HomeMy WebLinkAboutPermit Septic Tank 1975-07-14IANE COUNTY
'ILDINGBUILDING i_ MH I
PERMIT OR MOBILE HOA 'JSE PERMIT
PERMIT NO.
I7{
PRC I']ER'rY OWNER MAILING ADDRESS PHONE
& Marsaret tCal ker 7477 746-6428
CONTRACTOR MAILING ADDRESS PHONE
PROPERTY TOCATION _ INCTUDE POST OFFICE
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
17
RANG E SECTIqN TAX LOT NO,,3,* P G_fO CODE CENSUS TRACT
20-1 00'
same
EXISTING STRUCTURES ON PROPERTY
none
APPT.
NAME
&
MAITING
ADDRESS
LEGAT ACCESS TO PROPERTY
I7th. Place
PROPERTY SIZE - FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connect lo Existing Sewoge System ! New System !
SEWAGE DISPOSAT
PUBI.IC N SEPTIC TANK N OTHERE
PI-UMBING INSTALTED BY
OWNER E OTHER: NAME
FEES WATER SUPPTY
PUBLIC tr N OTHER
BUITDING
WASTE DISPOSAL
PTUMBING
PTAN REVIEW
PARK TRAII.ER
TOTAL
COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAI..
DRAIN FIELD REQUIRED
uN. FT TRENcH wioitr ii. oR se. FT.
Keep SDS I00 feet fi.on all wells
TYPE OF STRUCTURE OCCUPANCY ZONE PUBTIC UTIt. EASEMENT
BLDG. SETBACKS FT. FROM CTR. OF ROAD RIGHT OF WAY
FRONT SIDE INT,SIDE EXT.
USE CI,ASSIFICATION
REAR
/sl J.
AUTHORIZED SIGNATURE _ DATE(".f DATE
BTDG, PERMIT - WHITE
OFFICE COPY _ WHITE
COUNTY TAX _ PINK
PTUMBING _ CANARY
BUITDING _ GREEN
SANITATION _ GOLDENROD 3 I
Coll 687-4065 to schedule oll required inspections. All construc-
tion sholl comply with Uniform Building Code, D.E.Q. stondords
TMPORTANT: for subsurfoce sewoge disposol ond counly regulolions covering
plumbing. All buildings require o cerlificole of occuponcy before
being occupied.
(See Detoils on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. Ar SITE)
TANE COUNIY, DEPT. OF ENYIRONMENTAT MANAGEMENT
COURTHOUSE ANNEX, I35 EAST 6th, EUGENE, OREGON 9740Ironu l* 655- 13
$
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LANIi COTJNTY I]NVl.RONMEN'TA'
Namc artd Address of G^rner
\NAGIiI'1IiN'I'I'1,()'l'1,!,nN
'['e1e:phone:
Ttre building being.consEructed uttder thls permit wll-l be used for
Date thls properEy was Prtrchased
Do you now, or did you ever ov/n property adjacent to this tax lot? If so, please
list those tax lot numbers or draw those propel't,i-es on the plot plan below._
Indicate on your drawing the locatj-on of all homes (inclu-ding mohlle homes) now on
the property, as well as the location of the new building.
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Name of Applicant (lf dlfferent from owner):
Address
Teleph one
Ilap
Tax Lot
Applicantrs Interest: Buyer
M74-99
Seller Agent Permit /l
(
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b S ITE LUAT I ON
ICATION NO". BU ILD ING PERI,I IT APPL
()SITE INSPECTION
PLANNING DIVISION
l. Zoning Ordinance Cornpliance: Zon,
2. Subdivision 0rdinance Compl iance
3. Requi red Access4. Building Site (Area, t.,idth, Fron
5. 0ther (see cornments )
tl14-r 17 -03 sL ' I sUdlffi,z-#,l1ax Lor-\S/
t''lt t-]s L0T: BLOCK:
APPL I CANT
DATE
Not
Aool i cabl e4ry
()
taee) ( )()
Ye CKID BYNofr6. Setbacks c o
()
()
()
()
Front
Side ExterioTQbI
b
()Setbacks from interior lines:
Side 5
Rear q
N0(TTFPITEATMN#
BUILDING INSPECTION DIVISION
7. Plans Submitted
8. Soil Stability (footings)
9. Flood Plain
O. 0ther (see conrnents)
Not
I icable No Yes
1-I()
()
()
T'T()
()
()
COMMENTS:
L'ATER POLUT ION CONTROL
COI{}.IENTS:
Not
Aool icable Nor)ll. l{eets Department of Environmental
Qual i ty Standards.
