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Home My WebLink AboutPermit Building 1977-03-08TRS, TL \H,- eB-a (x ) Building Permit Acreage or Lot Size eo' x 10o I Partitioning #- ( )Completed( ) Pending Job Location 2555 Nortn Utn Street SPrin INFORMATION SHEET ( ) Site Feasibility Study for Septic( ) Would like to meet on site. Call Tank. Number of 3x&-\7 sites - (owner, etc.) APPLICANT'S NAME AND ADDRESS Keohart Inrtlde Test holes will be ready Subdivision Vera DeIle First I t l-on Lot 3 Bloc b l5go sou th rrArt Street Snrlnof e 1 d Or e oon s7l47l- Phone tb6-bbzg{ oWNER,SNAMEANDADDREsS,ifdifferentfromapplicant,sPhone CONTRACTOR'S NAME AND ADDRESS Keph5lt Bullder6 l6qo South "A'i Street SDrtBsrleld. Oresotr q7tr77 Phone Mailpermit or resultsof site feasibility study to (r )Applicant ( ) Owner ( ) Contractor( ) Prefer to pick up. Call ( owner, etc. ) when ready. STRUCTURES NOW ON THE PROPE NONE Zb6-bttzg PROPOSED USE (this permit)to bulld a home WATER SUPPLY Puh] {c--RnLntrow l,rlater Dtstrt t SEWAGE DISPOSA I Pranosed sentlc tenk PLUMBING B Jaek .Tackson Plumbino (x ) PROPERTY lS WITHIN ONE MILE OF CITY (S prinsf 1e1d (existing or proposed well, etc. lf public, name of system) (existing or proposed septic tank, etc.) S.l L Address 1155 Ocean Street Ett aene O16d6n r*ri*** oFFtcE usE oNLY BELOW THIS LINE ***********r* ( ) New Address Necessary zoN E ( ) Facility Permit Necessary ( ) Special Permit Area. lVlinimum E ton lnterior Side Yard --- Rear (FROIVI PROPERTY LI NES) SETBACKS: Front rQqe_ Side Facing Street (FROM CENTERLINE OF ROAD) To: Planning/Building lnspedor/Sanitarian/Surveyor. This applicant appears to have a problem with Your assistance will be appreciated. By Permit Processing Section Response: c55-12 D ivisionBy D EPA RTIVI ENT O F E NV I RON ME NTA L IVIANAG EIVI ENT Permit Processing Section 125 East 8th Avenue 687-4394 PERIVIIT # TRS, T ,7. Z #3/.( JOB LOCATIO Partition ing LANE COUNTY PERMIT 7C ( ) Completed SubdivisionAcreage or Lot Si Lot-- Bloc Contractor's O.S. # APPLICANT'S NAIVIE AND ADDRES q OWNER'S NAIVIE AND ADDRES CONTRACTOR'S NAME AND ADDRESS lVlail permitto ( )Applicant ( )Owner ( ) Contractor. ( ) Prefer to pick up. Call (owner, etc.) when P Phon Phone- ready. neho STRUCTURES NOW ON THE PROPERTY THIS PERIVIIT IS FO # B ED ROOIVIS-# PLUIVIB I NG CO NN ECT IONS WATER SUPPLY SEWAGE DISPOSAL_= --- S'I' # TH IS PROPERTY IS WITH IN ONE IVII LE OF THE CITY OF ' PLUIVIB ING BY I herebY certify that the above statements are true and accurate,and that I have the following legal interest in the property -owner of record; to act for the owner of permit. -contract purchaser; - potential buyer;realtor or age nt. I further certify that (if not the owner) I am authorized reco rd ,and that said owner is aware and approves of this action. I here by agree to comply with allapplicable Codes relating to this Fee Paid Date ) NEW ADDRESS () FACILITY PERIVIIT