HomeMy WebLinkAboutPermit Building 1979-09-19POST THIS PERMIT ON MAIN BUILDING AT SITE
JOB ADDRESS.2415 North 38th Street, Springfteld Oregon CONSTRUCTTON pERt\ItT + LC-26O2-79
1gg, 11. 17-02-19.4 , 1501 Subdivision: E
This permit for the referenced property is hereby .ttlEoved. Setbacks and other conditions ot approval must be strictly observed. Violation can
result in revocation of this permit, citation under provisions of Lane County's lnfraction Ordinance, and/or other remedies allowed by law.
Applicant/Address: Donald L. Branch, 2576 North 16thr Springfleld, Oregon 97477
Owner/Address: aame
Contractor/Address: aame
?ntractor's OS # I total Construction Value: $59'761.00
Telephone: 746-03LG1746-0389s*
Telephone: sane
Telephone: sane
Construdion approved bythis permit: sFD G 864 sq fta upper e 768.q ft; gerag€d e 576 sq ft; ulc deck 0 400.q ft;
forced alr heatlng and lnstall SDS
stnrctures nor on proPerty! Doue
Water Su
PLANNING DIVISION
Ralnbow Water Dist.+Bedrooms: 3 +Plumbi Fixtures: 11 + Em na
Zoning: R-l Partitioning + W544-77 Parcel + 2 Parcel Size: approx L acre
Minimum required structural setbacks, from: centerline of road, front: 65r ; centerline of road,
side exterior: na ; interior property lines: 15t;rear property line: 2Or
Special lnstructions: Partitlon complete. Front setback ls 65r fron nlddle of Cul-de-sac. OK per t{.8./SS
WATER POLLUTION
CONTROL DIVISION
For information call 687-4394,Eollls
Site lnspection + 77480 lnstallation specifications: 1000 gal. min. septic tank capacity;
ZLG lineal feet of drainfield required; max. depth of trenches: 3g-36rt
Septic Tank
10'
10'
5',
50'
sJtu."t ,
nter ror property lines
Special lnstructions: Install a serlal distribution system of seepage trencheg contoured
to the slope aecordlng to the attached plot plan signed D. Jotnrson, aept 5) L979"
Dnift'iddement area to be reserved as shown on the plot p1an. Trench botton to be 30-36 lnches
d06p wlth a total of 18rr of gravel, L2" under the distributlon pipe as shown on the
J9tached sheet. (2) attachements.
10'
100'For information call 7-395,9between 8:00 - 9:00 a.m., I(athl_ WLederhold
Edge of road right-of-way
Building foundation
Wells, other water sources
CONSTRUCTION
PERMITS/INSPECTION
DIVISION
Type of Construction: 5-N Group: R-3 Fire Zone: 3 Use Classification
lnstructions: See reverse slde of pernlt for requLred called lnspectlons.
SED
For plans information call 687-3767 between 8:00 a.m. and 9:00 a.m., JID Laob
For inspections (see back of this permit) call 687-4065 between 8:00 a.m. and 5:00 p.m.
lane countyDirections to Site
Date lssued:
r 200 feet south of Winelos
09-19-79
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE / PUBLIC SERVICE BUILDING
125 EAST 8TH AVENUE, EUGENE, OREGON 9740.I
By:ToT. Morris/ly G
fl lane county
WN
Name
Addres s
p
The above app'lication is being held by the Permit Processing Section for the following
reasons :
HOLI' SIIP
AppLrcATroN 8{-<q - 77
>n s/1 77 €*"12 /Qn^'{^on
Di vi s'ion :
Si gnature:
Division:
Si gnature:
o-e2444-/1
Date -77
Date
This application will be held until If the informat'ionrequiredabovehasnotbeenfurntsrreacat.ionwillbecancelled
Fees paid for waste disposa'l systems (site inspections and/or applications to install
the septic tank and drainfield) are nonrefundable. Sonn refund ma.y be made on the
build'ing and plumbing portion of your appf icat'ion if cancellation is necessary.
