HomeMy WebLinkAboutPermit Miscellaneous 1974-05-21N
3 /7\?.UEST FOR S ITE FEAS IB I L ITY S t's.t.#74-t3F
THIS IS A PRELIMINARY REPORT l,JHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE BUILDING PERHIT.
PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK.
PIEASE PRIl{T
tf subdivlsion - Name: 2 Nt nd),T r o N io D6lPtSe Lot# +BIock #5
tu-fi?/sa jL-or
0n Iy Yes
ce
6?E-a AcT
/: os JL/
Secf ion Owner of Property
No. of Sites I
No. of Acres
*o / Tota I
Yes ,a NobililEF;'E;E;,i-
$,?ep
dJ,a0
Owne r
Buver t/\.'
e
tlr
-l\Townsh ip Range ffi
LG o r.1 Kr r,.t N 6 T 7
Name
lLEa Dc 1 R-og € ,,tu € .
Heil in9 AddieaE
g
ltL_z2g g x
Telephone #at ure o
$
$qCas h
aiheck
cant te Sel I er
Rea I torProposed Use , Appl icantrs lnterest
of i,ropertv: lsip e ll FA14tltLP L(tJewrg Property: 0ther (Specify
*l,H; tt3 NoRTh tlTti iloMCeropaity-Slze @ E-xTiCing-sJructures on Property
Property Locat ion (D i rect ions) :
RJ. R,6hr ou-
Proposed I'later Supply
Publ ic District:
Spring V/ell _0t r
FT e
DclRo<( uC l6 FT o*t tv.trt?Tfl I'tTh'
o
eos
es
nrtty
w ha c ?t t v
l./hen l,/ill Test Holes Be Ready? n +Y C--l - ta t
MARK TEST HOLES WITH OUR FLAGS W
Location of Test Holes on Property:bPGi2T
Draw diagram of property showing location of ny I andma and relationship of test holes to
these I andmarks :
[ilo RT lf
l
(
x X
oJ
q I
I
I
t,
I
v
M
0
i, /
TffiNAGEHJ$ro RT I{Ttl
lv)
I',?_MAKE CHECK PAYABLE
MAIL TO: LANE COUNTY DEPARTMENT OF ENVIRONMENTAL HANAGEMENT, 135 E
c 55-55
Phcn e:
5th Ave., Eugene. 0re
-,F
ztgl t22.Aa*
--_"/
I
APPROVED NOT APPROVED
a ,thor i S i gnatu re
,t-f2?
ate
:
#t TEST -Ho1 n f2 TECT HOLE
SITE DOES SITE I)oES IST t&et mlnlmrm standards for lndtvldual
waste dtsposal.
IF SITE tr'ES ,IST I{EET STANDARDS SPECITY BASIS OF DENIAL:
- Adruinistrattve Rules Requlre -- Your property found to be Deftclent -
IF SITE MEETS STA}IDARDS FILL OTIIT
Type of structure and approxtmte sewage flowl Slngle Famtl
ltult1-f enlLy
Corerclal
GPD,
GPD,
Industrlal
GPD
GPD
GPDInstltutlonal
NOTE: Soll absorbtlon area tn square feet
Aree necessary for sewage dlsposal systens -7-
PROFILE PROFILE
Inch Inch
Si,L
t2
,
48)
60-
36
,y
SiCL
c otHq
prteretcd Zone
lestrlctlve Layer_ln.
Impervlous Layer ln.
Uott Ll ln.
Percbrd llrter
Predlcted
6srrved
I}lte
Predlcted
0baeryed
ILte
2L4
L2-
36.,1
24-
48-r
60-
Saturated Zone
Predlcted
-ln.
Observed tn.
--
Restrtctlve Layer-ln
1n
,n
,n
ILayer
1
ln.
Impenrlour
llottllng
Perched lJrter
Date -
Predtc
Obsen ed
Dete
I
)NAME DATE OF FIELD EXIALUATION
ARE ALTERNATM SITE LOCATION, DESIGN OR IODIFICATIOII AVAILABLE, DESCRIBET
sr.tc r^rpcc rt*, *J3y'- {,'3 ?
