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Home My WebLink AboutPermit Building 1975-7-7 4h':"':~;,,:,;J ~;;.e:f(.fr ~.~', ~: -,.,,--- ,'--:-"'-'?C v~-' '.'" " '~. - \ " LANE COUNTY BUILDING PERMIT ~. ~~. ", :,BUllDING ( ') MH D)()(" " PROPERTY OWNER MAILING ADDRESS , \,~ . , , 00:1 V.UClYOtJ ' CONTRACTOR .,.,..-",.,. -.''''.;-' '-",V !fi'li3~;;=7S:-' USE PERMIT ' PERMIT NO,MH 362-15 PHONE SPRINGF~cllEGON 746-7953 ~'- PHONE , EUGENE, ,OREGON I OR MOBILE(''''>ME .~ 1125 NORTH 58 MAILING ADDRESS B ~ M BACKHOE SERVICE PROPERTY LOCATION - INCLUDE PqST OFFICE 2088 INLAND WAY' PROPERTY LEGAL DESCRIPTION - METES, BOUNDS ~TH,ADOITION TO rlLDERT GROVE .lOT 28 BLOCK 6 TWp RANGE' SECTION TAX LOT NO. P.O. Box CODE 18 'I' 11 1400 , . CENSUS,TRACT 17-186 EXISTING STRUCTURES ON PROPERTY APPL NAME B. /I, M. BAC/(HOE & SAME '\ NONE LEGAL ACCESS TO PROPERTY I.NL^ND WAY' . , MAILING PROPERTY SIZE ~ FT. ADDRESS FOR MOBilE HOME PERMITS ONLY No. of Bedrooms STRUCTURES TO BE BUILT THIS PERMIT PERMIT TO PARK ~OBIL~ HOME. .. WIDTH DEPTH AREA ... Connect to Existing Sewage System D TYPE C;::ONSTRUCTION SQ. FT. .~ BDRMS ~ 3 New System n VALUATION PERMIT TO INSTALL ~EWAGE DISPOSAL SYSTEM SEWAGE DISPOSAL . N PUBLIC 0 E~I ,BUILDING WASTE DISPOSAL PLUMBING PlANREVIEW PARK TRAILER 'tt. ' :J~.~ .,-,VV FEES PLUMBING INSTAllED BY' OWNER 0 OTHER: NAME. WATER SUPPLY. PUBLIC Ei XX 0 OTHER. SEPTIC TANK 0 _ _ 9THERD " . '10.00 ',04 81! .04 ,- COUNTY l./ TOTAL I, BUILDING & SANITATION SPECIFICATIONS .. MIN. SEPTIC .TANK CAPACITY WITH DIST. BOX: GAl. QOO ,DRAIN FIELD REQUIRED lIN, FT 1'jO TRENCH WIDTH FT. I 3D~PTH O~ SQ, FT. 300 '.' TYPE OF STRUCTURE OCqJPANCY I FRONT W,H BLDG. SETBACKS_~ 115' /s/ J. E. FT. FROM CTR. OF ROAD RIGHT OF 'WAY 5' SIDE INT, SIDE EXT. AUTHORIZED SIGNATURE - DATE ' Boss BY NEILSON, REAR ZONE rlRI!: ''I 7' p USE CLASSIFICATION UE " ' $HOOH/SANITARIAN' . PUBLIC UTIl. EASEMENT 1/7/15 DATE DLM BLDG: PERMIT"':" WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANlTATlON,.~ GOLDENROD :;s- Call 6B7-4065 to schedule all required inspections. All construc- tion shall comply with Uniform Building Code, D.E.Q. standards, IMPORTANT: for subsurface sewage disposal and county regulations covering plumbing. All buildi~gs'" require a certifisci!~!=>f.o~cup,a'ncy before. being occupied. (See Details on Reverse Side) I' ~~' y /:3 olP.g.ST (':THIS PERMIT ON MAIN BLDG, AT SITE) ,/ / LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANN~X, 135 EAST 6th, EUGENE, OREG.oN 97-401 FORM = (55-13 ~ G)#4 Cjf;f' RD3 SfI,'l-1..TAX LOT ;;'--1 f SUBDI. ,SION: No.mIl3(p2-7S LOT: BLOCK: APPLI CANT ~LJV1 \/t3vJ //?