In the event a Planning or some other long-term problem exists over which you have
no control we will hold the perm'it until the oroblem is resolved and we receive word
from you as to whether to prbceed with permit issLrance or process a cancellation.
c74-L39
PERMIT PROCESSING SECTION - 687-4394
d fi,,DEP,AOTI]E"T OF ENYIRONI4EiITAL I,lANAGEI,lENT
PSB, 125 EAST BTH AVENUEV EUGENE, OREGON 9740I
ft+Clty _
Appl ication #
Job Address
Township, Range, Section, Tax Lot /v-o Assigned Numbers
7-4
Subdivision
Appl ication for r{o t'7-f
Structures now on the property .{otlE
Proposed use of property: /-y'6sidentia1 /-7 Commercial
Affidavit: I,
Bl ock
f/ Industrial /_/ Public
hereby certify that this information is true and accurate.
Lot
t2
If this app lication is for an agric
ease prin
ul tural b ul lding it will be used for purposes ailowed by the State Building Code and
p
Lane County Code Chapter 10 (zoning) and for no other purpose.I have the following legal interest in the property:
i.-/ owner of record;con tract purchaser;I essee;holder of an exclusive option to purchasei
- duly authorized ac 'ts OW ble o f tiris appt ication.rl
S ignature,/Address Zg
Tel ephone or 7./c'449 Date z_a
rmit is ready notify:/_7 Contractor /-/ mail
77
When pe
Owner
I icant /_/
I
t,lt
z1
(zio)
Phone
Phone
7#-ae,
Con trac tor lt
Contractor's 0SR#Plumbing by
If Commercia'l: # of stories
Residential- i of bedrooms
SI test holes ready
/_/ Elisting, BP #
/_i/Proposed, SI #
# of employees # of units fA.rr/*r# fi 77
SDS:
Sq Un it
Cos, t. Ft. or
of Sites(--Des ion Val uation Fee
dau
{d
Total Val uati on: $
Plumbing fixtures at $
Sewer/water conn. at $$
,u/4,
each
each
$
/_/ Casn ,*/'/ cn -.4eck #
Received by
Water Supply
Proposed _
Year InstalIed
PERI4IT PROCESSING Zone
Minimum setbacks
Comments
To be
Instal lation
Plans check fee
4% State surcharge
Chaftge-ef-Occrl.oa.ocJ,.s DS
Subtota l $
$
Existins __{D.$,
IOTAL
$
t
le\0O I tank;
Parce l Si
i nt.tFl
ooD
A
Da te
of drainfield; max. depth of trenches
#_
fron t de r fr
5-By
,srpec
i fi ca ti ons
. Tobe t
Directions to si
/ SIFO Pl ans to: CP&l
t^]PC
Ho d Slip
to PCC
Da
Compl eted
t Da te
set Req u i red':
&I
C
/ Planning
/ Pub 'I ic l./orks
I Elevatjon /-/ n/a
7l Address
/_/ Faci l i t), Permi t
4
Y
// Environmental Health
,a)auyt 'sltnk^, q*v,M,
-
@ fuzr/rttutuTt
Part.ri
on permit
FOR INFORIIATION about progress of your appiication call: Permit Control Center 687-HELP (687-4357)
I
/z
7z
t
Fee
Code
.1
o
Parcel
a
el -77
WATER POLLUTION CONTROL
-
1
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)r
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L
_'l_ *
I
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l0-
22
14
26-
I...ANE CT}UNTY I}EF'T ENV I.t6T RHCEIF'T * 2&A2-19 DATE 08?07928 AFF,LICANT BRANCH, DT}NALD L. ADDR ?5?6 NCIRTH t 6TH, SF'RIN6FIELD, ORE
.- TL* 1?02{ ?4001500 SUETDIV t-oT BLK30 NEt,' BI.-DG TYFE SFD USE R NO BDRI.IS 03 NO I'NITS OO{ NO STORIES NO BLDGS OO1
CODE APFL NT} ACTION I}ESCRIFTION SQ FT TINIT COST VALUATION FEE DAYS32 BF SFD. |'IAIN 864 35. ?5 30456
FF SFD. UFPfiR 1&8 30.23 ?3?OB34 FF GARAGE 5'16 8. S5 509'7
tlF uNC. DECK 400 ?.50 I 000
36 BF.
t{F38 EF LC ?60??? NEbJR
NO. FIXTURES:CONNECTORS: ?
i'{f:IHANIUAL- f"EE:
STATF- SURCHAR$F-
FLAN CHECK FHE
ET-EV ADDIT FF'
COI',1F,LtiTL.D $Y
5.00
5??61
EACH *
4X
li0x
ENVH
TOTAL F.EEXX
t0'7.00
65.00
10.00
11.?ri
1 41 .00
40.00
4?4. ?t! CK
c
L-.1
t.
q,
t.J
t.
