HomeMy WebLinkAboutSpecial Inspection Septic Tank 1976-5-13
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Use Only _~ '.. \Ao ~ Yes No
Re~~e 'b' Code C.T, Number Soeci~l Permit Area Urbanizinq Area
THIS IS A PRELIMINARY REPORT WHICH OOES NOT INSURE THE~SUANCE OF A FUTURE BUILDING PERMIT.
PLANS OR EXPENOITURES MAOE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK. ~~I
. PLEAS E P R I N T ~
If Subdivision - Name~1,,~~ JJ.A ./.....>::-fJ- ~l;I. C1.d2.Jl.. Lot Block K9si
o 7;> /F2--.j~, 6z.o0 P J"~~J Yes V No ' ;>0
Townsh ip Range Sect ion Tax Lot No. "~f Property Owner I 5 Consent ~
~~nY.l . ~dJT No. of Sites I $ \-1~
Na' .,
S"~3.r- J1tt~ s::::p. No. of Acres $ 0= ____
M:sf~Ci/ _ ~~j Total $ n C..:::::.-----~ ~
7tr7~8'7s.- {~~A7ld.~ y,s::/B-7t.= ~~:~k . \,2 /" ~
Telephone # SJnature of Appllc nt Date Owner /Seller
Proposed Use '\u. n 'II ...I'r'U~n Appl icant's Interest BUy/, t-/' Realtor
of Property: lVI~ k1ror-~ in Property: Other (SpeC/ifv.yt
~OX).-Ir~~ ~..
Property Size Legal Access - Road Name Existing Structures~n Property
~s Property Within One Mile of C~it J Proposed Water. Supply
es / What City? .~ Publ ic _ ~trict.: p
No V I Spring /'ilell Other (Specify):
Property Locat,jon (D i rect ions): In \ :2- ~ P .:z.;.., ~~/I.-/
~~.) ~ QJ r /.
-, IV I /
When Will Test Holes Be ReadY?~ \( ~ . { ilb)'. :L'1.1 tp
MARK TEST HOLES WITH OUR FLAGS (Da7~'r . ~ \V' . "
Location of Test Holes on Property:
Draw diagram of property showing locltiln of any landmarks and re"ationship of test holes to
these landmarks: V
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MAKE CHECK PAYABLE TO: ENV I RONMENTAL MANAGEMENT
MAIL TO: LANE COUNTY OEPARTMENT OF ENVIRONMENTAL
C55-55
'.
Phon e: 687-4065
MANAGEMENT, 135 E. 6th Ave., Eugene. Ore.
~-
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SITE EVALUATION WORKSHEET
\.
LOCATION:
/ tr RANGE
rrl,
TWP.
ZONING:
PROPOSED
( I
6}) X ~1S-
SIZE OF PROPERTY:
WATER SUPPLY:
COMMUNITY ~
SECTION ;?, J' )'
TAX LOT # r; :20-0
USE:
, ~~ ~ ;f~J~7
USABLE kEA: ?Y....,.[
AMOUNT
PUBLIC I I
INDIVIDUAL I -I
IF SITE MEETS STANDARDS FILL OUT:
Type of structu~e and approximate sewage flow: Single Family
Multi-family gpd'., 0' Industrial
Commercial gpd Institutional
MINIMUM DESIGN REQUIREMENTS:
Length of disposal trench
Distribution Method:
required
Equal 0
Yes tJ
Curtain drain required:
Other:
::n-o
I tn) 7e
Ser~al D
No Q(L
gpd
gpd
gpd
/150 gal.
SPECIAL SITE CONSIDERATIONS OR VARIANCE OPTIONS OR OTHER ALTERNATIVES:
NAME:
-dJ~
(- < (J
C74-126
DATE OF EVALUATION:
0'-.;2. J;. 7c
BUILDI~G SITE EVALUATION ... '..- '&~rr
*B.UILDING,~ERMIT.AP.PLICATIO.N~O. 7b;"''32-7.-.
() SITE INSPECTION
PLANNING DIVISION Not'
Applicable
I. . Zoning Ordinance Compfiance:Zone l'J4-1nIf( )
2. Subdivision Ordinance Compliance ( )
'3. Required A.ccess .. . . ( )
4.. Building Site (Area, Wi,dth, Frontage) ()'
5. Other (see comments)' , . ( )
COMMENTS: .
T S
SUBDIVI~. "
Tf-X LOT
LOT:
BLOCK:
APPLICANT
DATE
No Ye,s
T)TI
() (I ,)
( ). ( !~
( ) (VI)
( )'(q.
CK'D By~ff~/.<'-7b
6. Setbacks frbrn'cfl-of road~
Front AI/A
Side Exierior ,
. 'Setbacks from inter I or 1 i nes:
Side I
Rear V~
..
