HomeMy WebLinkAboutPermit Building 1974-04-15Por
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Telephone #
Proposed Use
of Property:
?4,ry X H&;
Property S i ze ga
Yes No
of Property Ownerrs Consenl
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Lot # 2l Block # /
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6/73 REQUEST FOR SITE INSPEC'
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE BUILDING PERHlT.
PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK.
t1 - 3 -21 PtE PRI T
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No. of Sites
No. of Acres
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$
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$Tota I
Cas h
Check {
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LJhen W i I Test Holes Be Ready?- /5--
I1ARK TEST HOLES I./ITH OUR FLAGS
Location of Test Holes on PropertY
Draw diagram of property showing I
these I andmarks :
nt Seller
App I icantts lnterest Buyer Rea I tor
in Property:0ther (Spec i fy)
ame st ng tructures on rope rty
te
tion of any Iandmarks and relationship of test holes to
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owner X
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Prop erty Locat ion (D i rect ions) :2'? ?D ,l/ortl 23 <D s/'
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MAKE CHECK PAYABLE TO: HEALTH AN
MAIL TO: LANE COUNTY BUILDING AN
c 55-55
177'
ANITATION
ANITATION DlVlSlON, 135 E. 5 th Ave., Eugene, Oregon 97401
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District:
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APPROVED NOT APPROVED REASON FOR NON-APPROVAL
STATUTORY AUTHORITY
oRS 431 . I 30 and 447.OZO
OAR 4l-020 Par. I
lnsufficient Iot size for
liilfvidual sewage disposal and
water supply.
OAR 4l-030 Par. I
_ Heavy impervious non-
absorpt ive so i I .
oAR 4l-020 Par. I
I,/ater Tab le above m in imum
l G[e s tanda rds.
0ther
Aut r tze i gnature
te
St emds u.-\tY\ r<lu\rerm,x\
for SD>,
Engineered Site Modification Feasibil ity:
Poss ible Not Recommended
EGiLD ING S iTE EVALUAT ION
Building Permit Appl ication No.__
S i te tnspect ion 7q -22 A
Pre-Permit lnvest igat ion
:l.s /, a s2Tl
/.2-
TAX LOTR
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PLI
NA}4 E
ADDRESS
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PHONE()
LANE COUNTY PLANN ING DEPARTHENT NOT
DATE
NO YES DATE
iEEl icable -r)
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2.
Zon ing Ord inance Compl iance(zone4ra-r -lSubdivis ion 0rdinance Compl iance
3. Requ i red Access
4. Bu i ld ing S ite (Area, Width,
Frontage, Setback)
5. 0ther (see comments)
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CO},IHENTS:
BUILDlNG INSPECTION SECTION NOT NO
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YES NA}tE
6. Plans Submitted
7. Soi I Stab i I ity (foot ings)
8. Flood Pla in
9. 0ther (see Connnents)
COHI'IENTS:
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()
()
()
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)
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()
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SAN ITAT ION SECT I ON
Sewage Disposal
Usable Area
I'Iater Supp I y
0ther (see Comments)
aool icable--rr() (
NOT NO YES NAI'18 DATE
10.
lt.
12.
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CO}I}4ENTS:
TO APPLICANT:
Your Building Permit / Site lnspection:
u-q g? N can be approved.
( ) Cannot be approved at this time as indicated on item N0.above.
()
()
()
Questions and further information on items I through 5 contact the Lane-
COUNTY PLANNING DEPARTMENT. Questions and further information on items 6
through l3 contact the Lane n Buildi and San i a D iv is ion.
Will be held in this o
ls being returned.
Your bu i ld ing perm it app I icat io n fee is being returned under seParate cover.
ce unt you can reso vet P ems tn cated.
LANE COUNTY PLANNING DEPARTHENT
| 35 S ixt h Avenrie Eas t , Eu gene , 0 regon 97401
PH0NE z 342-t3tt ExT. 231
LANE COUNTY BUILDING E SANITATION DIVISION
135 Sixth Avenue East, Eugene, 0regon 97401
PHONE z 342-l3ll EXT. 4l I
c55-28
r
NA/'IE
I
DATE
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Permit -7+q>\
Loeation:sectRtl r.lf nS
FIELD INSPECTION SHEET
Completed By Sanitarian
Tax Lot or Acct. No.J i
\ere public sewers available or nearby? (Distance)
Are there zoning or environmental considerations?
Size of property , t\ h-. \U.G .S
Are other systems in area malfunctioning?N\O
Is there room for future e:<pansion?
Surface feature
Slope:
con
CT
siderations: (Explain)
Flood plain
Plants:
Rocks:
Low area:
Drainage way:
Streams:
water supply and utili
Conununity water:
Private water:
'R'nnnbovJ
Location:
Water lines:
Gas lines:
!{e11s on adjacent properties:
Soil Classification (If lhown) :
TEST HOIE RESULTS
#1 Test IIoIe #2 Test HoIe #3 Test Holeo"s Sltrt, \sooc'.0"o"
Is curtain drain required?
REMARKS:
fnterim Form #G
1
Surname
Receipt No.
Yes
REQUEST FOR SITE INSPECTION
THIS 15 A PRETIMINARY REPORT WHICH DOES NOT INSURE TIJE ISSUANCE OF'A IUTURE
BUILD]NG PERTtrT. ANY PI,ANS OR IXPHIDITUHES MADE IN RELIANCE UPON THIS REPORT
ARE AT YOIIR Olr{N RISK:
No. Sites
No. Acres
TO{TAL $
No.Proposed e of Property
Property ZE Ur
Yes
sting Structures Is Property Wlthin Mile of a City?
cit Y No
posed Water Supply Obher
SpeclfyPubl-ic Di-strict Sprine Wel-1
s Consent
No
Name
and
Address
$
$
Area
OwnerDate
erest in PropertyApplicants
Special Permit Area
Yes No
Legal Access - Road Name
Property locati-on: (
See Below
APPROVED NOT APPROVED OTHER
Er:gineered Site Modification Feasibility:
possible Not Recommended:_
ffiFORE CONSTRUCTION 1S STA-BTED bring this form to the Building and Sanltation
Division and make application for a building permit. If the property ls a porti-on
only of a tax 1ot, a metes and bounds descrlption of the parcel rmrst be furnished.kact specifications for the sewage disposal system r,rriIl appea.r on the buildingpermit. Two sets of the building pfans and plot plan r^riII be required.
L"A.NE COUNTY DEPT. OF ENVIRONMENTAL MANAGEMENT
135 EAST SIXTH AVE\[UE, EUGENE, 0Rm,ON g74ot Authorized Signature
ATUTORY AUTI{ORITY. l+3l.L3O ar.d I+L7.ON
IOR NON-APPROVAL
1
cient l-ot size
ewage disposal
Insuffi
individual s
water
Heavy impervj-ous non-
Water table above
bs
A1-O30 Par. 1
OLher
c55-32
Date
Trp. Ha"ge Se"tio. Tax - dofffi
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