HomeMy WebLinkAboutPermit Septic Tank 1981-06-22POR OFFICE USE ONLY
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Two Copies of Plot P1ans
l.lechanical Checklist
Pfumbino Checklist
Plan Check fnfo Sheet
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PROPOSED USE OF FROPERTY
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EXAMINED THE COMPLETED APPLICATION FOR PERMIT, and do hercbi ,rcrtifi' that all lnform.rtior hc
ify that any and all work perforned shall be done in accordance with the ordinanccs of Lane County and the
to the work described herein, and that No OCCUpANCY will be made of any structure without the permission of the Building Divisj.on, f further.r{rrtrfy
that registration with the Builder's Board is in fu1] force and effect as required by oRS 701.055, that if exenpt the bas.is for exenption i-c not.rd
hereon, and that only subcontractors and empl-oyees who are in conpliance with oRS 701.055 will be used on this project. I HAVE READ AIID CIIECf.ED THIS
APPLICAI ION THOROUGHLY.
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SIGNATURE
sI Fperuzlle $)dvtD
NAME (please prant)
Laus
is true and correct arrd I fr)rthc
e St.rLe of Oregrn I,^rLair)in,l
Efr,
I Contracto]
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cert
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BLocK.
CONSTRUI ^'ION/PLACEMENT
PERMIT
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COIUPLETE THIS
tr PLANNING
Ctrlinimum Sctbacks: L,
PLEASE USE BLACK INK AND PRINT.
ZONING:RA Partition #Zone
tranL c
Parcel t
interior
Parcel- Size Las;
A/*OC)&.L, siale re ar
Coments:
o...,6-tZ.Bl
fl nunar, AppRESSTNG . CR1D COORDINATE.N E
Date:
Date:
X SA}iITATICh[:B. P. +4;..ro, ^..o'l lssucd?ves [-l No
et ds9 Depth
ie ld k,(,Trenches
Date:
-------77
rnstallation
Specifications:
Coments
6rancal Ion t50
Use
Coments:
*Date:
Descr jrption Sq. Ft
FEES PATDToTAL VALUATIoN $
By:
Date:
PERMIT APPRO\,ED oFFICIAL/DESIGNEE (per oRs 456.8
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT / 125 EAST EIGHTH AVENUE, E
C74.L94 SEE REVERSE
CONSTRUCTION AUTHOR]ZED BY THIS PERMIT
Fixed Fee,/
Unit Cost
Floodplain Fee $
Subsurface Fees $
Building Fee $
Sewer,/Storm Drain/Water $
Plumbing Fixtures $
Mechanical $
Plans Check Fee $
State Surcharge $
ToTAL FEE $
Check sh
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DATEffi, oREGON 97401
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fl ffrOOOpf,afU: rn f.lood hazard area? D ro I v.s, see attac]red sheet.l
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SETBACKS AND OTHER CONDITIONS OF APPROV]\TMUST BE STRICTLY OBSERVED. VIOLATION CANYSULT IN REVOCATION OF THIS PERM
CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, ANDIOR OTHER REMEDIES ALLOI,IED BY LA["I.
I^IHEN READY FoR INSPECTI0N CALL 687-4065. A MiNIMUM 0F AT LEAST 24 HoUR ADVANCE NoTICE FoR INSPECTI0N REQUEST MUST BE
GIVEN. Have the fo1)ow'ing information ready: Permit number, job address, type of inspection, when it will be ready,your name and phone number, and any special direct'ions to site.
BUILDING DIVISION:
REQUIRED II ISPECTI ONS
l) FOUNDATI0N INSPECTI0N: To be made after trenches are excavated and forms erected and when all materials for the foundation
are delivered on the job. Where concrete from a central mix'ing plant (commonly termed "transit mixed") is to be used,
materials need not be on the Job.
2) CONCRFTE SLAE 0R UNDER-FL00R INSPECTI0N: To be made after all in-slab or under-floor building service equipment,conduit, piping accessories and other ancillary equipment items are in place but before any concrete is pouredor floor sheathing installed, including the subfloor.
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3) FRAMING & INSULATIoN INSPECTI0NS: To be made after the roof
a1l pipes, fireplaces and chimneys and vents are complete an,walI insulation and vapor barrier are in place.
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i1 framing, fire blocking and bracing are in place and1l rough electrical and plumbing are approved. A11
4):Tobemadeaftera111athingandgypsumboard,inter.iorandexter.ior,isinp1ace
but before any plastering is applied or before gypsum board joints and fasteners are taped and finished.
5) FINAL INSPECTIoN: To be made after the building is complete and before occupancy.
APPR0VAL REQUIRED. No work shall be done on any part of the building or structure beyond the point indicated in eachsuccessive inspection without first obtaining the approval of the building official. Such approval sha'l'l be given onlyafter an inspection sha'll have been made of each successive step in the construction as inaicited by each of ine inspeitionsrequi red.
N0TE: A11 building permits require inspections for the work authorized, such as but not limited to:
A. BL0CK WALL: To be made after reinforcing is in p1ace, but before any grout is poured. This inspection isrequired for.each bond beam pour. There wiII be no approval unti'l the plumbing'and electrical inspections
have been made and approved.
B. w00D ST0VE: To be made after completion of masonry (if applicable) and when installation is comolete.
Installation shall be in accordance with an approved nationally recognized testrng agency arrd the manu-
facturer' s instal lation instructions,
C. tl0BILE HOME: An inspection is required after the mobile home is connected to an approved sewer or septic
system for: setback requirements, b'locking, footing connect'ion, tiedowns, skirting, and plumbing
connecti ons.
