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Home My WebLink AboutPermit Building 1979-04-27SUPPLEMENT NO.0003 0l,,lNER BUILDING PERM IT 66uesae rCS S CONTRACTOR Y (rt 168 a SS p 6EE. In PROPERTY ADDRESS (guitd'ing Valuation) +lr t Revj sed ( I Jadd i t'i on [ ]correcti on d ) Prior () Signature of App 1 i cant Fee Received T0TAL Want.pai []amt. due []refund ?)l5.60 amt.dr".....-- Da te- Bl dg. Waste Pl umb. Plan R. 3%sur. -a5.0D rC t o eet{- c74-LL9 LANE COUNTY DE +t' Date lcash llcheck o 44rX) v.fttI .JJA r ]'-l ) il.1 Z (Qol r\Olr1 A ---l- Ox-r SLtyn=<J -Y4JL\L-^-' )( D6B/S?P_ /POST THIS PERMIT ON MAIN BUILDING AT SITE + JOB ADDRESS:2522 s 20tb, ssrt{tf,r..1d, oH CONSTBUCTION PERMIT # i!ti-lj.E!:?! LANE COUNTv DEpARTMENT OF dNVTBONMENTAL MANAGEMENT, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 TRS, TL:1r-O:l-21-43 Ia U2 Subdivision: lhyllLr P*t* This permit for the referenced property is hereby result in revocation of this permit, citation under Setbacks and other conditions of approval must be strictly observed. Violation can provi sions of Lane County's lnfraction Ordinance, and/or other remedies allowed by law Telephone: Telephone: Telephone: Total Construction Value: ction approved this permit APplicant/Address: Owner/Address: Contractor/Address Contractor,s OS # ILrr 1885pff;at) effins &ry ,9trtrrldlcf Water sup ly: PLANNING DIVISION + Bedrooms Zoning: Partitioning + Parcel + lVlinimum required structural setbacks, from: centerline of road, front: side exterior: ; interior property lines: ;rear property line: Special lnstructions: + Plumbing Fixtures:#E Parcel Size ; centerline of road, For information call 687-4394, WATER PoLLUTIoN CONTROL DIVISION Site lnspection +* lnstallation specif ications: lineal feet of drainfield required; max. depth of trenches: Special lnstructions: gal. min. septic tank caPacitY; ks nter lor property lines Edge of road right-of-way Buitd tng foundation Septic Tank TO' 10' 5', 50' Drainfield -T0'- 10' 10' 100'between 8:00 - 9:00 a.m., CONSTRUCTION PE R M rrs/tNSPEcroN D lv tstoN Well other water sources For information call Type of Construction: Instructions: ReLaf$l Group: For plans information call this permit) Fire Zone between 8:00 a.m. and 9:00 a.m., call 687-4065 between 8:00 a.m. and 5:00 p.mons (see back of oo !,gth 6 By: ."II DING - GREEN; PLUMBING - CANARY; SANITATION - GOLDENROD; A & T - PINK - -+inrts to Site: For i 6l!''- L Use Classification: SITE INSPECTION DIsAPPROVED Dar e I NSPECTOR APPRovEo R r !tlnx s FOUNDATION INSPECTION A Reua nx s Ac.qre" 2-9 oqtrq DrsappnovE o F7 Darr lnspecron UU FRAMING INSPECTION APPRovED D Drsrppaoveo D Drrr Rr t-trRx s I tsprcton LATH OR SHEETROCK Appnoveo Rruanx s I NSPECT I ON Dr sappnoveo Dar e I NspEcton F I NAL I NSPECT ION Ap pnov r o N DrsrPpaovso REManxs u.r ,o.