HomeMy WebLinkAboutPermit Septic Tank 1987-12-1506
Lane County Authori zafitort for,FOR OFEICE
1
TOW}iSHIP t7 RANGE o3 t 33
Three Copies of Plot Plans
Mech/P1umbing Checklist
Legal Interest Document
Plan Check Info Sheet
Two Copies P lans
#
Applica
Permit
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l^,CATION
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t3 PROPOSED USE OF PROPERTY
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DECI,AIIUION OF ,c
""o "'T"u OF
istinged. oF BE(AMS
#fr.:7434OiiNER I
Wil}1 oAN IIX:Y#VIS NAME AND
)
do hereby certify that all infomation hereon is true and correct, and that IFOR PERMITTHE COI4PLETEDI TTAVE
CHECKED THIS THOROUGHLY.
of authori ttachedacontractauthorizedntthw1evidenceagetyrecordonteresttheINthertyProPefollowinglegalofthWIorditheonancesLaneCowtheandoftheStateaIlandworkdrfomeha11donebeaccordancetylnOregonf!rtherI certi thatfy any pe t ur-of trucs wature thethout MI on theof di DivisionBuithatandOCCUPANCYNOwabenadepengrtai-ni theto dework cribed anyhereinn9pe
effectand as oRs 70 ttha if the forbasi s erhBuiIdetherBoardINtsfulforcebyexemp xemptirthecethattraLionrequiredrti fy regls
d thi-s t I READ}IAVE ANDthwl701ORSwill055useonbeddarewhoproleINhereonnotedandthatsubcontractorsemployeescomplianceonly
YOUR AUTHORIZATION HAS BEEN BASED ON THE FOLLOWING CONDITIONS:
partition # Parcel # Parcel Si'e-
YCs, SEE ATTACHED SHEET.I pr,ooopr,Rtn,In flood hazard area?
Yes
Installatsion
Specj.fications:
A,rCO}4.}lENTS:
Date:
Group.fl pr,axs EXAMrNArrolil :
COM}IENTS:
Date:
No
Nou6rsr:pl,
' - Gallon
-?4fl&<k
'v
.,
UseType
s. r. *B P. # 6r4a
,l o'
READ THIS SECTION CAREFULLY.
Installation Record Issued?
inte rear
I pmunruc/zoNrNG Zone
de
Date:
Date:
Lineal Feet
of Drainfield
cL, .fro.t.
- . , (t Maxirnum Depth
?V of rrenches
Minimurn
col'$lENTS
TOTAL VALUATION $CON STRUCTION AUTHORIZED BY THIS PERMIT
DE ption t
c
$
)
)
>
\Sq. Ft
Fixed Fee/
Unit Cost
Floodplain Fee
Subsurface Fees
Building Eee
i.1ech/PImbg Fee
Pr ans Check Fee
State Surcharge
DEQ Surcharge
TOTAL FEE $$@,
{
IAL/DESIGNEE per ORS 456.805 I
OF PUBLIC WORKS LAND MANAGEMENT DIVISION' 687
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR ]NSPECTION INFORMATION
7 12 -Lr7f1
BU DATE
1,LANE COUNTY
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purchaser;n
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SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATI
CATION OF THIS PERMIT, CITATION UNDER PROVISIONS OF-LANE COUNTY'S INFRACTION
REMEDIES ALLOWED BY LAW.
WHEN READY FOR INSPECTION,CALL 687-t4065. A MINIMUM oF AT LEAST 24
. Have theJot lowing inf ormation -ready:
Septic Tank
10r
10r
5r
50'
Drainfi-e1d
ON CAN RESULT IN REVO-
ORDINANCE, AND,/OR OTHER
}IOURS ADVANCE NOTICE FOR INSPEC-
permit number, job address, type@nof inspection, when it wilI be ready, lour name and phone number, and any.special d.irections to site.
iurr,oruc DrvtsroN:
REQUIRED INSPECTIONS: "
1. Foundation Inspection: To be made after trenches are excavated and forms erected and when allmaterlETs for-TEe foundatj-on are delivered' on the job. Where concrete from a central mixingplant (commonly termed "transit mixed") is to be used, materials need not be on the job.
2. concrete Slab or Under-Fltoor rnspectlon: To be made after.aII in-slab or under-floor buitdingservice equl-pmentl-conEuTt, plpTig accessories, and other ancillary equipment items are inplace but before any concrete is,poured or.floor sheathing installed, i.ncluding the subfloor.
3. Framing & Insulation Inspections: To be made after the roof, all framing, fire blocking, and' bracinf are in place'and a-11 pipes, fireplaces, chimneys, and vents a::e complete and a1i rough' electrical and plumbing are approved. AII walI insulation and vapor barrier are in place.
4. Lath and/or Gypsum Board lnspection: To be made after all lathing and gypsum board, interiorana-ext-eri-or-s in place-Eut EETore anlz plastering is applied ana tbfoie gypsum board joints
and fasteners are taped and finished.
5. Final Tnspection: To be made after the building is complete and before occupancy.
APPROVAL REQUIRED. No work sha1l be done on any part of the building or structure beyond the pointindicated in each successive inspection without first obtaining the approval of the building official-Such approval shall be given only after an j-nspection shall have been made of each successive stepin the construction as indicated by each of the inspections required.
