HomeMy WebLinkAboutPermit Septic Tank 1994-12-22DISPOSAL SITE
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Written Directions
EVAL loN u6BfsP,e-
SEWAGE
TRS,. 03.ag.e.//3Loo Job
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I -63-Z-s-zl- l>b@
Subdivision
Lot- Block-
APPLICANT'S NAME AND
OWNER'S NAME AND
WATER SUPPLY 3
srRUcruRES NowoNrHEpRopERTy NON f PROPOSED USE OF PROPERTY 3t
\
above statements are true and accurate, and that I have the following legal interest in the property:
I further certity that (if not the owner) I am authorized to act for the owner of record, and that
HOLES uLe,o a,/Signatu
'**** **r ******* **************r***********r** ******- OFFICE USE ONLY BELOW
I herg[ldertify that the1/ realtororagent.
SITE MEETS STATE STANDARDS YES NO
Standard System X tr
Sand Filter fl\ tr
1 Foot Capping Fill tr n
of record;purchaser;
-potential
buyer;
'of this action
ar*t**11*ttt*t*t*tttli*t*l *t*tt**t
LAND USE COMPLIANCE
Zoning Acreage or Lot Size (TOTAL)
Partitioning #-Parcel )Completed
) Pending
FLOODPLAIN TNFORMATION
! Floodway
All or part of this site may be in a flood hazard
area for which 100 year flood levels have not
been established. Extra precautions may be
appropriate to assure that the building site will
be reasonably safe from flooding.
All or part of this site may be in a flood hazard
area for which 100 year llood levels have been
established. A building elevation above the 1 00
year flood level may be required.
All or part of this site may be in aflood hazard
area in which a floodway has been designated.
Building may be prohibited subject to
demonstration that the cumulative effect of
proposed development will not inclease the
1 00 year flood level at any point.
YES NO
tr
n
tr
Low Pressu re Distribution
Holding Tank
Other
u
n
tr
co
[J Approximate
Study Area
tr Detailed
Study Area
THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE
BUILDING PEI
ARE AT YOUR
RMIT.S OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
SITE IS APPROVED, SEE REVERSE SI
.r 'i Af,'|r- ^nr*rv TNVTRoNMENTAL HEALTH, 125 EAST grH AVENUE, EUGENE, OREGON 97401 (697-4051)
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