---I H. DATE (",12'11'15 I I I I CK'D By:~l~ 6. Setbacks from ell of~~d'p Front ~ S ide Exterior, Setbacks from interior lines: Side ~ Rear 7"Cr.o.E) ~' BUILD"NG'SITE,.EVALUATION r~. , , ! ., )<f ( ) B~ILDING PERMIT APPLICATION SITE INSPECTION 1. 2~ 3. 4. 5. Not AD'p 1 icab I e Zon i ng Ord i nance Comp Ii ance: Zone AA-mH- ( ) Subdivision Ordinance Compl iance ( ) Required Access ( ) Building Site (Area, Width, Frontage) () Other (see comments) ( ) PLANNING DIVISION COMMENTS: No Yes () 00 ( ) ~ ( ) ( ) ( ) ( BUILDING INSPECTION DIVISION PLANNING DIVISION ACTION PENDING: YESl ) NOl } APPLICATION# 7. Plans Submitted 8. Soil ,Stability (footings) 9. Flood Plain 10. Other (see comments) Not ADDl icable ( ) ( ) ( ) ( ) COMMENTS: WATER POLUTION CONTROL Not ADD 1 i cab 1 e ( ) ( ) 11. Meets Department of Environmental Quality Standards. 12. Other (see comments) COMMENTS: No Yes . () \XJ pi e1= DAI'l" ( ) ( ) ( ) ( ) ( ) ( ) CK'D BY::?V.o. >?--P~ 'tJ... ~) Y DATE '7-3 -? s-' No Yes ()TI ( ) ( ) CK'D BY: )~ 7//!lr \ ; DATE TO APPLICANT: ~our Building I Site Inspection: ,L .....().,r Can be approved. ~~ (~Cannot be approved at this time as indicated on item NO. above. ~/~~: Questions and further information on items 1 through 6 contact the LANE- ~~ COUNTY PLANNING DIVISION. Questions and further information on items 7 through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION. . ( ) Will be held in this office until you can resolve the problems indicated. ( ) Is being returned. ( ) Your building ('ermit aEPlic~!_l.9.!'__~,~__L~einq r~tur:ned under .?JlllJl.C.i'te cover, OEPARTMENT OF ENVIRONMENTAL MANAGEMtNI . 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANNING DIVISION PHONE:. 687-4186 C55-28 ".:i " , , .' I~) \0' '" 'Z-o I / ./ ,... "'" .j. ~ ---- / / " \- / , ,,.......... / ,.......... /' / ,/ /. /' /' ,/ .~ //\ // i, -- ., \ ,/ / /~/ / i.....' \. /' / <; / ~/~A< . . ,/ /-' .' ,..... /\~.~:~ \" \../ ;"/'~:> \/\~",.~,.,. ", ' 'i'~~2~\:_-~--~\ , \ ,,1"'\ \' . ---..---::- \'~.1.- , . _':-:.-----\ . ...,......."..."....'...-.--" I ,\\ .';' \ \ .:.. ~_.,~,~,....J ~ ,~_..""...-......-..- ~' ~A;~ C/'" .=\<2 ~.. se.."1'l.' ,,_\\-1>-1-\ ~ ,-;" r::>;'.{ N ll) t ril: . , LANE COUNTY ENVIRONMENTAL MANAGEMENT PLOT PLAN Name ;md A~ress ot' ,Owner f)~" ~fll&l/'"#1fH..( ./ '_,___ .1/)'> Yln \9l~pJ7 r-f2I-I(5-' _ Telephone:_71Z_C-2_7;:Y'~' The building being :constructed under this permit will be used for ,~pJij!.. J rYJI.- k./ If Date this prop~{ty was purchased (j It 17( . 