HomeMy WebLinkAboutPermit Land Drainage Alteration 1999-09-20This permit is required for any site activity in the flood plain and everywhere site alteration consists offifty (5O) cubic yards of material or more an9/or if a drainageway ls affected, withiri'gity llmits and
This Side To Be Filled Out by Applicant
Permit Expiration Date: '
Cl
Date o1Appl ication ?-ZO -qq
Site Address
State:Address :
Property Phone:3 257[
Springfield, Oregon
Tax Lot: 7Oetr
Journa! number applicablo Land Uso App lication
OZLqqUGB Tax Map No:
Phone
,.1
Destination:On
Project
ntity R0 Y ilc
ter:Suppl
ter
tr
W EXCAVATION,Oua
RAG DING
Address
Source Location
Material
tr FILL,
Suppl
CROSS SECTIONS, J
SOILS & GEOLOGY PLAN,
DRAINAGE, POLLUTION AND EROSION CONTROL PLAN
ADDITIONAL INFORMATION,
E(
tr
tr
tr
tr
tr
es
and
nd
REPLANT]NG PLAN
COMPANY Nel//e: lhhrzh4 u Frgrveze.tt-,< , PHONE QaP
STATE
COMPANY NAME:
STA
PHONE
CITY
ADDRESS:crw
PROJECT SUPEBVISOR:
ADDRESS:
,
PROJECT SUPERVISOR:
__---r---_-
-o
CITY:
Co
Explratlon Date; 6Registration Number:
MOB]LE PHONE:
PHON
OFFICE PHONE
EMERGENCY PHONE:
PROJECT SUPERVISOR:
CONTBACTOR NAME:
ADDRESS:
STATE:
. l^c
I undsrstsnd that I or mv auccossora may. have future p]ans for.my property whlch may bc antlcipated or unantlclpated atthls time. I underatand that suc.tr tutuiC titins mirVresuke permiti'ato tiviropem.ont rpprovatg lrgm inlcrifoi i'pilh?riialunderstand that notwithstanding any q'onrova-!.oi thib Laridandbiiinage Att'eiiiiirn f-irinlt'i-UoAFi,'tfrat it-irri'ti-riJ'i?"- -
application of fulure permits.or.alRroValb'tha clty may reyt-w ino iC;ffi[lilii;fiff;#iig]t'fti"rii;uil11dii'li;e
xtgsfi?:zl3:!:ffi::1","'ll',h?$I; LH?o;i:'ifi#il,.i1f, FLg,rtii:"1fflgsi1ii,il;tit*"'a:*j*ld;itx,"Jffi;,
FET
M
IJJo-
Zo
-lF
M
LIJFJ
LU
U
Z
-l
Mo
oZ
oZ
s
By slgnature, I ttate and 8916o, that I hate.carefully examined tho comptotod .ppllcrtion and. do hereby certify that ell[.riffi'pJH:*,5lrr"^sEiji[$rr"&!i"-,1,':?:ii::r[t',ffi1i,*i1i,1,t*,nir:mf ,.,:lg,li.::[frir:i:rs."{lr.state of oreson portainins to- the wdrk otsdribJi-trereiri. tlnitiii'i-"-riliilriat onri Coni;;cril;tr;inptoyec who are tncomplianco with ORS TOi.OSS will be used on this pro1ecr.
The 9ity may lnspect the work site described in this permit at any time durlng a ono yoar perlod follotr,J ciiV;i;tiiff;i}Jripieii6JiTt-n;;;;;b"l;oir"na-rdecrJ'v, iiirie'6rtv,e cole'd.esicratto", ,"il1%$;rltl?X'&t"?1,""
[itr:!':ffi'-fi t""',::u&:ib".i%:,T?ffi't^'.T:iilt1!:iili"."ryd iiiB,:',T,sl"#il[li;.*?il,lx dxdl,tglfi:xr,"the thirtv days wiu be perrdrmed uiirre ciiv-ind ih; a;Gilii'oE i,irrEi'i5'ihe permittee.
a
tho 8tre6t,the
I furthor agree to snEure that all are requostsd st
on th6 site at all lc readable from
Afo.
Signature
ul
TEf
kzgo
erruru fuil;L# ?arssy'
t
to
FAX-
ccIrlz
=o
ltFz
EfU'zoo
0coFo
TEFzoo
cDzs
TL
r,uEv,
zo
E
TEttl5
clz
5
:r'
6
UJEfoul
TE
i
trYfrt Community r.nur *
Ditch,-El Culvert, E Natural
WETLANDS, Descri
X , FEMA
DRAINAGE, O Storm, O
FLOOD PLAIN, Zonez
FLOODWAY, FEMA Cor{munity Panel No.:
$20.00
$3o.oo
$40.00
$40.00 For the first 10,000 cubic yards, plus
920.00 for each additional 10,OO0 cubic yards or fraction thereof
$22O.OO For the fir6t 1OO,O01 cublc yards, plus
S20.00 for each additional 10,000 cubic yards or fraction thereof
$34O For the first 200,001 cubic yards, plus
$6.00 for each additional 10,000 cubid yards or fraction thereof.
$30.00
930.00 For th6 first lOO cubic yards, plus
$14.00 for each additional 100 cublc yards or fraction thereof.
$156.00 For the first 1,000 cubic yards, plus
$12.00 for each additional 1,000 cubic yatds or fraction thereof.
$264.00 For the lirst 10,000 cublc yards, plus
$54.00 for each additional 10,000 cubic yards or fraction thereof.
$750.00 For the first 100,001 cubic yards, plus. ,
$3O.OO for each additional 10,000 cubic yards or fraction thereof.
Qao.@
Aj-Dtur2L 0 -/4 -qq
Estimated Volume
Receipt No 3ss va Date
rR 1'**!r
Received
100,001 To 2oo,o00
2OO,OO1 CUBIC YARDS OR MORE
Received by:
Grading Permit fee:
Plan Check Fee:
PLAN CHECK FEES:
UP TO 1OO CUBIC YARDS
101 TO l,OOO CUBIC YARDS
1,001 TO 10,000 cuBlc YARDS
10,000 To 100,000 cuBlc YARDS
GRADING PERMIT FEES:
UP TO lOO CUBIC YARDS
101 TO l,OOO CUBIC YARDS
1,001 TO 10,000 cuBlc YARDS
10,000 To 100,000 cuBlc YARDS
loo,ool ro 2oo,o0o
Date: q
Receipt No,31bOn D
Date: /
tr Malntenance:
tr Buitdins:Date:
Date
Date:
Date:
Maintenance: Date:
Date:lssued by:,
Rarlt rlred Flnnl lnsttpr.tlanl,
Pprm It Numbcr
Plrnnlngr
Engineorlng:
Bullding:
Date
Date
E] Land and Drainage activity as outlined in this permit has been completed in accordanco with
the Provisions of this Permit.tr hfiN,?.|}dr?5?t!Po$t %1tlYllJf"t ffYf]inud in this permit has not been completed in accordance
tr Land and Drainage activity was performed prior to application for this permit.
Date:Accepted by:
FEI
fvl-rl
IJJo-
Zo
ETF
fvlr-lEI
=IIJ
U
Z
-rrv
-in
nZ
nZ
s
,1/6/1998
Date:
,
Engineering
Uut
(a
is Side To Be Fil
ulc,
z
IEo
lrJulIL
,azo
EozofJ
.,.
I
o
IU
=lrl
lIG
;.
azoF.(J
trlo-U'
Z