HomeMy WebLinkAboutPermit Septic Tank 1974-01-28'II.D!NG PERMIT OR MOBITE HOfV.IANE COUNIY
PERMIT TYPE - BUILDING MOBILE HOME OSC REG. #
J5E APPLICATION
PERMTT #'7
PROPERTY OWNER ADDRESS2l
MAILING ADDRESS
o 6
PROPERTY,,TION _UDE POSI OFFIC
PROPERTY LEGAI. DESCRIPTION
LOT_BLOCK_SUBDIV.
TWP RANGE
Iharrn d L L*{METES&BOUNDSEYES
ATTACHED NO
SEC.TAX LOT CODE CENSUS TRACT
,)3 2?
DESC RtflE EXtSTtNG STRUCTURES ON pROpERTy tr ANY
horse-Mock
-
APPTICANT
NAME
AND
MAII.ING
ADDRESS
TEGAT TO PRO ROAD NAME OR #
t€-
PROPERTY DEPTH AREAff tao
FOR MOBILE HOME PERMIT ONLY
Number of Bedrooms
STRUCTU TO BE BUITT IS PERM TYPE CONSTRUCTION SQ. FT # BEDRooMS VALUATION
SEWAGE DISPOSAL PI.UMBING INSTAI.TED BY
PUBUC tr SEPTIC TANK OTHER OWNER OTH ER NAME
PIANS FURNISHED FACILITY PERMIT
BI-DG.
WASTE DIS.
PTUMBING
PtAN REVIEW
PARK TR[R.
TOTAI-
FEES WATER SUPPTY
PUBI.IC OTH ER YES YES N
PTUMBING FEES
-
FIXTURES
S
FEE DATECASH E R
CHECK N FEE
PUBLIC WATER
CONNECTION FEE
t-
#32.-
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIREDMIN. SEPTIC TANK CAPACITY
WITH DIST. BOX, GA[.oo
h"1,,r*-
TRENCH WIDTH FT OR SQUARE FEET
o/
tIN. FT 2_
)f,//" -a<
TYPE OF STRUCTURE OCCUPANCY ZONE REAR YARD PUBTIC UTII.. EASEMENT
USE CLASSIFICATIONBTDG. SETBACKS _ FT. FROM CTR. OF ROAD RIGHT OF WAY
FRONT SIDE INT. SIDE EXT.
rections to Find Property
_ OFFICE_ JOURNAL
- AUDIT
COPY I
COPY 2
COPY 3
Dqte PIANNING DqtE BIDG. INSP..7
REAR
Form # css-t2
Connecl to Existing Sewoge System f or New System R.q. n
TANE COUN
BUTLDTNG E
BUIIDING PERMIT OR MOBIIE Ho,vlE USE PERMIT
MH E PERMTT NO.
PROPERTY OWNER MAITING ADDRESS PHONE
CONTRACTOR MAILING ADDRESS PHONE
PROPERTY LOCATION - INCLUDE POST OFFICE
PROPERTY TEGAT DESCRIPTION -METES, BOUNDS
RANG E SECTION TAX LOT NO CODE CENSUS TRACT
EXISTING STRUCTURES ON PROPERTYAPPT.
NAME
&
MAITING
ADDRESS
TEGAT ACCESS TO PROPERTY
PROPERTY SIZE - FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connect to Existing Sewoge System ! New Syslem I
STRUCTURES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION SQ. FT. # BDRMS VALUATION
SEWAGE DISPOSAT
PUBTIC N SEPTIC TANK tr OTHERE
PLUMBING INSTALTED BY
OWNER ! OTHER: NAlv{E
BUII,DING
WASTE DISPOSAT
PI-UMBING
PI.AN REVIEW
PARK TRAII,ER
F EES WATER SUPPLY
PUBUC f]tr OTHER
TOTAL
COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAI..
DRAIN TIEID REQUIRED
I.IN, FT TRENCH WIDTH FT.OR SQ. FT.