(l) Footings and piers to comply with State foundation requirements for mobi'le homes or as recommended
by the manufacturer,(2) Mobi'le home minimum finish floor elevation shall be certified when required by a floodplain
management letter.(3) l4obile home tiedowns, when required, and skirting shall be installed and ready for inspect'ion
within at least 30 days after occupancy. Tiedowns and skirting shall be installed per enclosure.
D. SWIMMING P00L: Below grade when steel is in place and before concrete is poured. Above grade when poolis installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMIT WILL EXPIRE IF I.IORK DOES NOT BEGIN
tllTHIN .l80 DAYS, 0R IF l,lORK IS SUSPENDED 0R ABAND0NED FOR M0R-E THAN]B0 DAYS. SUSPENS]ON 0R REV0CATI0N MAY 0CCUR IF THIS
PERMIT hlAS ISSUED ON THE BASIS OF INCOI1PLETE OR ERRONEOUS 'ITFORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS I{ILL DO SO AT HIS OWN RISK
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS
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Permits shall be effective for one year from.the date of issuance..
Upon completing the construction for which a permit has been issued the perm'it holder sha11 notify the
Department by submitting the instalTation record foym. The Departnrent shall inspect-the construction to. -
determine if it complies with the rules contained in this division. If the construction does comply vrith.
such rules, the Department shall issue a certificate of satisfactory completion to the permit holder. If the
construction does not comply with such ru1es, the Department shall notify the permit holder and shall require
sat'isfactory completion before issuing the certificate. Fai'lure to meet the requirements for satisfactory
completion within a reasonable time constitutes a violation of ORS 454.605 to 454.745 and this rule.
Setbacks - Subsurface Sewage Disposal
From Interior property lines
Edge of road right-of-way
Building foundation
Irlel Is, other water sources
Septic Tank Drainfield
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,?ECORD oF A,PPROVAL Or,NDtvtDUr,t sEwAcE^qry9-sa?"siJrs^.i
^.*,AppRovAr ro ocduii' iitirbifice
ISSUED IO:
No-" - *i /+r<.IANE COUNIY
Properry Addrass *.(:tutt" N"' 't'- / : (: L
Aloil To
.-.8 q 8.q* ,z
.Totol numbcr: tiving Unirr I -- Bodroomr. ..*J .. Borhr / Basomenr,Worar Supply by .y pvblic System lndividuol Sysrem Community Syslem Gorb. Grinder
Yos Nc r' Orher
StPflC IANX; Disronce from well ,-- feet. Moteriol C t,.,' ., A u- I- ri No. of Comporlmenrs /
fee I
sq. fr.
Distonce from well .
c.!a.0ao.':
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(1.; recsr
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of filrer ovsr tile
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Iotol liquid copocity :r:-- --- -..,-_-.,-_-_-.'/9'>gol. lnside lengrh 7/-ft. tnsido widrh y F.,-Di,ometer feet. Liguid deprh {feelIII.E DISPOSAI. fIETD:Distributicrr box
no.
.,, -.--.._._.feer; Building FoundotionNeorcsl tot line,lront ./ rr= r ft.isidc /. t
longth of eoch linc-- _-__C|e -:-l*_e..:-)_ f-feet. |.{o of lines )Iotol le ngth of rile liner.. .feet. Dislonce between lines , '
.Iotol effective obrorption oreo in bohom of tronchas:fronch widrh Z e..,.--,inchcr.
lypc of filrer moreriol:
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.-- .--.--___,grovol; broken ttons._--,Fepth of fiker mororiol behaorh tilo ._ -. . -:.(._-tnRernorkr: C ,-ff-r.
Dotc o{ lnrpccrion -_l - - t t L...t_-: _ _ .. _ _ _.. 6,,,*.4,Lono County Hoolrh Dgportmant
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form c55-11-YICINITY MAP Permit No \b3l -8t Twnshp
Standard System E Alternative ! (Specify Type
(5r\\\r^-Job Location (Street \r5
E IN BLACK INK
Range 3 qe .\.3 Tax Lot \1qoo
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Subdivision / Partition #
DETAIL
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Parcel \ Lot-- Block \
PLOT PLAN AS CONSTRU TED
Scale \ ": ?.(}
7
'11,
I have personally luspected the system
shown hereon and certlfy that tt is
conatructed ln fuI1 eourpllance wlth the
ovlsions of OAR 340 Dlvtston 71
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License No
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From D
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's name certify that a (Mfg
and Mercury Float Switch (Mfg. and No
Signatu
l.
Gravel Depth Below Tile t
Total Length of Lines \So'
(Model No.) -...-.-
Pump
have been installed with this sewage installation
USE BLACK INK ONLY
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FOR INSTALLER'S USE Trench
Tank Ca \ooo Manufacturer.
Measured Distance from Well to Tan v
onding Co
License)
tf nstalled By Owner-
atel$\g\D
Date
(Signature ol Owner)
Applicant's Name I Address
L-^-.
\3\ \d's\o.^ Q\,r*.
FOR SANITARI N'S.USE o Approved U Disapproved n Needs Correction
CO [/ ENrs
System Ca /day Signatu
INSTALLATION RECORO & CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this
evidenceasperORS454.665 ofsatisfactorycompletionofasubsurfacesewagedisposalsystemattheabovelocation.
Public Service Building, '125 E. Bth Avenue, Eugene 97401.
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