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Home My WebLink AboutPermit Building 1977-09-30TRS, TL t7 -Job Location Bt\nq ^r\'\ tryYitten DirecLions {cr,,fp (h ( ) Buitding permit Acreage or Lot Size 2a X /)? Partitioning#..---.----- ( ) completed( ) Pending APPLICANT'S N AME AND ADDRESS r *,4 7t I INFORMATTON SHEET ( ) Site Feasibility Study for Septic Tank Number of sites Test holes will be ready Subdivision aJ L.1 v tta t Owner ( ) Contractor.B.rd ,/ ( BY RTY IS WITHIN ONE MILE OF CITY * ****t* * * *** *+ ** r** ** * J+*** * SETBACKS: Front Side Facing Street (FROM CENTERLINE OF ROAD) Ryq?r rct /? Btock 5 Pho ne Phone Phone 24d * /677 Con o # 2 ",2o q existing or proposed well, etc. lf public. name of systeml lnterior Side Yard Rear --(FROM PROPERTY LINES) OWNER'S NAM E AND ADDRESS , if differen t from applicant'sCONTRACTOR,S NAME AND A DDRESSMail permit or results of site feasibilit y study to) Prefer to pick up. Calt STRUCTURES NOW ON TH ROPE RT PROPOSED USE (this permit)(- ,. WATER SUPPLY SEWAGE DISPOSAL P (existing or proposed septic tank, etc.) t. '. N!QSl v I LUtylrNc Kr^o* Address OFFICE USE ONLY BELOW THIS LlNf ***************+*********i***r*ir****x*++++ ( ) Facility Permit Necessary -t ) Special Permit Area. lVlinimum Elevation ( ) New Address Necessary i ZON F owner, etc. To: Planning/Buildin g I nspector/San itarian/SurveyorThis applicant a ppears to have a problem withYour assistance will be apprecia ted. Response By Permit Processing Section By DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Permit Processing Section 125 East 8th Avenue 687-4394 c55.12 ivision I t ) 2,r,4 * ?of PERN/IIT # TRS, TL JOB LOCATIO Partition ing LANE COUNTY PERMIT ) Completed Subdivision "' Acreage or Lot Size Contractor's O.S. # OWNER'S NAME AND ADDRE Lot- Blo nk APPLICANT'S NAME AND ADDR Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when readY CONTBACTOR'S NAME AND ADDRESS Phone Phone Phone STRUCTURES NOW ON THE PBOPERTY THlsPE8MlTlSFoR#BEDRoolV]s-#PLUN]BlNGcoNNEfiloNS- WATER suppLy- SEWAGE DlsposAl -== '-..- s.l. # THIS PBOPERTY ISWITHIN ONE IV]ILE OF THE CITY OF-. PLUIV]BING BY I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: -owner o{ record; -contract purchaser; - potential buyer; - realtor or agent. I further certify that (il not the owner) I am authorized to act for the owner ot record, and that said owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit. Fee Paid $-DateSignatu re NEWADDRESS () FACILITY PERM IT TO T RANSPO RTATION DEPT.- ( } SPECIAL PMT. AREA. IV]IN. ELEVATION: - SANITATION BUILDING Type of Construction -Group --Fire Zone c..-""* Use classification By Date B V:Date Minimum Septic Tank Capacity (Gallons) Drainfield Required - Lineal Feet Maximum Depth PLANNING REOUI RENnENTS SATISFIED. By Date lssued ZONE SETBACKS: FRONT SIDE FACING STREET (FROM C/L) INT. SIDE YARD REAR (FROIVI P/L) LANE COUNTY DEPARTMENT OF ENVIRONMENTAL IVIANAGEIVIENT, 125 EAST BTH AVE., EUGENE, OREGON 97401 POST THIS PERMIT ON MAIN BUILDING AT SITE C55-1 3 BLDG.pERMTT-WHtrE; BUtLDtNG-GREEN; pLUMBTNG-GANARy; sANrrATroN-coLDENRoD; oFFtcEcoPY-wHlrE PHONE:687'439 trqq Comments: Date: 1t Il, i a v )' a: I I I a rli o \tt a \t tt. PERTVIIT # TRS, TL JOB LOCATION Partition