*?eD f-f D o^,,_ AV Oc.tTfl'NSPE.T.R q),,t ,^7, CERTIFICATE OF OCCUPANCY Rraov ro I ssuE Ret4a Rx s D Nor Rerov ro lssuE D Dare I Hsprcion ct POST THIS PEBMIT ON MAIN BUILDING AT SITE . r()s hDDFESS2522 N 20th, Sprr.rgfield, OR coNsTRUcTloN PERMIT * LANE COUNTY DEPARTI\4ENT OF ENVIRONTT4ENTAL N'IANAGEI\4ENT, 125 EAST 8TH AVENUE, EUGENE, OREtbii-5746i TRS, TL:17-03-24-43 Tl 112 S'rbdivision: Phylll. ?atl Ipt 2, Dloct 2 T:ris permit for the referenced property i3 hereby-3ppsoved- Setbacks and other conditions ol tpproval must be strictly observed. Violation can .esuli in revocation of this permit, citation under provisions of Lane County's lnfraction Ordinance, and/or other remedies allowed by law. Applicant/Address: Owner/Address: Contractor/Address: Contractor's OS *r Construction approved by this permit BuEch l{ells, 1885 Hrry 99N, Eugene, OR 97402 Gerald Sraofford, Sprtngfleld, OR 97477 Enerald gar{nm{ng Poo1e, l8B5 Hwy 99N, Eugene, oR LtZg4 Total Construction Value: na 97402 Telephone: Telephone: Telephone: 688-1090 747-4663 688-1090 * Water Su PLANT{ING DIVISION +r Plumbing Fixtures:+* Employees: 7Oxl49 IZoning: a61 Partitioning +r na Parcel +* neMinimum required structural setbacks, from: centerline of road, front: 56i - side exterior: o, ; interior property lines: 15, ;rear property line: 26r Special lnstructions: Parcel Size ; centerline of road, WATER POLLUTION CONTROL DIVISION For information call 687 Site lnspection +r o, 56 * lineal feet of drainf . lnstallation specifications: ietd required; max. depth of trenchesr * Special lnstructions:(* replaceoenc): gal. min. septic tank capacity; Replace the dral"nJ.lne removed by the pool e:xcavallon. See plot plao for detall. Do not eonatrucf fllter room cloger than 101 frou new llne. between 8:00 - 9:00 a.m. Setbacks I n ter-ior property I i n es Edge of road right-of-way Building foundation wells, other water sources Septic Tank -T0'-10' 5', 50' Drainfield -T0'-lo' l0' r00'For information call CONSTRUCTION PE RMITS/INSPECTION DIVISION Type of Construction: I nstructions: Relnforclf,g Group: ua Fire Zone: n& Use Classification: , plumblng aad electrlcal Lnspectlona per notea on plaae. Pool For plans information call GB7-3767 between 8:00 a.m. and 9:00 a.m., .Iln Lanb For inspections (see back of this permiti call 687-4065 between 8:00 a.m. and 5:00 p.m. Directions to Site: Eo spfd., uorrh on lgrh ro 2400 block, left to 20Eh Eo ZS2Z. Date lssued: 05-04-79 By, Joh Srueed/lJf Suln pool. Structure8 now on propertys house. +r Bedrooms: ) \ . POST THIS PERMIT ON MAIN BUILDING AT SITE ,Ldg hooarss, " coNsrf,ucrloN PER[4lr # ]: LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVENUE, EUGENE, OBEGON 97401 TBS, TL: r;- Subdivision: ' This permit for the referenced property is hereby result in revocation of this permit, citation under Setbacks and other conditions of approval must be strictly observed. Violation can provisions of Lane County's lnfraction Ordinance, andlor other remedies allowed by law. Applicant/Address: OwnerlAddress: ContractorlAddress: Contractor's OS + il"I"s, 18S5 hmftord, S Swi.mlns P BuEch l GeraLd SmeraI LL294 Total Construction Value Telephone: Telephone: Telephone: Construction by this permit rea TroL on lrfoF€r Water SuPPIY + Bedrooms + Plumbing Fixtures:+ Employees: PLANNING DlVISION Zoning: Partitioning + Parcel +r Minimum required