HomeMy WebLinkAboutPermit Building 1981-09-03dld CON STRU CTTON/PLACEM E NT
PERMIT
CO}IPLETE THIS BLOCK.PLEASE USE BLACK INK AND PRINT.IIIS
FOR OFFICN USE ONLY
Parcel SizetrPLANNING/ZONING:,"raRA
, ,r"^, (?()'
Partition #Parcel #
llilimum Setbacks
Conments:
C L
", =,o, ,43 ,nterior 4t **_47
1'wo Copics of plans
f fwo Copies of plot pLans
f]l,lechanical Checkl_rst
f] etumbing Clrecl:list
Plan Check fnfo Sheet
Applicati
Permit #
RANGEo2,T?
f(eside:rtia1
[-l commercial
I rndustrial
flruutic
P US
m
Proposed
i s ting
NUMBER
print)SI
s- H"-+NAME
structure rt
TIAVE CAREFULLY INEDE XAM COMPTHE D,LETE PLIAP FORCATION PERMI do hc rha he ao.)n d arrd thcUTrtithatandfyanyalLworkrme dfoper sh be done n accordance rh othe rd 1t ce of CountLane theandY oLao he s ofthworkdecrrto ntlbedhereithatandOCCUPANCYNObemadeofanythothernssoforlpeButhe1donurLr)9 her g(Eha 1S ra !'reg lon th Buithe Ider Boards 1S 1n fu fo ce and t,s redrequi oRsby 10 o t the basixenpt S for exenF r:dnothereonandthatonsubcon1yandractorswhoarei.nemployees Ian ce th oRscomp 70t wil055 be used on READHAYE At]Dct CI THIIEC}:EDProTHOROUGHL,YION
t-^Ll L'wr Le l
&ot..r.'-..
! es.,nt
8
tr FLOODPLAIN:In flood hazard area?
S. I. #
Fr" f] vus, see atracrred sheer
Date:
Date:
Date:
-2t> -g
tr RURAL ADDRESSING: GRID COORDINATE
N
SA}JITATION:
E
B. P. #lnstallatiori Record Issued? ! v"= f] n"
lnstall ation
Specifi-cations:
Gal]on
Tank
Lineal Feet
of Drainfield
Maxlmun Depth
of Trerrches
n
Date:o
W PLANS EXAMINATTON: TyPe 4tJ ",*r-W Use
Corments:
Date:
CONSTRUCTION AUTHORfZED BY THIS PERMTT
Fixed Feel
Unit Cost
Floodplain Fee
Subsurface Fees
Building Fee \
Sewer/Storm Drain/Water
--.1-nr"*ing
Fixtures
Mechanical
Plans Check Fee
State Surcharge
TOTAL FEE
FEES PATD BY:
By:
Sq.5't.S
$
z--77-
t-r)
-) Z.q
4etgttu _-_----=-
.J'/6.93b.9
$
$
;
$
s
$
$
-.
kTOTAL VALUATION S
W*L:*
Date
PERI"IIT APPROVED BY BUILDING OFF]CIAL,/DE (per ORs 456
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT / 125 EAST EIGHTH AVENUE, EU
C74.Lg4 SEE REVERSE
I
a-
DATE
*-\oREGON 97401
I.ELEPHONE NIJMBER
I (_c rt i thafl a1 trlF I
li l_C La iOretl-)t\[/] r1t
that 1S
I
Conments r
SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED' VIOLATION CAN RESULT IN REVOCATION OF THIS PERMIT'
cITATIpN SNDER pRovrsrolrs oi tRrr iourutv,s ir'trnncuoru oRDiNANcE, AND/0R 0THER REMEDIES ALL0I^IED BY LAll'
I.IHEN READY FOR INSPECTION CALL 687-4065.
GMN. Have the fo1 lowing informatioq*1
your name and phone number' and any spec
BUILDING DIVISION:
A MINIMUM OF AT LEAST 24 HOUR ADVANCE NOTICE FOR INSPECTION REQUEST MUST.BE
"ulyr- i.rrii number,'joU uJir"tt; irpa of inspection, when it will be readv'
ia'l directions to site.
