HomeMy WebLinkAboutPermit Septic Tank 1975-09-084:) t/?t
LANE COUNTY utJl[DING
BU|LDING r MH I
PERMIT OR MOBITE HOME-- USE PERMIT
PERMIT NO.a4et-rl
.OWNER MAITING ADDRESS PHONE
CONTRACTOR
Srare
MAILING ADDRESS P ONE
PROPERTY LOCATION _ INCLUDE POST OFFICE
e4'l rtl t{
PROPERTY LEGAL DESCRIPTION - METES, BOUNDS
RANG E SECTI ONtu.3.q * SZ8
CENSUS TRACTTAX LOT NO.CODE
Htesr
EXISTING STRUCTURES ON PROPERTY
't' r',JoN[
APPI..
NAME
&
MAITING
ADDRESS
Sltts
TEGAI ACCESS TO PROPERTY
PROPERTY SIZE - FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connect to Existing Sewoge System I New System I
srnr..tcrunrs ro er er-rrur iuts peRt,ttr rypE coNsrRUCTroN se. FT. F BDRMS vALUATToN
PnroR
SEWAGE DISPOSAT
PUBTIC tr SEPTIC TANK N OTHERE
PLUMBING INSTALTED BY
OWNER fl OTHER: NAME
FEES WATER SUPPTY
PUBLTC tr tr OTHER
BUITDING
WASTE DISPOSAT
PI.UMBING
PI.AN REVIEW
PARK TRAILER
TOTAT
NOTE:hr,
A
l'i
, - 'rtr: I'le:e-sorY Lou'e
County Perrruts.
$__.-
COUNTY BUILDING & SANITATION SPECIFICATIONS
, MIN. SEPTIC TANK CAPACITY
WITH rDlST. BOX: GA[.900
DRAIN FIETD REQUIRED
tIN. FT TRENCH WIDTH FT.OR SQ. FT.
KEEP ALL PARTS OT SEUAGT OISPffiAL S}3TA{ IOO TEET FROH ALL WfLt'sI
TYPE OF STRUCTURE OCCUPANCY ZONE PUBLIC UTIL. EASEMENT
BIDG. SETBACKS FT. FROM CTR. OF ROAD RIGHT OF WAY
lls SIDE INT.
USE CLASSIFICATION
FRONT SIDE EXT.REAR q
AUTHORIZED SIGNATURE _ DATE DATE
H 7
BLDG. PERMIT _ WHITE
OFFICE COPY _ WHITE
COUNTY TAX _ PINK
PLUMBING _ CANARY
BUILDING _ GREEN
SANITATION _ GOTDENROD
Call 687-4065 to schedule oll required inspections. All construc.
tion sholl comply with Uniform Building Code, D.E.Q. stondords
IMPORTANT: for subsurfoce sewoge disposol ond county regulolions covering
plumbing. All buildings require o cerlificole of occuponcy before
being occupied.
(See Detoils on Reverse Side)
(posT THIS PERMTT ON MA|N BLDG. AT SITE)
IANE COUNTY, DEPT. OF ENVIRONMENTAT MANAGEMENT
COURTHOUSE ANNEX, I35 EAST 6th, EUGENE, OREGON 9740Ironv -- C 55 - t3
att
LANE COUNTY ENVIRONMENTAL }dNAGEMENT
Name and Address of Oqrner
PLO? PLAN
Telepltone:-.--'_-_
The building being constructed under this permit will be used for
Date this Property \^las Pu rchased
Do you now, or did you ever own property adjacent to this tax lot? If so, please
list those tax 1ot numbers or draw those properties on the plot plan below'.---
IndicaEe on your drawing the location of.all homes (including rnobile homes)now on
the property, as well as the location of the new building.
Name of Appllcant (if different from owner):
Address
Telephone
Applicantrs Interest: Buyer
M74-99
Map
Tax Lot
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Se11er Agent permlr ll 9,/ 2l -7..-
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BUtLDtNc pERtltT AppLtcArtlr-No" ) /zy -z{
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'I{SPECTION Not
I icable
Zoning 0rdinance Comp I iance: Zone
BLOCK:
CK!D BY:h& , %(t/a>5/
SetbacksffiFront ./ O
Side ExteriorZ-
Setbacks from interior lines:
S ide .{
I
2
3
4
5
Reoui red Access
euitaing Site (Area, }Jidth, Frontage)
0ther (see comments)
J5 TJ2
5U8D
'
y' S
O3s', 9f rar LOT
l-.ri
LOT:
APPL t CANT
DATE
Subdivision 0rdinance Compl iance
c0r{}.rENTS:
No Yes7yffe.()vr8i?() ()
()
()
()
()
PLnNxING OIVISION ACTTON PENDTNG.YES( I No (l APPT=ICAT ION#
BUILDING INSPECTION DIVISION
Plans Submitted
Soil Stabil ity (footings)
Flood Plain
0ther (see conments)
7
8
9
0
No Yesr) TT() ()
() ()
() ()
Not
Aool icable-*-T:r
()
()
()CK!D BY:
DATE
COMMENTS:
WATER POLUTION CONTROL
I I . l{eets Department of Envi ronmental
Qual i ty Standards.
