HomeMy WebLinkAboutPermit Demolition 1978-10-05s.l. #
TRS, TL 1"3.1 +qol Job Location
Written Directions
Subdivision
Lot- Block
SITE FEASIBILITY REPORT FOR SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL
APPLICANT'S NAME AND ADDRESS TT tl
OWNER'S NAME AND ADDRESS
Ph
PROPOSED USE OF PROPERTY -
WATER SUPPLY WITHIN ONE MILE OF THE CITY OF (NO
I hereby certify that the above statements are true and accurate, and that I the following legal interest in the property:
-owner
of record;
contract purchaser; potential buyer; realtor or agent.rther certify that (if not the owner) I am authorized to act for the owner of
record, and that said owner is aware and approves of this action
TEST HOLES READY ;Signature Date
* * * * * * * * * * * + * * * * * * * * * * + * x x xQpplQf EONLYBELOWTHIS LINE * * * * * * * * * * * * * * *.n r( * * * * * * * * * *
SITE: E TVEETS STATE STANDARDS t] DOES NOT I\NEET STATE STANDARDS
Partitioning ( ) Completed( ) Pending
Parcel #-
THIS IS A PBELIMINABY BEPORT WHICH DOES NOT ENSUBE THE ISSUANCE OF A FUTURE BUILDING PERMIT. ANY PLANS OR EXPENDI"
TURES |\,!ADE lN RELIANCE UPON THIS REPORT ABE AT YOUR OWN RISK. lF SITE lS APPROVED, SEE REVERSE SIDE.
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AUTHORIZED SIGNATUBE DATE
Division of Water Pollution Control
LANE COUNTY DEPARTTVIENT OF ENVI RONIVIENTAL TVIANAGEIVIENT
c55-32
AUTHORIZED SIGNATURE
Permit Processing Section
DATE
125 EAST 8TH AVENUE, EUGENE, OREGON 97401 687-4061
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Mail.eport to ( ) Applicant ()Owner ( ) keferto pickup. Call
-
(ownq, etc.) when ready.
. -9UCTURES NOW ON THE PROPERTY
LAND USE COMPLIANCE
Zoning
Acreage or Lot Size- (TOTAL)
Tn, l,*l ^/-./c,tl
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)OAR Chapter 340, Division 7, Section 72-O20(61: This report shall remain in effect until issuance of a
permit to construct, unless in the meantime conditions on this or adjacent properties have been altered in
any manner which would prohibit issuance of a permit, in which case this evaluation report shall be con-
sidered null and void. Technical rule changes will not invalidate any evaluation report issued pursuant to
this section.
Before construction is started bring this form to the Department of Environmental lVlanagement and apply
for a building permit. Exact specificationsfor the sewage disposal system will appear on the permit.
lf the property is only a portion of a tax lot, a partitioning or subdivision must be approved before the
permit will be issued.
Only persons having a valid license issued by the Department of Environmental Ouality 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.)
)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
125 EI 8TH AVENUE, EUGENE, OREGON )1
NG DMSION Current Zonin
Partlttonlng t-- [pencti.ng f]co.p 1e ted
Parccl No,_
Partl tlon nq Requlred
Other I
ll ?EA POLLUTION CONTROL I of
NGV Slt. Inspectlon(8)
6DS Constructlon l-l New ! nepalr
Nunber of Bedroomgt--
Comacrclal,/Industrlal - I o! Employee!