structural setbacks, from: centerline of road, front: side exterior: ; interior property lines: , ;rear property line: Special lnstructions: Parcel Size ; centerline of road, For information call 687-4394, WATER POLLUTION CONTROL DIVISION Site lnspection + lnstallation specifications: lineal feet of drainfield required; max. depth of trenches: Special lnstructions: gal. min. septic tank capacity; Setbacks fiGiior property lines Edge of road right-of-waY Building foundation Septic Tank 10' 10' 5', 50' Drainfield -T0- 10' 10' 100' l.an sstr Wel other water sources CONSTRUCTION PE RM ITS/INSPECTION DIVISION Type of Construction: I nstructions: For information call Group: between 8:00 - 9:00 a.m Fire Zone Use Classification: For plans information cal For inspections (see back between B:00 a.m. and 9:00 a.m., it) call 687-4065 between 8:00 a.m. and 5:00 p.m I of this perm Directions to Site Date lssued: ft 6l!' - By c55-1 3 BLDG.pERMtT-WHITE;OFFICECOPY-WHITE;BUILDING-GBEEN;PLUMBING-CANARY;SANITATION-GOLDENROD;A&T-PINK mo, SB geee, oR 9V402 ) ) k(- Job Address Appl ication for Structures now on the Property LV 1(-Ir If this app 'I ication is for an a cu tu ra td Lane County Code ChaP ter I0 (zoning) and for no owner of record;V-contract purcha-----du1y authori zed to act for the owner, wh Si gnature/Address Te1 eph on" bXTS'-toqo or When permit is ready notify: /l Applicant /-/ }wner Owner Con trac tor Contractor's 0SR# DEPARTIIENT OF ENVIRONI'IENTAL I{ANAGEMENT PSB, I25 EAST BTH AVENUE EUGENE, OREGON 9740I r.t$5:"tsii ..q ffiu$'ki q tal !;,Bffigffiiig6$iiig#,r*rogr.rr1fi[i &4*#;romi$]$iiit /-/i0.ffir#.iiffii /--l :i$ usrtrt$tiii l-r :#ii,b*$rtiii Affidavit: I,hereby certify that this information is true and accurate. ing .it will be used for purposes allowed !v tne State Building code and other purpose. I have the following legal interest in the property: ser; lessee; holder of an exclus'ive option to purchase; ro is knwTeEgeable of this appl ication. Da te /-/ mail z1 Phone Loffi-l(fqOd Plumbing by - torn trac DO NOT WRITE BELOW THIS LINE If Commercial Residential: # of employees --SI test holes ready -Affxistins, /_/ Proposed, //07'72'# #c[1(. -.G,s4 i,EFeii $gg**iffi$ii!tiiiilil{iii|: :filfti::::llunl! mlt, .#,:rEf;,,,,$litEtl,,, l$sSifi Val uati on F 6"0 $ $ Total Valuation:$ at at $$each each/_t /_/*\*\LL3 Received by. Water Supply 6Pr<rrJC-f a,;2 Proposed - Existing y' Year Instal led $ Su btotal TOTAL $ $ 4% State surcharge Plans check fee Change of 0ccupancy $ 37,r*) PERMIT PROCESSING Zone Minimum setbacks Part. #Parcel # , side ffi-; int rea r Date a=e-237 Parcel Si zet, front Corments To be typed on permit By CP& I Type To be typed on permit Grou p Fire Zone Use Classification By Da te PhoneFor plans information cal l (area inspector) Directiops to site (nt Lo4 l0 eg = * 6r , / t sSJ4 Plans to: ,1ro.' r-4r, 7 7 etanning /-/ Pullic Works , Elevation /-/ n/a /7 Address /-/ Facility Permit /_/ Environmental Heal th CP&I I^JPC set(s) 7- set(s) Da te Requ i red Hold Slip to PCC Da te Compl eted Date to PCC -{=a FOR INF0RI'IATI0N about progress