U
FL
-49 HTCH- SUR12 FCK
sD,s
14
11 N0.
48
,SIFO CPI50 .I'AKEN TY HLH
52
SDS I
tdF I F t"AN
I
54
56_
58
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50
62 ___
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t0
9t
I
8r
64
46
lane countyHOLD SI.IP
APPLICATION #
6Dv
-
Name
Address
pco
The above appf ication is being held by the Permit Processing Section for the following
reasons:
q-/ & ^?cl'.\A
p
Division:
Si gnature Date
0
n3
flY tf Division:
Si gnature:Date
Thi s appl i cation wi I I be hel d unt'il . If the information
required above has not been furnished by that date your application will be cancelled.
Fees paid for waste disposal systems (site inspections and/or applications to install
the septic tank and drainfield) are nonrefundable. Some refund may be made on the
building and plumbing portion of your application if cancellation is necessary.
In the event a Planning or some other long-term problem exists over which you have
no control we will hold the permit until the problem is resolved and we receive word
from you as to whether to proceed with permit issuance or process a cancellation.
c74-L39
PERMIT PROCESSING SECTION - 687-4394
PERMIT PROCESSING
PLANN I NG
PUBLIC I,JORKS
FLOOD PLAIN MANAGEMENT
Department of Public Works
I 25 East Bth Avevue
Eugene,0regon
687-4.l 95
PERMIT NUMBER
PARTiTION NUMBER
SUBDIVISION
OTHER
TO
APPLICANT'S NAME
ta
SITE ADDRESS t-".1 ,L
PERMIT VALUE IS A SUBSTANTIAL IMPROVEMENT.YES NO
SITE IN FLOOD HAZARD AREA YES NO
SITE LOCATION IS WITHIN A FLOOD HAZARD APPROXIMATE STUDY AREA, EXTRA
--PRECAUTIONS
MAY BE APPROPRIATE TO ASSURE THAT THE BUILDING SITE WILL
BE REAS0NABT_Y SAFE FR0M FL00DING. MOBILE H0ME TrE DordNS REQUIRED.
SITE LOCATION IS I,JITHiN A FLOOD HAZARD DETAIL STUDY AREA.
(M.S.L. ) REQUTRED.
(M.S.L. ) REQUTRED.
MOBILE HOME TiE DOWNS REQUIRED iF GROUND ELEVATION THAT MOBILE HOME
WILL BE PLACED ON iS BELOW THE REQUIRED MINiMUM FiRST FLOOR ELEVATION.
SITE LOCATED t^JITHIN A DESIGNATED FLOODWAY CHANNEL, BUILDING PROHIBITED.
RECOMMENDATIONS :
I
2
J
MiNIMUM FIRST FLOOR ELEVATION OF
MINIMUM FOUNDATION ELEVATION OF
=.E
r#{
x
rO-{
DATE {.
c99-2L
BY
CIIrY C)F SPH,I\TGFIEIJD
SPRINGFIELD, OREGON 97 477
August 23, 1979
346 MAIN STREET
726-3753
PUBLIC WORKS
Lane County Water Pollut'ion Control
I 25 East 8th Avenue
Eugene,0regon 97401
ATT t
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6)
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SUBJECT: SANITARY SEWER AV AILABILITY FOR 17 02 19 4 TAX LOT 4OI
Your inquiry regarding the status of storm and sanitary sewers in the vicinity
of the subjbct property has been referred to me. At the present time, the
area is seived by neither storm nor sanitary sewers. However, as you are prob-
ably aware, development along 3lst Street is progress'ing in the direction of
the property in question. t^le anticipate that storm and sanitary sewers could -be available to this property w'ith'in five years . :1")/-
Please contact me at 726-3753 if I may be of further assistance to you.
Very truly yours,
f"4*r! Burtr
Robert E. Barrett
Ci t.y Eng'ineer
REB : CC: cw
ntl emen:
lane county
Date
HOLID SIIP 6t!'
