HomeMy WebLinkAboutPermit Septic Tank 1987-06-12La e Cou v t tiza"tiotl for'
SEPTIC IX8R[8Xt0NxffBRx[BAt(xREUIEt{ REPAIR
t8
LOT
FOR OFI.TCE USE ONLY
Application/
Permit f
RANCE
02
SECTION
05. 2. I
TAX LOT [Jour oF
850.l
PROPOSED USE OF PROPERTY
Xl nesidential n rndustrral
fleuuricCommercial
BI.OCK
LCCATIO}J ADDRESS STREET CITY ZLP
845 So. 42nd St.S r1 field
CURRENTLY ON
SFD
DIRECTIONS TO SITE
Main St. to R - 42nd - lst hs on L pas! Mt, Vernon Sch.
D;SCRIPTION OF PROPOSED WORK - BE SPECIEIC
SEPTIC ID(gREfiXXqI)(XRqflXXq'M REPAI R
DECI.ARED S VALUE
= OF BEDROOMS * OF STORIES OF E},IPLOYEES I./ATER SUPPLY Proposed
Exist
Oi\NER,S NAME AND ADDRESS (
SOULE, .-p;py' $sv 845 So. 42n, Spr.97 477
TELEPHONE NUMBER
CONTRACTORIS NAI{E AND OSR #
BoYD, Bill 37123 Wheeler Rd., Pleasant Hill 97455 746 5s54
TELEPHONE NUMBER
344 39s2
P:RI'IIT TO BE MAILED TO (NA}48 AND ADDRESS)TELEPHONE NUMBER
I tlAvE CAREFULLY EXAI,IINED THE CoIIPLETED APPLICATIoN FoR PERMIT, arrd do here)r_v certify that all inforaation hereon is true and correct, and that I
have the following legal interest in the property
I flrther certify that any and aL1 work perfomed
pertaining to the work descrj.bed herein, and that
ther certify that registlation with Ehe Builderrs
is noted hereon, and that only subcontractors ed
CHECKED
"HIS
APPI,ICE"ION THOROUGHLY.
Iorru. of recof,d; I cr,rrra,,t prrrchaser; l]authorized agent.
sha11 be done in accotdait,r,, hitlr tL,i o.drrancca of Lane Cowty and the Laws of the state of oregon
No occUpANCy will he na,ie of aii srrricture without the pemission of the Building Division. f fur-
Board is in frrl1 force ;rnd effect as required by ORS 701.055, that if exempt the basis for exenption
employees who are in compliance with ORS 70I.055 will be used on this project. I HAVE READ AND
I 6'lil/g-to-{t
prin
CAREFULLY. YOUR AUTHORIZATION 'tAS BEEN BASED ON THE FOLLOWING CONDITIONS:
el,i.4 W**01 aa"t"" *A/ ,"rLl
6- 1 0-8Date
Install-ation Record Issued? n v""
l/L
ou al qf,qeq
UseI er,ens EXA.t'4rNATroN :Grorp_
COM}IENTS:
Date
No
nor Ae.^se onl rJ.,/ i.tz[ aQ lva d*],
cL,front
! senrterrou: s. r. *_B. P. *
)tr, 9nh;l Arlal nea ln,.€,i0
cL s ide rear
cor'olENTs S
interi"or
Parcel #ParceI
GaLlon
Tank
Lineal Eeet
of l)rainfield
Installation
Specifications:
colrr,"*rsJn t//
ltaximum Depth
of Trenches
READ THIS SECTION
[t pr,aNxrNc,/zoNrNG:
Minimum Setbacks:
Zone Partiti-on #
tn 4rta oP ol!'{rz,^fie-t;'Y
Date
PERMIT BY
COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687.4061,
125 EASTSTH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INE'ORMATION
IGNEE Der ORS .805
LAN
cr4-25 Rg.
?-o**elp
tr
?LJ*H;-
DATD
ACTIVITY INFORfrIIATION SHEET(
Please complete all ltems above dotted line
' ?ri.,:'l,ix:nY{,xl urJ:*
FTLLING our * LTNES wtLL GET you INFoRMATToN oNLy
I
*DArE C-r tC t {7
7/*oPERSON
MAKING
REOUEST
A
CITY *,ror. o( . rr?l$-!CITY
T E L E p HoN E rruq -L-{ 6 f -f5-U-rrouetJ-f 4 3? 5?--TELEPHONE
*pnOpeRTY ADDRES
OR
MAP & PARCEL NUMBER (round on tax maps in the Assessment & Taxation Dept.)
{LE
5o 2
D A dA 7 77
STAFF WILL DETERMINE
-
Zoned Flood Plain
Zoned Flood Plain
Zoned Flood Plain
(2J k)eb
ACTUAL
PROPERTY
OWNE
Tax Lot
-i 5o rlz d
Tofinsh'rp Range
naf ,
Section
/f
Township Range Section Tax Lot
Township Range Section Tax Lot
TOTAL CONTIGUOUS PHOPEBTY lN SAME OWNEHSHIp: ACRES
*REQUESTldescrtbe what you want to /,; t /r J
,4
/Dire ions to site t/ 9zuse ,N Le sf
arrtrruraarrsrrrrrststaff use onlytttarrarrrrur.rara..
Com ments:
Land Management Division, Public works Department 125E.8th Ave., Eugene, oR 97401 phone 6g74061
a r I
Boo
o:
[f : 5 LANH C0UNTY DEFT ENv HGT IIECEIFT + ltl?48? DATE 06{08r
AFF'I-ICANT B0YD, BILL ADDR 3?1?3 tlHEHL-ER RD., FI-EA,SANT HIt-l-
TL* t s0305?t 08501 sullDrv t-01' ttLK
NHI,' BLDG TYPE USH: R BDRI*IS O UNITS OOl STNRIES +T|LDGS OOI F'HONE 9?? 9999'
OUINER NHE SOL'LH, JE.F:HY ADDR 845 S 4?ND ST. SF'RINGF'IIIL.D
CTJDE AIsF'I- Nfi ACT:tCIN DESCHIF"I'ION Sfi F1' L'NI1' (:O.ST VALUA'I'II]N FEH DAY'
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