HomeMy WebLinkAboutPermit Septic Tank 1986-06-27Nl-R{(D
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RURAL ADDRESSING
CUECKED iijlt i 5
Lane County Authotiza'tion -f<lr'
SEPTIC DISPOSAL SYSTEM INSPECTION FOR LN. RV.
FOR OFFICE USE ONLY
l33ii:'i'""' 174f,-fl
TDW};SHIP
17
RANGE
03
SECTlON
^24.3.4
TAX LOT
359
flour oF
S'JBDIVI e
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LOTIPARCEL BLOCK
PROPOSED USE OF PROPERTY
Effi-esidential ! rndustrial
f]r,,uri.Commercial
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1862 Yenta Ave., S ield 97477
L]ITY
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DESCRIPTION OP PROPOSED WORK - BE SPECIFIC
SEPTIC DLSPOSAL INSPECTION FOR LN.
DECI,ARED 5 VALUE
= OF BEDROOMS * OF STORIES # OF EI'IPLoYEES I.'ATER Proposedsti
BR0W, George
OiINERTS NAME AND ADDRESS
same 726
TELEPHONE NUMBER
t220 747 2603
CCNTRACTORIS NAME AND OSR #TELEPHONE NUMBER
PJRI'IIT TO BE MAILED TO (NAME AND ADDRESS)TELEPHONE NIJMBER
I HAVE CAREFULLY EXAMINED THE Coi4PLETED aeer,rcatrory,.6h PERt4rT, ar,d ,lo hereby cettify that aL1 inforration hereon ls true and correct, anat that f
have the following Legal interest in the propertrrffin., of record; f,conr:ract. prrrchaser;[authorized agent.
I f:rther certify that any and all work perfomed shall be done in accoldance with the Ordltrances of Lane Cowty and the Iaws of the State of Oregonpertaining to the work described herein, and that NO OCCUPdNCy will be made of arii strrrcture wi.Ehou! the pemission of the Building Division. f fur-ther certify that registration lith the Builderrs Board is in fuII force and effect as required by ORS 70I.055. that if exempt the basis for exernptionis noted hereon, and that only subcontractors ad employees who are in conpliance with ORS 7Ol-.055 wilL be used on this project. I IU{VE READ AND
CHECKED THIS APPLICATION THOROI'GHLY.
6 - -z-rJ 6.
mXo (pl-are print)DATE
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Ge o'a" &ort
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION 1IAS BEEN BASED ON THE FOLLOWING CONDITIONS:
Date:
COMI'IENTS:
Date:
COMI.IENTS
UseIYpeGroup
ON PE
D PLANS EXAMINATION:
IIRFNAL PLANNING ACTION RELY. NO S CI
I sutrtatrou: s. r. #B. P. *
o".", 6-24-86 I-l
Parcel sir._Partition f Parcel #
interior rear
Lineal Eeet
of l)r:ainfield
Installation Gallon
Soecifications: Tank
rnstalLation Record rssued? f] v"= fl n"
Maxinum Elepth' of Trenches
I pr,allwrucrzzoNrNG: zone-
Minimun Setbacks, "", fro.t-
cor,1llENrs: FoR LN. REV. PURPoSES
cL,
=id".
zlr).A-KS /o47-FC
avoesrcweE Geinns 4s6.805 (t) ) DAIE
LANE COUNTT DfPARTMENTOF PUBLTC WORKS LAND MANAGEMENT DrVlSrON,6874061,L/ 125 EAST 8TH AVENUE, EUGENE, oREGoN 97401
SEE REVERSE FOR INSPECTION INE'ORMATION Clt+-'25 Rllil
ill'
-
ACTI ;TY INFORMATION ,HEET
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
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PROPERTY OI,INER
MAI I
€bz.a-.
3 rvlap 6i PAFIeEL NUMEEFT
RE UIRED r N F0RI4AT r 0N )
from tax maps in Department of Assessment and Taxationor from tax statement)
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7L/7-ZA\
BUSINESS TETEPFONEI HOME TELEPHONE #m
2 PROPERTY ADDRESS
( IF DIFFERENT FRO
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TOI^JNSH IP
03, Zrl 3MNE smTION
4__ TeL
TAx L0T(S) 0R PARCEI-T TONIXG
MilNSHIP FAN-GE SEE-rIoru W ZON I NG
MNSHTF RANGE SEETI_ON W ZON i NG
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:ACRES
4 SUBDIVISION ( if appl icable)LOT BLoCK_
5 REQUEST (state exactly what you plan to do) Ta-.,-r -+z-Lu:.. *--* fro-.-.-_
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6 DiRECTIONS TO SITE:
** FOR STAFF USE ONLY **
ZONE/LAND USE:
L4-33
LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 9740I / 687-406I
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