-
D Dzu/4u
Name
Address
p
The above app'lication'is being held by the Pe
reasons
t
'l
at
4N Yg.t
D'ivision:
Si gnature:Date
Thi s appl i cat'ion w ill be held until . If the information
required above has not been furnished by that date your application will be cancelled
Fees paid for waste disposal systems (site inspections and/or applicat'ions to install
the septic tank and drainfie'ld) are nonrefundable. Sone refund may be made on the
building and plumbing portion of your applicat'ion if cancellation is necessary.
In the event a Planning or some other long-term problem exists over which you have
no control we will hold the permit until the problem is resolved and we receive word
from you as to whether to proceed wrth permjt'issuance or process a cancellation.
/'1
c74-139
PERMIT PROCESSING SECTION - 687.4394
APPLICATTON #_
6
Processing Section for the following
,L
I l-\t
/t WkU*. /
ndrrfieh,
T-qgo 1$fu \lnsrcb{??nr /a,pfx/il|d ru,tdu- gfu
oA& 3qo -1t-bo&a\ &r+W -Trc,ndnoa
"Lwlk {W*ptnDh
*a?
Vd- Qr.fe
-aol /lnM) *., /nt rsv-"radad, \/etz,zat
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26/D
uYl,urt^t- O
6ldruru4-fu.
W/''*f'
ry
4s
L4
0
L.
Yf,
7b
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J+z^
= Z1D
Z7D
V'p/r,r/r"
(
4bq = tlgz lr!-/ P'r#/5 6L Ztb n6f ztbepl .
= 190 dar %dryrldpr,4W
-tfllrvlc/v
b#oh
6 e2
,l
7-'
Lo
tu
530 //^ul
Zbaz-7
l7-oz-/q,Y
ff19,
-
l--
'"ne countyHOLI' SLIP
APPLICATION #
Name
Addre s s
Zip Code
The Lane County Water Pollution Control Division cannot proceed
wi th process'ing your appl i cati on because :
l. incomplete appl jcation ( items deficient).
Address and/or directions to appl jcation s'ite.
Proposed Number of bedrooms in dwel'ling.
Approvable plot plan (see attachment).
Notificatjon of date test holes will be ready.
Verification of existing system q
)
uired (memorandum
explaining th'is p re attach
re
ed
Two test hole
or repai r
area of th
of
0ther:
M74 - 181
WATER POLLUTION CONTROL DIVISION /I25 EAST 8th AVENUE / PUBLiC SERVICE BUILDING
'deep) required for exPansion
ewage disposal sYstem in the
ra'infields.
2
3
4
ENVIRONMENTAL MANAGEMENT DEP/ EUGENE, OREGON 9740I
ARTI'IENT
687-4061
Z',X4',X
i sti ng
pos ed
DEPP"TIJENT OF ENVIRONI,IENTAL I{ANAGEMENT
PSB, 125 EAST gTH AVENUE
EUGENE, OREGON 9740I
?
Job Address /7-o
itUU,!
Appl ication for
Structures now on the property 4atqE
if*snrf,tifiiiag$.;1ffi:i.;EffiF*r.,tii.i.. i /-/ i$.qffine$:il,$ii
Affidavit: I,.2ztt /42, z) Z, ./Zla/c/
,['ti.'n#ii*iiji:ii[ii,i]ii,ltrtr:If this application is for an agricultural building it will be used for purpo
Lane County Code Chapter l0 (zoning) and for no other purpose. I have the fo
l/ owner of record;tract purchaser;I es see
-duly
authori ac who is OW eab le
Si gnature/Address
Te1 ephone or
When permit is ready not'ify:I i cant /-/ Owner f7 Contractor !y: l-l rrail
Olner Z z1
contractor lt //(zip)
tt0;li*tff.tt 5,4{ i -f 'zzp ,.,*t e:i$*tdjiilunb[r$:.
/--lt$#ffit$tliii rlfr.$;tffi
, hereby certify that this information is true and accurate.
ses allowed by the State Building Code and
llowing legal interest in the property
lder of an exclusive option to purchase;;hoof this appi 'i cati on r2
Date a
Phone
Phone
7y'2-o,z
Contractor's 0SR#Plumbing by
If Commercial
Residential:
: ,'#.!:!Otiii$tgtiti8$,!