REQU IRED INSPECTIONS
1 ) F0UNDATI0N INSPECTI0N: To be made after
ffiob. where concrete
materials need not be on the,Job'
?) CONCRETE SLAB OR UNDER-FLOOR INSPECTION:
urrw"-
or flooi itrbat[tng insta]led, including t
trenches are excavated and forriis erected and when all materials-for the foundation
from a centra.l mixing;i;.;-i;;il.niy termed "tiansit mixed") js to be used,
To be made after a,l.l in-s.lab br under-floor building service equipment,
iii..v A;iil.;i items'ari in prui" but before anv concrete is poured
he subfloor.
blocking and br-acing are in place-and
cal and ilumbing are approved. A11
:
3)
4)TH
t
wa]'l' {nsulation and vapor barrief'
:.
GYPSUM
re any p AS
Setbagks -.Subsurface Sewaqe Disposal.............,-..-
I
From: Interior property lines
Edge of road right-of-way
Building foundation
^,.-- . -.!,lells, other water sources
ea'fter thp roofi. all fra$ing
Seotic Tank Drainfield
-T0'r- -T0-,-
are comp lete and a'11 rough el ectri
are in P.lace.
To be made after a'l'l lathing and gyp sum board, interi or and exterior, is in Place '
s .app or before gYPsum bpard io,ints and fasteners are taped and finished.
To be mad
and vents
, fire
5) FINAL.INSPEq.II0N: To be made after the building is complete and'before gcqupancy'
APPR0VAL REQUIRED. No wolk shall be'dong 9n aly par:t of lhg.blild-ing.q1 strY:lYl:,bevond the point indicated in each
success.ive inspect.ion-*ii1ori iirst obtaining-ii,"';pprovai or.tn" trirai.ns'oifi.'iul. -Such aoproval shal'l be given on]y
after an .inspection Jr,'lii"nir"'u"!; ;;il or 6uit' suttessive steri-in'ttre'l6nit"rition as ind'ii:ited bv each of the inspections
,NSTE: AI1 building pey,mits require inspections for the work authbr"ized, such as but not limited to:
A. BL0CK WALL: To be nracie after reinforcing is in place, but before any grout is poured' This inspection'is
required for each bond beam pour. There wi|l be no iipiouur until tire-plumbing'and electrical inspections
have been made and aPProved.
B. ritOoD sT0vE: To be made after completion of masonry (if applicable) and. when insta'llation is comolete'
instaj.lation shall be in uc.o.oin.e with an approved nationally recognized testrng agency arrd the manu-
facturer's instal lation instructions'
c..-l,loBILE H0ME: An .inspection is required.after-the.mobi'le home is connected to an approved sewer or sept'ic
system tori- setuaCk'requiremenitl"uii.tiril'rooting-.onnection, tiedowns, skirting, and plumbing
connecti ons.
a(1) Footings and piers to comply with State foundation requirements nfor mobi'le homes or as recommended
(2) {i,uif. home minimum finish floor elevation shall be certified when required by a floodplain
r'' "mhnagement letter'(3) l4obile home tiedowns, when required, and skirting shall be installed and ready for inspection
-iihi; ;; i.;;;-3tj iivi"rit.r'o..rpiniv. Tiedowis and skirtins shall be installed per enclosure'
D. sWIMMING p00L: Below grade when steel is in p'lace and before concrete is poured' Above grade when pool
is installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING I^IORKING HOURS. THIS PERMIT I^IILL EXPIRE IF I'IORK DOES NOT BEGIN
l^tITHrN 180 DAys, 0R rF r,loRK rs suspENDED 0R ABANDoNED foB llqBE.THAN 180 DAYS. SUSPENSI0N 0R REVoCATIoN MAY oCCUR IF THIS
i;iRMit wAs issuto oN-iHr-gAsiS 0F INcotIPLETE 0R ERRoNEoUS INFoRMATIoN.
