HomeMy WebLinkAboutPermit Septic Tank 1994-12-29O bB/srerv?aa-c
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PERMIT #
BEouEsr sEPTrc svsrE"N4 TNSTALLATToN
FOR:
97477
PRdPoSED usE
NONIE
2
cca r
@,ISTRUCIlotl COGTAr'ALUE
NO.
INSTALLATICI\i OF SEWAGE DlS PGAL SYSTED4
NEAREST
FAIRVIEW TA}4ARACK TOW
,T LEFT ON W.
TRINA A. TRAVESS L9648 APACHE RD.
TRINA A TRAVESS L9648 APACHE RDl
BEDORTFIA CCIJSTRUCT]ON
1
b-rnE-crotts ro sng rnou RIGHT CI{TO TAIVIARACKTO FAIRVIE!{MILL STREETNORTH OI\
r1.
INGFIELDSPR,TOU]NAL
Bm{D 97702
BEI{D 97702
914185024 MAIN SPRINGFIELD APOTY
s true and correct(3-2"-"/and herebY
PRINTNNE
I have carefullY read BOTH sides of this aPPli all inlormation i
READ CAREFULLYI Your Authorization ls Based On The Following Cond itlons
DATEAPPROVED BY:FEES DUE: $
oALL FoB tNspEcfloNs (SEE BACK OF FOBM FOR TNSTBUCTIONS) 687-4065
SEPTIC Permlts are good tor one year. ALL other permits expire atter 180 days unless lnspectlons are current.
LMD o40 Rev.6/92
SBTE-.AC.KSAI{DOTTIBRCONDMONSOFAFROVALMUSTEBH?*+TIONS
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cr*rrcNsMafsEllG;;-fii;'ifuprouirioiTiii-r"irft-doilW,lB*iffi;%fffi^i&"tdtr.ffi
A MIMMUM OF AT LEAST 24 HOURS ADVA}.ICE NOTICE MUST BE GMNFOR TNSPECTTON REQUESTS
[fuve the forowing information ready when you calr: 6g74*s
Permit number - Job dg":, _ Type of inspection required _ When ir will be readyyo,r name and phone nrunbei - A"y speciai airections to the site .* r ..., ,
PowERToE*,BRUPoNLAND'
"*"'m*L%i,Tff^i#3$l:Hffiif8#&?iffi'rffi?$If;Ii*';gH*.r^,,*oFrHBrRF,NcrroNs.o,o,
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"t'ENTER UPON ANY LAND AND MAI(E EXAMINATIONS AND SURVBYS AI{D PT.ACE AND MAINTAIN THB NF'ESSARY MONUMB}ITS AND MARKERS THBRBON.
F,LINDATI.N IN'PECTI'N: ro be made arter excavatio*l"X?"Tfi:?H::1ff:X. any required reinforcing steer is in place.UNDERGRoUND PIPING INSPECTIoN: To be made after atl undergt*a plp-g has been insta[ed, prior to any backfil.coNcRETE SLAB oR UNDER-FLooR INsPEcrroN: To be made it".
"u
in-slab or under-floor building service equipment conduit, pipingaccessories and other ancillary equipment items are in place but before -y "orr"."* is placed or floor sheathing installed, including the subfloor.RoUGH MECHANICAL INSPECTToN: To be made- after all du"tirg *o g* piping ias been installed and prior to being covered.ROUGH PLUMBING INSPECTIoN: To be madeafter all plumbingi*gr,Ii, i, in p'iace, p"i".;;;; covered.FRAMING INSPECTION: To be made after the all framing, rire uo,*in!, t acirrg and roof are in plac'e and all pipes, chimneys and vents are complere99 ft" rough electical, plumbing, and mechanical inspections have beeniade and approred. '
INSULATIoN INSPECTToN: To be made after all insulation and vapor barrien are in place, prior to covering.LATH AND/oR GYPSUM BOARD INSPECTIoN: To be maae arter at tathing and gypr*n u-4, interior and exrerior, is in place but before anyplastering is applied or before gypsum boardjoints and fasteners are taped ard finished.ADDITIONAL INsPEcrroNs MAy BE REeurRED, such as buinot limited to;BLoCK WALL: To be made after reinforcing is in place, but before any grout is poured. The inspection is required for each bond beam pour. Therewill be no approval until the plumbing and electrical inspections have beeimade and approved.FINAL MECHANICAL INSPECTIoN: To be made jutt p.io. to the structure or remodeled area being occupied and prior ro operating any equipment.FINAL PLUMBING INSPECTI^O_N:{o be made jusrixior to rhe builtling, struchrre orremodeled area being occupied.FINAL BLTILDING INSPECTToN: To be mader aftel finish gadins and Iie building, struchue or remodeled area is completed and ready for occupancy.MoBILEMANUFACTURED HoMES: An inspection is required-after the mobile home is connected to an approved sewer or septicsystem, prior to covering sewer or water lines, for setback requirements, blocking, tiedowns and plumbing connections.