OthGr
AVERAGE PROCESSING
v,cto.H,
Hv,
il!'-!-
ts,Ft,tsro
trHot}l
tl
to thls permlt.D"r. g/2t/79
CONSTRUCTION PERMITS AND INSPECTION(Seo abovc for I of bedrooms,/l of ernployee
n :{obll6 Hotoe'
t] permanent
tr Temporary
n RenewalStructurE-
PEE
$
Sq. Ft. Val t lon
Total vtluation
s.-=-
t_
Subtota I
{l St6tc Surchargc
Plans Check Fee
Change of Occupancy
TOTAL BUILDING PERHIT TEE
l,tlninul! rtructura Betbacks:
atreet 3 FrontFror! centerlina
Exterior SId€
FroE lnterlor ot Iines: Side Rear
f] conuo'l p aheet to appllcant f] Curl cur ro appllcant
I Evol{
oI
, Plujtrbing fixtures at
-_
Sewery'dater Conn. at
PUBLIC
PUBLIC
tr Address tr Minlmum Elevation
n Pacillty perrrit
Each S
Dach S
s
s
s,
s
tlnft
Carh
E}IvI HEALTH
Roc 'd
ffiTieorrnea-i further agree
AFFTDAVTI: rf thls permlt ls for an agrlcultural buildting, r hereby declare that this bulldtngulII be used for agricultural purposes as arrowed by zoning and/or the state Building code, andf9T n" otler PurPose.. r furthir certify-that the statemenfa and other Lnformation submltted onthls application are true anrl accurate,'and that r have the forlowing 1egal inter€st in theprop€rty: onner of record; contract purchaser; lessee; holder of an excrusive optlonto purchasEl-_dury authorizeil-to act ro''a perion'"t -;;;-til r"'Ti;;;;; i"sli ii..r."t,
?OTAI, S
t or that the ovner of record ls knowledgeable of this hrle coLinry
comp wt all lca codeo relatlag
Applicant'B Signature
THIS IS YOUR RECEIPT, AND DOES NOT GIVE YOU PERIi.IISSION TO BUILD.
lon INFORIIA?ION ABOUT THE PROGRESS OF YOUR APPLICATION, CALL PERMTT CONTROL, 687-{357 (687-HELP)
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Address
lmum Elevation
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$t'[E EVALUATIoN WORKSHEET
LocArroN , rwp. /7 **.u Ol.-/7 TAX LOT #SECTION
ZON lNG :RA PROPOSED USE:
SIZE OF PROPERTY:/booo.Pfl*AI"IOUNT US$LE AREA:qll
WATER SI.IPPLY:COI.MI.INITY PIJBLIC TNDTvTDUAL [f
SUBDIVISION/PARTITION 6/eilon Icc*s lor_/3 _BLocK___.___P ARCEL
IF SITE MEETS STANDARDS FILL OUT:
Type of structure and approximate sewage flow:tso
P*)
ItuIr.i-family
Conrnerc ia I gPd
MINIMUM DESIGN REQUIRE}GNTS:
Length of disposal trench required
Distribut,lon Method:
CurE.ain draln required:
Other:
Single Farnily
lndus tria I
Ins titutional
/do tu Of 75 lnn*/ fl
gpd
spdr//J,uo,
gpd
cpd
1750 gal.
Equal El Serial
No ^Fz}.Yes
SPECIAL SITE CONSIDERATIONS OR VARI.ANCE OPTIONS OR OTHER ALTERNAT]VES:
.o a
16rrU*Z *
/1 S
DATE OF EVALUATION:tr/",/ 7L
NAUE:
DCIC
&tgle 1c
c7 4-L26
StJon 7{
6
#T TEST IIOLE II 2 TEST HOLE
I
Resrrict.ive Layer &inImpervious Layer -dL_ii
t2
36
SLOPE
24 cv
I lt
du q,
o/44r-a-
I,lotcIing -*>**1.
1n
1n
111
48
60
8f) in
PERCI{ED WATER
SATURATED ZONE
PROFILE
lnchPredicted
Obse rved
I)l t-t'
Predi c ce d
0[rsc rvcd
Dace
strictive Layer _i.ervious Layer _in
1.2
1n
1n
36
60SLOPE
,11+
48
ol
1n
PREDICTED WATER
SATURATED ZONE
tcling
PROFILE
Inch
Predic re d
IfI e
].n.
Predic ted
Obse rve d
DaLe
se rved
te
DOES NOT MEET MINIMUM STAIIDARDS.
ADM]NISTRATIVE RULES PdOUIRE A MINIMTJM DEPTH OF:
36 inches Eo an impermeable layer
30 inches to a restrict.ive layer
60 inches Eo a perrnanent wat,er cable
24 inches to a Eemporarily perched \^raEer table
OTHER REASONS FOR DENIAL
SIr 7y - qe-o
ON YOUR PROPERTY THE DEPTH
I,IAS:
inches
inches
inches
lnches
I
SlTE DOES
PLOT PI.AN:
Stream
,tu \.Lr-
Drainage or
pond
la I ' !a .ea r.. r,,l ,
Road
----
liest llole @
\ % SloPe
Cut Bank
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Ire nce
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I ANE COUNTY-I)EPANTMEN OF ENVIRONMENTAL {ANAGEMENT
125 EA BI'H AVENUE, EUGENE, OREGON 9,,d1 6h
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