TO TRANSPORTATION DEPT._-- () SPECIAL PIVIT. AREA. IVIIN. ELEVATION Signature SANITATION lVlinimum Septic Tank Capacity (Gallons) Drainfield Required - Lineal Feet lVlaximum Depth BUILDING Type of Construction cr",-"^t* Use classification roup ire Zone mments DateDate:BB PLANN ING REOUI RETVIENTS SATISFI ED. Bv Date Date lssued LANE COUNTY DEPARTIVIENT OF ENVIRONN4ENTAL NNANAGEIVIENT, 125 EAST 8TH AVE., EUGENE, OREGON 974O1 POST THIS PERMIT ON MAIN BUILDING AT SITE BLDG.pERMtT-WHtTE; BUtLDtNG-GREEN; PLUMBING-CANARY; SANITATION-GOLDENROD; OFFICECOPY-WHITEc55-13 PHONE: 687-4394 ZONE:SETBACKS: FRONT SIDE FACING STREET (F RON/l INT. SIDE YARD REAR (FROM P/L) PERIMIT # TRS, T JOB LOCATIO LANE COUNTY PERMIT Acreage or Lot Size- Partitioning ) Completed Subdivision Contractor's O.S. #Lot- Bloc APPLICANT'S NAIVIE AND ADDRE ss OWNER'S NAME AND ADDRESS CONTRACTOR'S NAIVIE AND ADDRESS Phon p Phone- Phone lVlail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when ready STBUCTURES NOW ON THE PROPERTY THlsPERl\4lTlsFoR#BEDRool\4s-#PLUMBlNGcoNNEcTloNL WATER SUPPLY SEWAGE DISPOSAL s.t. # THlSPRoPERTYlSWlTHlNoNElVllLEoFTHEclTYoF.PLUlVlBlNGBY I hereby certiJy that the above statements ar€ true and accurate, and that I have the following legal interest in the property: -owner of record; -contract purchaser; - potential buyer; - realtor or aqent. I further certily that (if not the owner) I am authorized to act for the owner of record. and.that eid owner is aware and approves of this action. I hereby agree to corrlply with all applicable Codes relating to this permit, Fee Paid S-Date ( }NEWADDBESS I FACILITY PERI\4IT TO TRANSPORTATION DEPT.- ( } SPECIA L PIV]T. AR EA. MIN.ELEVATION:- SANITATION BU ILD ING Type of Construction roup -Fire Zone Use Classification Comments Comments By Date By Date lVlinimum Septic Tank Capacity (Gallons) Drainfield Required - Lineal Feet Maximum Depth PLANNING REOUI RETVIENTS SATISFIED. B ZONE SETBACKS: FRONT Date SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD , REAR (FROM P/L) LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT. 125 EAST 8TH AVE., EUGENE, OREGON 97401 PHONE: 687-4394 POST THIS PERMIT ON MAIN BUILDING AT SITE BLDG.PERMTT-WHtTE; BUtLDtNG-GREEN; PLUMBtNG-CANARy; SAN|TAT|oN-GoLDENRoD; oFFtCEcopv-wHtTEc55-1 3 Signature v:Date lssued: SITE INSPECTION Ap pnov E o REuanx s Dtsappnovro D Dare I ,/- t4 -?? t*,e,cro^a* FOUNDATION I NSP t0N APPRov E D Reuanxs Dr SAPPRovED Dare -l 1 I Nspecron FRAMING INSPECTI DrsrppRovEo D Dar e l"i-lNSPEcroR t 11 ,*,n-. -- 4 APPRovED ReuaRx s LATH OR SHE AP PRov E o Rrltrnxs I NSPECT I ON Drsappnovr o F7 Dare,-2/-I NSPEcToR FINAL INSPECTION / AppRoveo / l/ / Drsappnoveo Rrurnx s A DarE 1 ' /7'7 7*r"rrro^ CERTIFICATE OF OCCUPANCY Reaov ro lssue RrurRx s D Nor READY ro lssue D Drre I ruspecron d D TRS, T JOB LOCATIO LANE COUNTY PERMIT Acreage or Lot Size Contractor's O.S. # Partitioning # APPLICANT'S NAME AND