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HomeMy WebLinkAboutPermit Field Test & Inspection Report 1974-01-04E/73 r se only Catl ce w -.EQUEST FOR SITE INSPECTION s.r. #?/-4 $ Yes No c T S c rm AAr 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 , N C Zle,rJ-rruzz b n4/d&av) /4./.D z(z q x ,q4e-tz at G*zog\2{/ - /'ra e . 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 ty es j/ l.lhat C i ty eo5roperty Wi t in 0n <>< I 0 !0i P- I 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 c -+4 1t1o "o "./ ho[", | 1 qfLr\ c>f+e-r f ), (') 6 t,t-{ c L ( II I .\ clt^o/ ot l)/tv en:. o,-,7 1t^"" \tr.-,. i lA(\ \\\ rc/gfl, 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