TYPE OF STRUCTURE OCCUPANCY ZONE PUBI.IC UTIt. EASEMENT
BI.DG, SETBACKS
FRONT
FT. FROM CTR. OF ROAD RIGHT OF WAY
SIDE INT. SIDE EXT,
USE CTASSIFICATION
REAR
AUTHORIZED SIGNATURE - DATE DATE
BTDG. PERMIT _ WHITE
OFFICE COPY _ WHITE
COUNTY TAX - PINK
PTUMBING _ CANARY
BUITDING - GREEN
SANITATION - GOTDENROD
Construction to comply with uniform building
covering plumbing ond sewoge disposol. All
of occuponcy before being occupied.
code ond county regulotions
buildings require o cerlificote
(See Stotement on Reverse Side)
(posT THts pERMtT oN MAIN BrDG. AT S!TE)
LANE COUNTY, B[DG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 9740I
ronu #655-13
BUILDING S ITE EVALUATION
Building Permit Appl ication No.
S i te lnspect ion
Pre-Permit lnvest igat ion
rs /(,H.g/,#,;,s 22 rAx Lor-
l€- cg 8=6
X -7
e
APPL I CANT:
Nr\1.1E
ADDRESS
(
()
PHONE
OATE
LANE COUNTY PLANNING DEPARTMENT NOT NO YES NAl"lE DATE
app! iqable()(,)
()
()
) ()
(
(
()
()
)
2
Zoning 0rdinance Compl iance(zone_)
Subdivision 0rdinance Compl iance
3. Requ i red Access
4. Bu i ld ing S ite (Rrea, I./idth,
Frontage, Setback)
5. Other (see comments)
(
CO},IMENTS:
BUILDING INSPECTION SECTION NOT NO YES
le -
NAI'iE DATE
6. Plans Submitted
7. Soi I Stab i I ity (foot ings)
8. Flood Pl ain
9. 0ther (see Corrnents)
COMHENTS:
() ()
(
(
(
() ())
)()
()
()
()/ -Lv -7f
--F.
SAN ITAT ION SECT ION
Sewage Disposal
Usable Area
Water Supply
0ther (see Comments)
aool icable--O (()
()
()
()
NOT NO YES NAI.lE DATE
)
))
-a10.
ll.
12.
13.
()
()
()
()
TO APPLICANT:
v?ggf {}
Your Building Permit / Site lnspection:
Can be approved
Cannot be approved at this time as indicated on item NO.-above.
Questions and further information on items I through 5 contact the Lane--
COUNTY PLANNING DEPARTMENT. Questions and further information on items 5
through I J contact the Lan e County Buildftrg and Sanitation Div .
Wil I be he ld in this off ice gnaft- you can iesolve the problems indicated.
!s being returned.
Your building permit appl ication fee is being returned under separate cover.
()
()
()
LANE COUNTY PLANNING DEPARTI4ENT
135 S ixth Avenr]e East, Eugene, 0regon 97401
'HoNE: 342-l3ll ExT. 231
LANE COUNTY EUILDING 6 SANITATION DIVISION
135 Sixth Avenue East, Eugene, 0regon 97401
PHONE: 342-l 3l I EXT. 4l I
28
COH}lENTS:
SLAB FLOOR
PLUMBING GROUND/ORK
Ap pnov r o
REulnx s
Dare I rusprcron
GAS PIPING GROUND'ORK
AP PRov E D
Rruanx s
D DrsaepnovEo D DArE I ruspecron
ROUGH PLUMB I NG
A ppnov e o
Rruanx s
D DrsappRovro D Dare I rusprcron
ROUGH GAS
Ae pRov E o
Reunnr s
PIPING
Dr sAPPRovEo Dar r I Hspecton
F I NAL PLUMB I NG
AppRov e o
RE uanx s
Dr sappRoveo Dart /'77-7 4 tNspEcron
FINAL GAS PIPING
Ap pnov e o
REuanr s
Drsappnovro Date I Nspecron
CERTIFICATE OF OCCUPANCY
Rraov ro lssuE
RrulRx s
DarE I NSPEcToR
D Drsappnoveo D
D
D Nor Reaoy ro tssuE D
-
IANE COUN'.
.BUILDING -PF$;T OR MOBILE H(USE PERMIT
PERMIT NO.
PROPERTY OWNER
BUILDING MH
MAILING ADDRESS PHONE
CONTRACTOR MAITING ADDRESS
D
PHONE
PROPERTY TOCATION _ INCTUDE POST OFFICE
PROPERTY LEGAT DESCRIPTION -METES, BOUNDS
RANG E SECTION TAX LOT NO CODE CENSUS TRACT
EXISTING STRUCTURES ON PROPERTYAPPL.
NAME
&
MAITING
ADDRESS
LEGAL ACCESS TO PROPERTY
PROPERIY SIZE - FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connecl to Existing Sewoge System New System !STRUCTURES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION SQ. FT, # BDRMS VALUATION
SEWAGE DISPOSAI.