of your application call C74.L7L permit Control Center 687_HELp 687-4357) 7.,A+hone t tion, Tax Lot i. /:/ }\t. Ang by z1 PI pu rpose s the fol I ow ho f-thll appl own-----du I pu owner rrl When pe rmit is ready notify:! Appl icant tcCommerc i a l is information is true and accurate.Affidavit: I, --fule-aseprlnil-al lowed by the State Building Code andlication is for an agricultural building it vtill be used for I have ing 1ega1 interest in the propertyCode Chapter l0 (zoning) and for no other purpose. If this app Lane County lder of an exclusive option to purchase;er of record;con trac t rchaser; I essee; , who is knowledgeable o icationy authorized to-act-Tor tne /_/ Contractor !y: /-/ nail Si gnature/Address Job Address Appl ication for /_/ phone Lot -.-- Block _ Ci ty Te1 ephone Contractor's 0SR# Owner Con trac tor Structures now on the property Township, Range, Subdivision PSB, 'I25 EAST BTH AVENUE EUGENE, OREGON 9740I DEPARTI1ENT OF ENVIRONI4ENTAL I1ANAGEMENT Phone Phone /_7 Industrial /_/ , hereby certify that th Proposed use of property: 17 Residential Exi sting _ TOTAL $-- Fee Valuation FeeCodeDescri pti on $ $ $ Check # Received by----- SI test holes ready /-/ Casn I,Jater Supply If Commercial: # of stories Residential: # of bedrooms Sq. Ft. or # of Sites Total Val uati on : P1 umbing fixtures at Sewer/water conn. at each $ each $ 4% State surcharge Plans check fee Change of 0ccupancy Un'i t Cos, t $-_=--- Subtotal SDS: /l Existing, BP # / / Proposed, SI # # of employees -----. # of units Proposed _ Year Instal led App.l ication # Assigned Numbers ?rt. PERMIT PROCESSING Minimum setbacks: Part. #Parcel #Parcel S i zett , s'ide int Comments To be typed on permit By Da le WATER POLLUTION CONTROL Instal lation specifications 5o ,.b Reph"ena^ t gal. tank;ft. of drairrfieli; rnax" depth of trencires; To be on 'it Te1 ephone By Da te Directions to site /-/ srFO Pr ans to' fiB8', - ::i[: ] r-/ CP&I /-/ lv{PC /-/ Pl ann i ng /-/ Public liorks / / Eievation /-/ n/a ! Address /-/ Faci ) i t1, Permi t /-/ Environmental Heal th Da te Requ i red Hold Slip to PCC ila te Comp I eted Da ce 'to PCC FOR INFORI,IATI0N about progress of your appiication call Permit Controj Center 687-HELP (687-4357) or Da te $ $ $ ( b Zone ,) +l^ naa) { a,..s{, ,' /', , DEPARTI'IENT OF ENVIRONMENTAL I1ANAGEMENT PSB, I25 EAST BTH AVENUE. EUGENE, OREGON 9740I .:ffi H*iiE;*fi tsa,iii*.:ilrt:iai,%:79 Job Address Appl ication for i# Structures now on the property '.:Pf,9B+$Sil:::;.U$fi i:::gf ::: :Hf opert$i:+: Arridavit: r, 6^rfef^., L,.,n-tIlZ riS.l.*s';i 11 !ErIrOQ'K! -,t-) /7ii'rt usi.fr.,tsiliit, /-/ _, hereby certify that this information is true and accurate by the State Building Code andal interest in the property: n exclusive option to purchase; z1 [s.t,ffi,FEi.ffiff,.9,tr1If this application is for an agricultural building it will be used for purposes allowed Lane County Code Chapter l0 (zoning) and for no other purpose. I have the following leg owner of record; contract purchaser; lessee; holder of a---V-ady authorized to act for the owner, who is knowled-geable of t-nis application. S i gna ture/Address Te1 ephone 8-or Hhen permit is no fy: M Applicant /-/f7 Contractor !y: /_/ nail /!f phone Owner 6fui,e z1 Phone PhoneCon trac tor z1 Contractor's OSR#PI ng by NI- A '{rr rl I r,ngr - {>t&tV1zdf DO NOT I^jRTTE-BEIOTTrIS LINE If Commercial Residential: SI test holes ready ::i,::l::::,:, ,,h,8€,, mCI#SC$[liit:H*$Srlt.: I.lt,.,.,ur,,,,.