NOTE:
A.
D
From:
B
AII building permits require inspections for the work authorized, such as but not limited to:
Block WaIl: To be made after reinforcing is in place, but before any grout is poured. ThisInspecElon.is required for each bond beam pour. -There will be no aplroval until the plumbingand electrical inspections have been made and approved
Wood Stove: To be made after completion of masonry (if applicable) and when installation iscompfete. Installation shall be in accordance with an appiovea, nationally recognized testingagency and the manufacturerrs i_nstallation instructions.
Mobile Home: An inspection is required after tbe mobile hpme is connected to an approvedsEilE?-rci-EEptic-system for setbacti requirements, blocking,tfooting connection, tie-dtwns,skirting, anrl plumbing connections
1. Footings and pie1,s to compllz wi-th State foundation requirements for mobile. homes. or asrecommended by the manufacturer.
2. Mobile home minimum finish fl-oor elevation shall be certified when required by a flood-plain management letter.
3. Mobile home tiedowns, when required, and skirting shall be installed and ready for inspec-tion within at.l-east 30 days after occupancy. Tiedowns and skirtj-ng sha1l be installedper enclosure.
Syimming-Pgo1: Below grade when steel is in place and before concrete is poured. Above grade
w:Ee n-poo I-TE-i n s ta 1 I e d .
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURTNG WORKING HOURS. THIS PERMIT WILL EXPIREIF hTORK DOES NOT BEGIN WITHIN 180 DAYS, OR IF WORK TS SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS.SUSPENSTON OR REVOCATIOI'I MAY OCCUR IT THIS PERMIT I.JAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
TNFORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
SUBSURFACE AND ALTERNATIVE SEWAGE D]SPOSAL SYSTEMS :
1
2
Permits shall be effective for one year from the date of issuance.
upon completing the construction for which a.permit has been issued, the permit holder shallnotify the Lane county Department of Planning and Community Development by submitting theinstallation record form. The Department sh;Il inspect the construction lo determin. it itcomplies with the rules contained in this division. rf the construction does comply with suchl91e:, the Department shall issue a certificate of satisfactory completion to the p'ermitl holder.rf the construction does not comply r4ith such rules, the Depar'tment shall notify th. p.iinitholder and shai] require satisfactory completion before isiuing the certificatE. railure tomeet the requirements for satisfactory completion within a reasonable time constitutes a vio-lation of oRS 454.605 to 454.745 and lnis iute.
Setbacks - Subsurfa.ce Sewage Disposal
Interior property lines
Edge of road right-of-wayBuilding foundationWells, other water sources
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AC ^ IVITY INFORMATIC^..tr SHEET
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
hne county'o_
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PERS0N MAKrlff'REQI|ESr
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2. PROPERTY ADDRESS
( IF DIFFERENT F
3 ruae B PAFIeEL NLJMEIEFI (from tax maps in Department of Assessment and Taxation
or from tax statement)(REQUTRED I NF0RI4ATr0N)
TOIME-TF MNGE smTMN mN'IXr
TOINSH.IP MNGE SEETI_OII MINN-
TOINSH F MN-GE SEETMN
TOTAL CONTIGUOUS PROPERTY IN SAME OT,INERSHIP:
MN'IfiG-
ACRES
4 ,rrrrr-ON ('if appf icable)LOT BLOCK
5 REQUEST (state exactly what you plan to do)e fr,
6 DIRECTIONS TO SiTE TIC J
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** FOR STAFF USE ONLY **
ZONE/LAND USE:
BY : _ DATE:_TIME IN:_ OUT:_
NUMBER
DATE
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LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 9740I / 687.406I
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, CIIY STATE ZIP CODE C ITY STATE ZIP CODE
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/ICINITT AP Permit No. 7210'03- rwnshP /ry"'rN BLAq(JNK
ange c/J Tax Lot 43o OBE
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pecify Type)
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USE
Section 27 3'3
form c55-11'
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Standard System I Alternfrve S
Job Location
Subdivision /P Lot-- Block-Z--
PLOT PLI\N AS
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FOR INSTALLER'S USE Trench
Tank Capacity 7sY 6 /Manufactu
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BLACK INK ONLYtt
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Gravel Depth Below Ti le d
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lnstal tl
lTrtle as shown on OEO lrcensl
Telephone
License No.From Drainfield-Tota Li
I ding Company
Measured Distance from Well to Ta
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's name)- certify that a (Mfg
and Mercury Float (Mfg.
Signa
FOR SANITARIAN'S USE ON
I Length of
(Model No )ump
lSignaturs ol Lrcenw)
lf lnsta
Applicant's Name
oate/-3*9/
have been installed with this sewage ihstallation
Date' /- 3 -93
ystem Approved tr System Disapproved E Needs Correction
COMMENTS:
ieolrc
TJnk
.k
qse
e €System Corrected Da
/32 Y ksr System Ca l.lday Signatu
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION WhEN by the County Sanitarian, this certificate is
evidence as per oRS 481.665 of satisfactory completion of a subsurface sewage disposal system at the above location
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