HomeMy WebLinkAboutPermit Septic Tank 1986-05-27,,,fl*iii'f,?3-l;;,,dil*h
SEPTIC DISPOSAL SYSTEM INSPECTION FOR ,,oa, *uura,
-iE:*i:.i,""/6ZS_fr
OFFICE USE ONLY
f app
PAF,CEL BLOCK X nesidential fl lndustrral
PROPOSED USE OF PROPERTY
Commercial Public
CTTY ZIP
ION
,Qz-IF 4WORK - BE
SEPTIC INSPECTION
OF # or enployEcs-
' -
'r-, €-
weren suffi
Proposed
ExistiADDRESS
/-NUMBER
NAME #
c(7 NT]MBER
DATE
.fy that Ell infomation he
;::tk:'iii:t3iti;Oregon
compliance
CHECKED APPI..ICETION THOROUGHI,Y
I IIAVE CAREFULLY EXA}IINED lHE CO,IPLETED APPLICATION f.OR pERl.fIT, arrd do hereby certi reon ls true and correct, and that fthe following Iegal interest in the property: !orn". of record;f] cc,r,tra,.t. p,rrchI f:rther certify that any ild all work perfomed shalL be done in accordanq,: with tLe and the Laws of the st.ate ofIrertaining to the work described herein,st:.rrrcture without the pemissi on of the Building Divisionther certify that registration with the f fur-
and thal NO OCCUPANCy will be nade of aljBuilder's Board is in fuI1 force an.1 effecl as required by ORS 701.055,that if exempt the basis for exemption this project. I HAVE REA"D AND
is noted hereon, and that only s ubcontractors ud employees who are in with ORS 7Ol.O55 be used
-t
Parcel
re ar
Date:
Instaltation Record Issued? f v." f] N"
Installation l'laximun Depth
Specifications: _ Tank of Trenches
Date
COMT1ENTS:
Date:
cL C L
calIon
UseGrouD! pr,eus EXAI\,IINATION
SANITATION: S. I. *B. P, it
I pmxurnc,zzoNrNG
Minimum Setbacks:
cot'01ENTs FOR
s ide interaor
Partition #Parcel #
Lineal Eeet
of tlrainfield
READ THIS SECTION CAREI'ULLY. YOUR ORIZATION IIAS BEEN BASED ON THE FOLLOWING CONDIT]ONS:
^eING(per oRS 456.805
OF PUBL]C WORKS LAND MANAGEMENT DIVISION, 687.4061'LANE COUNTY D
125 EAST 8TH AVENUE, EUGENE, OBEGON 97401
SEE REVERSE FOR INSPECTION INE'ORMATION cr4..2s R4
RANGE_23
T
s-.'7-/L
DATE
SETBACKS AND OTITER CONDITIOSS OF APPROI'/AL 19:1..IE STRICTL)'OBSERVED'_'VIOI'ATION CAN RESULT IN REVO-
cArroN oF 1{rs pER}1rr, .iiiiior'u,,JDiR-pnovrsrons oi'ii":i-tui'iii's rNrnectioN-onorsesce' AND'/oR orHER
RETIEDIES ALLOWED BY LAW'
ffi;"Tg,.*I#H:l,i-ii},!li"?:.,;1":'}:Li:.:::::,l"Hffi:')"l::".:::":::,?;;"
of inspectron, when It ,iri.u" ready, you! ^.." ";d.;;;;.J-^'.o".,.u^a.uny'ip".iii
aiiectio.s to site.
BUILDING DIVISION:
REourR:D r\sPEcrroNs: .^--- 6...to.r and when alr
I. Founddtion Inspection: To be made after trenches are excavated and forms erected and when
mtiTu:.s 'ot tt":'otnuuilon u'u delrvered Jn-ttt",]ou' tJhcre concr^re fron a central mixrnq
plant (comon.v..iX!I-;i'I'.ii-.i""a"1 'J i] i""";"u, nateriaLs need not be on the job.
2. **--""H*!*.',,45#os*ff*#;."1:.:: :::"iii'-"liiliil:'::'?"':lt'l;:l:":':'ilu"o
PIace but u",o," l.}-.Ii",l.L i. pou."a oi^iiil'."r."i.n:.ng installId,,intIuding the subfloor.