*terl:et:::- ,,,#';,of,;,tb i . - :r:::r!:::r:r:r:::,::: - ""- :.$il$:*ll e-Z Existins, BP # l/ Proposed, SI # i*i:i;is.f i.:ilfl $j.t$ii.:., :$fi,lir;iliiEt:l::::i:a*:., l: ijt: .,f,il:iiii .:::.$jl:t+$::. .:$g+ti Val uati on Fee $ Tota l Va.l uati on $$ $ $ 4% State surcharge Plans check fee Change of 0ccupancy each $_ each $ Su btotal TOTAL $ as.m at at/_t /a Water Supply Proposed _ Year Instal Ied Exi sting _ PERMIT PROCESSING Zone Part. # Minimum setbacks t , front t, sta int rea r Comments To be typed on permit {+ By Da te CP&I Type_ Group Fire Zone Use Ciassification To be type don permi t o By Da te PhoneFor plans information call (area inspector) Directions to site /-/ stFo Plans to, 9lll - set(s) I,iPC _ set(s) 1-/ CP&1 /-/ |iPc l7 Planning /*/ Public Works ,Elevation //n/a /7 Address /-/ Facility Permit /_/ Env;ronmental Health FoR INFoRI{ATI0N about progress of your application call c74-L7L Hold Slip to PCC Da te Compl eted Da te Requ i red Date to PCC permit Control Center- 687_HELp (687_4357) # of employees _ $ 44qo Received uv 0AI[O€.O, s a.Parcel #_ Parcel Size t I Proposed use of property: // Residential // Commercial , Industrial /-/ Public ng it vrill be used for purposes allowed by the State Building Code and ther purpose, t have the following'legal interest in the property: /_/ phone -SfP-r,n -, kdc!Ci ty L. Lot Te1 epho ne tdi z1 or I CI on Sect i on Bl ock , hereby certify that this 'information is true and accurate If this application is for an a Lane County Code Chapter l0 (zoning) and for no o Cl ur',sS i gna ture/Add res s /-/ mail Owner Con trac tor Structures now on the property on for Contractor's 0SR#P1 umbing by Job Address \ . A DEpART'IENT oF.ENV*R.i,it4EitTAL .IANAGEt'1ENT nLJ PSB. r25 EAST BTH AVEttuE Y EUGENE, OREGON 97401 Affidavi t: I, (p gri lease print cul tural bu owner of record; contract purchaser; _lessee;duly authorized tract for the owner, who is knowledgeable o ' holder of an exclusive option to purchase; f tni s appl i cation . f-l,rc Da te When permit is ready notify: /l Applicant /-/ Owner Phone Township, Subdivisi Appl i cati Tax Lot # # Descri ption Su btota l /2,5O TOTAL $ Fee Code $ $ $ $ \t3 Total Va uati on : Valuation SI test holes ready # of unitsIf Commercial: # of stories Residential: ; of bedrooms Sq. Ft. or # of Sites each each 4il State surcharge Plans check fee Change of Occupancy Unit Cos t \-\ P l umbi ng fi xtures at Sewer/water conn, at SDS: 77 Existing, 7l Proposed, /'/ Cash /_/ Cnec Rece i ved lllater Supply Proposed _ Existing Year Instal led PERI'1IT PR0CESSING Zone Minimum setbacks t , front Part. #Parcel #Parcel Si ze t, side ; rear &0, Comments To be typed on permit By Da te *i44* ft. of dra.i