HomeMy WebLinkAboutPermit Septic Tank 1989-06-02u 6B/s PR-
Lane County Authori za'tton'fort
-7 SEPTIC ]NSPECTION FOR LOAN REV]EW
FOR OFFICE USE ONLY
Application,/
Permit *
IDWN-*SHIP
1B
RANGE
o2
SECTlON
06 1.4
TAX LOT
9600 xour oF
S'JBDIVISION,/PARTITION (if applicable)I,OTIPARCEL BI,oCK
PROPOSED USE OP PROPERTY
Re s identia 1
Commercial
n rndustrial
PubIic
E
I,CCATION ADDRESS L]1TY ZIP
97478-6505
STREET
Springfield, OR978 S. 4ALh Place
,Y PROPERTY
Road; turn right about 2 blocks; one block west of
DIRECTION-S TO SITE
42nd St & Jasper
; 1 block north of 40th & Pinyon; green house laure] hedgeFi lbert T,n
DNSCRIPTION OF PROPOSED WORK - BE SPECIEIC
SEPTIC INSPECTION FOR LOAN REVIEW
DECI,ARED 5 VALUE
= OF BEDROOI4S # OE STORIES # OE EI"IPLOYEES WATER SUPPLY Proposed
Existi
Myron & Marjorie Schlemmer
OiINERTS NAME AND ADDRESS
(site addr)7 46-9458
TELEPHONE NUMBER
CoNTRACToRIS NAME AND oSR #TELEPHONE NUMBER
Gordon SmiLh (Realty Ctr) 43A Coburg Rd., Eugene 974Of-5518
P:RI'IIT TO BE MAILED TO (NAME AND ADDRESS)TELEPHONE NU}{BER
344-2404
I 1IAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION FOR PERMIT, arrd do hereby certify that all infomation hereon is true and correct, and that I
have the following legal interest in the property,[orr". of record; Icontract puchaseriffiuthorized agent.
I f:rther certify that any and all work perfomed shall be done in accordance with the Ordi.lrances of Lme Cowty and the Iaws of the State of Oregonpertaining to the work descrlbed herein, and that No occUPANCY will be made of ani'strrrcture without the pemission of the Building Division. I fur-ther certify that registration with the Builderrs Board is in full force and effect as required by oRs 701.055, that if exempt the basj.s for exenptionis noted hereon. and that only subcontractors ild empLoyees who are in compliance with ORS 701.055 will be used on this project. I HAVE READ AND
CHECKED THIS APPLICATION THOROUGHLY
F
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION I{AS BEEN BASED ON THE FOLLOWING CONDITIONS:
Date:611/Rq
InstaIIatsi-on
Date:
COI,IIIENTS:
Date:
m
Gal1on
P-ud<_-
NN qPFOTAT. PT,AI\I1\ITT\Tr] Aflrt'TN I\T RtrOTJTRI.]D.COI$1ENTS
front
Speci fications:Tank
cL,
I seurtatrou, s. r. *B. P. #
Group Use
f] v"= ! n"
Parcel Size
Minimun setbacks:
Installation Record Issued?
Partition #Parcel #
interior re ar
Lineal Feet
of l)rairlfield
I ptluurNc/zoNrNG: zone_
cL, uidu-
!4aximum Depth
of Trenches
BY
LANE COUNry
IGNEE per ORS 805
OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687.4061,
8TH AVENUE, EUGENE, OREGON 97401
OFF
SEE REVERSE EOR INSPECTION INFORMATTON cl^4-2s R*
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Ave.Eugene, OR 97401 DtvrEor{
Exlstlng Bulldlngs or
lmprovements on
Property
lEt{ouso
E Barn
E Garage
EII lvlobile. Home
E Shed
SEPTIC INSTALLEDt=t{ Yes
El No
Water District
PHONE
(il not rn. .i
z--a--
(il not.rm. !.
CONTRACTOR Lrccn3c,
CITY \a5u
ztP
Ll 74r/
,,q )A-e
-T-
7
-7 44 ( Tzls7
tl-d hzhl
Please complete all lines inside white bo
a)tl emme
2'7.2
'cw
OWNER OF
11
F/.? .,,1
xes, if possible.
L
MAP, PARCEL NUMBER
(Found on t t mrpt ln lh. Arxtrm.nt & Trrrtlon D.pt)##k,# ?ffi
Dlrectlons to site
from Courthouse
A-za
-a
!i/
"/
-Lr'l)'eo{n^uh
4ofO.1/
D4u
zoN
a_9-64\J4sC,tJA I
ztP
SITE ADDFESS
>n o ) (--)z:)
P-Ls44* )4ao
dL-a)n
,aa "l
(\4
0
5
PERMIT TO:
3c
6),
For Moblle Home
Placement Only
No. ol Tip-outs
-
No. of Bedrms
License #-
Brand
Year
Size
Land Management Dlv. starf can
not be held responsible for
evaluatlons or recommendatlons
based on false, lnaccurate orlncomplete lnlormatlon
Partit
COMMENTS
FOLLOW.lnformation Re quest Onlv
TRS ed l-lYes No I--rso
-Yes No r-rAllowed U
Lot & Block
.srArF EVALUATI)N
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OD P
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4R 7-t t, ) fo-,.-/,
)
Townrhip Rrngr Sction l/a Slclion Trr Lot-
6,ffi Ti,;F Si-q-q- rEiEiidi- -fifGr-
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