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Home My WebLink AboutPermit Building 1976-11-09PERI\,11T NO CONSTRUCTION [ ] MOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ] NAIVIE ADDRESS CITY ZIP CODE LANE COUNTY PERMIT FOR --' n Owner PHONE tr Contractor NAfulE ADD R ESS O.S. Reg. rr CITY ZIP CODE PHONE Twp- Range- Section Tax Lot-Code- Census Tract Subd ivision Lot B lock Acreage - Width DepthAccess to Property (Road Name) Existing Structures on Property Directions to Property - Address: t STRUCTURE (# BEDROOIVIS)SO. FT VALUATION SEWAGE D ISPOSAL: PUBLIC [ ] SEPTICTANK [ ] OTHER [ ] PLUMBING INSTALLED BY: OWNER[] OTHER[] NAIVI tr BUILDING PLUIVIB ING 3% SURCHARGE--_-_---..-.-...--.------..-------._ IVIOB ILE HOl\ilE WASTE DISPOSAL PLAN REVIEW TOTAL WATER SUPPLY: PROPOSED t ] EXISTING I] PUB LIC COMIIVIUNITY NAIVIE PRIVATE WELL OTHER SPECIFY UCTION PERMITS & lNSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS MAX. TRENCH DEPTH I NCH ES STAY 1OO' FROI\4 ALL WELLS TYPE OF CONSTRUCTION- GROUP FIRE ZONE USE CLASSIF SETBACKS- FT. FROI\4 CTR. OF rM FRONT SIDE EXT FT. FBOIVI PROP. LINE SIDE INT R EAR ZONE AUTHORIZED SIGNATURES lsl ISSUANCE DATE BLDG. PEBN,IIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANABY BUILDING - GREEN SANITATION - GOLDENROD IMPORTANT Call 687-4065 to schedule all required construction inspections. Call 687-4061 to schedule all required septic system inspections. All construction shall comply with lhe State Buidling Code, D.E.O. standards Ior subsurface sewage disposal and the State Plumbing Code. All buildings require a certilicate of occupancy betore being occupied. (See Details on Reverse Side) POST THIS PERMIT ON MAIN BLDG. AT SITE LANE COUNIY. DEPT. OF ENVIBONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6Ih, EUGENE, OREGON 97401 MIN. SEPTIC I',qNK CAPACITY: GALS. MIN. DRAINFIELD-LIN. FT. PERIVIIT NO 2u1 +'16 n Owner CONSTRUCTION [ ] IVIOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY t ] NAME ADD R ESS CITY ZIP CODE PHONE n Contractor NAIVIE ADD R ESS CITY O.S. Reg. + Twp- Range- Section-Tax Lot- Code Subdivision- Lot B lock Acreage Access to Property (Road Name): - ZIP CODE PHON E ** Census Tract Width Depth Existing Structures on Property: Directions to Property - Address STRUCTURE (# BEDROOIVIS)SO. FT VALUATION SEWAGE DISPOSAL: PUBLIC [ ] SEPTICTANK [ ] OTHER [ ] PLUIVIBING INSTALLED BY owNER [ ]OTHER t I NAIVI F BUILDING PLUIVIB ING 3% SURCHARGE TVIOBILE HOTVIE- WASTE DISPOSAL PLAN REVIEW TOTAL WATER SUPPLY: PROPOSED [ ] EXISTING t ] PUB LIC COIVIIVIUNITY . NATVIE PRIVATE WELL OTHER-SPECIFY CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTR OL SPECIFICATIONS IVI I N. SE PTIC TANK CAPACITY: IVIIN. DRAINF I ELD_-- LIN. FTGALS.MAX. TRENCH DEPT I NCH ES AY 1OO' FROIVI A WE FIRE ZONE 4 USE CLASSIFTYPE OF CONSTBUCTION G ROUP SETBACKS FT. FROIVI CTR. OF r/W FRONT SIDE EXT FT. FROIVI PROP. LINE: SIDE INT. - REAR ZONE AUTHORIZED SIGNATURES ISSUANCE DATE BLDG. PEHMIT - WHITE OFFICE COPY _ WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLOENROD Call 687-4065 to schedule all i nspecti ons. IMPORTANT septic system inspections. All on shall comply with the Plumbing Code.for subsurface sewage occupancy before being d i sposal and the State occupied. (See Details on Reverse Side) ST THIS PERMIT ON MAIN BLDG. AT SITE LANE COUNTY, DEPT. OF ENVIFONMENTAL N4ANAGEI'iENT COUBTHOUSE ANNEX, 135 EAST 6th, EUGENE, OBEGON 97401 State Buidling to schedule all required Code, D.E.O. standards require a certiricate of PO All buildings LANE COUNTY PERMIT FOB , , TRS, T Job Location (Street, mile Subdivision //d/ auro__ a-> Blockl+.- -J.Flot Plan (FOR SANITARIAN'S USE ONLY: S system Approved flsystem Disapproved COMMENTS: :-1, signature, ...1 ' 4:L'Ll fl Needs Correction Date: / 2--ry-79 ? t, hP. & 7a FOR INSTALLER'S USE:low Ti Tank Capacity to CC Manufacturer + I ?!