'f I Do you now, or did you ever own property adjacent to this tax lot? If so. please list those tax lot numbers or draw those properties on the plot plan below, k-{) ',.:., Indicate on your drawing the location of all homes (including'.mobile homes) now.on ~ ~ ~ ~h~ ;~oP~~t~ ~ as well as :~e<~~~~~n~ ~f~ tnn:~ ::i;~i~:'~~~_ ~'_ _ _ = ~:_ _ ~~ ~'__ - ,- -- - '.. :-- - ~ -~ =;~: ~? ~~~~ ~~~~ =::=~ ~ ~~ t r=. ~~~~, =:,~: = - - -.~. =-l.~'''..~ ~.... - -- -- -- - -- - -.. .., .- -- .. ---- -~~~~i:=~==~~~~~=~~=~~~~=~~~~=~==~=~;===~====~=~_ --,'-'- ... H ~ _ :~~;-~~~~ -----'.:----- ...... ..'~, -- -- .. -- -. -..- ;;;..;..---~::::~- _ - ~ -: _ __ _ _. _. _ n. n_ .._ ._ .__ __ .__ .. - =~:; ~;;. -:-::;- -- - ,__ .::::: . u :.-_ c:' -: ~: : ~ _ ___ ==f~~~~=)t~:~~~~~~~:~~;~;;;=~;~~=~~~; -\ "I-,.",:,...:Q. ~ 'f\f\("'" - "'~ "', to --;~=.. ':--- .~'\ _I--\-,_~:: (.~\ I ~ --::-'=-, i mc:~1~~d:=~1~j~-=='~.ir .! _,I "f }I ., ,..., ". =. : \. :: ::; ~ ""', --I ----,-,-- "J, ,. , T' - _.~ l== _ , -- .. ' -... .. ":;:?-"" ,\;..;..~~ - '- ..,.,/ ".... , :~, L y_ .,0 =-,;;,,~~n ." ,.,:. 7-: - -- ... - ~'-- . __ I _ __ ''I'' -- I... i$- \-\,-~I. -~-------~~~------------~-- - ~ ,~ .I " '-, ___ ____. ' :t- ~ I ....:.- '-' i - ~------ ----------------.:.______----' "I':~,~G,~ ~~'~ . .... Il'Ii 'I I " -- - -- --. - - - - - - _ _ _ _ _ _ _ _ 1 ~ - If I I'!o:' T ,_.. -"'- -- - ,- !till ~" -.,. ,Y , N~me of Applicant' (if different from owner): &Niflifffi^ .:1-"'O@!iJ'Nt.,;. ',,:;;'AI Address ap /J...,\'~;,C.IVTAL 'l4^,.. ' Telephone Tax Lot . ~,.1" Applicant's In'terest: Buyer D Seiler 0 Agent 0 Permit .I1/lJ1I-:Jt:..:J-7..s-, M74-99 A Q-[ I Q.~ r -- v I / ( 0 I , I. '\ -2'; ~ . ~ --- , .. -. - - -1 QS~ ~-- " . Q9 ) ~ "-\ 1 I . I . ... ~ -. , , , r .i '. .. , -. , ~, . '- I -1 .J , ~ ,'. , ,9 . ..... r '. LANE C'''''!TY BUILDING, -' '[I' 7; I. oj' ~ ~ .., ~ BUILDING PERMJTtP~ MOBILl MH nX3\ ' MAILING ADDRESS ! I:::., NoonH sr. MAILING ADDRESS OME / ,. ; USE PERMIT PERMIT NO,I>f-I 3(,z~ 7S , .'1. " PROPERTY OWNER I' I.lOH MUIi\"~ CONTRACTOR 8 . M 6ACMtOlt StRY let., PROPERTY LOCATIO,N - INCLUDE POST. OFFICE ;::006 l,"""ltl) WAT' , . PR9PERTY LEGAL DESCRIPTION - METES, BOUNDS PHONE S,.RIHGf'IUO OIlUett 1li(..n53: PHONE P.O. Boll EVGcm:, Ol1!EOIl" " If: T? l'lul",. GIron L<l'l" 2B RANGE SECTION' .. ;// ,/" '_ v'-v ~ ~ 11 Dl.QCK 6 "jt<l Ace IT 11>>1 TWP TAX LOT NO, CODE CENSUS TRACT 17-186 1400 APPL NAME 8. &. M. BAtIlHOf: 1l!..,J. I.!',. EXISTING STRUCTURES ON PROPERTY ,<_.J, I~-,; Np.tiIt .'