nfielc; lilax, Jepth of trenches: WATER POLLUTION CONTROL Instal lation speci f ications gal: tank; To be typed on permit C?qe Te1 ephone By C 4 t- Da te Directions to site Pl ans to CP&l _ set(s) I,JPC . set(s ) Da te Requ i red Hcld Si ip to PCC D,l Corrrp l Date to PCC te eted/_/ StFA 1-i C.P&1 / -t u,pc /_ / Pl anni ng /-/ Public Works ,/ / Eievation /-/ n/a /-/ Address /-/ Fact l i ty Permi t / / Environmental Health F0R INFORiIATI0N about progress of your appl ication ca) 1 permit Controt Center 687-HELp (687-4351) Appl ication # Assigned Numbdri /-/ Contractor {l_: (zip) (zio) # of employees _ Fee $ $ (s s $ ) I I ) ) LANE COUNTY DEFT ENV I.IGT HECEIPT APPLICANT EMERALD POOLS DA'TE O4?O??'$ .l 0ss?9 TAXLCIT r ?03?40000000 SUEDIVISION PHYLLIS PARK LOT 2 BLK 2 NEtl BLDG TYFE USE R NCI BDRI'{S OO NCI UNITS OOt N0 STCIRIES N0 BLDGS O0{ CCIDE APPL NO ACTION DHSCBIPTII}N SQ TT UNIT CCIST VATUATISN FEE DAYS 8F BP BF BF LC tO?B?? POOL F,L NO. FIXTURE$: BP BF BP stdlt't P00L r$F'('cl{ NO. CONNHC'IORS : HESHANIf,AL FEE STATE SUftCI{ARGE PLAN CHECH FEH 4.O0 EACH * 4N ssi( ENVH TO]'AL ?5.00 S t ;t.50 10 0 0 0 0 0 SIFO IFI t,'F'C FLAN HLEV ADDR FP C$I{PLETED BY O:'CI'I?? l l l I i I 3?"50 CK rlu[ \3 ) I I Lot ) N.- 150 ,la q .Jo Job Locatlon Pernlt /l Permlt /l Permlt -x8o- NogrH Yr- TRS, TL For Permlt /l Permlt tl- Permlt tl- ForPIot PIan For For For For L Block Vlclnlty Map f-unc6 o JL / &F te Tt ,1r --1 w)) do ttlIoT c-\rl Ul oN : i I I I -l \,,/\),c u.tI, scdc .9 1 'l oJ- el lt t a:t-/F '[i i DITIilII, M D.!8DO TL 8ISTrr| NECORD , Ilrtrll-r C{DLt to9 grrt of for:r toaf.Iftx:r d rrtila both coplcs to Lne Gouat, UfffUf hDr,t tldt D.p.rtDent. '+" .{ IE[rrrnlc'lL tr roEl t7o7-72 nbllc El orh.r-Ltst tl. lrc r1l stri ft I-gtt Ilfii hcrtr Dlrt s D.pth Io.I Gal. Capaci ty Distribution Box :yes [t HoD BCt frCt Pillcrrbqt bclor-r .h lrlIrT lelr ,{ -a? -?e !or Lo Olyrt''tr ra*rtfetfal5lxurdr Utor E Date: i'-: - b- 7 'L- tr Olrggrovd DomAirrkr loC hto to 6rnat Steaderib Strnderde cll - rt -rT \'.-1 Lla- Or. Iti St I I C l(h -w, lr ,l a.!1. ;l l; ! "d I .a L: I a.,E T -'-.--.-\ I !a QQ Dllifr'rg s S.dt tjqr D.pt.. rt {:* , I 6crsl d cctan^rr.oa I'cAnrr t :}u I I de rS ralrr€ ADoll3t PHotr€ 1690 S. 'rAr, 5t. rrorRrr rocatrD{ - t {ctuo3 ro3t s?rct 252?rl. T0thr Spfd, LO' NO cooE ..rs -qACr [cphert lulldc Eltlil,.G S?irCTUtES ON 2tOPtrIy lbne 3 IAII'G ^ES TO PtOfttrY l,:go s. ,fA., St.ll. 2l: " r.r. mo?clrtringflclci0r. 97\77 uDnr 7a OTTTH :Alf a New sv'ir-.] - - {-ro\ECRWSDtrll in3 tfrod - 3:t. - ullGo I n*tal I range ti i el ryrtc; l0 !ub flx o39'oclr : numtxc rlrsrerilo rv _?rrtc =.r,lDxo Plt l/rrl owlrtt orHtt x^xf s{r?aY .. r^slf Darxl3lr*-truaa.G RAx tfvf,w ?li tlI t.E IFICArr'. strll( tllt, cltl(llv TA,. 'IADr.tlt o.st Fr c.L 900 ; t50 l|!XCH - rrtt zol{t| &J ttDo rtort d ro.D WAY u3t ctasstttc^noN5 lor qr.r!^r 7r Put ,'8"-rgs hi.?.!rhair D^ IE John 5::,.:., ItDG. 