HomeMy WebLinkAboutPermit Septic Tank 1985-04-04Gi@-
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ICE USE ONLYLaneCountAuthoriza,ttotl of:Applicatio
Permit *",r54-rs
PROPOSED USE OF PROPERTY
Xlesidential
T commercial
n rndustrial
fleruri..
I /
LOT
W irr ,g?"r2 Qryrzi.,CCATION ADDRESS
2f 22ru I I
BE SPECIFICOFED DECI,AP.ED 5 VALUE
WATER SUPPLY
sting' oE BEDRo,,.7'
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TEBDPHONE NI'MBERJffi€
TEITPHONE Nt'!,tBER\,4tn€S AND
€
certify that all infomation hereon ls true and correct, and that I
purchaser;f,authorized agent with evidence of authority attached.
. the ordj-nances of Iane Couty and the Laws of the State of Oregon
strrrcture without the pemission of the Buj.lding Divislon. f fur-
iher certify that registration with the Builder's Board is in full force and effect as required by oRS 701.055, that if exempt the basis for
is noted hereon, and that only subcontractors md employees who are in compliance wj-th ORS 70I.055 will be used on this project. I HAVE RE"AD AI'ID
*3#Fr-
HAVEI
thehave followi.ngrf:rthe ce!tify
to the.ngpertaini
CHECKED THIS APPIJICATION THOROUGHLY.
READ THIS SECTION
q.Ltlaft pr.ewnrnc/zoNrNG:
Date:
Specifications:
PLANS EXAI'IINATION:
COMIIENTS:
Date:
YOUR
Minimum
Installation /m
COMI{ENTS
Date
UseGroup-
front
,r,S...ro'r€cord rssued? fl x"" ! N"
cL,
SANITATION: s. I. *B. P- #
EN BASED ON THE FOLLOWING CONDITIONS:ZATION I{AS
?tl '
interlor rear
callon
Tank
Lineal !'eet
of Drainfield
Parcel * Parcel
lraximum Depth
of Trenches
Partition #
c". rid.,
<) , zJ:{-{-KJ-7\- ZpeEtytrr aF-pEd6o
LANE COU
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NPY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT
125 EASTSTH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INTORMATION
DATE
DlvlS|ON, 687.4061,
cL4-2s R*
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sErBr,cKS AND or*ER .",rr,ffiro'lnp,h''tr*r,""f,i^r.ri, or.r"uro. vrolArroN cAN REsulr i" ^.ro-c;:roN oF :Irs PE&i]IT, qTATTON qLqJ{PrlVISIO.,r{.1",gt LANE :OUNry'5 TNFRAC?rON ORDII-ANCE. AND,/OR OTHER
REIIEDIES ALLOWED BY LAW.tr
:-_:,F \.
!iHEN RE.\Dy FOR II'SPECIION, CALL 687-{065. .\ }1INI}lU}l OE AT LEAST 24 ITOURS ADVATiCE NOTICE FOR INSPEC-
f16I-TEa!-ESTS-li0ST-rE-ttvrxl---trii6-TEe tollowing information readyi permit nunber, job address, type
of inspecE.i.on, wfrm it wif be ready, your nane and phonL. almber, and any spec.j"al direcjiorrs to site-
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BUILDINGDMSION: i '1
REQUIRED INSPECTIONS-:
\
l. Foundation lnspectron: To be maqe after trenches are eficavated and forms erected and when all
AatsGTs f#-TIE--t-andation are delivered on the .rob. iJhere concrele fron a c&ntral nixi.ng
plant (comonly cermed "tr-an9iL mixed") is to. {e used, naterial" n?.q not be on the job.
2, Concrete Slab or under-iloor Inspe;'tim: To be made after alI iF-s1.b or rnd".-fIoor building
5ilvireqilpmmt,-EonEult, prp-1i{-EEEEssorres, and other ancillar}'equi.pment items are inplace but before any concrete is poured or floor sheathinq instalLed. including che subfloor.
3. Praming & rnsulation lasg-eglpl!: To be made after the !oof, aLl framing, fire btocking. and
bra-Ing are in pl"E-e ano aII piopes, f ireplaces, chimrleys, and vehEs ale coeplete and al.l, rough r\:'
electrical and plumbing are approved. ALI wall insulation and vapor.barrj.er..are in.plac,eJ'
4. Lath and/or Gypsum Board Inspectionr To be made aiter all lathing and qypsuir board, i.nLerior
and exterior, -is in place buL before any plastering is applied and before gypsw boarq joinLs
and fasteners are taped and finished. .i
5. Final Inspection: To be nade after fhe building.is complete and before occupancy. ''
APPROVAL REQUIRED. No work shall be done on any part of *-h" loitaing or Struiture beyond the poj.nL
indicated in each successj,ve inspection without firsL obtaj.ning 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 construclion as indj-caLed by each of the inqpegtjrons required.