/', /' ',(- LEGAL ACCESS TO PROPERTY 11I1.J\NCl'dAV ,"..; & ~ MAILING ADDRESS FOR 'MOBILE HOME PERMITS ONLY " No. of Bedrooms -1/ STRUCTURES TO BE BUILT THIS PERMIT PEIII^11 10 PAItlI ~ILt HeMt SAru; PROPERTY SIZE - fT. WIDTH DEPTH AREA ,r 'v',t;l' I ,,' "fl Conne~t -to Existing TYPE ,CONSTRUCTION Sewage System 0 SQ. FT. :t+ BORMS /" 3 New System n' VALUATION ., , .,. Prll'4,T TO IllaTALt.. St'lAot DI$l'OSJ\l STnlM (j"-., -' /1. ,. , j; , , -' "1 SEWAGE DISPOSAL iW\( ,'PUBLlC 0 SEPTIC TANK D BUILDING WASTE' [)tSPOSAL PLUMB'ING PLAN 'REVIEW PARK TRAILER I! TOTAL , OTHERD . ..^ ^^ FEES .,J-.-- 1._ ........- 30.00 .Olt . l';4.O't PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBliC D .l(Jl n OTHER II , j' . ,,'~j .j \'.j , ,.'1" '..-;' .. . '. ~ , . ; MIN. SEPTIC TANK CAPACITY ,WITH DIST. BOX:: GAL ~ COUNTY ,BUILDING ,&,SANITATlON I .'DRAIN FiELD ;REQUIRED UN, FT 150 SPECIFICATIONS 'H" -'J Jl~; . J" , 'I' j. . \, j 'J:'~ Li .1: TRENCH WIDTH FT. 3QtPTtlOR SQ, F1. ~. , I TYPE OF STRUCTURE ~..~ OCCUPANCY ZONE F'llle 3 1'PtJtUSE CLASSIFICATION PUBLIC UTlL EASEMENT l'~~ l. 1-," BLDG. SETBACKS _FT. FROM CTR. OF,ROADRIGHT OF WAY ''7' ")' FRONT SIDE INT. SIDE EXT. REAR I I J E iLAUTHORIZED,~IGNATURE-DATE " . . It<Ma .., "'" ....v" " SH80_/'4".TARIA" 7/7/75 DAT~t.M BlDG. PERMIT - WHITE OFFICE COpy - WHITE COUf'lT'/' TAX - PINK PLUMBING - CANARY BUILo"nSG - GREEN ,SANIT~T10N - GOLDENROD Call 687-4065 to schedule all required inspections: All construc- .tion shall comply with Uniform Building Code, D,E.Q, standards IMPORTANT: for subsurface sewage disposal and couhty regulo'tions., covering , plumbing. All buildings require a certificate_of occupancy. before " ' , being occupied, \\'5;:- )~~ '1 ~ "i <;::. )\(~~e"tdlls\?~ R~verse :~~h'S (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 i ! i ;'ORM ::::: C55- 13 . ~",.;...,.I.,_..,....,. SITE I NSPECT I ON ApPROVED Cl DISAPPROVED Cl DATE REMARKS FOUNDATION INSPECTION APPROVED / / DISAPPROVED L----/ DATE REMARK 5 FRAMING INSPECTION ApPROVED /1 DIS,APPRDVED 17 DATE REMARKS LATH OR SHEETROCK INSPECTION ApPROVED /. / DISAPPROVED L----/ DATE REMARKS . FINAL INSPECTION ApPROVED fift. D:PPp~ ~D~7~7lf~7 REMARKS CERTIFICATE OF OCCUPANCY READY TO' ISSUE / / NOT READY TO ISSUE Cl DATE REMARKS I1H~t.1.-7.? $~ 12 t)?f" I NSP,ECTOR INSPECTOR INSPECTOR INSPECTOR INSPECTOR I NSF:'ECTOR' ~' . ., , , " . ..~{ .." . .' J. .~t:l ' , '.. .. LANE CG"''1TY BUllDING\J BUILDING PERMIT OR MH DI'J( MAILING ADDRESS "2'5 NoRTH 58 MAILING ADDRESS. ---- MOBILE '-./ -.,...,;..--"".-- /))-13(,.)