'trilr - wrillIorrtct coTY - wHm(ouratv t^I - atqaurlt|lc - CAtaAl,r DUrtC[].G - C*tlrat^Nttatloi - cOtDtXtOO Comlruction to -comprly. wifh uniforrn burlding coje cnd ecur.?v regrrlorion5covoring plumoing ond rcwogc disl>orol. Ali bu;lCings regrj,.e o rirrif,t.,reat occuporr<y Sofcrc bcing ociupicd. (Scc Stotemcnt on Reverse Sicie, (ro5T It{S ?EtmlI oN MA|N B[Dc. AT SITE) ta}{t cou]fry, IDo. 3 :laN. Dty., cotrlr Housr, tuGGNr, ORTGON 97.01 "c.r :, C!t- rt _E f\ r7 3 24 ifo. d trdroorlr Conncct to Eri:ting Scwoge System '- Ii I r(, lf lurLY YHta ?ttlr?s2 Fr Ca )oltrl wloll. fr.or so. rr puu.tc ul[, trfscr:N, .,L I arrr{otrtto - oAlI *i.Jr * * t { li TRS, TL Job Location (Street, mile post)- Subdivision Lot- B lock FOR SANITARIAN'S USE ONLY: S'system Approved fl System Disapproved tl Needs Correction COMMENTS: Signature ,TA\Date 4thr YICINITY MAP I e(o P E ulI o FOR INSTALLER'S USE: Trench Depth Filler Depth Below Tile Tank Capacity N/lanufacture lVleasured distance to well from tank from drainfield PI,OT PLAN INSTALLATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this certif icate is evidence as per ORS 454.665 of sat- isfactory completion of a subsurface sewage disposal system at the above location. Return this form to: Permit Processing Section, Department of Environmental lvlanagement, Public Service Building, 125 East Bth Avenue, Eugene 97401 ultrlt- z(, 6 @o 0)LE (r, 5 0) E(oz J' PC(oo,=oo- Sca le: m +o-m oN c55-1 1 ,P ) TRS, T VICINITY MAP Job Location (Street, mile post €x-i ,{,\t ,*^iL Sca le Subdivision Lot- Block FOR SAN ITAR IAN'S USE ON LY: Ssystem Approved E System Disapproved fl Needs Correction Dro;-(i.-tl &l/;*to,^- Lza. I p- t.- al=1oc-t llo* sf**A^r"1. hc 1e<-z-.f f: $*"ouno o? gru*d lof size, *,*[ c7"'e f*/'*t *tr h**r+!/*t+ts eifi 1-ez.{aa<r</4r,i ;e rq *f Lz i-Le /to. i+*t ?<- a.*a D ,, /1?,,rr< *- hn<.<Is l-c ba ls..ts nature FOR INSTALLER'S USE: Trench Depth ller Depth Below Tile Tank Capacity /mr:Manufacturer A(GtuE ?oN. , lVleasured distance to well from tank Mo'from drainf ield PLOT PLAN ,i UJF o *---_-7 6 INSTALLAT RECO D AND ERTIFICATE OF SATISF RY COMPLETION When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat- isfactory completion of a subsurface sewage disposal system at the above location. Return this form to: Permit Processing Section, Department of Environmental Management, Public Service Building, 125 East 8th Avenue, Eugene gl4O1 > ) EN 3N .= €a #Nt\ gN o- uJtr) t-- z (J) \N s \ I \, \) s Ux N a\s ttc s \ LI(o Poc m +o-m o 7 tUL+ ,16 So D[ COMIVIENTS: 0\N I N Ns \ \JtY a0sn:( N F \ 'o *b TRS, TL Job Location (Street, mile post FOR SANTTARTAN'S USE ONLY: fl System Approved fl System Disapproved fl Needs Correction COMMENTS: Si Date: FOR INSTALLER'S USE: Trench Depth Filler Depth Below Tile Tank Capacity - Manufacturer lVleasured distance to well from tank from drainfield PI,OT PLAN Sca le: INSTALLATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat- isfactory completion of a subsurface sewage disposal system at the above location. Return this form to: Permit Processing Section, Department of Environmental Management, Public Service Building, 125 East Bth Avenue, Eugene 974O1 YICINITY MAP ! (o P v l,!t- o o6 0)!!! o) E 0) E (Uz -@PC(E C),= o tu E.f F. z(9 6 o + o- co fcN )i