12. 0ther (see cornments)
Not
Aool i cabl e
CKID BY:7r
DATE
COM},IENTS:
f, {T
( ) ()()
TO APPLICANT:
qr&
Your()c()c
Building / Site lnsPection:
an be approved.
annot be approved at this time as indicated on item N0
Questions and furt her information on items I through 5 contact t LANE-
COUNTY NG DIVISION"Questions and further information on items 7
t rou 2 cont ACt thE LANE COUNTY BUILDING AND SANITATION DIV S ION.
urill be held in this off ce unt i you can reso vet eP em s indicated.
ls being returned.
above.
rmit a lication fee is beinq returged LLLdg- sep-araJegqyef-
nri['mEHiA
135 Sixth Ave nue East Eugene Oregon 97401
pnorue | 697_4065
LANE COUNTY PLANNING DlVlSl0N PH0NE: 587-4185
c55-28
Your bui ldin
PLANNING DIVISION
I
NOTE:
CONSTRUCTION MOBILE HOME
APPLICATION FOR:
PLAN REVIEW
Ad
No pERMrr rflr - ,r rssuED rrNfir, THrs ApplrcA?roi.---as BEEN of,ngu tt-* h/ - 7f
sP.V1
zOOWNER
Name s clr
l-r CONTRACTOR
Name
O. S. REG. //
Tvp ection
Subdivision 6
ACCESS TO PROP (Road Name)
Existing Structures on Property:
Property Location - Address/Direct.lons:
Address Ctty zip
Tax Lot 1- code Census Tracta/
Phone
o
l./
t--J-rroperty /oo
g*Jd,
9( /.r 4t, 17,'4 'rf^o
v
e
SEWAGE DISPOSAL: .n (
Slte InspecEion ll l|lfu+al-/' -T-Exlsrlng DLsposal System
Pub1lc
Comunity
or New System Requlred
Name of CoumuniEy or Publlc System
WATER SUPPLY:
Well Sprlng Other € "-l
FEES
Bldg.
Wa6te Dlsp.
P1-umblng
Plan Revlew
Moblle Hone
1Z Surcharge
PLUI'EING:
Installed by Or^mer Other Name
,/O ) , oO PLLIMBING FEES:
of Fixtures Sewage
Connectlon
Water
Connection
PLANS FURNISHED
Signature of Applicant
Fee Recelved By
FACILITY PERMIT
Date:
CASH
PcofEvss YESNO
TOTAI ./oD,oo
Mln. Sep tlc Tank Capaclty_Drainfleld Requ ired - Llneal Feet 16R) u"xinum Dep Eh 3
type of Constructlon Flre Zone Use Classification
Bldg Setbacks - from Center of Road
e Int.
Rieht ot-f Way
ide Exterior (/a ^-Rear \
c55- t2
DATE:BUILDING:
I.ANE COI]NTY DE OF EIWIRONMENTAL MANAGEMENT
DATE
I
G-d
;. I ,osED sEurAGE DISPoSAL SYSTEM RE )
INSTAELER: Complete top part of form to signature and submit both copies with application.
PERI IT NO.z\zt-75
INSTAIIER_I-S_NAI,I=E m JonN Snoox &D,t.Nonrn llrn PlaceI
ng n s Bedrooms BathsV asement Water uPp vYes No Publ i c Other-Li st
Sept i c Tank:
Ft. f rorn wel I Steel tr Concrete l No. Cornpartments Gal. Capacity
I
L
nsi r mens ons: Ft.
th
NAI'IE W. E. lJreHr
HAILING
ADDRESS
Leng th L i nes-Ft .
4 6
ate
e sPosa
width Diameter D h Distribution Box
t er str u On-
e
B
rn
eet rorn
tJ il
ne
Front
Y
Side
No
er Be ou,it 1n
S i gnature
I.,id
T a
F I nes o
t. Between F
T
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ns rUs t
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CERTIFICATE OF SATISFACTORY COMPLETION
For Sanitarian Use 0nly: Date
ln accordance with 1973 0regon Laws Chapter 835, Section 214 this certificate is i
,fr"p*4,/?€o
as evidence of satisfactory completion of a subsurface sewage disposal system at the above
I ocat i on.p. epproyed: System lnstal lation conforms to current standards
I-I 0isapproved: Does not conform to current standards
Remarks:
r an s
LANE COUNTY
c55-1I
STATE OF OREGON DEPARTMENT OF ENVIRONI{ENTAL QUALITY
ure
l ';1 :'{:rP iS TO ASSIST LCCATll'lG
- ) ii' i l'i[ col,\i]ANY Assu'\iES
..ir-rriliiiTY rcR li'iAccLtRAclES'MA--{J_p,.A€J! _
SlXTH ADD|TION TO YOLANDA PARK
SECTION 24,
LAITE
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LANE COUNTY
BUILDING Il
BUTLDING PERMIT
MHN
N\AILING ADDRESS
OR MOBILE HON\E USE PERMII
PERNA\T NO
PHONEPROPERIY OWNER
CONTRACTOR MAILING ADDRESS PHONE
PROPERTY LOCATION _ INCIUDE POST OFFICE
PROPERTY TEGAL DESCRIPTION _ METES, BOUNDS
RANG E SECTION TAX LOT NO CODE CENSUS TRACT
EXISTING STRUCTURES ON PROPERTYAPPL.