ANYONE PR0CEEDING PAST THE PoINT 0f REQUIRED INSPECTIoNS IIILL D0 S0 AT HIS ot'lN RISK
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS
(r )
(2)
permits shal'l be effective for one year from the date of issuance.
Uoon comoletinq the construction for which a permit has been issued the permit holder shall notify.the.
;$;rffi;i-;v"iririitii.g-ttre-initatration ricbrd form. The Depaltment^sha'l1 inspect,the construction to
aei"irl."-ii"ii iompriei with the.rules contar:ned'in this aiviiibn. 'lf the construction does comply with
such rules, the Departnient stra'g'issue a cerii+iiat. oi iuiitructoiy completion to.the permit holder. If thel.
construct.ion aoes not-iomply with such rules, the Department shall notify the pbrmit holder and shall require
iiiiiricioiv completion ubt-ore issuing the certificate. Failure to meet the requirements for satisfactory
io*pi"iion *ittii' a reasonable time c6nstitutes a violation of ORS 454.605 to 454.745 and this ru'le.
'I 0'
5'
50'
'I 0'
l0'
'I 00'
h:lii.tlli,
$t_ri
!rrJ 1
Lit,
T'|...'ii' J'rs:::{ ?}{:Jt}:,itr.$:: "r.Lrrlrlr!, 1;{T' rql}}:t.rl:r_}i.l N*il.rr;*E:i-ln L.{ll. :lt'lHt'J lli"ll{; T'Yf:'h. iJ;{H Ii i'{u r,}rii'i,:i t}:r i.,rfi Lti.i l:'r;{ , i}0 { ru{1 ,:;l'iirt i:tr.:; t,t{i F[..t:fis,
,u,t::t"'u"
rii:rril... t{il f*T'l:rtr l}f:;iitt::r.'i.r:riir ],;r F'r' ir.{r:T. *nsi. i;,-,i"iri1:L}i,t rr*[::
rJri
I1 l:r
Li {:i
tl ri
f.'r []
ii f' !... i: J ,ii {.i:il i:i I Ii f\ ft ,:ii::'i... Nt-l " i::.ii"il'l.JIlH...i :
HIrFl
t'L, t'r
i tt l
,::. Li .:.r ii
{.t t.}i'i F,t Ii. {.1 1' t.i i:l,t:i :
i'.1[i il i-lf:r N .I r-i rt l... r'i:::[:
;il' fi l'li:. ;iJi.J Iir.li-ir:r i;;r., lii
l:r[..r::ri''J i-]i-!!::.t::lc; f i:::fi:
{ ri
"ift
i rJi:i{.}fj
I:.,..1 t.. lj ::::
r:l'rH l:.Iii
It.,
T'tl T'ttr l-. F'[i [:. x x
I I'l t] "
_\ -. t.lt.l
'1 t.tI't
1 a{ t'Il.l.- :.. ...
iJ -1. !-t t.t
i::'t'f {;: f.ii:,F
i, H:i,ltj : i.i
1'f:,|,i[::i{ i::'.r, F.:l_l_l
i:lt:i l::'l:i
l::' i!'r'1... r.i I l
;-i:ti'-tj ji: I
,i
t-:ilHIit_H1' l: ilH Iift T'ti
i" t... t\.
!rr::! -i ,.t i:.i 4 l-, / A'tI LI I r Ti
J
rl
o
(
(
(
'E
t-c
(.C
G
hne county
APPLICANT INFORIVIATION :
6l!'
