HomeMy WebLinkAboutPermit Septic Tank 1987-12-08:-///zd- u6d (;,G /R-7
ID La,ne County Authori za"ttott for'
'-7
rlonatr Flvi sti I)tr Sen r{c Svstert
FOR OFPICE USE ONLY
Applicatio
Permit *7F7
1.7 03
IOI.I
24
TAX LO?
600
SJBDIVISION/PARTITION (if appficible)LOTIPAi.{('EL ALOCK
;FOT,()SED USE OF PROPERTY
Gl nesidential
[l cc,uunercial
I-l rndustrral
PubIic
ION ADDRESS S'l'REET (-I,:'Y LLP
1e1d 3L444 Yera Drlve Orercin 97 477 -Sprln
Ilxlgrln Single Fanil Dwellinl
II;rvde ilr Ilarvest J.,,rne on Delrose
PROPERTYSTRUCTURES CU
left on Vera Drive on the rlght Irandrir,h
q;i;l 1. 6rf 76r 'lDESCRIP?ION OF PROPOSED WORK - BE SPECIiTIC
llepair exlstlng sepLic svstemr
DECI.ARED S VALUE
OF BEDROOI4S
na
f OF STORIES
na
H oT. EUPLoYEES
none Proposed
Existing
lVAIEN SUPPLY
Public
O;I.}JER'S NAl,lE AND ADDRESS
Gl-en 'f. Peterson, same as the job address atrove
TELEPHONE NUMBER
j/r 5-9!ol.
CONTRACTORIS NA}TE AND OSR #
S;rrne as a.l)oa'e
TELEPHONE NUMBER
7 h7 -A^l\?
, ra: :1.: .l r)1r''
P:RI\IIT TO BE MAIT,ED TO (NAME AND ADDRESS)TELEPHONE NWBER
S lrre
I I HAVE CAREFULLY EXMINED THE COi4PLETE:D APPLICATION POR PERMIT, dIJ (lo lrr:ri,l)i certrfi, that all rnformatiorr hereon is true and correct, and that I
have the following lega1 j.nterest in the property,flo"n.r of recor<i; f]..,r,rra,.t p,rrclraseri!authorized agent.I f:rCher certify that any and all work perfomed shalL be done in occordal,:,- rii:l; tl..: OrdrnanceE of Lane Couty and the Laws of the State of Oregonpertainj.ng to the work described herein, and that No OCCUPANCY will be made of tr.r srr'lrctrrre Bithout ttre pemission of the Building Division. t io.-ther cerEify that regisiration with the Builder's Board is in fuLl torce dnd efrect as required by oRs 701.055. that if exempt the basis for exemptionis noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 witl be used on this project. I HAVE READ AND
CHECKED THIS APPLICATION THOROUGHLY.
1
,,r
SIGNATUR.E DATE
'? ,"r;
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION ttAS BEEN BASED ON THE
l)l
rear
'r'flo Date:
fl senrthrrox,InstaLlation Record Issued? ! v." fl u"
J.q1,Q:'-'T:-
"4t.t.:!{11l
t't,
Da te
t', - . .).I pr,eus
CO}I}IENTS:
DaLe
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I:+4
COI'1,\lENTS
-/ -/'r
EXA.I4INA TI ON:
lK
/2" 7-6? 7
B. P. f
(;rour, - Use
t'linimr,m Setbacks:
Parce1 #! plaxNrNcrzzoNrNG
FOLLOWING CONDTTIONS:
, Parcel Size
rnstallation , , -7f-6aLlon
specificationst -l' 4-rc.{ .l tanr,-I -t'-,.'/.COIIIIENTS: tA'\'4'*f l. _ l4-rl
Maximum Depth
of Trenches
1!.,,I ,,.-..!f*. ,*i lc,\
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-PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE DeT ORS 805 DATF
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687.4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
r atfr n i, n
RAIIIJE lour oF
ul.Rr;c1tuN5 IU 5M;
NAME (please print)
(lJ-pn 'f. Petersorr
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WATIASTY DTID.'I ArurorY t(f,r
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Lane County Authori za,ttor: for,
Reoair Existing Senti c Svstem
FOR OFFICE USE ONLY
i2ni:i"i'""/3597-F7
t7
RAIIGE
03 24
SECTION
2 600
LOTIPAii( IL BLOCKcable
FFCP')SED USE OP PROPERTY
J-i nes rdential
[l cc,uunercial
n rndustr:.al
f]e,rur:."