12. Other (see cornments)I()()CK'D B
DATE
TO APPLICANT:
k Jour Building / Site lnsPecti
-}rJ' can be aPproved.-( ) Cannot be aPProved at thi
Questlons and further inf
on:
s time as indicated on item N0
ormation on items I through 5 con
Questions and further informati
above.,?rp tact t e LANE-
on on iteillT
N COUNTY D NG AND ATION DI ON
ce until you can reso vet e probWill be held in this
ls being returned.
c55-28
()
()
Your buildin
LANE COUNTY PLANNING DIVISION PHONE:587-4t 85
ems
S
i cated.
rmit a I i cati
135 Sixth Avenue
PHONE:597-4065
COHilENTS:
CKID BY:, 1,( ... .' ' "'
^
DATE
f
P
INSTALLER: Complete top part r-
.OSEO SEI.'AGE DISPOSAL SYSTEI REC
form to signature and submit bou,, copies with app
PERI{ IT NO
lication",
G
All,4, ts z ,4DY llrx Purce
No:
es No
pt c
Ft. f rorn wel I Steel
fJater
Publ i c
ns e mens ons:
Len th u, i dth
0t.,
NAME Rnupx L. Walxen Jn
t her-ist
Foundat i on
Side
a
er Be ov,
ile tn.
Concrete No. Compartments Gal . Capaci ty
e s Posa
D i ameter De t Distribution Box: Yes No
t str t Oll-Pe
t
r
}tAILING
ADDRESS
4 vr ewuourura
Feet f rorn
ll
t ne
FrontSpntrueFtELD0n.r
Lengt o nes-
For Sanitarian Use Only:
ln accordance with 1973
as evidence of satisfact
I ocat i on.
E[ Rpproved: Syst
f_l Disapproved:
Remarks:
lsF
em lnstallation conforms to current standards
Does not conform to current standards
5
Oregon Laws Chapter 835, Section 214 ttris certificate is
ory cornpletion of a subsurface sewage disposal system at
te:
iss
the
7i{,7rued
above
Trench
LJidth2
Total Sq.
Ft. 4/ e
Ft. Between
L i nes ,/*
Filler.
woe/i-
ru t s
E r ,r
RECEIVEM
JUL2 6 19i6 f
tANE, COUNTY
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HauSE AL MGMT.
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an an
LANE COUNTY
STATE OF OREGON OEPARTHENT OF ENVIRONHENTAL QUALITY
c55-r1 re
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c,y PERMTT /r /7 /lns
NOTE: NO PERMIT WIL. J ISSUED I]NTIL THIS APPLICATIO. \S BEEN APPROVED
ION
OWNER
Name
CONTEACTOR
Name
o.s. REc. /l
Tvp o
Subdlvls ion
Exlsting Structures on Property
MOBILE TIOME
APPLICATION FOR:
PLAN REVIEW
p
Address City r-p
Tax Lot_Code_Census Trac
?roperty
+
Ote L-69e{
Sectlon
AccEss ro PRoPERTY ,*"u *"r., 2v37 /qc<-/y(Ee Width , DeDth'q-R;/r-- {:
Property Locatlon - Address/Directlons:
ice Use
Sq. Ft
Arndt "rr0
SEIIAGE DISPOSAL:
Slte Inspect lon /l
WATER SI,]PPLY:
I.Ie11
ho Y
Spring Other
Sewage sa1 System
Pub1lc
Comunlty
or tem Required
Name of. Coxmuni.ty or Public Systen
Exis E
FEES:
B1dg.
llaste Dlsp.
Plumblng
Plan Revlew
Moblle Home
1Z Surcharge
TOTAL
PLTI,IBING:
Installed by Otrner 0ther Narne
5O.:- PLITMBING FEES
CASH
Sewage
Connection
I'URNISHED
YES
Slgnature of Appl
Fee Recelved By:.
Water
Connection
FACILIfi PERMIT
es
o"re', 6-? A'4
Min. Septlc Tank Capaclty--€@lO-LO Dralnfleld Requlred - Llneal Fee t---2OA-*xtmum oep th---51-.$
-
c55- 12 LANE COI'NTY D OF E}WIRONMENTAL MANAGE},IENT
a._
DATE:
Type of ConsEruction L Flre Zone L Use Classification
Bldg Setbacks 1 from Center of Road
Fronr h' slde rnt. 5'
Right of Way:
Side Exterior tu Rear
DATE:DATE:BUII,DING:->ru
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NO
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