HomeMy WebLinkAboutPermit Building 1976-12-013 rss- 7L
oe Job Location
INFORMATION SHEET
) Site Feasibility Study for Septic Tank. Number of sites
) Would like to meet on site. Call (owner, etc.)
Test holes will be ready
Subdivision t/ahnfino ParK tJ-to, 6
existing or proposed well, etc. lf public, name of system)
(existing or proposed septic tank, etc.) S.l
TttTRS, T
uilding Permit
Acreage or Lot Size-
Partitioning #- ( )Completed Bloc
pnon" 3 y'{' ttoT -Phonel+7 _3t73
Phone-en from a ,S
( )Applicant ( )Owner ( )Contractor
( owner, etc. ) when ready
STRUCTURES NOW ON THE PROPE lrl
PROPOSED USE (this permit)N
WATER SUPPLY c
SEWAGE DISPOSA t Extsfl$G SEPnc TertK
PLUMB tNG By extsftpe 6^It-? Address
I 1 ) pRopERTy rs wrrHrN oNE MrLE oF crry
******* oFFlcE usE oNLY BELOW THIS LINE ********r****
( )New Necessary
zoN
( )Facility Permit ecessa ry ( ) Special Permit Area. lVlinimum Elevation
Side Facing Street
(FROIVI CENTERLINE OF ROAD)
z-/ .r-/
lnterior Side Yard J Rear -1
(FROIVI PROPERTY LINES)
SETBACKS: Front
To: Planning/Building lnspector/Sanitarian/Surveyor.
This applicant appears to have a problem with
Your assistance will be appreciated.
By Permit Processing Section
Response
c55-12
DivisionBy
DEPA RTIVI ENT O F E NV I R ON TVIENTA L IMANAG EIVI ENT
Permit Processing Section
125 East 8th Avenue
687-4394
APPLI
(
(
E AND ADDRESS
OWNER E AND ADDRESS, if d
CONT R'S NAIVIE AND ADDRESS
or results of site
(Prefer to pick up. Call
/?o:-t?/x q 6tu
TRS, TL
Acreage or Lot Size
Contractor's O.S. #
APPLICANT ,S NAME AND ADDROWNER'S N
,,CNTRACT
AME AND ADDRESS
OR'S NAIVIE AND ADDRE SSMail permit to ( )Appticant ( )
LANE COUNTY PERMIT
PERMIT #
JOB LOCATIO
Partition ing ( ) Completed Subdivision
Lot -- B lock_
Phone-
Phone-
Owner ( )Contractor. () Prefer to pick up. Call
Phon
(owner, etc.) when ready
STRUCTURES NoW oN THE PRoPERTY
THIS PERMIT IS FOR
# B ED ROO IVIS--# P LUIVI B I NG CO N N ECT IO NS
\A/ATER SUPPLY
SEWAGE DISPOSAL- S.I. #
THIS PROPERTY IS WITHIN ONE IVTILE OF THE CITY OF . PLUI\4BING BYI hereby certify that the above statements are tr ue and accurate, and that I have the followi ng legal interest in the property
-contract
purchaser; _-potential buyer;
-
realtor or agent. I further certi fy that (if not the owner) I am authorizedrecord, and that said owner is aware and approves of this action. I hereby agree to com ply with all applicable Codes relating to thisFee paid $I -owner
of record;
to act for the owner of
i permit.
LEVATION:
--
( ) rurw ADDRESS () FACILITY PERIVIIT TO TRAN
Signatu re Date
SPORTATION DEPT.- ()SPECIAL PIVIT. AREA. IVIIN. E,SANITATION
Cornments
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal FeeilVlaximum Depth
BUILDING
Type of Construction
-Group -Fire
Zone
se Classification
Comments
B
PL ANNING REO
ZONE
LAN E COUNTY DEPAR
Date By
UIR EMENTS SATISFIED. B
Date
v:Date Date lssued:SETBACK S: FRONT SIDE FACING STR EET (FROIVI C/L) INT. SIDE Y ARD REAR (FROM P/L)
TIVI ENT OF E NVI RONI\4 ENTA L [\4ANAG EM ENT 125 EAST 8TH AVE., EUGENE, oREGoN 974o1 pHoNE: 687-4394POST TH]S PERMIT ON MAIN BUILDING AT SITEBLDG. PERMIT - WHITE; BUILDING - GREEN; PLUMBING - CANARY; SANITATION - GOLDENROD; OFFICE COPY - WHITE
c55-13
lane county-
HOLID SLIP
APPLICATION #G
t v,'d Name
Address
Z pco
The above applicatjon js being held by the Permjt Processing Section for the following
reasons:
Division:
Si gnature:
Di'vision:
Si gnature :
t*&
Date
s
Date
Th'is appl i cat'ion wi I I be hel d unti I If the information
required above has not been furn'ished by that date your application will be cance lled.