('1't'Y ZIP
1444 Vera Drive 97477
STF-EET
t 0r
Dwe11
PROPERTY
l_F
ose left on Vera Drive on the r t handLaner
existi temSCtic
,ION OF PROPOSED WORK . BE SPECITIC
na
IES
na
olr Et'1P
none
I.J^TER SUPPLY
Public Proposed
Exi s ting
same as the job address above
O;INERTS NAME AND SS
Glen T. Peterson
TELEPHONE NUMBER
591
CONTRACTORIS NAME AND OSR #
Same as above
TELEPHONE N1JMBER
82
ove Same
I IIAVE CAREFULLy EXAMINED THE CO'IPLETED APPLICATION !'OR PL:RMIT, arJ (lo htrllJ) certifi, thit aLt infolTatiort hereon is true and correct, and that I
2. 7:8?
DATE
rni
thehave tninterest the ofrlegaIfollowingproperty record COlrt ral cllage r1rSrr..uth zedoritf agenIcertif:rther that and workaI1 sha Ilfyanyperfomed donebe fn dr;r,OI otrCtnances andLane the ofLaws Statethe ofCouty OregoniniLope rta the dework cribed herein thatand NOn9 OCCUPANCY I ht1 oIinade lctrlre thoutwl the of ldinBui-Dipe ml ss 1on I lSlOn I fur-!hetherf,rti-that Eration rh Buithe f1de Svregis 1SBoard fullIN itnforce .t ft ASect re redul oRs 70 o5by 1that et the Ibasxempt for e xemptiasnotedheonreandonthatedu.bcontractors1y who INare a w1 thenployeescompl oRs 055701 1 beI used th 1S ecE.I READHAVE ANDprol
CHECKED THIS THOROUGHLYAPPLICATION
READ THIS SECTION CAREFULLY, YOUR AUTHORIZATION I{AS BEEN BASED ON THE FOLLOWING CONDITIONS:
/z-7-? 7Date:
rnstallatj.on Record Issued? f] v"" f, N"
Date
coltllENTs
I
COM}!ENTS
tr
tr PLANS
of Itr';r i lf.eld
G
c
SANITATION: s. I. #B. P. f
rourl-- use
Lineal Eeet
interlc,r
Partiti-on #Parcel #
Installation
Specifications:
Maximrnn Depth
of Trenches
collrrENrs: No olannins ae-tion reoulred " OA4-
I pnHurNc,zzoNrNG: zone_IIEI_
Mininum Setbacks, CL, front
parcel Size na
rear"", "ido-
BUILDING IGNEE (Der oRs 456.805(I))
OF PUBLIC WORKS LAND MANAGEMENT DIVISION,687.4061,
EAST 8TH AVENUE, EUGENE, OREGON 97401
LANE COUNTY
SEE REVERSE EOR INSPECTION INT'ORMATION ak-zs R*
= OF BEDROOMS
Gleu T" Peterson
NAME (please print)
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(il,r*, ACTIVITY TNFORMATION SHEET
*DArE /LJ 01 t87
*6le,o t,9fi
Pleaso complete all ltems above dotted llne
' tff ,i:,*:i:,Tr.Il aY:'i'i*
FILLING our * LTNES wtLL GET you INFoRMATIoN oNLy
ACTUAL
PROPERTY fiztl g
ATE_Z\P-,
MINE
-
PERSON
MAKING
REOUEST
ADDRESS ADDR
TELEPHONE IELEPHONE
{cpnopeRTy ADDRES
OR
MAP & PARCEL NUMBER (round on tax maps in the Assessment & Taxation Dept.)
I
Townshlp Range Section Tax Lot lain
Township Range Section Tax Lot Zoned Flood Plain
Township Range Section Tax Lot Zoned Flood Plain
TorAL coNTlcuous PROPERTY tN SAME owNERSHtp: ACRES
*REQUESTlaescribe what you wanr to do
Dire ons to s e
arrr.arrrarrarfrrattstaff use onlytttrarf.ur.r.r.urrru
Com ments:
Land Management Division, Public Works Depailment 125 E. 8th Ave., Eugene, OR 97401 phone 6g74061
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