HomeMy WebLinkAboutPermit Land Drainage Alteration 1999-02-11This permit ls requlred for any slto actlvity ln the flood plaln and everywheie'alta blteratloir conslets of
flfty (5O) cublc yards of materlal or more and/or lf a dralnageway ls affest6d; wlthln Clty llmlts and
Thls Slde To Be Hlled Out by Appllcant
Permlt Explratlon Date:
6erzoPropertyOwner
Address
'Sprlngflild, Oregon
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'/^'t . al-? 'f^L\llDate of
Sito Address:
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Phone:7?b498
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Journa! number appllcable Land Use
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EXCAVATION,
SourceEf FILL,
Address
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wav8, Prodosed ,
Bulfdihos.'Seotic
slides, ?rbpoied
Tax andmateofnanddl,m8p
lines,
land
ents.lmp16vem
lot num
SITE
DRAINAGE, POLLUTION AND EROSION CONTROL
SOILS & GEOLOGY PLAN,
REPLANTING PLAN
STATE)4,CITY
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COMPANY NAME:
PROJECT SUPERVISOR:
PROJECT SUPERVISOR:
COMPANY NAME:
ADDRESS: 2
STATE:
ADDRESS:
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ExplratlonRegistration Num
CITY: .<;Y
OFFICE
EMERGENCY PHONEMOBILE PHONE:
CONTRACTOR NAM
PROJECT SUPERVISOR:
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havr futurc
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By rlgnaturc, I stltc lnd agrce, that ! hate carefully examined the completed lpplicltlon a.nd dg lrcrqby ccrtlfy that all
lniformltlon hcrcln b truc rnd oonost, and I fufther certify that any rnd all work pcrlormcd rhall bc donc ln accordancc
wtth thc Ordlnrnccr of thc Ctty of Sprlngflcld, appllcablc-Chy Stcndrrd rpcclfloeilom rnd DrLwlmJ;'and tlr lawr of thc
Stac of Orcggn pqftlllhg 1o thc wdrk dcecrlbcd'hereln. I furthor ccrtlfy thrt only contrtcton rnd cmployccl who arc ln
compllance wlth ORS 7Ol .056 wlll be ueed on thls project.
at cny tlmc durlng r onc yrrrpcrlod foilowlng thc rccclpt by
cpccify, at Src CiVr rolc dcrecradon, eny rdditlonal rcrtoration
tho City. Thc pcrmlncc wlll b. notmcd h.wrttlng of rny work
noticc to complct! thc rvorE Work not aomplctcd rt thc cnd of
will be blllcd to thc pcrmlttcc.
arc ,cqucstod rt thc propcr tlmc, that plolcct addrcrr.lc raadable from
on thc dtc at all tlmca durlng conctnrcdon.
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thc work dcecrlbcd ln thlr
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Ditch, E Culvert, B Natural
None,
Date:
FEMA Community paner No.: 4lso|toooZ*
FLOODWAY, FEMA Community Panel No.:
DBAINAGE, El Storm, El
FLOOD PLAIN, Zono:
WETLANDS,
$20.00
$30.00
$40.00
$40.00 For the first 1O,OOO cublc yardc, pluc
$20.00 for each rdditlonal 10,000 orblc yarde or frection theroof.
t220.00 For thc flrrt 100,00t oublo yerdr, plur
S20.00 for each rddltlonrl 10,000 oublo yrrdr or lrrstlon thcrcof,
9340 For the first 2O0,OO1 cublo yardr, plue
$6,O0 for each additional 1O,OOO cubld yardc or fractlon th6toot.
$30.00
930.00 For the flrct 100 cublo yardr, plur
$14.OO for each additlonal 100 cublc yardr or fraction thor€of.
$166.00 For the firrt l,OOO cublc yardr, plur
$ 1 2.OO for each additional l,OO0 cubic yardc or frastion thoreor.
$264.00 For the first 10,000 cublc yardr, plur
$54.00 for each addltlonal 10,000 cublc yardr or frtctlon thereof,
$75O.OO For the first 1O0,OO1 c{blc ycrdr, pluc
$30.00 for each addltlonal 1O,O00 cublc yardg or frastlon thereof.
33043
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Receipt No: ru43
Received
Date
100,001 To 200,000
2OO,OO1 CUBIC YARDS OR MORE
Date:
Received by:
ReceiptGrading Permit fea:
Estimatod Volume:
Plan Check Fee:
PLAN CHECK FEES:
UP TO lOO CUBIC YARDS
101 TO 1,000 CUBIC YARDS
1,001 TO 10,000 cu8tc YABDS
10,000 To 100,000 cuBlc YARDS
GRADING PERMIT FEES:
UP TO 1OO CUBIC YARDS
101 TO T,OOO CUBIC YARDS
1,001 TO 10,000 CUSlc YARDS
10,000 To 100,000 cuBlc YARDS
100,001 To 200,ooo
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Planning
Enoineerino
Malntenance:
Bullding:Date:
Date
Date:
Date:
lssued by:Date:
Date
Pp rmit Number
ReqUlrerl Final lnspectlons,'
Malntenance:
Date
Date:
Planning:
Engineering:
Bullding:
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Land and Dralnage activity as outlined in this permit has been completed in accordance with
the provisions ofthis perririt.
hit$,flYp?6gfiffi,.r1$i.yil,Jfgrsyflin"d in this permlt has not been completed in accordance
Land and Dralnage activity was performed prior to apptlcatlon for thls permlt.
Accepted by:Date:
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1/6/1998
Date:
Side To Be Fill By City
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