a
!#,:':i0.t,iiltet liE(ffi811 -- )
DO NOT WRITE BELOW THIS LINE
# of employees _# fli!'_trji:__
:S$$tri; / /Jxistins, BP-_//3/ Proposed, SI
r4.rr*/Jls7qZ
SI test holes ready #
,imlt[i
iIss.*fi Fee
Total Valuation: $
ga
at$
at$5
a,u
each
ea ch
$
-*
Y
Received by
Water Supply
Proposed _
Year I ns ta l 'l ed
PERMIT PROCESSING Zone
-<
4% State surcharge
Plans check fee
one+s+af-0cs.ugnry -SD-5
el#' frilo Parcel Si
'int
Da te
Use ification
$
Subtota l $
$
$
$
(r)chr 4
Existing y'Est"
$
t
Minimum setbacks
Cornments
To be ed on permit
CP&l Typ
To be typed on permit
fron
Gro
ide r 3A
_/)llre lone 4
Pa rt #
By Da te
For plans information cal l (qrea inspector)
0irections to site
/ / Facility Permit
/7 Environmental Health
Phone
Hold Slipto PCC
Da te
Compl etedL/ Yro
rfl ceu
lfl wc
/ / Pl ann'i ng
/-/ Public Works
ffi
CP& I
l,,lPC
et(s)
et(s)
Pl ans to Da te Date to
PCCs
Eievation /-/ n/a
Add res s
permit Control Center 687_HELp GBI-4351)
"$r'
Valuation
FOR INF0RI\1ATI0N about progress of your application call:
c74-t7r
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I
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l:'l
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I A'/fr ttl
,g
L
r
TO:
PERMIT PROCESSING
PLANN I NG
PUBLIC WORKS
FLOOD PLAIN MANAGEMENT
Department of Publ'ic Works
I 25 East 8th Avevue
Eugene,0regon
687-4,I 95
PERMIT NUMBER
PARTITION NUMBER
SUBDIVIS ION
OTHER
APPLICANT'S NAME
SITE ADDRESS .T
PERMIT VALUE IS A SUBSTANTIAL IMPROVEMENT.YES NO
SITE IN FLOOD HAZARD AREA YES NO
SITE LOCATION IS hIITHIN A FLOOD HAZARD APPROXIMATE STUDY AREA, EXTRA
RECALJTIONS MAY BE APPROPRIATE TO ASSURE THAT THE BUILDING SITE WILL
BT REASONABLY SAFE FROM FLOODII{G. MOBILE HOME TIE DOI^JNS REQUIRED.
SITE LOCATiON IS WiTHiN A FLOOD HAZARD DETAII- STUDY AREA.
(M.s.L. ) REQUiRED.
(N"S.L. ) REQUiRED.
MOBiLE HOME TIE DOWNS REQUIRED IF GROUND ELEVATION THAT MOBILE HOME
WILL BE PLACED ON IS BELOI,*J THE REQUIRED MINIMUM FIRST FLOOR ELEVATION.
SITE LOCATED I^JlTHIN A DESIGNATED FLOODI^/AY CHANNEI-, BUILDING PROHIBITED.=-E
RECOMMENDAT I ONS
I
?
3
MiNiMUM FIRST FLOOR ELEVATION OF
MINIMUM FOUNDATION ELEVATION OF
-{x
t-O
-l
DATE
c99-2L
BY
POST THIS PEBMIT ON MAIN BUILDING AT SITE
JoB ADDRESS: cONSTRUcTtoN pERMtT #
TRS, TL: Subdivision:
-T-li:P",]T]l ]91..th" *Jerenced propertv-is hereby Setbacks and other conditions of approvat must be strictty observedresult ln revocatlon oI this permit, citation under provisions of Lrne County's lnfraction Ordinance, and/o; other remedies allowed by law.
Violation can
Applicant/Address:
Owner/Address:
Contractor/Address
\ )ontractor's OS #
Construction
Telephone
Telephone
Telephone
Total Construction Value:
approved by this permit
om(!d {
tnilEtn[Water
PLANNING DIVISION
+ Plumbing Fixtures:+r Employees
Zoning:
IVlinimum required st
side exterior:
Special lnstructions:
Partitioning + parcel +
ructural setbacks, from: centerline of road, front:
; interior property lines: ;rear property line:
Parcel Size:
; centerline of road,
For information call 687-4394,
WATER POLLUTION
CONTROL DIVISION
Site lnspection + lnstallation specifications:
lineal feet of drainfield required; max. depth of trenches:
Special lnstructions
Septic Tank Drainf ield-*lo-
10'
10'
100'
gal. min. septic tank capacity;
Setbacks
'i nteiior property lines
Edge of road right-of-way
Building foundation
10'
10'
5',
50'Well other water sources
CONSTRUCTION
PERMITS/INSPECTION
DIVISION
Type of Construction:
lnstructions:
Fire Zone
between 8:00 a.m. and
Use Classification
For information call
Group
between 8:00 - 9:00 a.m
For plans information call 9:00 a.m.,
8:00 a.m. and 5:00 p.mFor inspections (see back of this permit) call 687-4065 between
Directions to Site:
Date lssued:
DEHARTMENT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE / PUBLIC SERVICE BUILDING
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
lane county
c55-1 3
By fi!'
