HomeMy WebLinkAboutPermit Septic Tank 1994-09-24QL.r.ru.oo
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Permit No. 7O? Z4(MUST BE IN BLACK INK
Twnshp. l7 Range 03 Section z L/ rax Lot /)bffi
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Supdivision/Partition #Parcel Lot
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Block
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DETAIL SYSTEM PLOT PLAN AS CONSTRUCTEDn
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VICINITY MAP
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USE BLACK INK ONLY
FoR INSTALLER's USE: Trench Depth ?s* Gravet Depth Betow Tite 6*
Tank Capacity l*ooo htsrt- Manufacturer Wtrlrw^^e-tt€- 4*.rt=l o-., - *
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's name)certify that a (Mfg.)(Model No.)Pump
and Mercury Float Switch (Mfg. and No.)have been installed with this sewage installation
FOR SANITARIAN'S ONLY:tr Needs
COMM L
signature Date
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..I HAVE PERSCNALLY
SHCWN
coNS
IilsPECTED TI-IE SYSTEIT'
WITH
71 ."
System Capacity gal./day Signature
Date
DateISIQNS OF
INSTALLATION BECORD & CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian. this cerlificate is evi-
dence as per OBS 454.665 ol satisfactory completron of a subsurface sewage disposal system at the above location.
To request inspection, retu
Public Service Building, lt
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25 E.
three (3) copies of this form to: Lane County Environmental Health Services. located in the basement of the
8th Avenue, Eugene. OR 97401.
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