-7.)" OME USE PERMIT I PERMIT NO,Mfj 362-75 PROPERTY .OWNER PHONE Sp~I~Grlr~O On2GON 746-7953 PHONE 0;r.J MUNYON CONTRACTOR B Q e3 ElACltNOI!: SItIlI1II:l! PROPERTY LOCATION ~ INClUDE"PO'ST OFFICE 20:88 Irl~ArJD HAY' PROPERTY LEGAL DESCRIPTION - METES, BOUNDS ~TH ADDITION TO r'LOtAT G~Qva LOT 28 SLoc<< 6 TWP RANGE SECTfON TAX LOT NO. P.o. SOil ,Elll'l~XJt;..?,,Qmtp(m CODE CENSUS TRACT 18 ':I II IlJoo 17-186 EXISTING STRUCTURES ON PROPERTY APPl. ... NAME & MAILING' ADDRESS FOR MOBilE HOME ,PERMITS ONLY No. of Bedrooms 8. & M. BACIU>IOI!: NON!! LEGAL ACCESS TO PROPERTy If.lLAI'lD \1AY SM,11 PROPERTY SIZE - FT. WIDTH DEPTH AREA STRUCTURES TO BE BUILT THIS PERMIT PEII~IT TO PARK t.ro31~E H~lE F PeRI41T TO INSTALL Se:.\'IAGli: D.sposAi. SYSTem Connect to Existing TYPE CONSTRUCTION Sewage System 0 SQ. FT. +t 80RMS 3 New System 0 VALUATION SEWAGE DISPOSAL . Mli:1;1 PUBLIC 0 . BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER , FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC D XX n OTHER SEPTIC TANK 0 OTHERD J':' . "" .. -- ..,.""" TOTAL. , '<<>.00 .011 M;~ COUNTY BUilDING & SANITATION SPECIFICATIONS DRAIN FlflJ? RfQUJ~ED MIN. SEPTIC TANK CAPACITY WITH D1ST. BOX: GAL. goo UN,' FT 150 TRENCH WIDTH FT. 3D;rPT~ OR SQ, FT, 300 , TYPE OF STRUCTURE OCCUPANCY ZONE fIRE 3 7' PUEUSE CLASSIFiCATION PUBLIC UTIl. EASEMENT ~:H BLDG. SETBACKS __ FT. 'I)' FROM CTR. OF ROAD RIGHT OF WAY SIDE INT. 5' SIDE EXT. Is/ J. e:. Goss o\VT~'i:RlrgJ~GNATURE - DATE REAR " ,I I I FRONT SHOOR/OA"ITARIA~ 7/7/75 DA TM:'tl ;. BLDG. PERMiT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD IMPORTANT: Call 687-4065 to schedule all required inspections. All construc- tion shall comply with Uniform Building Code, D.E,Q. standards for subsurface sewage disposal and county regulations. cov~rin9 plumbing. All blJildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) .,,' \' , . \ (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT. COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401 FORM =- C55 -13 SLAB FLOOR PLUMBING GROUNDWORK -, 'ApPROVED / / DISAPPROVED .Cl DATE' REMARK 5 GAS PIPING GROUNDWORK ApPROVED / / DISAPPROVED' I I DATE REMARKS " , ROUGH PLUMB I NG ApPROVED .Cl 0 I SAPPROVED / / DATE REMARKS ROUGH GAS PIPING ApPROVED .Cl DI'SAPPROVE-D..Cl DATE RE~ARK5 i" 'F I NAL PLUMB ING ApPROVEO /y/ DISAPPROVED / / DAT@:J.~.)5 REMARKS FINAL GAS ,PIPING ApPROVED Cl DISAPPROVED', / / DATE REMARKS CERTIFICATE OF OCCUPANCY - , READY TO ISSUE / / NOT READY TO ISSUE- ;---? REMARKS INSPECTOR INSPECTOR INSPECTOR INSPECTOR ,",,,,,",s4' ~ INSPECTOR DA TE INSPECTOR '. " "'..'.'. '." j ....... .....: . . ",dIe of Or.egon DEPARTMENT OF ENVIRONMENTAL QUALITY INTEROFFICE MEMO To: Greg Gray Date:. 