Footings and piers to comply with state formdation requirements for mobile homes or as recorlmended by the manufacturer.Minimum finished floor elevation shall be certified when required by Floodplain Management
Tiedowrs, if required, shall be installed and ready for inspection witirin go i"y, "fto oJ"upancy. Tiedowns shall be installed per enclosure.
APPROVAL REQTIIRED
No work shall be done on any part of the building orstructure beyond the point indicated in each successive inspection without first obtaining theapProval of the building official. such approval shall be given only after an inspection shall have been made oflach successive step in the cons*ucrionas indicated by each of the inspections required.
rlrls PERMT*TLL ExpIRE "*#11?H'"lHB#i^If,h?T#ff9':3fl"$"if#i3BHSTSIr",ffifiJi"SiMoRE rlrAN,80 DAysSUSPENSION oR REvocAfioN MAY occuR IF THIs pERMrr wAs ISsuED oN THE sAsri oF tr[coMpLETE oR ERRoNEous n[FoRMATroN.
AI\IYONE PROCEEDING PAST THE POINT OF'REQI.IIRED INSPECTIONS \{tLL 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 dohereby certify that all information hereon is true and correct,-and that I have a legal inter_est in the property as owner of record or authorized agent. Ifurther certify that any and all work performed shall be done in accordance with the Ordinances of L*" iourrty and the laws of the stare of oregon per-taining to the work desctibe-d-her-ein.-I further certify that if I am not the owner of the property, my r%isuation with the Builders Board is in full forceand effect as required by ORS 701.055, and that if eiempt 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&ALTERNATIVESEWAGEDISPOSALSYSTEMS:
when subsurface construction is complete, tt
"
p"r*it t ou", shall notify the county Land Management Division by subrnitting the installation record
form. An inspection will be made by 1tufljn{ sanitarian. If cons*"-,i* "o*priitGq .11 *r""r a.certificate of iompletion will be issued to the permit
holder. If construction does not comply with rules, ,il;"".ih;Id"; wu u notinJ, and all corrections-shall be made before a certificate of completion
wi,beissued. Fail,re,";";;;H;i".y""-pr"il'ril#;",i"'fiilil;-;;;il;aviolationofoRs4s4'605 to454'745 andthisrule'
SUBSURFACE SEWAGE DISPOSAL SETBACKS SEPTIC TANK DRAINFIELD
From: f"t"iJ ProPertY lines 10' 10'
SAg" ofiona tight-of-waY 10' lCI
Building foundation 5' 10'
wdl#;thJ;aersources 5o 1oo'
LANE COUNTYOREGON
Date
EUGENE, OREGON
3op\''GO
Received from .e
I
I
Dorars $SOSL
For
a
-
$S*=__.9rs\s!
\$
1YgF!s
$Y Depaaruemr
**-t2Bv
PA BY:
CHEC Y Ng I s2864OTHER
LANE COUNTYOREGON
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v
EUGENE, OREGON
Date
Received
For
PAID BY:
6/
Bv
CASH ,/ur"@?7692 N9 1s2 r s8
$'$
ritlr'
.i\
6\
Lane
HOLID SLIP Countgtr
APPLICATION
LOCAT
F1'
bFS-'l
I
.OL
E
DDRESS
1
ZIP CODE
The Lane County Building and Sanitation Division cannot proceed with processing your application because
Incomplete application (items deficient).
tr Address and/or directions to application site.
I Proposed number of bedrooms in dwelling.
tr Approvable plot plan (see attachment).
tr Notification of date test holes will be ready.
2.tr
3.tr
4.or
Verification of existing system required (see attachment).
Two test holes (2'x(x5'deep) required for expansion or repair of existing sewage disposal
system in the area of the proposed drainfields.
SIGNATURE
.6)
ut
E
Iurg
Eolr
to from to
OFFICE HOURS PHONE
I no response has been received in regards to this matter by ,
,
the application will be denied.
