HomeMy WebLinkAboutPermit Septic Tank 1991-07-16Ale^Qt
PERMIT #
SEPTIC SYSTEM VERIFICATIOI,J
REOUEST
FOB:
sldes ol thls appll
A
caref ully that all lnformatlon ls true and
READ CAREFULLYI Your Authorlzatlon ls Based On The Fotlowl Condltlon3
APPROVED BY:DATEFEES DUE: S
CALL FOR INSPECTIONS (SEE BACK OF FOBM FOR
SEPTIC permlts are good for one year. ALL other permlts expire atter 180 days unless inspectlons are current
TRUCTTONS) 687-4065
V
ELLIS REALTY, 707 MAIIT STREET, SPRINGFIELDI OREGON 97477L
VIOLATIONS
SATBACKSANDOAHERCONDMONSOFAPPROVALMUSTBBSTRICTLYOBSER,VBD. VIOLATPNCAIYRBTITJLTINRBVOCATIONOFTI{IIIPBRMIT.
CITATIONS MAY BB IISITED UNDBR lHB PROVISIONS OP LANB COITNTY'S INFRACTION ORDINANCts ANDTOR CIHER REMEDIES ALLOWED BY LAW.
A MIMMUM OF AT LEAST 24 HOURS ADVANCE NOTTCE MUST BE GrVEN FOR TNSPECTTON REQIJESTS
Ilave the following information ready when you call: 6874Ms
Permit number - Job address - Type of inspection required - When it will be ready
Your name and phone number - Any special directions to the site
powERroBNrERr.rpoNLAND. "**m*f.?,518i.#3FHmX*tiH&!"iffi"ffiHBHfi1g?-.r "*oFrHBrRFLNcrroMr,MAy
ENTBR I,'PON ANY LAND AND MAIG EXAMIN/TTIONS A}'ID SURVEYS AND PI-ACB AND MAINTAIN THB NBCBSSARY MONI'MBIT5 AND MARKERS TIIERBC'N.
REQI.IIRED INSPECTIONS
FOTINDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
LJNDERGROIJND PIPING INSPECTION: To be made after all undergound piping has been installed, prior to any backfill.
CONCRETE SLAB OR UNDER-FLOOR INSPECTION: To be made after all in-slab or under-flocr building sen ice equipment conduit, piping
accessories and other ancillary equipment items are in place but before any concrete is placed or floor sheathing installed, including the subfloor.
ROUGH MECHANICAL INSPECTION: To be made after all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPECTION: To be made after all plumbing rough-in is in place, prior to being covered.
FRAMING INSPECTION: To be made after the all framing, fire blocking, bracing and roof are in place and aU pipes, chimneys and vents are complete
and the rough elecrical, plumbing, and mechanical inspections have bee,n made and approved.
INSULATION INSPECUON: To be made after all insuluion and vapor barriers are in place, prior to covering.
LATH AND/f,R GYPSUM BOARD INSPECTION: To be made aft€r aU lathing and gypzum board, interior and exterior, is in place but before any
plastering is applied or before gypsum board joints and fasteners are taPed urd finished.
ADDITIONAL INSPECTIONS MA-Y BE REQIJIRED, such as but not limited to;
BLOCK WALL: To be made after reinforcing is in place, but before any grcut is porned" The inspection is required for each bond beam pour. There
will be no approval until the plumbing and elecrical inspections have been made and approved.
FINAL MECHANICAL INSPECTION: To be made just prior to the structrre or remodeled area being occupied and prior to operating amy equipneot,
FINAL PLUIvIBING INSPECTION: To be made just priu to the building, structrre or remodeled uea being occupied.
FINAL BITILDING INSPECTION: To be made after finish gadins and the building, strucure or remodeled area is completed and ready for occupancy.
MOBILEA{ANLTFACTURED HOMES: An inspection is required after the mobile home is connected to an approved sewer or septic
system, prior to covering sewer or water lhes, for setback requirements, blocking, tiedowrrs and plumbing connections.
Footings and piers to comply with State foundation requirernenu for mobile homes or as recommended by the manufacturer.
Minimum finishd floor elevation shall be certified when required by Floodplain Manageme,nt
Tiedowns, if required, shall be instdled and ready for inspection within 30 days after occupanry. Tiedowns shall be installed per enclosure.
APPROVAL REQUIRED
No work shall be done on any part of Ore building or structure beyond the point indicated in each successive inspection without first obtaining the
approval of the building official. Such approval shall be given only after an inspection shall have been made of each successive step in the constnrction
as indicated by each of the inspections required.
APPR,OVED PLANS MUST BE ON TTIE JOB SITE AT ALL TMES DURING WORKING HOIJRS.
TrIIS PERMIT WILL H(PIRE IF WORK DOES NOT BEGIN WTITIIN I8O DAYS, OR IF WORK IS STOPPED OR ABANDONED FOR MORE THAN lEO DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF TIIIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PASI THE POINT OF REQUTRED INSPECTTONS WILL DO SO AT THEIR OWN RrSK.
Your signature on the front of this form verifies the following: I HAYE CAREFULLY EXAMINED THIS COMPLETED APPUCATION md do
hereby certify ttrat all information hereon is true and correct, and that I have a legal interest in the property as owner of record or authorized agent. I
further certify that any and all work performed shall be done in accordance with the Ordinances of Lane County and the laws of the State of Oregon per-
taining to the work described herein. I further certi$ that if I am not the owner of the property, my regisEation with the Builders Board is in full force
and effect as required by ORS 701.055, and that if exempt the basis for the exemption is noted hereon, and that only subcontractors and employees who
are in compliance with ORS 701.005 will be used on the job.
