HomeMy WebLinkAboutPermit Building 1975-05-29Sttr .r'11o., *YC-370
SYALUATICI
FOB. DEIEE}{INIIre SITE SUITABILITY
FC, DEYELOPT.IEXT UTILIZIIIG
SUBSURFACE SETACB DISPOSAL I'IEf,HODS
LGATIONT Twp o3 Sec.Tex Lot
f
Aro prbtlc tewera rvallabl'e or nearby? (Dtstance)
Are Chere zontng or envtronren taf constderrtlons?
Slzc of propert,y AmunE useeble erea
Are ochcr tysters ln erea knorn to be oalfunctlonlng?
Ia there rooo for future exPsnE lon?
Surface PeeEure conslderattons r (ExPlaln)
Slopes (1rl100')(z)
?
Flood platnt
Plants r
Bocks
Lor ereat
Dralnegerayt
Streaot t
Cut benk or elopet _
I{ater Supply end Uttl1t,les r
Comlnlcy lleter r
Indlvldual frters
lfater Llnes r
Gas Llner r
Ilella on edJaccnt
properttea t
Erlst.
nrlst. !
Erlsr. f]
B:rlst. fJ
No
p,..Lt o.+)
proposed [-l
Proposed I
Proposed f]
rroposed f]
(Sketch ln Plot Plan)
I
#T TEST HOLE #2 TEST HOLE
Heec nolntm,o standards for lndlvldual
rraste dlsposal.
found to be tc
Ind.rstrlal
Instltuttonel
SITE DOES
!tu1t1- f enl ly
CorPrclat
SITE InES
IT SITE q'83 .}OT HEIT STAIDARDS SPECITY BAS S OF DENIAL:
- Admlntscratlve Rules Re re-Your p
,^Oal I
IF SITE MEETS STANDAR"DS FILL OUTT
Type of structure end approxtute serrage f lowr Slngle Fantl.
/tl
GPD,
GPD,
GPD
GPD
GPD
NOTE: Soll absorbtlon area ln souare feeE
Area necessary for sewag" ar"pi,ri[ysteEa
ARE ALTERNATM SITE LOCATIONT DESIGN OR T,IODIFICATIOII AVAILABLE, DESCBIBET
PROFILE
Inch
Satureted Zone
1ve Layer I tn.- +r Layer _-l_1"..flD ln.
3T€/Lq/zr-
ln.
tn
ln.
ln.
Perchcd lJeter
Predlcted
Prcdlcted
0bscrved
Ibte
Restrlctl
Inpewlou
llott 1lng
Obacnred
Ilrte
L2
bi (-
36
)Src-
I
22tr
6
48
{a
PROFIJ,E
Inch
Percbrd ltter
C) t1 y-g/
prtrrretcd Zoac
lestrlctlve Layer ln.
rmpervlous Layer
-ir,.uott l1ng -
-1n.
tn.
ln.
n.
n.
Predlcted
(Deerved
ILte
Predlcted
Obsrrved
Dete
12-
24-
36-
48-
60-
I
L
04 *-
NA}TE DATE OF TIELD EI/ALUATION
I
O,,U
7
BUILOING SI EVALUAT I ON t 11 -r,-- -E--s **-'tt
SUBD I V I)*]ON:
J5
1,5-3h
LOT
( ) ilutLolNG PERHIT APPLIcATIoN N0.
(4 strE tNSPEcrloN
PLANNING DIVISION
Rextrg -
--:F
J r,,r Uft t ,
LOT:BLOCK:
APPL I CANT
DATE
()
()
()
I
2
3
4
5
Zoning 0rdinance Comp I iance: Zone
Not
I icable No CKIO BY:
6 Setbacks
Front
Side Ex
Setbacks from
Side
Rear
Yesq6(4
()
()
1-l()
()
()
()
Subdivision 0rdinance Compl iance
Reoui red Accessguitaing Site (Area, Width, Frontage)
0ther (see comments)
ter i or
i nter or nes:
s"r
COT,IHENTS:
PLANNING DlVlSlON ACTION PENDING: Y r-ruorl APPLIcAT!
BUILDING INSPECTION DIVISION
. Plans Submitted
. Soil Stability (footings)
. Flood Plain
. 0ther (see conrnents)
Not
Aool icable----17 YesrT()
()
()
Nor)()
()
()
7
8
9
0
()
()
()CKID BY:
DATE
COMMENTS:
},ATER POLUT ION CONTROL Not
ApplL cq!!e ,cL-Frrptq-
()
No
?\rTYes
I l. t{eets Department of Envi ronmental
Qual ity Standards.
12. 0ther (see cornments)() ()()CK'D BY:1
DATE
CO}II.IENTS:
TO APPLICANT:
Your Building / Site lnspection:
,r5o
( ) Can be approved"
I'rI Cannot be approved at th-Questions and further in
is time as indicated on item N0 " f/ "Aor.formation on items I through 6 cdtri?ilTE@
. Questions and further information on items 7tcPLANNING DIVISI
t 2 contact the LAN E COUNTY BUILDING AND SANITATION DIVISION.
( ) }/ill be held in this of@ resolve the problems indicated.
( ) ls being returned.( ) Y.,' bE
'9lssp?"#H+h#P#rifitifutfrrti,iht
135 Sixth Avenue East Eugene 0regon 97401
pHoNE. 597_4oG5
LANE COUNTY PLANNING DlVlSlON PH0NE: 687-4186
c55-28
tr I
\
Surhame Twp. Ranse S-e?ilon ru;-T3T 6ae eensus Tra-
Recei pt No Dat e Owner Owners
Yes
n sent
No
!!qUEIT FQ! s rrE FEAS rB rL rTY SrUpY
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
ARE AT YOUR OWN RISK:
Name
and
Address
No'--Sitas
$
$
$
No. Acres
TOTAL
Te e e o
P rope rty ze
Exi st i ng Structures
roPose Water Supply
Proposed Use o Property
Urban z ng Area
Yes No
ls Propertl, W t n One e of a City
What Cit ?Yes No
ther
Publ ic District Sori nq Wel I Spec i fy
pplicants lnterest in Property
Permi t Area
No
Special
Yes
Legal Access - Road Name
Property Location:(D i rect i ons )
APPROVED NOT APPROVED
BEFORE CONSTRUCTION lS STARTED bring this form to the Department of Environmental
Management and make application for a building perrnit. lf the property is a por-
tion only of a tax lot, a metes anC hounCs description of the parcel must be fur-
nished. Exact specifications for the sewage ,lisposal system will apPear on the
building permit. Two sets of building plans anC a plot plan will be required.
LANE COUNTY DEPT. OF ENVIRONHENTAL MANAGEMENT
I35 EAST SIXTH AVENUE, EUGENE, OREGON 9740I Authorized Signature
c55-32 Date