-
CHECKTIST
PLUMBING /MECHANICAI
or TIN-ease
PLUMBTNG coNTRACToR n Yes Firm
Address
fl r'lo E s"rr
MEGIANICAT CONTRACT0R fiffis Firm
Address
fl No I serr
1ng sq
Cont. OSR#
1p
?t. osR# /2 I / L_
PLI]MBiNG
Type of Fixture Nurnber of Each Fee On Each Total
Sink I $ s.ooJ.avatory .Wash Basin's. 00rub={@th or without shower)5. 00
Showcr !eparate 5. 00tertoi.5. 00
5.00Disposer I 5. 00
5. 00
5.00Eloor Drain 5. 00Sewer--1st 50ft.15.00tional 10 10.00
Water ce--1st 100 ft.15. 00each addit 1 100 ft.10. 00
Storm and Rain Drain- -1st 100 ft 15.00each additional fOO ft.10.00
Was te Connec t 10n 5.00'e j ector s.00
1 1 r 10. 00
C1
SIIB-TOTAI (Minimum $10. 00)
TOTAT FEE
MEG.IANiCAL
Type of Equipment Ifuinber of Each Fee on Each Total
Mechanical Permit Base Fee $ ro. oo
Furnace to 100 000 $ 6.00
Furnace over 100,000 BTU/H 7 .50
Clothes Dryer Vent 3. 00
Bathroom Ventilation Fan G fucf )5. 00 L :-'
- Range Hood with trlechanical Exhaust 4. 50
Wood Stove 6. 00Air Conditioner 0n1y 6. 00
Heat Punp 6. 00
Floor Furnace 6.00
Gas Piping System 1 to 4 Outlets
Per Ourtlet .50
Other (specify)
SI.E-TOTAL
TOTAL FEE
OFFICIAI USE ONLY
Appli./
Permit #-
Pr1ntJ (Ma11 [ulty or'
l8o2-E'li.r.at ilo _ PROPOSAL AND CONTRACT
T0: DonaLd & Marlene Aubrose Datel B/27/81
Inropoee to furnteh all matertale and pErform all labor Beceeaary
to conplete the fol}ovtng: AlSXAl fanlly roon addltlon and a ner
eeptlc tank.
All of the above uork to be coupleted ln a substantlal and workman
li.ke manner accordta6 to etandard prctlcee for the cost of $10r000.OO
Paynents to be made ln fuII a8 the work progreaae66 to the value of IOO%.
Ihe entlre amount of contract to be patd vlthln l0 daye or lOth of the non
after com pletton. Any aLteratton or devtatlon from the above epeclfl-
catlons lnvolvlng extra coet of matorlal or Labor rtll onLy be executed
upon urltten ordere for Bame, and vtLl becone extra charge over the eum
neuttoned 1n thla contract. A1I agreenepte must be made tn urltlng.
byr
AgCEPTANCE
Iou are horoby authorlzed to furnlsh aIJ. natsrlal and labor roqulred
to conpLete the work menttoned above, for whtch we agrse to pay the amouat
nentlonod tn aald proposal, and acsordlng to the terns there of.
ACCEFTED tsY:
-7n
DATEC fr - I 7 -r/
hne county
Environmental Management
ACTIVI-I-/ INFORMATION SI ;ET 6r
-
COMPLETE THIS SECTION. TNCOI4PLETE FORMS WILL BE REJECTED:
o ERTY/REF
I{h I LINC MAILING ADDRESS
??rc-
CITY STATE ZIP CITY STATE Z7P
ffi oSLs{g7c Lf.{
BGIKESs TELEPHoI,TE xuneen }IOME TELEPIIONE NUMBER BUSTNESS TELEPHONE NUI'{BER HOME TELEPHONE NUMBER
@ l,lerl rNFoRIuATroN To:
,paenlicaNT,/REpREsENTATTvE
! nnoernrv oI^INER/coNTRAcr PURCHASER
@ tAX MAp/pROPERfy OESCRIpTION NUMBER (from tax maps in Dcpartment of Assessment & Taxation or from tax statement):
Tax Map Number:/2- ?-Tax Lot (s) :2asL
! o,rt of TL *--- BY Partition *-
Tax map nurnber of adjoining property in same ownershipt ,ZFnon" f] Unknown
Tax Map Nunber:
n h z LOT:/4@ SUeorVrsIoN (if apglicabte):
@ nsQussf (briefly cescribe information needed):I
COI\,IPLETE THIS SECTION FOR I.AND USE,
CONSTRUCTION APPLICA SEE **FOR STAFF USE ONLY**
NUMBER
DATE:
TIME INITIATED
CHECKED BY:
ATTACHED EXHIBITS:
|]
d
Fltr
@ torer. coNTrcuous PRoPERTY rN SAME owNERSHTP:
@ Nuuern oF STRUCTURES oN PRoPERTY: standard home
Modular home- RV in use as residence
carage_ ShoP-
acres
Road Easement
@ rrnn DrsrRrcr:
I^lidth
Rot
SPr iaq
tLc@ rnrsnNt usE oF PRoPERTY:
@ rnornnrv ADDRESS:
@ orurn EASEIVIENTS OVER PROPERTY:
1) r:xrs't'rnc PERI.lrrS ON PROPERTY:
O t'rntuu D1s1'Rrc'r
Mobile home.