NOTEq A11 building permits require i,nspeclions for ttie work authorized, such as but not lj.mited to:
.A. Plglk EE:Ia.. tg be..made_after rein{orcing is in place, but before anli grout is'Boured. This
inspection is required for each borld beam pour. There will be no approval until the plwbing
and electrical i.nspections have been made and approved.
B. llood stove: 10 be made after conpletion of nasonry (if appLicable) *nd when installaiion is
com?letL fnstallation shaIl be in accordance with an approved, nationally recognized testing
agency and the nanufacture!'s insLallation instrucCions.
C. Mobile Home: An inspection is requj-red after the mobile home is connected to an approved
EEiEioi-E6ptic system for setback requirenents, bLocking, footing connection, tiedowns,
skirting, and plmbing connections.
1. Pootings and piers to comply wiLh State foundation requirements for nobiLe homes or aa
recomended by the manufacturer.,
2. Mobile home minimun finish floor elevation shall be certified when require'l by a flood- '
plain managenent letter.
3. Mobile home tiedowns, when requj.red, and skirting shall, be installed and ready for inspec-
tion wi-thin at least 30 days after occupancy. Tiedowns and skirting shall be installedper enclosure. ,t
D. Swj.ming Pool: Below grade when steel is in place and before concrete is poured. Above grade
;1m-pool-ls installed.
APPROVED PLANS MUST BE ON lHE JOB SITE AT ALL TIMES DURING WORKING HOURS., TITIS PERMIT WILL EXPTRE
Ir WORK DOES NOT BEGIN I,TITHIN IB0 DAYS, OR IF WORK IS SUSPEI'IDED OR ABANDONED FOR I'IORE TLIAN 180 DAYS.
SUSPENSION OR REVOCATION l4AY OCCUR IF THIS PERTYIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
ANYONE PROCEEDING PAST THE POI}.:T OT REQUIRED INSPECTIONS WTLL DO SO AT THEIR OWN RISK.
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SUBSUBFACE AND ALTERNATIVE SEI^IAGE DISPOSAL SYSTEMS:
2
Pbrmit.s shall be effective for one year from the date of issuance.
Upon completing the construction for which a permit has been issued, the permit holler shall
notify the Lane County Department of Planning and Comunity DevelopmFnt by submlfting the
instaLlatj.on record form. The Departnent shaIl inspect the construltior to deter-mine if it
complies with the rules contaj.ned in this division. If the construction does comply with suchruLes, Lhe Department shaLl j.ssue a certificate of satisfactory completion to the permiti holaler.
If the construction does not comply with such rules, the Departrent shall, notify t.he permit
holder and shaII require satisfactory ccnplet.ion before issuing the certificate. Failure to
meet the requirements for satisfactory c-ompletron wrthin a reasonable time constitutes a vio-
Iat.ion of ORS 454-605 to 454.'7'45 and this rule-
Setbacks - Subsurfacc Sewage Disposal ,:,'
septic rank SI!jj-tt-91-q
arom: Interror property lines 10 ' 10 'Edqe oi road rlght-of-uay 10' I0'
Bulldj.ng foundation L0'
l.lells, other water soulces 50' 100'
a
lane county
DATE:
RE
ADDRESS
\\-oa \q.85 \BOCrBO C)
The above parcel is zoned r
The def ion of this zoning is as fol
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L a-
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OI^INER
MAI AND TAX LOT NINAER
ACCOUNT NI'MBER IF AVAILABLE
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(t
t AND MANAGENIFNT Dlv/PUBLIC woRKS DEPT. I 12s EASI BTH AVENTJE / EUGENE, oREGoN 92401 / (503) 687-4061
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ACTIVITY INFORMATION SHLE.T
COMPLETE THIS SECTION. INCOMPLETE FORMS I.JILL BE REJECTEDI
I iY'uv t,U@vntt \-"(
?"s70 k. ?""35 -lPr"-;' =, C
{, l,qJ 0r'? ?qzzru
7,44_117 9_
ME CODE
'7u(* ? c 69" 4(, //t u
HOME TELEPHONE # BUSINESS TELEPHONE #
7*( >5/ o
BUSINESS TELEPHONE #HOME TELEPHONE #
2 PROPERTY ADDRESS
( IF DIFFERENT
3 naap B PAFIEEL NIJMBEFI (from tax maps i n Departme
tement)
nt of Assessment o:s/"qJ-.