PUBLTC tr SEPTTC TANK n OTHERE
PIUMBING INSTALTED BY
OWNER D OTHERT NAME
BUITDING
WASTE DISPOSAT
PI.UMBING
PTAN REVIEW
PARK TRAITER
F EES WATER SUPPI.Y
PUBUC tl N OTHER
TOT,AT $
COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GA[.
DRAIN FIETD REQUIRED
tIN. FT TRENCH WIDTH FT OR SQ. FT
TYPE OF STRUCTURE OCCUPANCY ZONE PUBTIC UTIL. EASEMENT
BI.DG. SETBACKS
FRONT
FT. FROM CTR. OF ROAD RIGHT OF WAY
SIDE INT. SIDE EXT.
USE CI.ASSIFICATION
REAR
AUTHORIZED SIGNATURE _ DATE DATE
BLDG. PERMIT _ WHITE
OFFICE COPY _ WHITE
COUNTY TAX - PINK
PTUAABING _ CANARY
BUILDING _ GREEN
SANITATION _ GOLDENROD
construction to comply with uniform building code ond county regulotionscovering plumbing ond sewoge disposol. elf buildings require o certificoteof occuponcy before being occupied.
(See Stotement on Reverse Side)
(posT THts pERMtT ON MAIN BLDG. AT S|TE)
I.ANE COUNTY, B[DG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 9740I
ronu Jt 955- 13
I I
I.ANE COUN1
BUTLDTNG E
3UIIDING PERMTT OR MOBITE HC
MHI
USE PERMIT
PERMIT NO.
PROPERTY OWNER MAII.ING ADDRESS PHONE
CONTRACTOR MAII.ING ADDRESS PHONE
PROPERTY TOCATION _ INCTUDE POST OFFICE
PROPERTY tEGAt DESCRIPTION - METES, BOUNDS
RANG E SECTION TAX LOT NO.CODE CENSUS TRACT
EXISTING STRUCTURES ON PROPERTYAPPt.
NAME
&
MAITING
ADDRESS
LEGAT ACCESS TO PROPERTY
PROPERTY SIZE _ FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connect to Existing Sewoge System ! New
TYPE CONSTRUCTION se. FT BDRMS VALUATION
m
STRUCTURES TO BE BUILT THIS PERMIT
SEWAGE DISPOSAT
PUBTTC [] SEPTTC TANK l-l oTHER!
PTUMBING INSTAII.ED BY
OWNER N OTHER: NAME
BUII.DING
WASTE DISPOSAL
PTUMBING
PI,AN REVIEW
PARK TRAITER
TOTAT
FEES WATER SUPPTY
PUBUC n fI OTHER
COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAP.ACITY
WITH DIST. BOX: GAT.
DRAIN FIETD REQUIRED
LIN. FT TRENCH WIDTH FT OR SQ. FT
TYPE OF STRUCTURE OCCUPANCY ZONE PUBTIC UTIT. EASEMENT
BI.DG. SETBACKS
FRONT
FT. FROM CTR. OF ROAD RIGHT OF WAY
SIDE INT. SIDE EXT.
USE CIASSIFICATION
REAR
DATE
BLDG. PERMIT _ WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PTUMBING _ CANARY
BUII.DING _ GREEN
SANITATION - GOLDENROD
Construction to comply with uniform building code ond county regulotions
covering plumbing ond sewoge disposol. All buildings require o certificoteof occuponcy before being occupied.
(See Stotement on Reverse Side)
(POST THIS PERMTT ON MAIN BrDG. AT S!TE)
I,ANE COUNTY, BTDG. & SAN. DIV., COURT HOUSE, EUGENE, OREGON 9740I
ronu1f655-13
AUTHORIZED SIGNATURE _ DATE
-
I
Darr
SITE INSPECTION
Ap pRov g o
Rruanxs
Dr sappRoveo I NSPEcToR
FOUNDATION INSPECTION
APPROVED
ReuaRxs
DrsAPPRovEo Dare I Hspecton
FRAMI NG
APPRovEo
Re uanx s
I NSPTCT I ON
Dr sAPPRovEo Drr r I NsPEcroR
LATH OR SHEETROCK
Appnoveo
RexaRx s
FINAL INSPECTION
I NSPECT I ON
DrsappRoveo f7 Dare
D I SAPPRovED Dnr r
I NspEcron
Ap pRov E o
Rrua nx s
Ir.rsptcroR
CERTIFICATE OF OCCUPANCY
ReaoY To lssuE
Rru rRx s
D Nor Rraov ro lssuE D DarE l rusprcron
Z\
NSTALLER: L<.mplete rug; part of f orm to signaturc and subnrit both coPies with appl ication.
