HomeMy WebLinkAboutPermit Septic Tank 1992-03-0468-zPERMIT
REAUEST
FOR:SEPTIC SYSTEM VERIFICATION
IiAIL PER14IT TC THE OWNER AT THE JOB ADDRESS ABOVE
NIME
read BOTH sldes ol thlsI have carefully
SON
that all lnformatlon b true and correcto
READ CAREFULLYI Authorlzstlon ls Based On The Fo Condltlons
1- {-f z-APPROVED BY:DATEFEES DUE: $
CALL FOR TNSPECTTONS (SEE BACK OF FOBM FOB
SEPTIC permlts are good tor one year. ALL other permits expire after 180 days unless inspectlons are current.
TRUCTTONS) 687-4065
LOCATION OORESS383i irrNSLo\,/ srREET, spRTNGFIELD, oREG0N 97tr77
AD TO 58Tu STREETI RIGI-iT ON 58TH STREET TO hJINSLOIII STREET
APPLICAilT ilATE I ADOAESS
LARR I AN T!'l0I'iPS0N, SAI1lE AS THE J0B ADDRESS AB0VE
11LI t;2 'l 0 200
YSTE
TO S I TE ABOVE .
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gWNEHS ilAME I A99FESS
NA
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EP I VERIFI ATIOI,!
NA
EXISTING
PrgPlnr ISII(GLE FAMI Y D1',ELLING
SAFlEAME AS THE ABOVE
OA'TE
VIOLATIONS
SETBACKS AND OTHEN, CONDMONS OP APPROVALMUSTBB STRICTLY OBSRVBD. VOLATIONCAI{R,BSIJLTIN RBVOCATION OFTHIS PERMIT.
CITATIONS MAY BB ISSIjED I,NDER THE PROVISIONS OP LAI.IE COT,NTY,S INFRACTION ORDINANCts AND/OR' OTHER RBMBDIFJ ALLOWED BY LAW.
A MINIMUM OF AT LEAST 24 HOLIRS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQI]ESTS
llave the following information ready when you call 6874065
Permit numb€r - Job address - Type of inspection requAed - When it will be ready
Your name and phone number - Any special directions to the site
powERroEN,ERUpoNLAr{D. **""ffi,ll?.iTffi#3Hfi{?ffirH'o#eTffi'#l8ffiffHf;1*ff-or^"*oprHBrRpuNcrIoNs,MAy
BNTE,R TJPON ANY LAND AND MAXE EXAMINATTONS AI{D SURVBYS A!{D PI.ACB AND MAINTAIN THB NBCtsSSARY MONT'MEXiITSi AND MARXERS THEREON.
REQT.TTRED TNSPECTIONS
FOUNDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
LJNDERGROLJND PIPING INSPECTION: To be made after all underground piping has been irstalle4 prior to any backfill.
CONCRETE SLAB OR LJNDER-FLOOR INSPECTION: To be made after all in-slab or under-flo* building service equipment conduit, piping
accessories and other ancillary equipment items are in place butbefore any concrete is placed or floor sheathing installd, including the subfloor.
ROUGH MECHANICAL INSPECTION: To be made after all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPECTION: To be made after all plumbing rough-in is in place, prior to being covered.
FRAMING INSPECTION: To be made after the all framing, fire blocking, bracing and roof are in place and all pipes, chimneys srd vents ue complete
and the rough elecrical, plumbing, and mechanical inspections have been made and approved.
INSULATION INSPECUON: To be made after dl insulation and vapor barriers are in place, prior o covering.
LATH AND/OR GYPSUM BOARD INSPECTION: To be made after dl lathing and gypzum board, interior and exterior, is in place but before any
plastering is applied or before gypsum board joints and fasteners are taped md finished.
ADDITIONAL INSPECTIONS MAY BE REQIJIRED, zuch as but not limited o;
BLOCK WALL: To be made after reinforcing is in place, but before my grout is poured. The inspection is rcquired for each bond beam pour. There
will be no approval until the plumbing and electrical inspections have been made and approved.
