HomeMy WebLinkAboutPermit Septic Tank 1988-09-19?'arT, CflL dY.UH- SPr<(D
-
La,ne Counl y Authori za,t ion
SEPTIC INSPECTION FOR LOAN REVIEI^I
EOR OFFICE USE ONLY
Applica b"a8Permit *
1\]WiiSHIP
18
RANGE
02
SECTION
06 4L
Eour oF
8406
PROPOSED USE OP PROPERTY
Er Re s idential
Cc,nunerc i a1
l-l lndustrral
PubIicaUfe )IOTIPARCTi BI.oCK
IO}I ADD STREET L'I':'Y ZIP
t227 S. 39th ield oR 97478-9501
CURRENTLY
D.scRIPrIoN oF PRoPoSED woRK - Bf, SPECIFTCSEPTIC INSPECTI0N FOR L OAN REVIEt,J
= OF BEDROO!,IS # OP STORIES # OiT UIIPLOYEES I./A?ER SUPPLY Proposed
Exi s ti
O:tl'--R ADDRESS
Rose Site Address
TELEPHONE NUMBER
741-@96
Coutnecton's NAME AND osR f TELEPHONE NWBER
IIESS)
Che.rvl Neu Real Estate g2o2g }rlarcola Roa.d, Springfield, OR 97478-97C
TELEPHONE NWBER3 933-2221
I HAVE CAREFULLY EXAI{INED THE COiIPLETED APPLICATIoN !'oR PERMIT, drld do hi:rel)y certi.fy that all rnfotration hereon is true and correct, ed that I
have the follwing legal interest in the property, Io*tu. of record; l] c<a,"..,,l p,rrchaser;flauthorized agent.
I flrther certify that any ild all work perfomed shall be done in ocuordail.re rilh tl,r o.Cr!)ancec of Lane Cowty and the Iaws of the State of Oregon
Irertaining to the work deicribed herein, and that No occupANcy wiLl he nade of 3ii srrrlcture without the pemission of the Building Dj.vision. I fur-
itrer certify that registration yith the Builderrs Board is in ful.r force and effect as required by oRs 701.055. that if exenpt the basis for exemPtion
is notedhereon, and that onLy subcontractors md employees who are in conpliance with oRs 701.055 will be used on this project. I tlAvE READ AND
CHECKED T1IIS APPLICAIION TROROT'GHLY.
Cl-lCRq L N E,u
NAME (please print)
9-tb-Itrr---;fi'-
YOUR AUTHORIZATION 'iAS BEEN BASED ON TIIE FOLLOWING CONDIT]ONS:
9lt6/88
COM}IENTS:
Date
I pr,aus
COMI'IENTS:
@
No
Date
tr
cL, f.ort- c",
=i
SEPTIC INSPECTION FOR LOAN REVIEt^l**NO SPECIAL PLANNING ACTION REQUIRE D
B. P. *SANITATION: s. I. fl
(;rour, Use
rnstallation Record rssued? f] r"" fl
COI{\ENTS
Parcel size
Minimurl Setbacks:
READ THIS SECTION CAREFULLY.
intertcrr rear
l'laximum Depth
of Trenches
Lineal Eeet
of I)rai.rlfield
callon
Tank
Installation
Speci fications
I pmunrnc/zoNrNG:zone- Partition *- Parcel #.
SIGNEE oRS 456.80s (1) )
OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
8TH AVENUE, EUGENE, OREGON 97401
OFF
E COUNTY D
125
SEE REVERSE FOR INSPECTION INE'ORMATION cL4-2s R*
F
-TFEe?f'tiS-T6-STr
Nnna Girren
DECI,ARL]D ) VAI,UU
r
tr
{
4
a,Cr
Io
3
nt
,,,\
It.
dti
a-rr
Q
{
d
\o sc\q-
s<-o-
\
-,€
[ \+"K I
\_u\.{tolo
kt-
\So\.o o*\ \\o*,**.*A b
)
€$flc-'$Ro="q
Loq'1 s.$\\\t\
Please complete all lines inside white boxes, if possibte.
LOL
not sma a3
t ??1 5.
not 3ama as abovc)
LicGn3r *
MAP, PARCEL NUMBER
(Found on tax map. ln th. Ais3rm.nt & Jlxatlon g.pl)
-Jho#o#4,k%*4!k
7o D
0
L
OWNEBS
N ttLu
1
q llo
"71
ZD
1ql- o6
Bq1
tc ltftrLD
56Zt
*-ffi ;;il ffi rFiiiiiii r"-, L"-i-
ffi- TfiA- $Ei16n- rtr'ltiEii6i- -liiifdi-
U NtrU
Exlstlng Bulldlngs or
lmprovements on
Property
d sor""Ef Barn
El Garage
EI lt/okrile. Home
E Shed
SEPTIC INSTALLED
Yes
Dlrectlons to site
trom Courthouse
d
El tlo
Water District
SITE ADDRESS
ztP
+h L 11 tr
MAIL PERMIT TO:
Zfrt-c
5 k
L
1L For Moblle Home
Placement Only
Brand
No. of Tip-outs-
No. of Bedrms
License #-
Year
Size
Land Management Dlv. staff can
not bs held responslble for
evaluallons or recommendattons
based on false, lnaccurate or
lncomplete lnformatlon