SUBSURFACE & ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
When subsruface construction is complete, the permit holder shall notify the County Land Management Division by submitting the installation record
form. An inspection will be made by a qualified sanitarian. If construction complies with all rules a certificate of completion will be issued to the permit
holder. If construction does not comply with rules, the permit holder will be notified, and all corrections shall be made before a certificate of completion
will be issued. Failure to meet satisfactory completion within the alloned dme constitutes a violation of ORS 454.605 to 454.745 and this rule.
SUBSURFACE SEWAGE DISPOSAL SETBACKS SEPTIC TANK DRAINFIELD
From: Interior property lines l0' 10'
Edge ofroadrighrof-way l0' l0'
Building foundation 5' l0'
Wells or other water sources 50' 100'
Please complete all lines inside white boxes, if possible.
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OWNEB OF PROPEBTY (iI
OWNEBS ADORESS (if not samc st
CITY
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Townehip Fange Scction 1/4 Scclion Tax Lot
Township Rangc Scction l/4 Scction Tax Lot
MAP, PARCEL NUMBER
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Exlstlng Bulldlngs or
lmprovements on
Property
IFI House
El Barnl-l Garagel-I Mobile. Home
EI Shed
SEPTIC INSTALLEDElYesl-I No
Water District
SC,(6
Directions to site
from Courthouse
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SITE ADDFESS 77'lIAIh
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u)dL^MAIL PERMIT TO:Nw R'r
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No.
For
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Brand
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Year
Size
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Land Management Div. stalf can
not be held responsible for
evaluatlons or recommendations
based on false, inaccurate or
lncomplete lnformatlon
0a *n_ gna;fze
Lane CountY Authori zatton'
dQ G'4
fon
SEPTIC INSP CTICN FOR LOAN REVI
L7
e /PtT .'-l:.
POR OFT'ICE USE ONLY
l::*i:"i'""'/f,a 0 -+/
T^DI LOT
115
sEcTlolr
24.3.4
FAIIGE:sHlP
03
Br-ocx
'FCT..I)SED
USE OF PROPERTY
K nesrdential f rndustrral
I ruuricC(,n.mercia1
LCCATION ADDRESS STIiEET
2490 North 16t.h Stleet. SPringf
Z7Pr-'I':'Y
a/iel-d Or eg on 77q 7 7- lcfj
dweIlExistf.
Off Mohawk Road or l9th street turn left, go to HaYden Bridge Road,turn right on North 16th
Street tn ardto Bill Medford s
SEPTIC INSPECTION FOR LOAN REVIEl^l
OF PROPOSED WORK - BE SPECIFIC
Proposed
ExistiPublicna
OE
na
OF
na
TELEPHONE NUMBER
7 46-27 03
NA!'IE AND
Same as the ob address aboveJack 0r Gloria Bradford
TELEPHONE NT'MBER
Same
,s waue AND OSR #
the
7 26-0825Pleasant Hill85815 Edenvale RoadJanet Mitzel ,Oregon 97455 -
t
correctand and thathe reonoIl truerh1f oma ti.,!o ccPERMPORaIJhr- r!lrt tifyAPPLICATIONTHECOY,PLETEDTIAVEICAREFULLY
zeauthori d agentrdrC(,I r,_ilrrchaseofrecard G-'1E-JIanttheinterespropertyf]o...aveh foI}the Iegalwrn9 onIawsthetheofStateofoLaneandOre9t i:.:llance 5 CoMtyndaI..Ishal donebeworkallrf omedthatsdPeanyf:rther u-certify Bui Divisiontne1din9ofrct*iirre thout !heIIropemissj.onNOOCCUPANCYhere in thatanddescribedworktheto ribasthesforpertainj.ng 055701 tha t exempfa5ctredoRsexemPtan.lf orce e fe recul byBoalnISul1Buithedersvithcertitherthat READ}IAVE ANDfyregisLrationth is ct IusedbeonoRst|.701 projewtarewhocompliance1nedenployeesj-s noted hereon. and that only subcontractors
CHECX'D THIS APPLIC}TION THOROUGRLY.
YOUR AUTHORIZATION '{AS BEEN BASED ON THE FOLLOWING CONDITIONS:
==-=- -Z Pa:+-i+-i.n A- Palce} #- Parcel Sizefl plexnrnc,zzoNrNG:
I'linlmum setbacks , t",c", .ido interr()r re ar
SEPTIC INSPECTION FOR LOAN REVIEI^J--NO S PECIAL PLANN ING ACTION REQUIRED
cor'!\1ENTS
Date:6-29-88 RLH
B. P. 1t Installation Record rssued? f, v"= fl N"! snsrterrox
InstaIIa tion
s. r. il
Gallon Maxin\:m DePth
of Trenchessoecifications: Tank
fl pr,axs
Date
(;Use
CO!!.IENTS:
SEE REVERSE FOR INSPECTION INI'ORMATION cL4-25 RU
Dale :
E COUNTY D
r oRs 456 (1) )
oFPUBLICWoRKsLANDMANAGEMENTDIVISIoN'6874061'
1 EAST 8TH AVENUE, EUGENE, OREGON 97401
READ THIS SECTION CAREFULLY.
Janet Mitzel , .
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