ing LANE COUNTY PERMIT Acreage or Lot Size Contractor's O.S. # ( ) Completed Subdivision Lot- Bloc k APPLICANT'S NAI\4E AND ADDRESS Phone- OWNER,S NAME AND ADDRESS Phone- STBUCTURES NOW ON THE PROPERTY THlsPERlvllTlsFoB#BEDRoolv]L#PLUl\4BlNGcoNNEcTIoNL CONTRACTOR'S NAIVIE AND ADDRESS Phone-- lVlail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when ready WATER SUppLy- SEWAGE DISPOSAL--- S.l. # THlSPRoPERTYlSWlTHlNoNEMlLEoFTHEClTYoF.PLUtVlBlNGBY I hereby certify that the above statements are true and accurate, and that I have the {ollowing legal interest in the property: -owner oI record; -contract purchaser; - potential buyer; - realtor or agent. I further certi{y that (if not the owner) I am authorized to act for the owner of record, and that said owner is aware and approves o, this action. I hereby agree to comply with all applicable Codes relating to this permit. Fee Paid $-Signature Date NEWADDRESS () FACILITY PERIV]IT TO TRANSPORTATION DEPT.- | SPECIAL PIV]T. AREA. MIN.ELEVATION:- SANITATIoN BU ILD ING lVlinimum Septic Tank Capacity (Gallons)Type of Construction roup ire Zone Drainfield Required - Lineal Feet se Classification Maximum Depth Comments: Comments By Date By Date PLANN ING REOUIREMENTS SATISFIED. By Date:Date lssued ZONE:SETBACKS: FRONT SIDE FACING STREET (FROM C/L) INT. SIDE YARD REAR (FROM P/L) LANE COUNTY DEPARTIVIENT OF ENVIRONTVIENTAL IVIANAGEIVIENT, 125 EAST BTH AVE., EUGENE, OREGON 97401 POST THIS PERMIT ON MAIN BUILDING AT SITE C55-1 3 BLDG.pERMtT-wHtrE; BUtLDtNG-GREEN; pLUMBtNG-cANARy; sANtrATtoN-GoLDENRoD; oFFtcEcoPY-wHlrE PHONE:687-4394 a,: PERIVIIT # TRS, T JOB LOCATIO LANE COUNTY PERMIT Acreage or Lot Si Partition i ng Contractor's O.S. # APPLICANT'S NAME AND ADDRE qq CONTRACTOR'S NAIVIE AND ADDRE cc Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call ) Completed Subdivision Lot- Blo ck Phon p OWNER'S NAME AND ADDRESS-Phone Phone (owner, etc.) when ready. STRUCTURES NOW ON THE PROPERTY IH|sPERMlTlSFoB#BEDRool\,S-#PLUMBlNGcoNNEcTloNL WATER SUPPLY- SEWAGE DISPOSAL- S.I. # THlSPRoPERTYlSWlTHlNoNEtVllLEoFTHEClTYoF.PLUlV]BlNGBY I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: -owner of record; -contract purchaser; - potential buyer; - realtor or agent. I further certify that (if not the owner) I am authorized to act lor the owner oi record, and that said owner is aware and approves o, this action. I hereby agree to comply with all applicable Codes relating to this permit. Fee Paid S-Signature Date ( SANITATION Minimum Septic Tank Capacity (Gallons) Drainfield Required - Lineal Feet Maximum Depth BUILDING Type of Construction Use Classification Comments roup ire Zone Comments By By Date PLANN ING REOUIREtVIENTS SATISFIED. Bv Date:Date lssued: ZONE SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROIVI P/L) LANE COUNTY DEPARTMENT OF ENVIRONMENTAL IVIANAGEIVIENT, 125 EAST BTH AVE., EUGENE, OREGON 97401 POST THIS PERMIT ON MAIN BUILDING AT SITE '55-13 BLDG. pERMrr - wHrrE; BUTLDTNG - GREEN; pLUMBTNG - cANARy; sANrrATroN - coLDENRoD; oFFrcE coprr - wHrrE PHONE:687-4394 { )NEWADDRESS FACILITY PERI\4IT TO T RANSPORTATION DEPT.