//l fi/rL- INSTALLATION RECORD AND CERTTFICATE 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 97401 \i!:v,oo,L1''c, C" := u.tE +G @ \q vt +tc(tlc,=o_o-trl L(D G qc Scale: oIV t0 v t?tlc+ t€t5' 4\ I ?.' A lz'tr c55-1 1 Measureddistancetowellfromtankfromdrainfield- \ \ \ N \\& \a\ d \ SLAB FLOOR PLUMB I NG GROUND^/ORK Ap pnov E o Reurnx s D Drsappnovro D Dare I rspecron GAS PIPING GROUND/ORK AppnovEo Reltanxs D r sappaoveo Dar e I ruspecroR ROUGH PLUMBING Appnoveo Rrua nx s dr,sAPPRovED D DorQ-d-*r**rr@ ROUGH GAS PIPING AppRovEo D DrsappRoveo D Rrurnx s Dar r I rusercroR F I NAL PLUMB I NG AppRov e o Rrurnx s Dr sappnovro D Dorr_{-/{-21 lruspe c FINAL GAS PIPING Ap pnov e o REManx s D r sappRoveo Darr I NsprctoR CERTIFICATE OF OCCUPANCY Reaov ro lssuE REunnrs D D D Nor Re aov ro lssuE D Dare_lnsercroR_ E LANE COUNTY PERMIT FOF PERTVIIT NO. ebiLb--66 CONSTR U n Owner rorrr ffi MoBTLE HorvrE [ ] pLAN REVTEW [ ] cHANGE oF occupANcy [ ] ADD NE ! Contractor O.S. Reg. +t NA E ADD R ESS CITY ZIP CODE Census Tract PHONE Range .. .-, Section Tax Lot T B lock Access to Property (Road Name) CodeTw Subd ivision \'1 Acreage Width Depth Existing Structures on Property ( Directions to Property - Address:*\ ST'RUCTURE (# BEDROOMS)FT VALUATIONso. \ SEWAGE DISPOSAL: PUBLIC[] SEPTICTANK[] '/ri PLUIVIBING INSTALLED BY: OWNER[]OTHER[] NAIVIoTHER [ ]tr \l t WATER SUPPLY: PROPOSED t ] EXISTING I ] PUB LIC COVIMIUNITY . NAIME BU ILD ING PLUIVIB ING 3% SURCHARGE IVIOBILE HOIVIE- -=*WASTE DISPOSAL PLAN REVIEW i': PRIVATE WELL OTHER-SPECIFY TOTAL CONSTRUCTION PERMITS & INSPECTIONS AND WATER POL LUTION CONTROL SPEGIF ICATIONS tMIN SEPTIC TANK CAP4ar*'GALS. l* . IVI ACITY: IN. DRA .*r 1INFIELD LIN. FT IVIAX. TRENCH PT FIRE ZON USE CLASSIF I NCH ES STAY lOO'FRO A WELL TYPE OF CONSTRUCTION GROUP E SETBACKS- FT F.F CTR. OF rAN FRONT OMI SIDE EXT FT. FROIVI PROP. LINE: slDE tNT. ".-- / ReAn ffi' I ,-": ,'g" ,a*ti,{r ZONE -; ISSUANCE DATESI GNATAUTHOR I ZED URES *C Call 687-4065 to schedule all requiredBLDG. PERMIT - WHITE OFFICE COPY _ WHITE COUNTY TAX _ PINK PLUMBING _ CANARY BUILDING _ GREEN SANITATION _ GOLDENROD IMPORTANT ieptic system inspections. All constructlon shall comply with the State Buidling foi subsurface sewage disposal and the State Plumbing Code. All buildings occupancy before being occupied. (See Details on Reverse Side) POST THIS PERM IT ON MAIN BLDG. AT SITE LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COUBTHOUSE ANNEX, 135 EAST 6th, EUGENE, OBEGON 97401 inspections. Call to schedule all required Code, D.E.Q. standards require a certificate of c55-13 t' l t a tltl ?4* rr t ,t SITE INSPECTION App nov r RruaRxs Dr srppnoveo D o^',, //-/2-76 I Nspecron FOUNDATION INSPECTION Ap pRov E ReMlnx s DrsnppRovEow D D*, //-/z- /6 I Hspecron FRAMING INSPECTION Ap pRov r o ReNlRx s *I NSPEcToRDrsappRovEo D /^ 4-77Dat r LATH OR SHEETROCK ArrnovEo Rruaaxs I NSPECT I ON Dr snppRoveo Dar r I NspecroR FINAL INSPECTION AppRovro Reuanxs D r slppRoveo Darr 2 * lo'-7'?tNSpEcroR CERTIFICATE OF OCCUPANCY Reaov ro lssuE RrueRx s D Nor Rraoy ro lssuE D Dorr_lNspEcroR_ H ._/. TRS, T ( .-.r\' PIot Plan /16/ 4/ze/ Job Location (Street, mile Subdivision ar eto"lE=l- FOR SANITARIAN'S USE ONLY: \X System Approved fl System Disapproved Ll Needs Correction COMMENTS: S nature Filler Dept Ti Date: /Z-rl-79 FOR INSTALLER'S USE: Trench DePth Tank Capacity ic CC lVlanufacturer Measured distance to well from tank from drainfield 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 hpelow&+) o tn N d\ N + o- co K t\ oo 0) ro! o) E'6 o) E J' C(,(J = o- uJ cc z m L o) (g#oc N $\.\ r.,] fi Scale \s o tCI v 2c * II(?t€ t?' f+ ls/ ,t\ lz A lz' Y/ DT c55-1 1 t