-Err
# Bedrooms:
SITE INSPECTION
AP PRov E D
Rruanxs
Dr SAPPRovED ,n Dare I NseEcton
FOUNDATION INSPECTION
APPRovEo
Rruanx s
DrsAPPRovEo
li2
Drr e I Nseecton
rRAM I NG
APPRov E o
I NSPECT I
Dr slppnoveo D o*, /l-z4o-L?t NS PE CTOR
Re uanx s
n<-<a-l*
LATH OR SHEETROCK PECT I ON
Ap rnov r o
RexrRx s
Dr SAPPRovED n Do-,rJ,/-- 1e-29 I HspEcron Q-rZIZ
F I NAL I NSPECT ION
AP PRov E o
Reuanx s
D t sappRoveo a^rr/.4&I Nsetcron
CERTIFICATE OF OCCUPANCY
Reaov ro lssue
Rruanx s
Not Reaov ro lssuE Drre I xspecroR
POST THIS PERMIT ON MAIN BUILDING AT SITE
JOB ADDRESS: CONSTEUCTTON pER[4tT +
TRs, TLr subdivision:
This permit for the relerenced property is hereby Setbacks and other conditions of approval must be strictly observed. Violation canresult in revocation of this permit, citation under provisions of Lane county's lnfraction Ordinance, and/oi other remedies allowed by law.
ApplicanvAddress: Telephone:Owner/Address: Telephone:
^ontractor/Address: Telephone:
/ntractor's OS + Total Construction Value:
Construction approved by this permit:ttD fl.s{t { ftj uppar ? f6s_f ftl srncnd 0 It6 r{ lrt rmo dlck q 40o ee Grtlotltd alr hrthg rd h.rrll tW
# Bedrooms:Water Suppl v:+t Plumbinq Fixtures:+ Employees:tn
PLANNING DIVISION Zoning: Partitioning +t Parcel +r parcel size:
Minimum required structural setbacks, from: centerline of road, front: ; centerline of road,
side exterior: ; interior property lines: ;rear property line:
Special lnstructions:
WATER POLLUTION
CONTROL DIVISION
Setbacks
In teii-o r property I i nes
Edge of road right-of-way
Building foundation
For information call 687
Site lnspection +
lineal feet of
Septic Tank
10'
10'
5',
50'
septic tank capacity;
atrt&n of rmgr tsach*o ccilaonrcdtfFtlnpe ncsqrdro& ts thrrfirl BD ba rwrrd cr
tr.I3h r t6gil af,, I# sf, 6mrro1,rharl" {X} *mrc}crrr,gl,
rG$.ead pl,o,A pf^s rt3ld B" Jgbmr r6pt, L lgr?.*h m tL $.t IEG,' trrct tartn to-t$ iO-lO ImlrrtlP rudsr ttn dl.rtrlDutfer p&r ar ahmn s tht
other water sources 100' For information call between 8:00 - 9:00 a.m.,
CONSTRUCTION Type of Construction: Group: Fire Zone: Use Classification:
PE R M ITS/INSPECTION lnstructions:
DIVISION
For plans information call
For inspections (see back of
, between 8:00 a.m. and 9:00 a.m.,
this permit) call 687-4065 between 8:00 a.m. and 5:00 p.m.
nq6_1 ?
Irfr '#hrrtrll,l
hne countyDirections to Site:
Date lssued:By:
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE / PUBLIC SERVICE BUILDING
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
Special lnstructions:
SLAB FLOOR
PLUMB I NG GROUNT'ilORK
Apphoveo
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INSTALLATION RECORD AND CERTIFICATE OF SATISFACTORY 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 fVlanagement,
Public Service Building, 125 East 8th Avenue, Eugene 974O1 c55-
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