HomeMy WebLinkAboutPermit Sewer Connection Record 1989-07-11SEWAGE DISPOSAL SITE EVALUATION
Job
Written Directions
WATERLot- Block-
APPLICANT'S NAME AND
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Subdivision
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pnone-f'f?- Z6-?3/ /1,t (2 Lr.Ji / /OWNER'S NAME AND
STRUCTURES NOW ON THE P
' nereby cgrtify that the
46ltororagent.
PROPOSED USE OF
above statements are true and accurate, and that I have the following legal interest in the property: owner of record;
-contract
purchaser;
-potential
buyer;
I further certify that (if not the owner) I am authorized to act for the owner of record, and that said owner is aware and
TEST HOLES Signatu
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of this action.
SITE MEETS STATE STANDARDS
Standard System
Sani, Filter
1 Foot Capping Fill
NO
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n
YES
tr
tr
tr
NO
tr
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YES
B
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Low Pressure Distribution
Holding Tank
Other
LAND USE COMPLIANCE
Zoning Acreage or Lot Size-------ffOTAL)
Partitioning #-Parcel #___(
(
Completed
Pending
COMMEN
! Approximate
Study Area
n Detailed
Study Area
tr Floodway
FLOODPLAI N INFORTIATI ON
All or part otthis site may be in a flood hazard
area for which 100 year flood levels have not
been established. Extra precautions may be
appropriate to assure that the building site will
be reasonably safe from flooding.
All or part of this site may be in a llood hazard
area lor which 100 year flood levels have been
established. A building elevation above the 100
year flood level may be required.
All or part of this site may be in a flood hazard
area in which a floodway has been designated.
Building may be prohibited subject to
demonstration that the cumulative eftect of
proposed development will not increase the
100 year flood level at any point.
THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
ARE AT YOUR OWN RISK. IF S]TE IS APPROVED, SEE REVERSE SIDE.
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LANE COUNTY ENVIRONMENFAL HE
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ALTH, 125 EAST 8TH AVENUE, EUGENE, oREGoN 97401 (687-4051)
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MEMO
TO: APPLICANT
FROM: LANE COUNTY ENVIRONMENTAL HEALTH
SUBJECT CONDITIONS OF SITE APPROVAL
lane county
Any alteration of the natural conditions in the area approved for the on-site system or replacement area may void this approval.
This approval is given on the basis that the lot or parcel described above will not be further partitioned or subdivided and that conditions
on subject or adjacent properties have not been altered in any manner which would prohibit issuance of a permit in accordance with
O.R.S. 454.605 through 454.755 and Administrative Rules of the Environmental Quality Commission. Any such subdivision,
partitioning or alteration may void this report.
WARNING: This document is a technical report for on-site sewage disposal only. lt may be converted to a permit only if , at the time of
application, the parcel has been found to be compatible with applicable LCDC-acknowledged local comprehensive land
use plans and implementing measures or the Statewide Planning Goals. The Statement of Compatibility may be made on
the attached form or its equivalent. Authorized Agent approval is required before a construction permit can be issued.
This report is valid until an on-site sewage system is installed pursuant to a construction permit obtained from Lane County, or until
earlier cancellation, pursuant to Commission rules, with written notice thereof by the Department of Environmental Quality to the
owners according to Department records or the County tax records. Subject to the foregoing, this report runs with the land and will
automatically benef it subsequent owners.
Only persons having a valid license issued by the Department of Environmental Quality under ORS 454.695 to install subsurface
sewage disposal systems or an owner or contract purchaser or his regular employees may install subsurface sewage disposal systems.
A certificate of satisfactory completion will not be issued if persons other than the above perform the installation.
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SITE EVALUATICII HONKS{ETT
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CoNSULTING EIIGINEEES & SUEUEYoES
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DAIE; JUN. 12.1989
DPAWll. LARRY OLSO{
N0: ro89 _
HO;ID SLIP Lane
Countg
APPLICATION #
LOCATION
NAME
ADDRESS
The Lane County Building and Sanitation Division cannot proceed with process'ing
your application because:
l. D Incomplete application (items defjcient).
Address and/or directions to application site.
Proposed number of bedrooms in dwe11ing.
Approvable plot plan (see attachment).
Notjfication of date test holes will be ready.
tr Verification of existing system required (see attachment).
n Two test holes (2'x4'x5'deep) required for expansion or repairH of existing sewage disposal system in the area of the proposed
drai nfi el ds .
u Other:
2
3
4
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S IGNATURE
to from to
OFFICE HOURS PHONE
If no response has been received in regards to this matter
the app'lication wi I I be denied.
LANE COUNTY ENVIRONMENTAL HEALTH SERVICES
Courthouse-Public Serv'ice 81dg. / 125 E.8th Ave. / Eugene, 0R 97401 / 687-4051
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