LGATIONT
)gI\rD. I /
Y4 n"lrl ,
EYALUATIOI
FOR DETENUINIIre SITE SUITABILITYFE DBYELOPMEIIT UTILIZIIIG
SUBSURI'ACE SEIIACE DISPOSAL METIIoDS
Rang .03 s"c. 24 Ter Lot #to Dz( Ko.o
Are pbllc seucrs evallable or nearby? (Dlstance)
Are there zontng or envlronrental conslderetfor,"? l^JO
Slze of property I A@unt useable a
Are oCher ryatens ln area knorn to be nalfunctlonlng ?0{l-\
Is there room for future expanslon ?e
Surface Feature conslderatlons r
Slopes (1rltOO') O
Flood plalnr
Plants r
(Expl.aln)
(z)
Boeks
Low area
Dratnageray
Streans r
t
Cut bank or alope | ,"'
lJater SuppLy end Utllttteos
Qemrn{gy l{ater t No Ao,;t ow uuqr-fcn
Propoeed ll
Proposed fl
troposed f]
rroposed f]
Indlvldual lJaterl Erlst. E
Water Llnesr
Ilella on adJacent
propertlee r
Gas Llnecr
Erlst. !
Erlst. f]
E:rlst. f]
,/t
Kl Y/t?
(sketch ln Plot Plan)
BUILDING SITE EVALUATION Js c/*
z 1-5s?
LOT-
L-q &_S
*t7
ls 1,,
6l,r\L
I()
()
Building Permit Application No.
s i te lnspect ion
Pre-Permit lnvest igat ion
APPL I
NA}lE
ADDR
PHONE
OATE(
LANE COUNTY PLAN N ING DEPART}4ENT NOT NO YES
Zoning 0rdinance ComPl iance
(Zone,ri &7
Subdivision 0rdinance ComPl ian'
Requ i red Access
Building Site (Area, t'ridth,- Frontage, Setback)
0ther (see comments)()()7 . *-S-82 -2,tJ
appl icable-rl-) ra,Dc! ()
llil()
)
(
2
3
4
5
CO},IHENTS:
BUILDING INSPECTION SECTION
5, Plans Submitted
7. Soil Stabil ity (footings)
8. Flood Plain
9. 0ther (see Connnents)
aool icable--Tr-(()
()
()
()
NOT YESNO
()
()
NAI',IE DATE
)
()
()
()
COI4}IENTS:
.
SANITATION SECTION NOT NO E
10. Sewage Disposal
I l. Usable Area
12. Water Supply
|3. 0ther (see Conrnents)
aool icable*rr-(
)
)
)
)
)
()
()
()
()
()
()(
CO}4HENTS:
TO APPL ICANT:
Your Building Permit ,/ Site lnspection:
( ) Can be approved.()CannotbeapprovedatthistimeasindicatedonitemN0.-above.
Questions and further information on items I through 5 contact the Lane-
COUNTY PLANNING DEPARTMENT" Questions and further information on items 5
through l3 contact the Lane County Bu i ld ing and San itelgn-Divir lpn.Will be held in this office until you can resolve the problems indicated.
ls being returned.
Your building permit appl ication fee is being returned under seParate cover.
)
)
)
I,ANE COUNTY PIANNING DIVISION
L35 Sixth Avenue East, Eugene, Oregon 9740L
Phone (503) 687-4186
LANE COUMY ENVIRONMENTAL I'IAIIAGEX'{EIIT
135 Sixth Avenue East, Eugene, Oregon 9740L
Phone (503) 687-4065
c55-28
l!
(kl
NA},tE DATE
wDATE
?/ -€3 7
Surname W ffinge SectTffi ffi-tffi 6ae -Census Tract
Recei Dt No.0w 0wners Consent
Yes No
Name
and
Address
REqUEST FOR SITE FEASIBILITY STUDY
THIS IS A PRELIMINARY REPORT V/HICH 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:
No. TIteE
ffis-
TOTAL
eP one roPos se rope r ty
rope rty ze U an z ng
Yes No
st n9 tructures ls Propert), Wi thi n One Mi e aC ty
What Cit ?Yes No
rea
P ropos
Publ i c
Water UPPIY
District Spring Wel I
0t er
Spec i fy
i cants nterest rope rtyPPn
Legal Access - Road Name
I'
pecial
Yes
Permi t Area
No
ffoperty Locat i on ; (D i rect i ons )
APPROVED NOT APPROVED
BEF0RE CONSTRUCTI0N lS STARTED bring this form to the Department of Environmental
Management and rnake application for a building permit. lf the property is a por-
tion only of a tax lot, a metes and bounds description of the parcel must be fur-nished. Exact specifications for the sewage disposal system will appear on thebuilding permit, Two sets of building plans and a plot plan will be required.
LANE COUNTY DEPT. OF ENV!RONHENTAL MANAGEMENTI35 EAST SIXTH AVENUE, EUGENE, OREGON g74AI horized Signature
c55-32
Aut
Dat e
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