3. rranins :-=++# H-iPffi;=,'?,?EoTi3!.1'l.il^l!i"i"?l;^ill.l'3Tl'z;'lil"'""li:-ll?''33i"braclng are rn Pl
elecLrrcar "no plumbrng are apProved' o'i'IIii;;;;i;Li;" and vaPor barrier are in prace'
4. Ld:h ard/e:-cy?:u!,H#"T#ff#; ":; :i.:?::,i;':: :llr13:':13 i::':l';il'li"i3;'i^!3li?l
and exterror, rs
and fasteners are taped and finished'
5. Fj.naI Inspection: To be made after the building !s conplete and before occuPancy'
AppRovAL REeurRED. No work sharl be done.on any part of the building or structure beyond the point
indicared in each .r..."Iir" inspection ,rai,ott'rfi'"i lltuit'"q tn" ippioit-r-oi-lh" r"iraing-official'
iilli-lpo..,'j,-l:rll ::'li;::"?liv"i;!:i"t:,tu:":i$:"i*ii X:'i:::'t'u'or each successive s'LeP
i:,::' ::l';:HiI ':i::"'.;;:';: '""o"..'""' ror rhe.work:":':::1::'-::':.::"":: :::,::l'T" '"'
A- Block l{aII: To be maCe after reinforcinq i's in place' but'before anv qrout is poured' This
u--sp*irm i" r.Iii.!i-rir'lacn-uo^a l..i ii".'.'it"i! "irr lt no "ppt6"t1 until the plunbino
and eLect!ica'' tllptlittti iu"t it"" made ind approved'
B- !"lood sEove: To be made after conPletion of masonrJ- (if applicable) and uhen inst'aIIation is
cmpleL4 rn"t.ii"tion inutr r" i. .."o,5i..3-;t;,h ;; uppio,"a, natronally recognized testing
asency and .nu ^iiiiu"l"iei's
installation instructions' l
c. NobiIe Home: .An inspection is required after the mobile home is connected to an approvec
seuer or ..o.,' 'ili!I'iii"""iut"i-i"q"ili;ttttl-ui;;ki"e'
rootins connection' tiedowns'
skirting, and prmbinq connectlons'
nts for mobire homes or as
1. Footings and piers to comply with State foundation requlremel
recoNended bY the nanufacturer'
2.i,lobr}ehoneminimumfinishfloorelevalionshallbece!tifiedwhenrequiredbyaf].ood.
Plain management Ietter'
3. MobiIe hone tiedowns' uhen required' and skirtj'ng shall be-installed and ready for insPec-
tion within ac least 3O days.rt.. o.lri.i;;.--ii.;;;t" and ski!tins shall be instaLled
Per enclosure.
D.swimj.nqPool:Belowgradewhensteelisinp)-aceandbeforeconcreteispoured.Abovegrade
wI6-Fo6t -is installed '
APPRoVEDPI,ANSMUSTBEoNTHEJoBSITEATALLTIMESDURINGWoRKINGHOURS.THISPERMITWILLEXPIRE
rF l.{oRK DOES NOT eSCrN WirHrt 180 DAYS, On rr woni rs suspENDED oR ABANDONED EOR }IORE THAN I80 DAyS'
SUSPENSION OR REVOCATION i'lAY OCCUR IF THIS PERMii.WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
ANYoNEPRoCEEDINGPASTTHEPoItJToTREQUIREDINSPECTIoNSWILLDoSoATTHEIRowNRISK.
SUBSURFACE AND ALTERNATIVE SEHAGE DISPOSAL SYSTEMS:
I. Permits shall be effective for one year from the date of issuance'
2.UponcomPletingLheconstructionforwhichapermithasbeenissued,thepermitho]'derShall
notify the t_"n" -"""iy Departrent of pLanning- and comunity Deveropment by submitting lhe
rnsrarl.aLron record fLrm.- The Department sh;I1 inspect the construction to determine if it
complies wi.th rhe rules contained in this division. If the construction does comPly wj.th such
ruJ.!s, the Department shall issue a certificate of satisfactory conpletion to the permiti holder.
If the constructlon does not comp.Ly wi.th such rules, the Departnent shall notify the permit
hoLder and shall requtre satrsfaciory completion before issuing the certificate. Failure to
meet Lhe requiremenis for satisfactory compl-etion wf,tshin a reasonable time constitutes a vio-
lati.on of ORS 454.605 to 454.745 and this ru1e.
Setbacks - Subsurfacc Serage Disposal
Septic Tank
From: Iilerior propert./ Iincs I0'
ECqe of road rlgirt-of-way 10'
tsuildrng foundation
liclLs. other water sources 50'
Drainfield
10,r0'
10,
100 |
ACTIVITY INFORMATION SHEET
COMPLETE THIS SECTION. fNCOMPITTE FORMS t,lILL BE NE;ECTCOi 6I:
{
EST R
\3\ O a D xt
I I
DEq8s- ? o t\J-] nqF
HOME TELEPHONE #B t BUSINESS TELEPHONE #HOME TELEpHoNT 7$\?4 l*2 PROPERTY ADDRESS b
( IF DIFFERENT F
3 ruae a PAFIeEL NIJMBEFI (from tax maps in Department of Assessment and Taxation
or from tax statement)( REQUTREp i NFoRMATToN)-rl +/(od7_o3_Z
TOI^JNSHIP RAN6E SECTION W MNIXG
ffiINSF.IP ffiNCE mnON ffi ZONING
m[mFIP RnilGE SmmON
.,
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
ffi ZON I NG
ACRES
O ,rrrurrrrON (if applicable)LOT BLOCK
5 REQUEST (state exactly what you plan to do),
6 DIRECTIONS TO SITE:
** FOR STAFF USE ONLY **
ZONE/LAND USE:
14-33
LAND MANAGEMENT DIVISION / 125 E. Bth AVE., EUGENE, 0R 97401 / 687-4061
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