be in a flood hazard area lor which 100 year flood levels have been established. A building elevation above the 100 year flood level may be required. All or part ol this site may be in a flood hazard area in which a floodway has been designated. Building may be prohibited subiect to demonstration that the cumulative etfecl of proposed development will not increase the 1 00 year flood level at any point. n Detailed Study Area THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT n Floodway ARE AT RISK. IF SITE IS APPROVED, SEE REVERSE SIDE. LANE c55-32 NTY ENVIRoNMENTAL HEALTH, L25 EAST 8TH AVENUE, EUGENE, oREGoN 9740L (687-4051) t enone 44 - /% ( (a/4rz' aa MEMO TO: APPLICANT FROM: LANE COUNTY ENVIRONMET,ITAL HEALTH SUBJECT CONDITIONS OF SITE APPROVAL lane county t 6l!' -Any alteration of the natural conditions in the area approved for the on-site system or replacement area may void this approval. This approval is given on the basis that the lot or parcel described above will not be further partitioned or subdivided and that conditions on subject or adjacent properties have not been altered in any manner which would prohibit issuance of a permit in accordance with O.R.S. 454.605 through 454.755 and Administrative Rules of the Environmental Quality Commission. Any such subdivision, partitioning or alteration may void this report. WARNING: This document is a technical report for on-site sewage disposal only. lt may be converted to a permit only if , at the time of application, the parcel has been found to be compatible with applicable LODC-acknowledged local comprehensive land use plans and implementing measures or the Statewide Planning Goals. The Statement of Compatibility may be made on the attached lorm or its equivalent. Authorized Agent approval is required before a construction permit can be issued. This report is valid until an on-site sewage system is installed pursuant to a construction permit obtained from Lane County, or until earlier cancellation, pursuant to Commission rules, with written notice thereof by the Department of Environmental Quality to the owners according to Department records or the County tax records. Subject to the foregoing, this report runs with the land and will automatically benef it subsequent owners. Only persons having a valid license issued by the Department of Environmental Quality under ORS 454.695 to install subsurface sewage disposal systems or an owner or contract purchaser or his regular employees may install subsurface sewage disposal systems. A certificate of satisfactory completion will not be issued if persons other than the above perform the installation. qJ EIss rN d- $t \o N h Fo -l.U tr = !t! -,C' t'ltr a @Or(o SJtu;o(o -J o= € r I! B 3 6' e .CIs. E o o ef GT.Dot c,t.Dett.DU' FTEHE89gr9tt s= gEIEUI I(ft N 0'1 ',o" W 120.00' _rr o x EfF S$rn t-& F i$, tJ$E'[ \ II ir D -0' -cl -] -a r !- -rlr VALK R.V. PARKING S - ,- I Rcyz,l.- tFI I l-4 [37'30" E 1o 4.94', I5r_0, VI @(o(oIui -r@qq = b TD K Et>r< I tT I I I t I I ) I Tax Refer€nc.e Appllca^C Depth a*2 Plt 1 etr P1r Ptc t1-* >Z Textule STTE EVALUATIO:'I ELELD HORKSI{EEI S.I.#z-ofu ao z-Part L BtkDat4: Zoninq: Ust':I Size:_later Supply soil l{at:.ix color and ..,tocEling (Notation}. tcoarse F=agraents, Poots, struc:::re, Inyer Lj-Eiting Effective Soil ct€Pth' etc' lic i2rui c"rktc ,/, /ad 't" b*rnnI5r, t- bracz+L/rj,L L c d>,-I ( bndscaPe l{ot€s#;E l,spect Grg.todraEerSlope - % Tc.a,- I Otb€r Slte Notes iYpe Syste!: rnr tl2l Jo.le fc l7 66 -s S15TE{ SPECXEICATIONS 45a *a Absorption 9aci1i l1fl f. ilax- o€gEh Absorpcion FaciIi:Y (in) ,frrq;!y RepIac€aerj Sfsteu S1z{ng Systern Slzkg Speciaf Co&ditloos E t 2-'z-9- p(nr 7.aN r,.{ Pg/F:sE 3 t4 {{-+z do I qz *a@ t^{-qz Oa'L:J',r)* ,G i, -t\s\I ht" q* '} t\jfl / V t