Storage
Barn
#of
Users
I erot plans (2)
I constr. Plans (2)
! site nlan
f] copy of Tax Map
flo.r,".----
By:
Date
Time In:Out:
[-l Rccept I-l neiect
Routed to:
*NOTE:
ATTACH A COPY OF TAX }4AP;
SHOWN EXISTING STRUCTURES
AND TAX LOTS IN YOUR OWN-
ERSHIP. OBTAIN TAX MAP
IN SELF HELP AREA.
7 /8r (OVER)
t
Tax Lot(s):
@ accnss ro IRoPERTY: puiltic Road Name lYo 5/
?' 24.E Eost Ei 'l'
/ lof
a,
4..,'^
SCREENING VERIFICATION :
COI\,IPLETE TH]S SECTION FO ,AND USE OR
1\I L,\-/PROPOSED USE OF PROPERTY IN DETAIL:
APPLI **FOR STAFF USE ONLY*I
ZONE/LAND USE:
Bv: all
Date: E-ZL)
@ eurlorxc REeuESrs
Contractorrs #lztt t*(for mobile home setup also)
rime rnrl'.&) out' li3[
I accept f] Reject
[-l planninq Application
-{n= r, u"t io" o.r* ia noo.
f| rnformation only :
Zoning :
Directions to Site:71
Check the type of permit regucsted:
J--l owelring: ! uew l-l Replacement fl additional;
[,aaai-tio., fl alteration;
f] uodular Home f] uouiru Ilome - Model-. Year_
E nv fl standard Construction;
tr Plan Check only
f| commercial: us"Floor Area
Comp. Plan Designation:
Comments:
SANITATTON:
Date:
i
Time In:_ Out: .
! accept E neject i
I slt. Evaluation Issue
PERMIT ISSUED
Permit *
(SAME DAY ONLYi):
By:
Time In:Out:
l-l aqricultural: Use
tr
@ saurratroN REeuESrs:
f Sit" evaluation for SDS feasibility
f llew system installation
f] nePa ir,/reP lacement
p or a.tuaion/re locat ion
f] uoot to existing
othcrs: use eor^r'l.u R*r*Ploor nr"" 339
I cf,..,g" of use - How?
ADDITIONAL INFOR}ATION
RA
,' *By i
:Date,
-
lane county
HOLID SLIP m!r-ttr
APPLICATION #
LOCAT I ON
nY
llt ??
NAME
ADDRESSt
Fl**": fi*'lt
l4
ry?
The above appl icatjon is bei n ld for the following reasons:
E
t Fr,tu" 4rWPoa,oti l*tw7oeza,
\j {rW4*
ffiae-AlWo*:**frgJ.v& la, Wt\ lu:i?qu,gP A* W
& V+l* fnr4:il€r.q WN\W, t,\A€"e 4* tw NTt,tE[] ?tEftrxE t rvtT]l"#
1,44l.uf/',rfL lf&&s fuapu4l^, i4') lvlqALc{l*
\
l\l
^
K'L
SIGNATMT
This appl jcation wi I I
above has not been fur
hel d unti I
b*?-4{61
PHONE
If the informatjon required
cation w'i I I be cancel 'led.be
ni shed by that date Vour appl"i
Building fees paid for permits cancelled under these circumstances w'ill be prorated
according to the work that has taken place as of the date of cancellat'ion.
