HomeMy WebLinkAboutPermit Septic Tank 1989-06-15aea/rcfi SEWAGE DISPOSAL SITE EVALUATION ffi-6
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Subdivision
STRUCTURES NOW ON THE
I hereby certity that the
Job
Written Directions
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8
PROPOSED USE OF PRO
Antr^ctabove statements are true and accurate, and that I have the following legal interest in the property:
-realtor
or agent. I further certifylhat (if not th6 owner) I to acl for the owner of record, and that said owner
ol record;purchaser;buyer;
and this
iST HOLES READY i;-fi sig Date
OFFICE USE ONLY Hls LINE tr*rrrrr r.rtrrl Itrrlarttat*tttttrttarttrrrirrtir
SITE MEETS STATE STANDABDS
Standard System
Sand Filter
1 Foot Capping Fi[
NO
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YES
W
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Low Pressure Distribution
Holding Tank
Other
NO
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ES
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Y
LAND USE COMPLIANCE
Zoning Acreage or Lot Size_[OTAL)
Partitioning #_Parcel
FLOODPLAI N I NFORMATI ON
F
THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
ARE AT YOUR OWN RISK. IF SITE IS APPROVED, SEE REVERSE SIDE.
tr Detailed
Study Area
(rloooway
All or part of this site may be in a flood hazard
area for which 100 year flood levels have not
been established. Extra precautions may be
appropriate to assure that the building site will
be reasonably safe from flooding.
All or part of this site may be in a flood hazard
area tor which 100 year llood levels have been
established. A building elevation above the 100
year flood level may be required.
All or part of this site may be in a flood hazard
area in which a floodway has been designated.
Building may be prohibited subject to
demonstration that the cumulative efiect of
propos€d development will not increase the
100 year flood level at any point.
t -({uff
-'',rr R0llMEN HEALTH, !?5 EAST 8TH AVENUE, EUGENE, oREGoN 9740t (687-4051)
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Study Area
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hne county
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XIEMO
TO: APPLICANT
FROM: LANE COUNTY ENYIRONMENTAL HEALTH
SUBJECT CONDTTTONS OF S]TE APPROVAL
6l!'
-Any alteration of the natural conditions in the area approved for the on-site system or replacement area may void this approval.
This approval is given on the basis that the lot or parcel described above will not be further partitioned or subdivided and that conditions
on subject or adjacent properties have not been altered in any manner which would prohibit issuance of a permit in accordance with
O.R.S. 454.605 through 454.755 and Administrative Rules of the Environmental Quality Commission. Any such subdivision,
partitioning or alteration may void this report.
WARNING: This document is a technical report for on-site sewage disposal only. lt may be converted to a permit only if , at the time of
application, the parcel has been found to be compatible with applicable LCDO-acknowledged local comprehensive land
use plans and implementing measures or the Statewide Planning Goals. The Statement of Compatibility may be made on
the attached form or its equivalent. Authorized Agent approval is required before a construction permit can be issued.
This report is valid until an on-site sewage system is installed pursuant to a construction permit obtained from Lane County, or until
earlier cancellation, pursuant to Commission rules, with written notice thereof by the Department of Environmental Quality to the
owners according to Department records or the County tax records. Subject to the foregoing, this report runs with the land and will
automatically benef it subsequent owners.
Only persons having a valid license issued by the Department of Environmental Quality under ORS 454.695 to install subsurface
sewage disposal systems or an owner or contract purchaser or his regular employees may install subsurface sewage disposal systems.
A certificate of satisfactory completion will not be issued if persons other than the above perform the installation.
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lmprovements on
El Mobrile. Home
El Shed
SEPTIC INSTALLED
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El I{o
Water
ProPertY
El House
E Barn
E Garage
1./1 - q
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Liccnse I
CONIHACI 9X
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s, if Possible'inside white boxePlease comqlete a ll lines
Dtrections to site
from Courthouse
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MAP. PARCEL NUMBER
(Found'on lat map. ln th. A3$.3mcnl & furilon DGPL)
#'-##riiriEii5i' AAl
Ewn.ttlp Bangc Scction t/{ Srclion frr Lot
lffi E;6- Scffi;- rTiTc?i6i- -Eil;i-
SITE ADDFESS
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For Moblle Home
Placement Only
No. of Tip-outs-
No. ol Bedrms
License #-
Brand
Year
Size
MAIL PERMIT TO:
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ed l-lYes
se ,,,'i, l-lYes
Land Management Dlv. stalf can
not be held responsible for
evaluatlons or recommendatlons
based on fatse, lnaccurate or
lncomplete lnlormatlon
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P1OI PUTI TPPMUED
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prior to srslru&n.
t25 East 8th
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Lane
APPLICATION #
LOCATION
NAME
ADDRESS
The Lane County Building and Sanitation Division cannot proceed with processingyour appl i cat'ion because:
l. D Incomplete application (items deficient).
HOLI' StI?
Address and/or directions to app'lication site.
Proposed number of bedrooms in dwelling.
Approvable plot plan (see attachment).Notification of date test holes will be ready.
n verification of existing system required (see attachment).
tr Two test.holes (z'x4'x5' deep) required for expansion or repairor gxlstlng sewage disposal system in the area of the proposed
drai nfi el ds .
CountgD
-r2
2
3
4 Other:
II
S IGNAT RE DATE
PHONE
received in regards to this matter by
from to
Ifn
the appl ica
EH
response has been
on will be denied
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LANE COUNTY ENVIRONMENTAL HEALTH SERVICESCourthouse-Publ'ic Service B1dg. / 125 E. gth Ave. / Eugene, 0R 97401 / 6gl_4051
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$E:rr,1 H:NV i.{$T HHIEIFl' '+ 'j]9006'7 DATE
^. APOR ?530 N" { ?'TH ST., SF'RINGF'IELD,; LOT,{
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-_NfiU BI.-DG TYFq U"YF- X frfRfiS $ UNI.fS 00{ ST0RIES ,t[tl...D'G,S 00'l FH0NE 72e
,'ttt^tHu:n NHE: JdNES, l'[::i) i\DDH ?530 N" 1?T]{ ,S'T,, ,SFIIINGFIELD,
C0uE ,lFr'L N0 ACT'I0N D[::St:[rIF'fIilN Stl F'T UNIl' [0,S'T VAI-.UAT]:0N FEE
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APPLICATION #
-
LOCATION
NAME
ADDRESS
The Lane County Build'ing and Sanitation Division cannot proceed with processingyour application because:
l. n Incomplete application (items deficient).
HOLID StI"Lane
CountgD
Address and/or directions to application site.
Proposed number of bedrooms in dwelling.
Approvable plot plan (see attachment).Notification of date test holes will be ready.
2
3
tr verification of existing system required (see attachment).
tr Two test.holes (2'x4'x5' deep) required for expansion or repairof existing sewage disposal system in the area of the proposed
dra i nfi el ds .
u 0ther4
If no response has been
the app'lication wi I I be denied
DATE
PHONE
received 'in regards to this matter by
from to
EALTH SERVICES
ve. / Eugene, 0R 97401 / OB7-4051
S IGNATURE
LANE COUNTY ENVIRONMENTA
Courthouse-Public Service B1dg. / 125 E. 8t
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to
OFFICE HOURS
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