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