BUILDING & SANITATION / ENVIRONMENTAL MANAGEMENT DEPARTMENT
125 East Bth Avenue / Public Servjce Bui'lding / Eugene, 0regon 97401 / (503)687-4061
)
I\.
A
4-cl.#l
DAIE
OFFICE HOURS
THIS MAP IS TO A.SSIST LOCATING
PROPERTY. TI-:E COA!P,r.'riY ASSUjITIES 3{m 21
'No LTABILTTY roR TNACCURACTEFIRST ADDIIoN To IVIONTEBELLo AoRES
RF5TR.IC7,OIJ -.tuq M pu sE.t*{
1* <:E-*rd d /-d /,2),4lS.ret,
t 67 4e7a4 DA1ffi,Ea 44. @ g vE
,w 4 A/k .* #iet B N ere - d4
l&.*.*ffiffip€M& Eea
a44.ea*<*@tnd-
/J1^t A.ArrY lfradrl.***er
/ / /J( *--* .|<L.a c. )-*
,/'AffiG@a-
sEcTloN t9, Tt7s, R2W, W.M.
LANE CoUNTI OREGoN
D€SCElPT|ON
, q$/u*ryA!.r ,7 A t4,4r 4ol4orcc.s@ O't.l4r'Wcn *, Pdo ,u dE AEa * Gttzt Fao No.6t (r4ttAr &raCea.)-bad A6'J5'Ea 9n4 66..n M tD /rtzncrtrJ ** Z'w ,@to Lto. 7€!, (t/2,S*€rr),w ,rytr i /org-7/d oc/ua /49a.24ter5oud 4p? /32o.&@ Z:& € rta ,l/o*e* @az a m ftut.*2zaw lrcdrd
i,/o. dZ u 7*tsttz ,/7 54,r*, 'er/6e 2 W€t. 4 tr l(/a-4t -C /LrEtuaat, Ru4 7*& -bd6o'-r4',-54* /2Z.OZ Eer.zee N*d4'€4'5t'Ers7 //e15 Fce D * w* k6.u e 34dSr*ee7.. d€<E .gd 6/.Za'/ffur ez.oisr:
70 * H, Y4?6r^/ F Jl4d s;76i) rct< 5e* 77'a/'-.b'E i A2.7J .ce i zg,e -5* /'2s'&'la@&a,2.<ilwcte _Sax 74'5b' WEs g.sr. eo rcir1 Tazi ,Uoad 0'/5-49. Z?sr /or/. 32 ;ce D 7* Mr 6 fu.*6. *2, t4'/-ate Gu*, Op..N.
t
vr
d{
{
II
II\
&4Le: t..te' I
((.,.i 9ta'w
t/rr,?cl_Bse4 a.
N*rErtLta 4*E
7
I
I
rl
,i' ti
UJ
q
I|
lr a
,J' i{
'is
t{ts
u p._
;tfr,
$[
li
.t
5
kfta da: t{oaer Atua a* Oerut
ial &,w cfras
AFFIDAVITstfrE * dddl 7zr-AdtY e la. I
I, Jott l-auazt, Je.,
gl 7fi J tetc cezeoty
*N7Ce 'Y Va: ?u7 *
Sr'os*ra& 4@ SoN a ue w _-!!-!- pta I Feetztqr , tX2 a.a.
*/ota tu* ru Oaat --Z*Z ^?Z%--Jlk au,$d erplaas r-zt- t- ?