3/4176 .From: D. Johnson Subject: Bris tol installation of subsurface sewage disposal system Below are my suggestions' for corrective measures to bring said system to approvable status: 'J.,~I.J~' According to our evaluation of this date and our conversation at the site, we should give 250 linear feet.credit for the existing system of approximately 400 - 450 linear feet. This takes into account that the last (or farthest) trench is better than 12 inches too low and that the first trench (or nearest trench) is.unfinished. It also takes into account that the gravel used thus far is too small in size and, therefore, unapprovable, Corrective measures would consist of: 1. Completion of first (or closest trench) with approvabie filter material approximately 50 feet. 2. Addition' of approved gravel to last (or farthest) trench and rais.e distribution pipeJ-:-lOO add:ltioU<ll fe'et. 3, Install additional 50 feet, of trench in an approved manner, This should give us 450 linear feet of approvable trench. ....:. ,-, NOTES: i)~;:: 'f.\~~~L'l '\'~-'''' .'-';),".;: Maximum of 125 linear feet can be credited to any.one trench. , - '<! : . Filter material throughout entire trench system should be level and no higher than the invert of distribution box outlet. " As I see. it, an option- to this action would be tq remove existing "peall gravel and replace with approved filter material and bring trenches up to proper level. I think that this action would back up an approval. If you have a conflict with this" let me know. DJ/jnf I.... . , OEO .4 INSTALLER: ~ ". -1 . " .. ,.'.. PROPOS SEWAGE,DISPOSAL,SYSTEM RECORD ,.' ,i ' :'j,!; ,.- , Co~plete ,toppa~t at forni, tosignature and submit both cop,es w.fthappl i,Si?,tjqn;'3' ;, :i~:- , , '. , ..,,, , PERMIT.,NO. fit M" 0 4 INSTALLER'S NAME , PROPERTY ADDRESS' ".' , ' . , :: , .. -;:-" \', , 'I \ ,I , ';~ :' 1'1-1..:> i..tJS'f,...,..'f Sf;",,-f..fJJ cr1k~ - Y -'- 1,\ t\..\1 C\ \'u"'''''t' r I , . Baths Basement, Wa er"Supply , . ' ' , Yes ,(lTcj') Pu Ii c)>\; Other-Li st' , ~.:. -()--+. M ' (3 J\-rJ~ \~ NO_,~ LiVC9 Units, ' Bed~o~s Septic Tank: Ft. from well St'eEd ,..0' '" ,co"n,'cr~te 1&1,.' ,NO.. Compartments ,Gal. Capacjty.:"'. ~' , 1('\("')0 ~:~~~~~~n~:~~~Z; Ft:~iameter:;. : Depth 5' ~::~~~~~~~n~\~~~l~ No ..:::~ DIfI^ y..,^~: .... :... .. "'" ''''';00'''0-"" , . t ' ,Feet from MAILlN'G '" -Z~ IV.' 5: ~ .. WEn ,Foundation ADDRESS~;~ 1,. . PO,..I " Lot Li ne . ' ::;rt=':~E;;\-\j Front. Si de Rea'r Le'!~th of/~ines-Fti). IT~ench,1 Tot~.~9-,.1 I F~., Betwee'}. IFiller).IIFiller Dep,th', IFIlh~,Be'ow 1 752J$3. '.4. 5. 6.Wldth2: f't.~")a.J .Llnes .ID " TVDe JI'Z Above Tile"LlnJrilew' in. ,lot P,ian'(see. instructions):._, '9~Q -L\ , <j. &=' :::; , ,~. ~' , , , .' . .JD ~. 