PLANNING DIVISIPN ACTION.PENDING: YES( .) ND( } APPLICATION#
Not.
Appl icable. No Yes
( ) Tl.o/J
( ,). ( ):~...>
. BUILDING INSPECTION DIVISION
Not
Applicable
( )
( )
()
( )
.'
7. Plans Submitted ' " .
8.Soi I.Stabll ity (footings) ..
9. Flood Plain
10. Other (see, com~ents)
COMMENTS:
'.
WATER POLUTION CONTROL
II.
Meets Departmen~ of Environmental
Quality Standards.
Other (see comments).
12.
!I
COMMENTS:
'.
. ~ '.
.,
No 'Yes
T) TI
( ) ( )
() ( )
() ( )
CK'D BY:
DATE
'.
,," !;
.. ~K'D BY#d~/~ $"-.;2~ 7~
. .. j . DATE
.'.
TO APPLICANT: ......
. '{our 'Bu ild ing I Site Inspect i on:
/}(~.N Can .be'approved.
.L )~Ir () Cannot b(! approved at 'tl')is time 'as indicated on item NO. above.
')... , f?' Quest i OilS and further i nformat i on. on items .1 thr.ough 6 c9ntact the LANE-
:1)\ 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 permit appl ic~.!.L~-,,-fei" is .bel,ng .(~tul:'(l.~d und..u:~r"t" r.nv"r
DEPARTMENT OF ENV I RONMENTAL AANl\La:MtN I .
.135 Sixth Avenue East. Eugen.e Oregon 97401.
.' RHONE:. 687-4065 " . . ,
"LANE COUNTY PLANNING DIVISION PHONE: 687-4186
C55,..28
1 1
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V.c3 O.j O~oJc>3 \J~.~~J
Twp. Range Section Tax Lot
, )~;.,
"-"'
Code
~ J ...:'
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.... '.:.....l':::~! .l~.l1n:.)"i:h
. S'Ir.name -
,,...3
Census Tract
Receipt No.
Date
:,.;o~.J-75
I Own~~:: I n~]
Owners Consent
Yes--, No
REQUEST FOR SITE FEASIBILITY STUDY
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT. ANY PLANS OR EXPENDITURES MAOE IN RELIANCE UPON THIS REPORT
ARE AT YOUR OWN RISK:
Name K.:nns(-.h l;;I.tc 1 $ :'5:lJQ
and No. Sites
Addreso 5335 L~1" 3i.:t> Sp.1CC 121 $
No. Acres
~l?r!'lLfbld. :)1:c30n n07 TOTAL $ i~.UO
Telephone No.
70-5875
Property Size
60,;.n5
Existing Structures
i.1or.t:
Proposed Water Supply
publ ic District,;.t Sorinq
Applicants Interest
J>uyor
Legal Access - Road
(!"rboL' uri.ve
in Property I P~~1s1~d H~~J~ of Property
Nam~ Ispecial.permit Area I Urbanizing
Yes "-l. No Yes No ..,
Is Property Within One Mile of a City?
What City? :']t:~.n~;,:~.cJ.,~ Yes.iUt. No
Other
Soecifv
Area
Well
,Property Location: (Directions) ,;O:'1.t:11 2.11Q 81:0 ::0 L"~1.'bor .l.t~':;./'l ',.1 ..:i.'.Jl:ie0Z~.ul;:~o
APPROVEO .~~l NOT APPROVED
'l.'L.~ t:.r.c;.:. ():~ tn.:: i:cwi: ~101cl) can 02 ';.J,'?ZOUV(;'c1, ':':or sept:l.c (~:tE,..pO.3'.J. .;,yit81ll-3
:,.n ..:2.'(;,] trU;i;': j~3 .t..U~H.:'LVCo. fvX' the ~3pi :::'31f.3il~ Ot U1(. d.::':-.b~';':i,..:J.do
OAR Chapter 340 Divlsion 7 Section 72-020 (6).
This report shall remain in effect until issuance of a permit to construct.
unless in the meantime conditions on this or adjacent properties have been
altered in any manner which would prohibit issuance of a permit in which
case this evaluation report shall be considered null and void. Technical
rule changes will not invalidate any evaluation report issued pursuant to
this section.
BEFORE CONSTRUCTION IS STARTED bring this form to the Department of Environmental
Management and make application for a building permit. If the property is a por-
tion only of a tax lot, a metes and bounds description of the parcel must be fur-
nished. Exact specifications for the sewage disposal system wi' 1 appear on the
building permit. Two sets of building plans and a plot plan will be required.
LANE COUNTY DEPT. OF ENVIRONMENTAL MANAGEMENT
135 EAST SIXTH AVENUE, EUGENE, OREGON 97401
(;..~'-' ,.., [:.:, ---,
C55-32 B
t"fU~~~,oS.i~e.d ~'li gnatu re
Date
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