ADDR CONTFACTOR'S NAME AND ADDRESS Mail permitto ( )Applicant ( )Owner ( ) Contractor. ( ) Prefer to pick up. Call PERTVIIT # ) Completed Subdivision Lot Bloc k OWNER'S NAME AND ADDRESS- Phone Phone Phone (owner, etc.) when ready. RUCTURES NOW ON THE PROPERTYSTI fH IS PERTVIIT IS FOR # B ED ROOIVIS-# PLUIVIB I NG CO N N ECT IONS WATER SUppLy- SEWAGE DISPOSAL- s.l. + THlSPRoPERTYlSWlTHlNoNEtVllLEoFTHEClTYoF.PLUlVlBlNGBY I hereby certify that the above statements are true and accurate. and that I have the following legal interest in the property: -owner of record; li_contraa purchaser; - potential buyer; - realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of record, and thai said owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit. Fee Paid $-Signature ( )NEWADDRESS ( ) FAC|LtTy pERtVltT TO T RANSPORTATION DEPT.- { ) SPECIAL PMT. AREA. MIN.ELEVATION: SANITATION BUILDING Type of Construction -Group -FireZone Use Classification Comments mments lVlinimum Septic Tank Capacity (Gallons) Drainfield Required - Lineal Feet lVlaximum Depth By:Date B Date Date lssuedPLANNING REOUIREMENTS SATISFIED. By Date ZONE:SETBACKS: FRONT SIDE FACING STREET (FRON4 C/L) INT. SIDE YARD REAR (FROIVI P/L) LANE COUNTY DEPARTMENT OF ENVIRONIV1ENTAL TVIANAGEIVIENT, 125 EAST BTH AVE., EUGENE, OREGON 97401 POST THIS PERMIT ON MAIN BUILDING AT SITE C55-13 BLDG.PERMIT-WHITE; BUILDING-GREEN; PLUMBING-CANARY; SANITATIoN-GoLDENROD; OFFICECOPY-WHITE PHONE: 687-4394 Date =- ( SLAB FLOOR PLUMBING GROUNDdORK APPRovEo Rruanx s / / DrsappRovEo F7 Dare I Hspecron GAS PIPING GROUND/ORK Ap pRov e o Retqa nx s D DrsAPPRovEo D Dare I xsprcroa ROUGH PLUMBING AppRovro E DrsrppnovrD D oaryl-Al-O? Reuanxs I ruspec ROUGH GAS PIPING Ar pRov E o ReMaRr s D DrsappRoveo D Drr r Ir.tspEcron FINAL PLUMBING APPRovEo M DrsAPPRovEo D Rr tlaRx s Dar I Nsprcr FINAL GAS PIPING Ap pRov e o Rruanx s D r sappnoveo I ruspecton CERTIFICATE OF OCCUPANCY Rraov ro lssue Reua nx s Nor Reaov ro lssuE ,ffi-y,a, D Dore- D Dore_lnsercroR_ ,l -b-FAWfr,tz 4(ZL /fSS L<4y', dS, TL Job Location (Street, mile post)lz-z-zISubdivision Lot- BlockPIot Plan FOR SANITARIAN'S USE ON LY: Sp.System Approved fJ System Disapproved tl Needs Correction COMMENTS: Signature Date L{-e-z7 FOR INSTALLER'S USE: Trench Depth -?C. f ltter h elow T Tank Capacity Manuf actu lVeasured distance to well from tank from drainf ield a il' ( --7r ,e,.| ,f -rl <>c ulF o z 6) D ! fc, c_ (( s N f\\ IJ P ctr)L t Lu ah o) !E o, =(! o) E(U =0 PC(! € a- \ o INSTALLATION RECORD AND CERT!FICATE OF SATTSFACTORY COMPLETION When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat- isfactory completion of a subsurface sewage disposal system at the above location. Return this form to: Permit Processing Section, Department of Environmental Management, Public Service Building, 125 East 8th Avenue, Eugene 97401 N\\l.i N d N \ 00 u L o) (!PoC \Sca le\(\ \ + CL co DT c55-1 1 ( F-c= L N" N J\