HomeMy WebLinkAboutPermit Field Test & Inspection Report 1974-01-04E/73
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-.EQUEST FOR SITE INSPECTION s.r. #?/-4
$
Yes No
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THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ]SSUANCE OF A FUTURE BUILDING PERMIT'
PLANS OR EXPENDITURES MADE tN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK'
PLEASE PRIl{T
lf Subdiv!sion - Name:Lot #Block #
/7 -4- >{
Township Range Sect ion
<oo
Tax Lot No.Owner of P
No. of Sites
No. of Acres
ate
e rty /d= aas@
z{ aeTotal $ -M
Cash
Yes uTlo
0wnerrs Consent
Owne r Sel Ier
,8 . F. P.a uok -l\
Name
n9 5S
1$)//. u ?a 3
TAlepEoneF
Proposed Use
of Property:
re of App can
x
ilo,"t P
heck
Appl icantrs lnterest B
in' Property: 0ther (SpecifY)
uyer y'Rea I tor {
Joil- 5L.
P roperty ze Legal Access - Road Name Exis
Property Locat ion (D i rect ions) :
When Will Test Ho s Be Ready?
MARK TEST HOLES l^/ITH OUR FLAGS
Location of Test Holes on PropertY
Draw diagram of property showing Iocation of any lan
these I andmarks :
tructures on P rope r ty
roPose ter v
Pub-l ic tz-iist r ict :
r ect v
e
o
!
dmarks and relationship of test holes to
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MAKE CHECK PAYABLE TO: HEALTH AND SANITATION
HAIL T0: LANE C0UNTY BUILDING AND SANITATION DlVlSl0N, 135 E. 6 th Ave., Eugene, 0regon 9/401
c 55-55
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eo5roperty Wi t in 0n
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APPROVED
Engineered Site Modif ication Feasibility:
Poss ible Not Recommended
I
REASON FOR NON.APPROVAL
STATUTORY AUTHORITY
oRS 43t . I 3o and 447.020
oAR 4l-020 Par. I
lnsufficient lot size for
li'd, vidual sewage disposal and
water supp I y.
oAR 4l-030 Par. I
_ Heavy impervious non-
absorptive soil.
oAR 4l-020 Par. I
Water Table above minimum
lE'fe standards.
0ther
r gnatu re
l-t Ll - /4
Date
NOT APPROVED
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BUILDI st TE EVALUAT I ON r_JJLRd aL r
CENSUS TRAC.
Ax LoT 4e
( ) tsuilding Permit Application No.__
11/ si." tnspection ,4'1
( ) Pre-Permit lnvestigation
APPL I CAN
NAI'IE
ADD
PHONE
DATE
LANE COUNTY PLANNlNG DEPART}4ENT NOT NO YES
() ()appl icable
l. Zoning 0rdinance Compl iance ()
()
Zone Ar:--T )2. Subdivision Ordinance Compl iance ()
()
()
3, Requ i red Access
4. Bu i ld ing S ite (Area, Width,
Frontage, Setback)
5. 0ther (see comments)
(
()
()
()
()
()
()()(+-
CO},I}.IENTS:611*<.Dt ?c--1 ,/11-/4 2
BUILD]NG INSPECTION SECTION
6. Plans Submitted
7. Soil Stabil ity (footings)
8. Flood Plain
9. 0ther (see Conrnents)
NOT NO YES NAI'IE DATE
li able
)(
()
()
()
()
)
)
q
d
()
()
()
()
COI4MENTS:
SAN ITAT I ON SECT I ON
Sewage Disposal
Usable Area
Water Supply
0ther (see Comments)
NOT NO
EEFt icable -()
YES
(
DATE
10.
lt.
12.
13.
rr ()l-r1 - 74
()
()
()
()
()
()
()
COM},IENTS:
TO APPLICANT:
il
\FYour Building Permit / Site lnspection:(s Can be approved. /'/tr-7/ € j '( ) Cannot be approved at this tim'e as indicated on item N0.