LANE COUNTY ENVIRONMENTAL HEALTH SERVICES
courthouse-Public Service Bldg. / 1zs E. Bth Ave. / Eugene, oR 97401 t 697-40s1
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DATE
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Please complete all lines lnstde white boxes, if posslble.Exlstlng Bulldlngs or
lmprovements on
Property
l-l House
Ef Bam
EI Garage
Ell lrlobile. Home
1-1 Shed
SEPTTC INSTALLEO-? F
=['
sTfl *
Water District
TTI_
FFOSEQzToz
CIT Y ztP
l-+-zzrZ
O$rNER OF PnOPERTY (il not um. u.boy.)PHONE
OWNEAS ADDRE3S (ll not sm. r.bov.)ztP
Llcrni T Dlrectlons to slte from
nearest maln lntersectlon
,t/-r"Sf.
fo /;*?P t/r tut)
S614 r1rtu)v?)
MAP, PARCEL NUMBER
(Found on lu mrp. ln th. Arrttmant I Turtlon D.pL)I zoNe FLOOD PLAIN&#*,# 4**f
ffift"-ilffirrr-ffii-Ei--
"ltm-ffi-'lffii- Effi;- rllEi6i- -ffr-
S'TE ADDRESS
For Moblle Home
Placement Only
No. ol Bedrms
License #
--
Dlstance from Moblle
Home to:
Water Seurer/Septic
Brand
Year
Size
MAIL PERMIT TO:
5
& Block
STAFF EVALUATION
TRS Verified [-]Yes NoI-l
Allowed Use r-.lyes No t-r
Land Management Div. staff can
not be held responsible lor
evaluations or recommendations
based on false, inaccurato or
LMo r.e- 282 incompletg informatio
r',il 4-68 02/92
-)./ t ,Ka -
D: | *ct
/'O^ \/er
o^t /t)
Consumer
Infororation
Report
,t!0
-LZ/28/94 11:16 1Ii503 4E5 3587 TITLE GTIARITNTY ld 001
299 East lSth Avenue r P.O. Box 10960 r Eugutc OR fi+4+Dfi : Phcre (503) {SF358E r Fuc (503) 48511597
PREPARED FBRI
6REAT I.,ESTERN TTIBBILE HOMES
SALES & LISTINE INC
5iA?4 MfiIN STREET
SPRTNBFTELD, OREGON 17478-0,0]g@
#ITTN: JAtrK ITATE PREPARED= L?,t?.Bte*
PRBPERTY ADDRESS: tlEEiT EUINALT BVE (VffCRNT LAND)
BPRINEFIELD, OR
trtil{f{ENTs: MFltr# L7-43-e7-ts1-41 1aa
ET'ICLT]SED PI.EBSE FIIiID THE FTILLOT{INE PER YBUR REtrUEST:
TFIX IhIFEFTiYIETIEl\I
tYlAP
EEFY = llEED./EEI{TFlfaET
CalI for After Hours Custouter Service Reguests.
Thic Utlt infortltbrr hll bftn {urrdshd, 1flttrt drurg* in @rfornEEe wiEr the guidelines appror-ed by the SEE of Oteton
Insurance Comrnissionca Thr Insurznce Division cautions titcorediaies thet drls-sernice it a-esignai to benefit trt uJtimne
irsue<l5; indircrfurinatc usc orrly baefiting irttttrcdiaries will not be perrrit:d Said senrices may Ue afcontinued. No tiaDility it
rssumed lor rrry cnnrs in thb aport
First tn Title & Escrow-First in Senrice. 1er:ting Lane C-ounty Since 7888.
-
48 5-3 59 6
^ L2/2s/s4 l1:r0 t}503 485 3597 TITLE GUARANTY @ ooz
L?re3/94 18I ?8r 61
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RD
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1eE3
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a+4.?e
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1994
RSUM RENL PRtrP ACCBUNT SUHMNRYf,ctrTr egB613 199+ RSSESSMENT YEAR trtruNTyr LHNEINDEX: F I,IAP Etr 178tse7ts1811aa atrtrT x YRn LE 94AtrtrT STf,Tr LONLyTSADJ
trRBtr DESGR: L7 sa ?z at-urta@ NAME eDDE: TRAUESS TRINALEEtrLr 1984€ HpfftrHE
BEND gR
FRCIP ADDRrYRTA YRLA 9A
PRBP CLNSS lEB STAT CLASSACRES trYCLE
nssEssEl) (Flv)LAND L6,479rfiPs
TIF1BER
RES NEIEH 4A6DE CtrFI NEIBF{LAST NCTIUITY O9-11-94 CBNTROL BRBUP A4
LEVY trODE 19-83r+ ZtrNE TAX CERTIFTEDT
REHL I4ARKET (RMV)
15! 47A
T994 YENR Tf,X:
TAX DUE Le?_4 yEARr
TfiX DUE trRIBR YEARSIL6147O INTEREST AS BF 1A-Eg-94
TBTHL BALANEE DUETt6,47O 0LDEST DELINtrUENT YERR
6RBSS r
EXIIIPTS T
NET:
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- Read Carefully! -
lusf draw a'Parcel Plan Delow A Parr.- - PIan is a drawing
to do this drawing if your lot or parcel is less than one acre.