Z0N/NG I
(RE RED INFORi4ATION) or from tax sta
LoYTtoJo^t
S,r* tbv ## # ffiS dl )t
fi 74.
)i{ b NANGE SMTION M ZONING
,
R-ANGE SETTION ffiw ZONIXG-
TOTAL CONT P I ACRES
4 SUBDIVISI0N (if applicable)BLOC
5 REQUEST (r;tate exact'ly wh an to do) _- -.
0 16.
t-J6 DIRECTI0NS T0 SITE: t-6 L-
/OL
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o,t r'Lt o 2 J
RSHIP:
!e r't a
L t z€t\S e{laE 7y FOR STAFF USE ONLY **
NUMBER
DATE
FtJt
{
BY: _ DATE:_ TIME IN:_ OUT:_
I-AND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 9740I / 687-4061
Z0NE/LAND USEi
I
hrre ccurty t
ACTIVITY INFORMATION SHEET
COMPLETE THIS SECTION.INCOMPLETE FORMS t.JILL BE RIJECTED!ffiIt. -
-7
I 5 .oV
\-f
L L)C
dF+-? 2+77
(,/D W2 PROPERTY ADDRESS
( IF DIFFERENT F
3 rvlae I pAFtcEL NLTMBEFT ( from tax maps ior from tax sta
-4# ffis
n Department of AsREDI NFORI4ATION )L<>tiloJo^y, I n
S/r.e lbV mfrsfirp
tement)
sessment and Taxation
v,A dt))d
ZON I NGfr77
)i{ b G TOi.fiSMF R]NGE.sEmoN ffi ZONINGt
MINSF]tr MNGE SMTMN ffi ING
TOTAL CONTIGUOUS PROPERTY I
ACRES4 SUBDIVISION ( if appt icable)
BLOC5 REQUEST (r;tate exacily wtr an to do)
0 I
6 DIRECTIONS TO SiTE: /^cZ Ot ,J *L){-7s c)(),/Gr rLr J2-
J'e>r a s'7 3rLt<en5P { /4E b2 v FOR STAFF USE ONLY **
ZONE /LAND USE:
BYr.- DATE:_ TIME IN:-- 0UT:
NUMBER
DATE
{7t/,
\
LAND MNAGEMENT DIVISION / 125 E. 8th AVE., FUGENE, OR 9740I / 687-4061
J
ZZtlIZ L/_ 7vG ? r. o?ffi iioMtffi)irE-}-
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VICINITY MAP Permit No
]I,UST B
l-7
Standard System E( Alternative T
Job Location (Street Address)4.
Subdivision / Partition Lot- Block-
DETAIL SYSTEM PLOT PLAN AS CONSTRU TED
scawhr' "=1Li"'
o *{
9)
It
?b Ll,74
?,V 4 -*'Twnshp.
E tN BLACK INK form c55-tl'
n""g"-- section lq , z,z Tax Lot l*OE/'z
5E
de
N
rn 7
7M
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9
ry*l
IY
lnstal
Measured Distance from Well to Tan k
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's name)- certify that a (Mfg
Date-and Mercury Float Switch (Mfg. and No
Signa
Date-5--7::&S FOR SANITA
COMMENTS:
US ONLY:
System Capacity /day Signa
tl
Gravel Depth Below Ti
Lines l50
(Model No.) , ump
have been installed with this sewage installation
Date q-z-8S
Correction
CVtalt[onx.QPz
FOR INSTALLER'S USE: Trench
Tank lti6p Manufacturer
/000 use K INK ONLY
lTrtle as shown on DEo Icens)
Telephone
License No
Bonding Company
lSigrature ol Lrcenw)
lft By Owner-
A s Name I Addrsss
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION
evidence as per OBS 454.665 of satisfactory completion of a subsurface sewage disposal
Corrected
When signed by the County Sanitarian, this cortif icate is
oarc 5 -) -ti-
oag -f^23-g{
system at the above location
et3-tt
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EBlHFil"[gA7"5g[Y"'9. IVE "t"HB' I 6Yfr8EYEU'e?' X+fi' ?St{PUBLIC WORKS DEPT.- EUGENE; -OREGON 97 4O I
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