'I, ' , ~. \~ ", f , -\'~ ':'. (~ , - I, '\ ~;)r I \ ~ ' ! ' ...,-::, ....-- " '. .~ / ;'D'B~ r . ~'.. -f)' ~BS . . . "f1\-l-lV, \, . -I. ., 5' ~:~' ',: F..-1-":,u' ;,P.Ra?OSED , 'TR /7: IlvE1( r n' .... .1 . " , ' . / Date.:?!''!. I 15' Si(l!laturet'?JP.YTI~ /'X1Tj~"<:: .f I,. " CERT 1 F I CATE OF SAT I SFAC:rORY C PLETmN OC/ I) For .Sanitarian ~se Only:, : Date: ',: (.-'. In accordance with 19730reg()n LawsChapt~r 835, Secfion 2 4 thi,s certificate is issued' as evidence of; satisf,actory completion of a subsurface. sewage disposal sy.st'em at" the above , . loca~.',' :.' . ~ iI'pprov,ed: 'System I nsta Ilat i6n conforms to current standards Cl Di.sapproved; Does not con~o,rm to current. standards RemarKS: , ',STATE OF OREGON DEPARTMENT OF , ~" ~~an.s Signature. IIPt~~TY ENVIRONME TAL, QUALITY ' 'C55-11..~ 1 , 'NOTE: CJ ' OWNER ~ CONTRAC'TOR O.S. REG. II Twp. /"6 Subdivision ACCESS TO PROPERTY - ,- NO PERMIT PERMIT Itl!Jjj-Jt:.J.:(J:. BEEN APPROVED ~ LL BE ISSUED UNTIL THIS APPLIa )N HAS " APPLICATION FOR: ~ ~ PLAN REVIEW CJ CONSTRUCTION -CJ DO^I L lilitH/of? LL25/lJo , Name f Address 3.?fVI ,&illldt- Po MOBI~E HOME Name Address Phone Range 5'~ -::> ~ / I" f';..Q _~ ~ection Tax Lot -r j/,J f;fbh- (::rrc..... /HId", ';Ob. - Lot;2 'it Block r_ (Road Name;_~ i...J ~ o JI1~Mj I ?~;1 h ~ Code Census Tract Property Acreage 1#, Width~Depth 3'5 /ztft{ e. Existing Structures on Property: ./.PJ 9:~ Property Location - Address/Directidns: / Below for Office Use Onlvxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx ~ ~d.:xv ~ Sq. Ft. Min.' Septic Tank Capacity Bf,{ih ~...J!-v SEWAGE DISPOSAL: Site Inspection # WATER SUPPLY: Well FEES: Bldg. Waste Disp. Plumbing Plan Review Mobile Home 1% Surcharg'; TOTAL Spring XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX #Bedrooms Valuation :3 ~?:.& Exls ting Sewage Disp a1 System' CJ Publi ~ C5<::L Name of Community or PUbliC.'SYstem~1 or New System Required ~ Other PLUMBING: Installed ~ Other ~ Name (~.oD ~,~ .(1 of Fixtures Sewage Connection Water Connection C\ ,./ , =- g), :;j-d , D i) . HI PLANS FURNISHED FACILITY PERMIT pio t-' ~ (;8;d YES c:=J NO 0 _ ~ YES c:=J NO . Signature of APPlicanE~".t5)f }, f)~ Fe~ Received By:r....6--- Date: ~-:J7~ C:::] CASH K-,Ef'. () t.L. ~ECK' Drainfield Required - Lineal Feet InJ Maximum Depth -~ Type of Construction /i1?.;-I, Group r. ' :/ 'Use Classification ~M ~ Bldg Setbacks - Front 4-1:: ~ C55-12 Fire Zone ~ from Center of Road ,Right of Way: Side Int.----.!5 Side Exterior . Rear/'pLlE.. Zone PA--MitJ- . ~ DA/~~ ~rb~ COUNTY ~rION: \ \' - DE TMENT OF 7J/7~ {)~;I&~ }ga~ ,- I' V-- ENVIRONMENTAL MANAGEMENT DATE: ~...~-rr~ ?~