FINAL MECHANICAL INSPECTION: To be ina& just prirn to the strucnre or remodeled ares Flng occupied and prior to operating aty equitrrnecrr .
FINAL PLIIMBING INSPECTION: To be made just prior to the building, strucurre or remodeled area being occupied"
FINAL BLJILDING INSPECTION: To be made after finish gfading and the building, structrEe or remodeled aea is completed md ready for occupancy.
MOBILEMANUFACTURED HOMES: An inspection is reguired after the mobile home is connected to ur approved sewer or septic
system, prior to covering sewer or water lines, for setback requirernents, blocking, tiedowns and plumbing connections.
Footings and piers to comply with State formdation requirenrents for mobile homes or as recommended by the mrrufacturer.
Minimum finished floor elevation shall be certified when required by Floodplain Management
Tiedowns, if requted, shall be installed and ready for inspection within 30 days after occupancy. Tiedowns shall be installed per enclosure.
APPROVAL REQTIIRED
No work shall be done on any part of the building or structure beyond the point indicated in each successive inspection without first obtaining the
approval of the building official. Such approval shall be given only after an inspection shall have been made of each successive step in the construction
as indicated by each of the inspections required.
APPROVED PI,ANS MUST BE ON TTIE JOB SITE AT AI.I TMES DURING WORKING HOURS.
THIS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WTITIIN I8O DAYS, OR IF WORK IS STOPPED OR ABANDONED FOR MORE THAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF TTIIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
aNYoNE PRoCEEDING PAST TIIE PorNT oF REQITTRED rNspEdiroNs WILL Do so AT THErR owN RrsK.
:,:
Your signature on the front of this form verifies the following: I HAYE CAREFULLY EXAMINED THIS COMPLETED APPLICATION, and do
hereby certify that all information hereon is true and correct, and that I have a legal interest in the property as owner of record or authorized agent. I
further certify that any and all work performed shall be done in accordance with the Ordinances of Lane County and the laws of the State of Oregon per-
taining to the work described herein. I further certify that if I am not the owner of the property, my regisuation with the Builders Board is in full force
and effect as required by ORS 701.055, and that if exempt the basis for the exemption is noted hereon, and that only subcontractors and employees who
are in compliance with ORS 701.005 will be used on the job.
SUBSURFACE & ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
When subsurface construction is complete, the permit holder shall notify the County Land Management Division by submitting the installation record
form. {1 inspection will be made by a qualified sanitarian. If construction complies with all rules a certificate of completion wiil be issued to ttre permit
holder. If corstruction does not comply with rules, the permit holder will be notified, and all corrections shall be made before a certificate of compietion
will be issued. Failure to meet satisfactory completion within the alloned time constitutqs a violation of ORS 454.605 to 4il.745 and this rule.
SUBSURT'ACE SEWAGE DISPOSAL SETBACKS SEPTIC TANK DRAINFIELD
From: Interior property lines 10' 10'
Edge of road right-of-way l0' 10'
Building foundation 5' 10'
Wells or other water sources 50' 100'
Exlstlng Bulldlngs or
lmprovements on
Property
Xror."b Barn
[3 Garage
E lrlobile. Home
EI Shed
SEPTIC INSTALLED
l-EYes
l-I l.lo
Water District
Please complete all lines inside white boxes, if possible.
FFOtrEOWNEn OF PROPERTY (il not Bmc r3 rboy!)
OWNERS ADOAESS (i, not xm. .. rboy.)
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For Moblle Home
Placement Only
No. of Bedrms
License #-
Brand
Year
Size
MAIL PERMIT TO:
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Dlstance from Moblle
Home to:
Water Saarcr/Seplic
Land Management Div. staff can
not be held responsible lor
evaluations or recommendataons
based on false, inaccurate or
incomplete information
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