PERMIT NO.
INSTALLER.S NAI'IE PROPIRTY AUDRESS 96-74---
N -Aartrs -Blfttila1fleflngd-Ir&ter Supply
Yes No Public 0ther-List
s{qioflbrrk:
Ft. from wel I rrlff/r{!{]
xx
No. Compartments
Feet
WEII
Gal . Capaci ty
No
Foundat i on
1000 grl.
er Be ou.,
ile in
,I
Conc rete
xx
lnside Dimensions: Ft.
Len th width
OWNER
XAHE
MAILING
AODRESS
o
6
e sPosa F
D i ameter 0e rh Distribution Box: Yes
5 0t er stri ut i on-PE XT
Lot L
Front
rom
ne
S ide Rea r
Le
l.
tng
4
l)
tn.
Filler
Tvpe lf iller Depth
lAbove Tile\./idth
rench Sq.Tota I
Fr.
Ft. Between
Lines(bn 6&e 5Brstructions t: :I
t?
(-.\IC.\)(/\\c,
*"*se-
Da te S i gnature
CERTIFICATE OF SATISFACTORY COMPLETION
For Sanitarian Use 0nly:Date:1-st- t Iln accordance with 1973 Oregon Laws Chapter 835, Section 214 this certificate is issued
as evidence of sat.isfactory cornpletion of a subsurface sewage disposal system at the above
I ocat i on
Approved: System lnstal lation conforms to current standards
Disapproved: Does not conform to current standards
Remarks:
tureantarans
LANE COUNTY .
STATF OF ORFGON DEPARTMENT OF ENVIRONMENTAL OUALITY
c ,f-g
PROP' ID SUBSURFACE SEWAGE DISPOSAL S**TEM
fnst. 1er: Complete top part of forn. )
sLgnature and subml.t both copi,es wl.th
appX.icatLon.
B {rn
fnstallerrs Name
No.
Septic
I
h e)tNo. I Permit No -7
PubIic /=otnut-
r
ty List
Bedrooms
3
Baths
I Yes- No.)l
Basement
ER (#,,8,.ru !bFt.
Lengt:h /lt
Applicant
Name
Mailing
Address
I
Date
weLl
Dimens : Ft.
wtdth O / Dianeter
6
Gal.
Ie DLsposal Fle
Depth 5 Dlstribution Box: Yes
Other Distributlon - Tlpe
Feet frour
Foundation
Iot LLne
Signature
)S "o-
Ft
5
of
3
'1
4 ,Total sq.tt. ctil Ft. between
LLnes 16 c Filter. /
rur" l'L in.
,ons
:t lL iF.
,l
(il I7/
I
lrt
n
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l..h)
G
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8o9,.{anltarian use only:lY Approved: System Installation Conforms to DEQ Rules for Subsurface Sewgge Disposal
Ef Disapproved: Does not Conform to DEQ Rules for Subsurface serf,age Disposal
Date: /-30'7{
Remarks:
- , SanitarianrsState of Oregon
Departnrent of EnvLronmental Quallty
Interim Forrn #2
I
I
I
I
i
I
2
3
4
5
6
7
8
PI,OT PLAN MUST INCLUDE:
IJegaI description (Bottom of page)
Property dimensions
Direction of North
All roads (existing and proposed)
Driveways (existing and proposed)
Location of structure(s) on,property
Location of water source
Direction of slope
PLOT PI.AI\I GUIDE
For Preparation of Exhibit {lI
o
11.
L2.
13.
14.
15.
Iocation of trees
Proposed location of septic tank
and drainfield and replacement area
Dimensions and spacing of leach lines
Distance from system to property lines
Location of test holes
Draw to scale
Iocation of wells on adjacent lots
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DR)VEWAY
GAL
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lpo r WELL ON
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9-I./ND6N LANA'../( rnoeos e a)
PHOPOSE
BDM
PL,4N
SCA (E /"= bo'
Section 2 T. :r.=s
Tax Lot or Account No. z-roo
Interim Form #5
R.zW, W.tr,l .