HomeMy WebLinkAboutApplication APPLICANT 1/28/2022City of Springfield SPRINGFIELD
Development & Public Works _
225 Fifth Street
Springfield, OR 97477
Accessory Dwelling Unit (ADU) - Type I -OREGON
Project Information (Applicant: complete this section)
A licant Name: Catherine Henry, TTEE Phone: 303-990-2114
Company if applicableyGrow Emerging Companies LLC 401K Plan Email: Chenry®grow-ec.com
Mailing Address: 54850 McKenzie River Drive, Blue River, OR 97413
Applicant's Rep.:
Phone:
Company:
Email:
Mailing Address:
Property Owner: Catherine and Mark Henry, TTEEs
Phone: 393-990-2114
Company: Grow Emerging Companies LLC 401K Plan
Email: Chen raw-ec.com
Address: 54850 McKenzie River Drive, Blue River, OR 97413
ASSESSOR'S MAP NO: 1703273401602
TAX LOT NO(S)-
OS -Pro
a Address: 1025W. N street, Springfield, OR 97477
Property
Size of Property: 1.1 Acres ❑x Square Feet
Type of ADU: xConversion of part of house (describe existing use) was guestliving area in church
(check one) _Conversion of accessory structure (describe existing use)
_Addition to house _New detached dwelling
Zoning of Property: _Low Density Medium Density _High Density Residential
Signatures: Please si n and print your name and date in the a ro nate box on the next a g.
PropertyRequired
Associated Cases:
Case No.: � �\--DDDO z0�-rtyp\
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Datedb
Reviewed : � )
Application Fee: 16)
1L,�2�i
Technicaf'�
Postage Fee: 0
TOTAL FEES: 1 0o I PROJECT NUMBER:
Revised April 3, 2018 Sandy Belson page 1 of 4
Signatures
The undersigned acknowledges that the information in this application is correct and accurate.
Applicant:
�eL71� P L( rI Z iil w , M7e Date:
Signature
Ca t�P ne_ 4e ✓l rt TrEE Gvo n/ �ry pp I C Ce pan leS Lf G yol l�
Print�J �J
If the applicant is not the owner, the owner hereby grants permission for the applicant to act in his/her behalf.
Owner:
Date:
Signature
Print
Revised April 3, 2018 Sandy Belson page 2 of 4
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LANE COUNTYPUBLIC WORKS
Decommissioned Septic Tank Certification
3050N. DELTA HWY, EUGENE, OR 97908
If you are connecting to an area -wide sewage collection system or you are replacing your septic
tank, please don't forget to properly decommission your existing septic rank. An unattended
and forgotten septic tank can become a serious hazard. Oregon regulations require you to
property decommission the septic tank as described below.
Oregon Administrative Rules (OAR) 340-71-185 Decommissioning of Systems.
1. The owner shall decommission a system when:
a. A sewerage system becomes available and the building sewer has been connected
thereto, or
b. The source of sewage has been permanently eliminated.
2. Procedures for Decommissioning:
a. The tank(s), cesspool or seepage pit shall be pumped by a licensed sewage disposal
service to remove all septage
b. The tank(s), cesspool or seepage pit shall be filled with reject sand, bar run gravel, or
other material approved by the Agent, or the container shall be removed and properly
disposed.
To ensure the above referenced standards are met, please complete this form and submit it to:
Lane County Onsite Wastewater Program
3050 N. Delta Hwy
Eugene, Oregon 97408
Township Range2,Z Section_C2] 114 Section — Tax Lot .CA Oa .
Site Address: 1025 i A) 0 5A S O r N nAA Vek1 C) K 9 -1 Lt -1 -7
Property Owner Name: I' 10. r� H e n r�f
The septic tank to ad at the above refere )ced property was pumped of sludge on I -Z?- 2 2
�(�� (Date)
by ./ `� 1----- License # R 1— 917 .
(SignaWre of l.ieenaetl GOWalor)
The septic tank located at the above referenced property was then backfilled with sand or clean
bank run gravel on 1 -G 1-4Z, after being pumped of sludge.
Signature: �2
LANE CG. STD REV 09-10-12 BOC
LAND MANAGEMENT DMSION I PURLIC WORKS DEPARTMENT/ 3050N. DELTA UW 1 FUME OR 970081 FAX 541 Gr2-3907
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