/4PPEOYALS
/t* Cqtn R<wtx 6tuea
Aa€.rr fr * w&2 voL4!r/c/ aq 1@ oea.
a.PP.5t/qt2
@u.srotcc
CN4,S/NCz
4-//-17-
/4u*d
54JeYa1
v
n;2-. Z'&c-/L
./
aEGlS7Fe&t J4/fE 5A^/4L EN6/ilC6a.&^a '&
pll 54e N OA4Juffi/tD ,14o g4@ w,rd RoZQ iloru4€!6 Ve L1!O E2E-'Ftar z4OotrtU m Ll*aao Aaet'As :slbwN leel:N 4e zr&f f A*tO
t
4 wc /p/7te. Pdq ra lALvautUO .!'a53'ttu P/?F, a r4s rc@s :r-rc %<1 c da 4tulo. 7{r g.o fur7 tf*,5aq/ O'/t'43't4€u ,at4o rli FEoa a tdd td fr. effi a Gq ?Bo,.b.A/ .&*t Zae)xta fufr 8i..1,5* 66'Js'eas 94.6a Fa tu * tud € /tE s€cr.N € @€-zNa e dq .6o /^,to.a,t iuo &m fut$,Zg,.g,o EN Gffi@e /tt*7N ,e,re 494.24 fta| .fu'rrt /ldo /r2o.@ rccr Slsr C * .U.*e9 CoUe *,fuS@r7 a*a.rd L4/c Cr1.4 No-O2 tu TrTS-, e 2 Na h/.t*f., tu .Le^z, aq.!rl. &6a "' 94.1--.LL. ,?T
EILEDfi*_otrocr_-_-J
APa 2J lE
7'
.t lT1
;r
Ir,h
p.i
rl
t
i
?'btfuM @.d
a-arNr s4$cN&t* *O-d Z
5&a44
DEO|CA
ENod
TION
14 ltt do /,evill L. 14il!A4t ao tar&L c.WLL|iU', tqu^ro ,4o p.E,.ap€ * *t d re ..% e ,4'loova otsaoEo ,4odd/ & 7w wa @ t&,a/ q q &o $a/v/G * * 4t w 4 xr 4*C, ,ar7 a{
74"r,0 a. /tt,'t.' ,
ACKNOWLED6EAIENT
(letetU zeor4nC D * RBq ttuAvct? 14 524,fr 15 sW-1
t'-t\'t"
c. ,{/t/./Al/s, ldato a{ stt; e*
4!O a*Y 4@P.sxe ?41 rurap,
tr,j,
.t
!
zf- -f r
(
"\.-----l
q)
{
-JI f
*,
bs
7
A_
u
(
\\
r
h
*
/
/I
./
/
/
/
/
Ir/
r
/Z- oz - /7.J z ?SZ /dndd. e,zZ*,rldA
\r
LANE COUNTY INSPECTION RECORD
PH ONE NUMBEOWNER'S NAME
C
E
ET BACK REQUIRE TS
SIDE
#PLUMBING F I XTURES
FRONT I NTERI OR REAR
I.J RK BY PERMiT
DiRECTIONS T SITE
zbtC
ST BER
T
proved
ON INSPECTI N
Correcti on
MOBILE HOME SE P INSPECTION
D'isapprov ed Da te I nspect
CONCRETE SLAB / UNDER-FLOO R INSPECTION
Approved Correcti on_ Dj sapproved Date Inspector
urffrR Sl-nB / PLUMBING GRo NDI,JORK INSPECTION
Approved Correcti 0n Di sa p ved Date I nspector
ROUGH PL
Approved
LIfiEII.IO INSPECTION---tZ-cr..Eiiio. oisapproved-Dat e ? - 3 .'-il Inspector #
FRAMING INSPECJION
Approved / Corcection Disapproved I_--t'-Date /O -8/tns pector
BARRIER INSPECTION
Approved Correcti on_D'isapproved Date /a=/ -$lnso ector
LATH / GYPSUP BOA
Approved u/ Co rrection DjsaPProved - Date,b-r/-Ftrnspector 91 -
RD INSPEC I I N
rINAL PLUMBING INSPECTi ON
ion i s approved Da e ,i/*3a_1f,l I nspectorApprovedCorre
FTNAL WASTE DISPOSAL SYSTEM I NSPECT iON
i sapproved Date 1( (fl Q4)Approved zf Correct'ion D Insp ector
I ECT N ILE
Approved Correct'ion sapproved Da te ns pec tor
CERTIFICATE OF OCCUPAN CY TEMPORARY CERTIFI CATE OF OCCUPANCY
Approved___Correcti on Di sapprroved Date-_--.--
Form C74-197
Insp ec tor
7
l. _,/
n
h1
!