'this sheet (Side l), will serve as your Parcel Plan.
icale that will let your parcel be completely shown on this
;klist to make sure you have everything you need on your
,pment Guide No. 6.1 for sample drawings.
R-}IOVE/-
and Ek",
TJNFOLD
this sheet.
Use it for your Drawings.
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i. Eighth Avenue, Eugcne oR 97401 lSul1et-zaw
Devclopmat
Plm shows dwclog
m6trm dily,or
mtirclot cprcelif
it's l* thm one
lcna.
Plot Plan Submittal Form. Side 2
LMD File No.
Propefiy Information
0wner Name
Owner Address
Owner Phone No.
Parcel Map and Tax Lot No.
Size of Parcel in Acres
Instructions -
If your lot or r-rcel is one acre or more irl size, you r
of your entire parcel. regardless of size. You do not neer
Your Development Plan, to be drawn on the other side c
Pacl Plen shows thcqrticlot
cpmcl. Neded only if lc c
parccl is cre am c larga.
Parcel Plan Checklist
Be sure to draw or list:
fl t. en arrow pointing North
fl Z. eccurate shaPe of Parcel
fl :. t-engttrs of all property lines
fl +. Nanrat feanrres like creeks
or woodlands
[l s. att streets or roads along or
into ProPertY, bY name
l-l 6. Location of all structures,
with distances to Property
lines
flz. nriveway access
l---l 8. Powerlines or other
easements across Property
l-l 9. Area of DeveloPment Plan
(Side I of this fbrm)
Suggested Scales for Drawing:
1 inch = 100 feet
Fill in the Property Information box. Select a drawing
sheet (see examples below the Checklist). Use the Chr
drawing. Draw in black ink or #2 pencil. Refer to Develr
1 inch 200 feet
l-ane County l-and Managcmant Divisiqr, 125 l
CANCELLATION
REFUND AUTHORTZATTONap{r'
PERMIT ,I
/rt tt
o APPLICANT E- conrnacton B omunn
Reason for refund/cancellation, -{.*-r' 'n - t ,4'.' 4*t,o , -
Signature:Date
The fol.I-orciag raiJ-l. be co"{'Ieted by couaty staff
ur(, ar {rcoro(t ql,l!go.{
f-r erld (oc qre. dirt6.l rr/rc€ (ric. lcp<tlru .nd./d.ppl.iscl@ to irut.lt t.{tic ti(t..td dr.l. tl.ld, .(.o<\dln(lly 06 a.(srd.bl.-
&(urd qy bc o brif<tlnq, pt(-biry c pL6.log lD.tidj .ccodiag to tb. .@t o( tt Feiv.P9l'iq(l@ p6€ctcd-
Account: Prog,-Fees Paid DescriPtion
BuiJ-ding Official
(signature waived
-
I
Refund
24-067 4/ 42L20
24-067 4/ 42L24
24-067 4/ 4L235
24-061 4/ 46204
24-0674/ 42123
24-067 4/ 42L36
24-067 4/ 42L37
24-067 4/ 42L28
24-067 4/ 46233
24-061 4/ 42L20
020
020
020
020
020
o20
020
o20
020
o20
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
BuiJ-ding Permit $
I'fechanical Permit $
Plumbing Permit $
Plan Check Fee $
State Surcharge $
Mobile Home Fee $
MH State Surcharge $
MH EIec- Feeder $
Rural Addressing $
Copies./Ordinances $
24-0427/42L33 240
24-0427/42L23 240
24-0427/42L34 240
24-0427/42L32 240
24-0674/42L25 oLO
24-0674/42L50 010
24-0674/46202 010
24-0674/462L1 110
Total fees paid
#r/t /3
Receipt #0
Authorizi-rrg Sigmature
IIIA.:SE '(r(E
O'DCX PAYAAIE IO:
T{AHE:
ADDRESS
*8**!fr63"1'" *"""i *. r-l Disposal{ gj* 35T 3::"'H:i::::""
Environmenta1 Bealth Maaag:er
f{ater Testing
Planning Prog'ram Mauager
(signature waived
-
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