HomeMy WebLinkAboutPermit Septic Tank 1984-06-28ITfi!'
-
La,ne v ization for,FOR OFFICE USE ONLY
Two Copies of Plans
Three Copies of Plot Plans
It{echlPlumbing Checklist
Legal Interest Document
!ef"" Check Info Sheet
n/Applicatio
Permit *
P TAX
LOT BLOCK 3
PROPOSED USE OF PROPERTY
Keside-ntial
l-l commercial
l-l rndustriar
n euuric
DECI"ARED $ VALUE
#ffi sed
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MJI4BER
I HAVE CAREFULLY EXN4INED THE COT,IPLETED APPLICATIO.I FOR
have the fol-towing Legal- interest in the propertr,(rn.. ,
I f:rther certify that any and all work perfomed/shail be ,
ther certify that registration with the Bui.rder's Board is in fulr force and ef
.r'
NAI'IE
true
enployees
CHECKED APPLICATION
PERMIT, and do hereby certify that alL infomation hereon is and correct, and that I
of record; Icontract purchaseri f,autnorizeddone in accordance with the ordinances of Iane
agent with evidence of authority attached
CoEty and the Laws of the State of Oregonto the work described herein, aDd that NO OCCUPANCY will be made of any structure without the pemission of the Building Division. I fur-fect as required by ORS 701.055, that if exempt the basis for ei.s noled hereon. and that only subcontractors and xho are in complj-ance with ORS 7OI wiU be usea on this project- I HAVE READ AND
. YOqR/AUTHORTZATTON HAS BEEN BASED ON THE FOLLOWING CONDTTTONS:
q Partition #- Parcel # parcet Size
I Rr,ooopr,arll: rn frood hazard areaz n no n ves, sEE ATTACHED SHEET
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PLANS EXAI\TINATION:
COMI1ENTS:
Date:
, ,q!'
c L
No
Etr,6L _a6
Date
tr Type Use
s. r. #,.,. o lS?&3 Instal
JY
CO!1}1ENTS:
interior rearMinimm se
COM}IENTS:
Date :
Date:
GaIIon
Tank
Lineal f'eet
of Drainfield
#^-*,/ | rnstallationt Specifications:
READ THIS SECTION CAREFULLY
I plaxtlrncrzzoNrNG: zone
c L,
TOTAL VALUATION $CONSTRUCTION AUTHORIZED BY THIS PERMIT
Fixed Fee/Unit Cost
Floodplain Fee $
Subsurface Fees $
Building Eee $
!.1echlPlmbg Fee S
Pl ans Check Fee S
State Surcharge $
DEQ Surcharge $
TOTAL FEE S$
iption
BY
a"tli; . nt'|?, ,
Sq. Ft.
OFF IC IAL,/DES IGNEE per ORS 455.805
125 EASTSTH AVENUE, EUGENE, OREGON 97401
EE REVERSE FOR INSPECTION INFORMATION
2f l*" trt/
LANE DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687.4061,
DATE -t;
8LTo"'.*'
a1.ff 0oo[
14-25
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SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVO-
CATION OF THIS PERMIT, CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND,/OR OTHER
REMEDIES ALLOWED BY LAW.
WHEN READY PoR TNSPECTIoN, CALL 687-4065. A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE FQR INSPEC-
@u.-rrEve-TEe-.1Iowinginforhationready:permitnumber,jobaddress,typeof inspection, when it will be ready, your name and phone number, and any special directions to site-
BUILDING DIVISION:
REQUIRED INSPECTIONS:
I. Foundation Inspection: To be made after trenches are excavated and forms erected and when aII
materEfs for ifie foundation are delivered on the job. Where concrete from a central mixing
plant (commonly termed "transit mixed") is to be used, materials need not be on the job.
2. Concrete Slab or Under-Floor Inspection: To be made after all in-s1ab or under-fIoor building
sernTce equlpmentl-EonEult, plplirg accessories, and other ancillary equipment items are in
place but-beiore any concrete is poured or floor sheathing installed, including the subfloor.
3. Framing & Insulation Inspections: To be made after the roof, all framing, fire blocking, and
[r""f"-; are-Tn pTace ana-I p1Fes, fireplaces, chimneys, and vents are complete and aII rough
electrical ana -plumbing are approved. A11 wall insulation and vapor barrier are in place.
4. Lath and,/or Gypsum Board Inspection: To be maile after aII lathing and gyPsum board, interior-
"na ""t"ii-or;=-Tn-place-EuE-EeTore any plastering is apptied and before gypsum board ioints
and fasteners are taped and finished.
5. Final Inspec-tion: To be made after the building is complete and before occuPancy.
APPROVAL REQUIRED. No work shafl be done on any part of the builcling or Structure beyond the point
indicated in each successive inspection without first obtaining the approval of the buitding official.
Such approval shall be given only after an inspection shall have been made of each successive step
in the Lonstruction as indicated by each of the inspections required.
NOTE: A11 buildj-ng permits require inspections for the work authorizeil, such as but not l-imited to:
A. Block WaII: To be made after reinforcing is in place, but before any qrout is poured- This
InspecETon is required for each bond beam pour. There will be no aPproval until the plumbing
and electrical inspections have been made and approved.
