HomeMy WebLinkAboutPermit Building 1986-09-20,drf
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YICINITY MAP Permit No 24 3z-8e Twnshp
Standard System fA Iternative S tr(
Job Location (Street
Subdivision / Partition #
IDETAIL
BE IN BLACK INK
Range o?-Section i?,3. I Tax Lot q13
T
Parcel- Lot- Block-
AS CONSTRU TEI'
Scale
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MUSTt'7
form c55-l-1-
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Date ,
erv u
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COMMENTS
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w.
I nstal
Telephone
'cense No
Bond Company
led By Owner-
'ii
FOR INSTALLER'S USE:Trench
Tank Capacitv]OD!-Manufacturer
INK ONLY tl
Gravel D epth Below
From Drainfield-Total Length of Lines?2.f!_
(Model No.)-Pump
have been installed with this sewage installation
D arc-aaf /7-?6
Approved E System Disapproved E Needs Correction
USE
Measured Distance from Well to Tan
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION
I (installer's name certify that a (Mfg
and Mercury Float Switch (Mfg. and No
Signatu
FOR SANITARI N'S USE ONLY:{Signalure oI Owner}
Applicant's Name I AddressC:aeV g(or..rouD
tr Corrected
System Capaci l./day Signatu
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When by the County Sanitarian, this certificate is
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evidence as per ORS 441.665 of satisfactory completion of a subsurface sewage disposal system the above location
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TRS# 17 - 02 - 19.3.1 913 DATE iSSUED:081286 PERMTT# Z4gZ-6Q
Ol^/NEii's NAME PHONE NU ERANTHONY SAXMAN
TRA NA}'IE
KONO LD BUILDERS n NE NUMB 746 3682
TS n.
SIDE 7'INTEf,IOR 5,7'LUMB I
SDS APPROVAL REQUIRED
REAR
ZEO Y IT
Construction-Single Family Dwe11
DI
Hayden Brid ge Road to N. 33rd to Cul-de-sac on left.
S DREE
33rd Street, Springfiel d 97477
MOB P
pprove d Date /Correcti on Date Insp ector
RS
Approved Da
Co ton Da te
rrecti on Date
I nsp ector
I nspector
OTHER INSPECTIONApproved Date Correct'ion Date I n s pector
Approv
A ppr0ve
roved
Datero
orrect ion Da te
Correcti on Da te
Correcti on Date
rrecti on Da te
I nspe ctor
Inspector
I nsp ector
I nspe ctor
LATH /-GYP SUM BOARD INSPE
Approved Date Correcti on Date Ins pe ctor
prove
rovep
te 4 - r-dL/Correc t i on Da te
Correcti on Da te
I nspector
Inspector
prove
ILE H
/Correction
PLAC
Da te Inspector
CERTiFI
Appro ve d
TE OF OCCUPANCY TEI'lPOtrARI-ERTIFICA
Date
TE OF PANCY
t"17 4 - Lg7
Da te
n
Insp Approved r_..--I nsp ._
LAN E COU NTY I I,IS PECT I ON RECO RD
S
F
App Da te
Date
LANE COUNTY, OREGON
DEPT. OF ENVIRONMENTAL MA SEMENT
CclEIEIECTIctN
(
NclTICE
CONSTRUCTION PERIVI ITS
A INSPECTION DIV'
JOB ADDRESS 3 DATE
BLDG. PERIVIT -rrLTO
NOT
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FIE.INSPEGTIctN FIEOUIFIEEl
Phone E,El7-4o,6,55 FoFl aPPElovAL INSPECTOR