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HomeMy WebLinkAboutPermit Septic Tank 1986-06-27Nl-R{(D - 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 Q LOTIPARCEL BLOCK PROPOSED USE OF PROPERTY Effi-esidential ! rndustrial f]r,,uri.Commercial ztP 1862 Yenta Ave., S ield 97477 L]ITY '/d 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 (1 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! €I -cl)€*- . Qc 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) L Al i C E 7L/7-ZA\ BUSINESS TETEPFONEI HOME TELEPHONE #m 2 PROPERTY ADDRESS ( IF DIFFERENT FRO ,( (s)/l' 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-.-.-_ a-(/-.\^"-t I'(r\./.- $" g{ F Cu r,a- 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 C I /t rdtj tA h o Cr*-A Ll e- ^r*'*N f, \ t- I l L _i