B. liood Stove: To be made after completion of masonry (if applicable) and when installation is
complete. Installation shalI be in accordance with an approved, nationally recognized testing
agency and the manufacturerrs installation instructions-
C. Mobile Home: An inspection is required after the mobile home is connected to an approved
sewer or septic system for setback requirements, blocking, footing connection, tj-edowns,
skirting, and plumbing connections.
l. Footings and piers to comply with State foundation requirements for mobile homes or as
recommended by the manufacturer.
2. Mobile home minimum finish floor 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 least 30 days ifter occupancy. Tiedowns and skirting shall be installed
per enclosure.
D. Swimming pool: Below grade when steel is in place and before concrete is poured. Above grade
;Een pool-f=-ins tatled
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMTT WILL EXPIRE
IF WORK DOES NOT BEGIN W]THIN 180 DAYS, OR IF WORK TS SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IE THIS PERMIT WAS fSSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFOR}4ATION.
ANYONE PROCEEDING PAST THE POINT OT REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
S UBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
permits shall be effective for one year from the date of issuance.
Upon completing the construction for which a.permit has been issueil, the permit holder shall
n6tity the r,ane County Department of Planning and Community Development by submitting the
installation record form.- The Depart$ent shil1 inspect the construction tso determine if it
complies with the rules contained in this division. If the construction,does comply $tith. such
ru1ls, the Department shall issue a certificate of satisfactory completion to the permitl holder.
If th; constrlction does not comply with such rules, the Department shall notify the permit
holder and shal1 require satisficiory completion before issuing the certificate. Failure to
meet the requiremenfs for satisfactor!, comptetion within a reasonable tirne constitutes a vio-
lation of oRS 454.605 to 454.745 and this ru1e.
Setbacks - Subsurf.ace Sewage Disposal
I
2
Interior property lines
Edge of road ri.ght-of-way
Building foundation
WeIIs, other water sources
Septic Tank
10t
10r
5t
50r
From:
Drai nf ie fd
10r
r0 r
10!
100 r
[rrx: courty
ACTIVITY INFORMATION SHEET
COMPLETE THIS SECTION. INCOMPLETE FORMS l.lILL BE REJECTED!
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V,'.k. L tyrJct lke(L
l^LrultC
PERSON MAKING REQUEST
luL frtyyrqruck S1 sa rw-x-
MAILING ADDRESS MAILING ADDRESSsp"t[X c;K QtYztI JL,ITY
BUsl rlES s- rr-rEP-ri0r[tr-*
2 PROPERTY ADDRESS
STATE ZIP CODE UIIY STAT E ZIP CODE
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HOME TELEPHONE #BUSINESS TELEPHONE #HOME-TEIEPHONE #
(rF DTFFERENT rno@
3 rvlae B PAFIeEL NIJMBEFI
( REQUTREp INFoRI4ATI0N)
(from tax maps in Department of Assessment and Taxation
or from tax statement)
tz ^03 21__3
TOWNSHIP RANGE SECTION
3 6s c sefufu\
ZON I NG
T0II-N'SF]P MNGE SEeT-tolr ffi ZONING
ToilNSFTF RA-NGE SEmmN ffi ZONING
lolal. CONTrGuous PRoPERTY IN SAME oWNERSHIP ACRES
4 SUBDIVISI0N ( if app ticabte) Mrr[o P.,rL LOT BLOCK
5 REQUEST (state exactly what you plan to do)CL t9
4lrL s"ro[*a-r^ k
6 DIRECTI0NS T0 SITE: I 2
r
ZONE/LAND USE
** FOR ST,F USE ONLY **
TIME IN:_ OUT:_
NUMBER
DATE
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DATEBY:
LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 9740I / 687-4061
I (
TRS, TL Job Locatlon (Add
Pernlt ll
Permit
Permit
For Pernlt #
PernLt
Pernit
For
Plctt Plan For For
For For
Subdivision
Lot Block
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YICINITY MAP
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I personally lnspected the sys
shown hereon and certLfy that lt 18
constructed ln full coryllance slth
the P rovlliong of OAR Dlvtelon 71.
DAIE: 7 lele
lnstall C"""
Telephone
License No Ssqra
nding Co
Da t" \\s\sq
lnstalled By owner-
Date-
lSignature of Owner)
Applicant's Name I Address(\.K'. Lso \( c.*
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Permit No \r \6- sL\Twnshp
MUST\'1
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tx'r\i *\a.E
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USE K INK
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rn ul ng an a on
BE IN BLACK NK form c55-11
Range section an.33 Tax Lot .39oo
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MTNT
Standard System ( Alternative S Type
Job Location (S
Subdivision / Pa G.rr 1o \nqx\o K Parcel-Block 3
DETAIL SYSTEM PLOT PLAN AS CONSTRU TEI)
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FOR I USE:Trench
Tank ooo Manufacturer
Measured Distance from to Ta From Dra
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's na certify that a (M (Model No.
and Mercury Float Switch (Mfg. and No.)- have been installed with this sewage installation.
Signature Date-
FOR SANITARIAN'S ONLY:Approved tr isapproved N Correction
ne-6'- ' '
Date-
oate H7-//.
Corrected
System Capacity l.lday Signatu
INSTALLATION RECORD & CERTIFTCATE OF SATISFACTORY COMPLETION When signed by the county Sanitarian, this certificate is
as per ORS 441.665 of satisfactory completion of a subsurface sewage disposal system at the above location.
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'Public Service Building, 125 E. Bth Avenue, Eugene 97401
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