Fees paid for waste disposal systems (site 'inspections and/or applications to install
the septic tank and drainfield) are nonrefundable. Some refund may be made on the
building and plumbing portion of your application if cancellation is necessary.
In the event a Planning or sone other long-term problem exists over which you have
no control we will hold the permit until the problem is resolved and we receive word
from you as to whether to proceed with permit issuance or process a cancellation.
c74-139
PERMIT PROCESSING SECTION - 687-4394
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SITE INSPECTION
Appnov E o
RrMaRx s
D r saprnoveo oare E -/J -/6 I NSPEc
FOUNDATION I NSPECTION
o^,, /2 -/e 46r NSPE.T.R g,r'{
-T-APPROV ED
REtIARK s
FRAMTNG INSPECTION
APPRovEo
Re uanx s
I 5 APPROVED
*=_orsAPPRovED J oorr2 - 7 --7? lxspecron
LATH OR SHEETROCK INSPECTION
Dr SAPPRovED Drr e ItrspEcton
Ap pnov r o
REtt I nx s
FINAL INSPECTION&I NsprcroR
AP PRov E o
Reuanx s
DrsAPPRovEo
CERTIFICATE OF OCCUPANCY
Reaov ro lssuE
Reuanx s
D Nor REAoy ro lssuE D Drre-lHsercton-
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PERN/IT #
TRS, T
Acreage or Lot Size
Contractor's O.S. #
JOB LOCATION
Partitioning
LANE COUNTY PERMIT
( ) Completed Subdivision
Lo t . Block ,'
APPLICANT'S NAME AND ADDBES
OWNER'S NAME AND ADDRE
CONTFACTOR'S NAME AND ADDRES s
Mail permitto ( )Applicant ( )Owner ( )Contractor ( ) Prefer to pick up. Call
STRUCTURES NOW ON THE PROPERTY
{-l
/ |:.,/'' !Phone
Phone
Phone)t (owner, etc.) when readY
THIS PERTVIIT IS FOR
WATER SUPPLY
# B ED ROOIVIS--# P LUIVIB I NG CO NN ECT IONS
. I SEWAGE DISPOSAL s.l. #
-
TH IS PROPERTY IS WITHIN ONE IVIILE OF THE CITY OF PLUIVIB ING BYI hereby certify that the above statements are true and accu rate, and that I have the followin g legal interest in the property
-contract
purchaser; _ potential bu yer;
--
realtor or agent. I further certif y that (if not the owner) I am authorizedrecord, and that.said owner is aware and a pproves of this action. I hereby agree to comp ly with all applicable Codes relating to this -owner
of record;
to act for the owner of
permit.
Fee Paid $Signature =___- Date( ) NEW ADDRESS ( ) FACtLtTy pERMtT TO TRANS PORTATION DEPT.- () SPECIAL P IVIT. AREA. MIN. ELEVATION
SAN ITATION
lVlinimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
lVlaximum Depth
BU ILD ING
c..,"""1,
Use classification
roup ire Zone
Comments
B Date
PLANN I NG REOU I R EIVIENTS SATISFI E D B
Date
ZON E
Date Date lssuedSETBACKS: FRO NT SIDE FACING STREE T (F ROIVI C/L)INT. SIDE YARD , . REAR ,(FROM P/L)
LANE COUNTY DEPARTIVIENT OF ENVIRONIVIENTAL IVIANAGEIVIENT, 125 EAST BTH AVE., EUGENE OREGON g74O1 PHON E: 687'4394
POST THIS PERMIT ON MAIN BUILDING AT SITEBLDG.PERMTT-WHtTE; BUtLDtNG_GREEN; PLUMBtNG_CANARy; SANTTATTON_cOLDENROD; OFFtCECOp\/_WHtTE
B
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TRS, T Job Location (Street, mile post)4?A
PIot Frlan
frEOEEVil,i
FOR SANITARIAN'S USE ON LY
COMIVIENTS:
ffiSyrtu. Approved f! System Disapproved fl Needs Correction
By
Si
FOR INSTALLER'S USE: Trench Depth VtU Filler Depth Betow Ti
Tank Capacity Manufacturer
from drainfield
Date i- t'
F2< tsli
5€Pfl'
T..kd'c.
G(
JAN $ + 1977
LANE COUNTY
ENVIRONMENTAL MGMT.
lVleasured distance to well from tank
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INSTALLATlON RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION
When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat'
isfactory completion of a subsurface sewage disposal system at the aboye location.
Return this form to: Permit Processing Section, Department of Environmental fVlanagement,
Public Service Building, 125 East 8th Avenue, Eugene 974O1
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