NAME
&
MAITING
ADDRESS
tEGAt ACCESS TO PROPERTY
PROPERTY SIZE - FT.
WIDTH DEPTH AREAFOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connect to Existing Sewoge System tr New System !STR UCTU RES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION SQ. FT. # BDRMS VALUATION
SEWAGE DISPOSAI
PUBTIC T] SEPTIC TANK fl oTHERn
PLUMBING INSTATTED BY
OWNER E OTHER: NAAAE
BUITDING
WASTE DISPOSAT
PTUMBING
PTAN REVIEW
PARK TRAILER
(FEES WATER SUPPLY
PUBLIC tr OTHER
TOTAT
cou NTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAL.
DRAIN FIELD REQUIRED
I-IN. FT TRENCH WIDTH FT OR SQ. FT.
TYPE OF STRUCTURE OCCUPANCY ZONE PUBI.IC UTII.. EASEMENT
BLDG. SETBACKS
FRONT
FT. FROM CTR. OF ROAD RIGHT OF WAY USE CI.ASSIFICATION
SIDE INT.SIDE EXT REAR
AUTHORIZED SIGNATURE _ DATE DATE
BI.DG. PERMIT _ WHITE
OFFICE COPY _ WHITE
COUNTY TAX _ PINK
PTUMBING _ CANARY
BUILDING _ GREEN
SANITATION _ GOLDENROD
coll 687-4065 ro schedule oll required inspections. All consfruc-
tM p .RTA N r, i;'i, iH 1."""I tly! lj ! jl [::i : ;x, ::" "ff *; j;1.,3;,':T**
plumbing. All buildings require o cerrificore of-o..uponcy-u"ro..being occupied.
(See Detoils on Reverse Side)
(POST THIS PERMIT ON MA|N BrDG. AT S|TE)
IANE COUNTY, DEPT. OF ENVIRONMENTAT MANAGEMENT
COURTHOUSE I,NNEX, I35 E,AST 6Ih, EUGENE, oREGoN 9740Ironu #655-13
5tID
-
Lane County authori zation for,
SS S'L'I'IY ZIP
)
PTION OF PROPOSED WORK - BE SPECIFIC
1
IS NAME OSR
I HAVE CAREFULLY EXAI4INED THE COMPLETED APPLICATION !-OR PERMIT, ar,d Llo herelry certify t-hat aII j.nfomation hereon is true and correct, and that I
rave the following Legat interest in the property, !or... of record; I cc,ntra.:t plrrchaseri Iauthorized agent.
I frrther certify that any and all work perfomed shal1 be done in ccoldail.:,r wiih the ordrnances of Lane Couty and the Laws of the State of Oregon
pertaining to the work described herein, and that NO OCCUPANCY wi1l" he nade of aLi strructure wlthout the pemission of the Building Division. f fur-
ther cerLify that registralion with the Builderrs Board is in full force and effect as required by oRS 701.055, that if exempt the basis for e
is noted hereon, and that only subcontractors ed employees who are in compliance with ORS 701.055 wj"II be used on this project. I IIAVE READ AND
:HECKED THIS APPLICATION THOROUGHLY.
/-
tlaltr (please'print)SIGNATURE DATE
FOR OFFICE USE ONLY
Application/Permit #
RANGE SECTION TAX LOT nour or
--EL BLOCK
PROPOSED USE OF PROPERTY
Residential
Commercial
[-l rndustrial
Pub I ic
a
ROF2OF EI'IPLOYEES Proposed
Exi s ti
NUMBER
u
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION IIAS BEEN BASED ON THE FOLLOWING CONDITIONS:
fl pnxnrnc,zZoNrNG:zone_ Partition #- Parcel #- Parcel Siz.-
Minimum Setbacks, "", frort-c",.id..interlor rear
COMIIENTS:
trDate
Installation GaIIon
Specifications: _ Tank
# rnstallation Record rssued? n v"= [-l HolJ t_.1
Lineal Eeet
of Dr:ainfield
Maximum Depth
of Trenches
COM}IENTS:
Date:
fl pr,ens EXAMTNATToN:
COM}IENTS:
Use
trDate
PERI{IT APPROVED BY BUILDING OFFICIAL,/DESIGNEE (oer oRS 456.805 (1) )DATF
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DlVlSloN, 687,4061,
J . ,- l2sEASrSTHAVENUE, EUGENE,oREGoNgT4olb5SEE REVERSE FOR INSPECTION INE'ORMATION cL4-25 R*
I saurtatrow: s. r. *_ B. P.
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