'12?),
lt1 qQ 1
MUST Bt1
r-7A1)
E!N
Range
L4&e
YICINITY MAP Permit No
Standard System d-A Iternative m tr (Specify
Job Location (Street
Subdivision / Partition #
I'ETAIL SYSIEM
f-/ous€
l<- f'-<-v
ll Eu)
FDP;fiau
1'
sn
Jft
5
t ),,
form c55-11-
Section /q, 3 Tax Lot 2G
Block-42-
CONSTRU TEID
lo' -+
l8a2-8 I Twnshp
K
Parcel-
r(
\t
PLAN
IXIt-1 ,LUA
\
d'i'a
w
,sau
Kd DT
t(,
l.
\..,
's
-t
r,lJ
t
6?,8c
-i,
I
,!
(
N
I
I
I
J
a
{
1?4\\
){r N
..h
\
A<A
,D tsC\..fet.{,f riu4fx t9
y-l ltL
v
$^r
,,,staller Rou u/;u)ernc t\ cnulriu
USE BLACK INK ONLY(Tiile as shown on DEO license)
Telephone
License No.
Bondi ng Com
lf lnstalled By Owner-
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's certify that a (Mfg
oate2:/1:El and Mercury Switch (tv[g. and. No
Signatu
FOR INSTALLER'S USE:Trench
Tank Ca Manufacturer
Measured Distance Well to Tan From Drainfield_Total Length of Lines_
(Model No.) Pump
have been installed with this sewage installation.
Da
Date- ---
USE O LY p'systemFOR SAN Disapproved E Needs Correction(Signaluro of Own€r)
s Name I
trS
System Capacity l.lday Signa
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this certificate is
evidence as per ORS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location.
Xeturn this form to: Building and Sanitation Div., Dept. of Environmental Management, located tn the basement ot the
Public Service Building, 125 E. Bth Avenue, Eugene 97401.
e-q 47 AJ . 2,4+L
,
)
7.9
a(-
s
Gravel Depth Below fk 6 "
a
-
COMMENTS:
r
{...L/'itr\..,}.,,.-)\-,4r\i..rr:qr}'!+it-,rr::'ii{.e1,.{.).';\"/;')
Sco A 3q lhqt ? r/
v
/67.57
fr_ _
.Y
:r t^.,)
oJ'\
,OJ
oli -o,-{
_ L---.
I
I
I
Cv','r!
,(
)\-l
I
I
I
IFl>t
C\
1-i
"t(t.,.
))')
t/*
.i
\
,,D
., L)
t5
rt'
uo
C,(--
,
llll'
o)r
Et
-LJ
7--)L
.3
[:lit
()
ffifx
r1LIj!--t(.{t
)
2r3; h ) 3r'i.ulF
o o)
{'
(r
--- I lv
I
- - - - -- - 1
N
/(-a.5
It,tlr
.)rfl
Lt
1.6 / t+
8oo 4
7
Q / orf. : , €:,"s1 AIJ /,
, 3q hq(.2 (
E
rF----
?i
-1\
"nf'=
.
I
I
I
I
2{' *t\\}o$,S\o
/Y uJ
.)
at :s
(-
//.",/\
{olr-
tG '/
;jon.'r.,{5
{tc-L'I $
Lo
Dt\'t9-
CT
ru
offi
ffL&4
S (q l.-
7.')
)
l"- 2o
00
UJ
o
:^f 3J N'o 3l
.l
I
)