- { }SPECIALPI\,1T. AREA, I\4IN. ELEVATION: - Date: tlt brDMa rloon PLUMBING GROUND/ORK Appnoveo @ Reua nx s oore /0'J L-77"sPEcroRD t slppnovro GAS PIPING GROUNU/ORK Ap pRov r o Rrurnx s D r slppRovEo Dare I Hsprcron ROUGH PLUMBING Appnoveo E DrsrppRovro ReuaRrs Date //.-I rsprcroR fri: ROUGH GAS PIPING Ap pnov e o Reurax s Dr sappRoveo DarE I rus pe cton FINAL PLUMBING Appnov e o Re uaRx s M DrsrppnoveD D oorr-9-/3ff €*I Nspecton FINAL GAS PIPING Ap pRov e o Ret,taRxs D r sappRoveo Dare I xsprcton CERTIFICATE OF OCCUPANCY Rraov ro lssue ReuaRxs I NSPEcToR D D Nor Reaoy ro lssuE D Dore_ PERTVIIT # TRS, TL JOB LOCATION Partitioning # LANE COUNTY PERMIT Acreage or Lot Size Contractor's O.S. # ) Completed Subdivision Lot- B lonk APPLICANT'S NAIVIE AND ADDRE qq OWNER'S NAIVIE AND ADDRESS CONTRACTOR'S NAIVIE AND ADDRESS tVlail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when ready Phone- Phone- Phone- STRUCTURES NOW ON THE PBOPEBTY THlSPERMlTlsFoR#BEDRooMS-#PLUMBlNGcoNNEcTloNL WATER SUPPLY- SEWAGE DISPOSAL- S.I. # THlSPRoPERTYtSWlTHlNoNElVllLEoFTHEclTYoF.PLUlVlBlNGBY I hereby ccrtily that the above statements are true and accurate, and that I have the foilowing legal interest in the property: -owner of record; -contract purchaser; - potential buyer; - realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of record, and that said owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit. Fee Paid $-Signature Date NEW ADDRESS FACILITY PERI\4IT TO TRANSPORTATION DEPT.- () SPECIAL PI\4T. AREA, IV]IN. ELEVATION i sRtilrATtoN Comments By lVlinimum Septic Tank Capacity (Gallons) Drainfield Required - Lineal Feet lVlaximum Depth Date BU ILD ING Comments: By Type of Construction -Group -Fire Zone Date PLANNING REOUI RETVENTS SATISFIED. By Date lssued ZONE SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROM P/L) LANE COUNTY DEPARTIVIENT OF ENVIRONIVIENTAL N/IANAGEIVIENT, 125 EAST BTH AVE., EUGENE, OREGON 974O1 POST THIS PERMIT ON MAIN BUILDING AT SITE c55-1 3 BLDG.pERMTT-wHrrE; BUtLDTNG-GREEN; pLUMBTNG-cANARy; sANrrATroN-GoLDENRoD; oFFrcEcoprr-wHrrE PHONE: 687-4394 I Date: SITE INSPECTION Dar -/f - 71 tr,rspEcron FOUNDATION I NSPECTION Ap paov e o d DrsaepRove o F7 o^r, //- /C - ? ?I HspectoR Re uaRx s FRAM I NG AppRov e o RsManr s I NSPECT I ON Dr sappnoveo I NsPEcroR LATH OR SHEET Ap pnov r o Rrurnxs T ION Dr sappnoveo D*,1/- 8 a?I NsPEcroR F I NAL I NSPECT ION Ap pRov E o Reuenx s D r sappRoveo o*ZJJl "d I Nsprcron CERTIFICATE OF OCCUPANCY Rraov ro I ssue REua Rx s D Nor Rrrov ro tssuE D Dare_I HspecroR Appnov r o Rruanx s n DrsAPPRovEo D D oor1@? D ilo-f4t bL,t-E ,.vz4/d,U74*- Job Location (Streret,t-I mile post t ? Btock 5Subdivision FOR SANITARIAN'S USE ONLY: t#Qv.t", Approved COMMENTS: fl System Disapproved tl Needs Correction S nature:oate,/) '/2 -7 FOR INSTALLER'S USE: Trench DePth Filler Depth Below A Tank Capacity too 0 ManufactursT €ufs-e Sa-J * C*aue / TRS, T PPlot Plan L.- lVleasured distance to well from tank from drainfield -f,L. 85'L,u7 6s' L,u,€I INSTALLATION RECORD AND CERTIFICATE 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 Management, Public Service Building, 125 East 8th Avenue, Eugene 974O1 -o\ s,d\ \a c( 0l \\(\ ItIl G 3 q) GPoc r.u(r lF z(, 6 \./+L m oo o)LE g) =(! o) E(oz ! Pc(oo o- m Scale Ir -('t l) \s ( q I t0 s r olPt U P$ s ,qr'ft t N c55-1 l