Questions and further informa
COUNTY PLANN ING DEPARTI.iENT"
above.
tion on items I through 5 contact the Lane-
Questions and further information on ifffi; 5
through l3 contact the Lane County Buildinq and Sanitation Division.
Will be held in this office until you can resolve the problems indicated.
!s being returned.
Your building permit appl ication fee is being returned under separate cover.
LANE COUNTY PLANNING DEPART},IENT LANE COUNTY BUILDING S SANITATION DIVISION
135 Sixth Avente East, Eugene, 0regon 97401 135 Sixth Avenue East, Eugene, Oregon 97401
PH0NE z 342-l3tt ExT. 231 PHoNE: 342-l3l I ExT. 4l I
()
()
()
c55-28
NAME DATE
'. *f" y{
Permit #T,
I - lcl 721FIELD INSPECTION SHEET
Completed By Sanitarian
r,ocation, sect.2L(1_L n. 03 Tax r.ot or Acct. No. 5=OCT
Are prrblic sewers available or nearby? (Dlstance))r'/2 )l\ |
Are there zoning or environmental considerations? 'V Sl_t-
Size of property:t l+ctes
Are other systems in area malfunctioning?
Is there room for future exPansion?h qf-e--a-
Surface feature considerations:(ExpIain)
Slope:c
Flood plain:
PIants:
Rocks:
Low area:
Drainage way:
Streams:
water supply and utilities:
Conmrunity water:
Private water:
water lines:
Iocation:
Gas lines:
I{ells on adjacent properties:
Soil Classification (If Known):
TEST F.:OI,,E RESULTS
#1 Test IIoIe #2 Test Hol-e #3 Test HoIe
0"*/0"r ;r,,L /o*^0'-{o'r Sqo//,-,,o'
t)
Interim Form #6
Is curtain clrain required?
REI{ARKS:
-A
Surname Twp. Range Section Tax Lot Cc Census Tract
cei-pt No.Or^n:erDate
Yes
ers Consent
No
Name
and
Address
FEQIIEST FOR SITE INSPECTION
THIS IS A PRE],TMINAXY REPORT WHICH DOES NOT TNSURE TI{E ISSUANCE OF A FUTURE
BUTLDING PER.MIT. ANY PI,ANS OR DPENDITURES MADE fN REL]ANCE UPON THIS REPORT
ARE AT YOUR OIj'lN RISK!
No. Sites
u
$
No. Acres
TOTAL $
Proposed Water Supp1yhrblic District
Proposed Use of rty
Ur
Y
fs Property Within Oee Mil-e of a ty?
What Ci ?Y No
Obher
Speci-fy
ephone
'v Area
N
ru ures
Sprins Wel-l-
Applicants Interest in Property
Legal Access - Road Name Special Permit Area
Yes No
Property Iocation: (Directions)
See Bel-ow
APPROVED NOT APPROVTD OTHffi
Er:gineered Sit e Modifi-cation Feasi-bility :
Possibl-e Not Recommended:
BEFOBE CONSTRUCTION IS STARTED bring this form to the Building and Sanitation
Division and make applicati-on for a building permit. ff the property i-s a portion
only of a tax lot, a metes and bounds description of the parcel must be furnished.kact specificatlons for the sewage disposal system will appear on the buildingpermit. Two sets of the building plans and plot plan will be required.
LANE COUNTY BU]LDING AND SANITATION DTVISION
135 EAST SIXTH A\rm[UE, EUGENE, oREGON g7t+Ot Authorized Signature
TUTORY AUTHOR]TY. 1+31.130 and 447.ON
F'OR NON-APPROVAL
-O2O Par. 1
Insuffi-ci-ent ]ot size
ewage disposal
er su
vidual s
Heavy impervious non-
VE
'ar. 1
Water table above
1
St
Obher
c55-32 Date