HomeMy WebLinkAboutPermit Septic Tank 1987-12-14FOR OFT'ICE USE ONLY
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BI,oCK
PROPOSED USE OF PROPERTY
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fleuuri-cCommercial
I ndus tr ial
SaBDrVlsroVpERTiTroN (if applicable)
S/J- AIIAC\\EL LOT./PARCEL
I.,CCATION ADDRESS STREET81b SouAclZ\*7qZLPo
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DECI,ARED S VALUEDEscRrprroN oF pRoposED woRK - BE spEcrFrc U
SEPTIC INSPECTION FOR LOAN REVIEt,I
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OE STORIES I^JATEROF Proposed
Existi
= OF BEDROOMSa+-
NUMBER
!ruMBERIS NAME AND
I EAVE CAREEULLy EXAMINED THE COMPLETED APPLICATIgN EOR PERMIT, a/,J ,l , rrerclr; certify t-hf,t all infomation hereon is true and correct, and that I
have the following legal interest in the property,fu. of recorcl; [] c<,r,:ra.,t prrrchaser; Iauthorized agent.
I f:rther certify that any and all work perfomed/shall be done in -u^ulddir.r-j niLli ti..r a.dlrancc! of Lar,e Couty and the Laws of the State of Oregon
pertainj,ng to the work described herein, and Chat NO OCCUPANCy wj.tl be made of lLl srrircture 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 exemption
DATE
CHECKED THiS APPLICATION
j.s noted hereon, and thaE only subcontractors ed emPloyees who are in with oRS 701.055 will be used on this project. I HAVE READ AND
Date
rnstallation Record rssued? ! v." fl N"
l,taximum Depth
Specifications of Trenches
COM}IENTS:
Date:
COI'lt'lENTS
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UseDPLANS EXAMINATION:
REOU i REDFOR LOAN REVIEt^, NO SPECIAL PTANNINL ASEPTIC INSPECTION
B. P. #
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Type- Grorp-
cot"t}lENTS
Installation
fl pmuxruc,zZoNrNG:
interior rear
Lineal Feet
of orainfield
caLlon
Tank
AUTHORIZATION ITAS BEEN BASED ON THE FOLLOWING CONDITIONS:
Parcel #- Parcel "ir"-Z/k-./
ANITATION: S. I. *
Minimum setbacks, c", fron cr., uid.-
READ THIS SECTION CAREFULLY. YOUR
Partition *
0ot"-(/[ro
Lane County Authorization for
C?G /<-/0
SEPTIC INSPECTION FOR LOAN REVIEt^J
LANE COUNTY DE
Der ORS 4 .805
OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687.4061,
8TH AVENUE, EUGENE, OREGON 97401'l
SEE REVERSE FOR INSPECTION INFORMATION c1,4-25 R%
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STRUCTURES CURRENTLY ON PROPERTY
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