HomeMy WebLinkAboutPermit Septic Tank 1992-11-17 (2)
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SEPTIC SYSTEM VERIFICATION
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LOC:ATI?;l,~DRESS
13~, COTTON WOOD STREET, SPRINGFIELD, OREGON
STRUCTURES NOW ON PROPERTY
EXISTING SINGLE
PROPOSED USE SEPTIC NSTALlBl
PRIVATE USE
FMlILY DWELLING
WATER INSTAllED
NO. OF STORIES
NO. OF EMPLOYEES
OONSlllUCTION OOSTNAWE
oes..."..... ._.a: PRClPC6ED~
NO. OF BEIlRClCMl
SEPTIC SYSTEM VERIFICATION
DIRECTIONS TO SITE FROM NEAREST MAIN INTERSECTION
CENTENNIAL BLVD. TO ANDERSON, TO COTTONWOOD.
APPLICANT NAME & ADDRESS
PHONE
484..4815
726..9213
AARON STICKLER,
OWNERS NAME & ADDRESS
DAVE DUKES, SAME
CONTRACTOR/INSTALLER! BUILDER NAME
PHONE
AS THE JOB ADDRESS ABOVE
CCB.
PHONE
EUGENE, OREGON
97401
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STREET
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ZIP
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/EES DUE: $ APPROVED BY: -0 ~,~___
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Cf},1UL r;:()~ UIMSP!ECrWNS (SEE fJJf},CK Or;: [n::mJ!/J f?OR DNSJ:.1!UCrWNS) ~8'1DLJ065
\ S/E19rlC iwrmUs BJriF) good 'lor on& yeBJr. ALL oiher permiis iF)J{pi,e BJ'Iier 180 days IJnf~$s InspecUof'ls BJre ctJrr~mt
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LMD 040 Rev, 6/92
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VIOLATIONS
SBTBACKS AND OTHER __.'vu.ONS OF APPROVAL MUST BB SlRICIt. Y OBSERVED. VIOLATION CAN RESULT IN REVOCATION OF lHIS PERMIT,
CITATIONS MAYBE ISSUED UNDER nIB PROVISIONS OF LANE COUNTY'S INFRAcnON ORDINANCE AND/OR OTHER REMEDIES AlLOWED BY LAW.
A MOOM"0M Oll<' AT ;.'i!.AST ?.4 :E:OmS ADV AMeS NOTICE J.V:"JST ~E GWEN FOR liNSPEC'1r.:CN ~Qms-:~
Have the following information ready when you call: 687-4065
Permit number - Job address - Type of inspection required When it will be ready
Your name and phone number - Any special directions to the site
PUBLIC OFFICIAL RIGIITTO TRESPASS ON PRIVATE PROPERTYORS 215.080
POWER TO BNrnR UPON LAND, nIB COMMISSION, AND ANY OF ITS MEMBERS, OFFICERS AND EMPLOYES, IN nIB PERFORMANCE OF 1liIlIR PUNcnONS, MAY
"'" .."" UPON ANY LAND AND MAKE BXAMlNATIONS AND SURVEYS AND PLACE AND MAINTAIN nIB NECESSARY MONUMENTS AND MARKERS THEREON,
REQUIRED INSPECTIONS
FOUNDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
UNDERGROUND t'll'll-lG INSPECTION: To be made after all underground piping has been installed, prior to any backfill.
CONCRETE SLAB OR UNDER-FLOOR INSPECTION: To be made after all in-slab or under-floor building service equipment, conduit, piping
accessories and other ancillary equipment items are in place but before any concrete is placed or floor sheathing installed, including the subfloor.
ROUGH MECHANICAL INSPECTION: To be made after all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPECTION: To be made after all plumbing rough-in is in place, prior to being covered.
FRAMING INSPECTION: To be made after the all framing, fIre blocking, bracing and roof are in place and all pipes, chimneys and vents are complete
and the rough electrical, plumbing, and mechanical inspections have been made and "ppw,ed.
INSULATION INSPECTION: To be made after all insulation and vapor barriers are in place, prior to covering.
LATH AND/OR GYPSUM BOARD INSPECTION: To be made after all lathing and gypsum board, interior and exterior, is in place but before any
plastering is applied or before gypsum board joints and fasteners are taped and fInished.
ADDITIONAL INSPECTIONS MAY BE REQUIRED, such as but not limited to;
BLOCK WALL: To be made after reinforcing is in p~ace, but before any grout is poured. The inspection is required for each bond beam pour. There
will be no approval until the plumbing and electrical inspections have been made and app'v ,ed.
FINAL MECHANICAL INSPECTION: - To be made just prior to the structure or remodeled area being occupied and prior to operating any equipment
FINAL PLUMBING INSPECTION: To be made just prior to the building, structure or remodeled area being occupied.
FINAL BUILDING INSPECTION: To be made after fInish grading and the building, structure or remodeled area is completed and ready for occupancy.
MOBILE/MANUFACTURED HOMES: An inspection is required after the mobile home is connected to an "t't',,,,ed sewer or septic
system, prior to covering sewer or water lines, for setback requirements, blocking, tiedowns and plumbing connections.
Footings and piers to comply with State foundation requirements for mobile homes or as recommended by the manufacturer.
Minimum fInished floor elevation shall be certified when required by Floodplain Management
Tiedowns, if required, shall be installed and ready for inspection within 30 days after occupancy. Tiedowns shall be installed per enclosure.
APPROVAL REQUIRED
No work shall be done on any part of the building or structure beyond the point indicated in each successive inspection without first obtaining the
approval of the building official. Such "t'p,vval shall be given only after an inspection shall have been made of each successive step in the construction
as indicated by each of the inspections required.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKlNG HOURS.
THIS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WITHIN 180 DAYS, OR IF WORK IS STOPPED OR ABANDONED FOR MORE THAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF THIS PERMIT WAS ISSUED oN :fHE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYOWJE IP'~iOClElEjj))lINiG l,PA~'lI' 'lI'lHIlH: lP'OlIN'lI' OlF ~lH:Q1Um.JH:jj)) lINSIP'lB:CnONSWlIlLlL,lDlO SOA'lI' 'IT'JtlIlB:JIIRI OWN M~k~.
Your signature on the front of this form verifies the following: I HA VE CAREFULLY EXAMINED THIS COMPLETED APPLICATION, and do
hereby certify that all information hereon is true and correct, and that I have a legal interest in the property as owner of record or authorized agent. I
further certify that any and all work performed shall be done in accordance with the Ordinances of Lane County and the laws of the State of Oregon per-
taining to the work described herein. I further certify that if I am not the owner of the property, my registration with the Builders Board is in full force
and effect as required by ORS 701.055, and that if exempt the basis for the exemption is noted hereon, and that only subcontractors and employees who
are in compliance with ORS 701.005 will be used on the job.
SUBSURFACE & ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
When subsurface construction is complete, the permit holder shall notify the County Land Management Division by submitting the installation record
form. An inspection will be made by a qualified sanitarian. If construction complies with all rules a certificate of completion will be issued to the permit
holder. If construction does not comply with rules, the permit holder will be notified, and all corrections shall be made before a certifIcate of completion
will be issued. Failure to meet satisfactory completion within the allotted time constitutes a violation of ORS 454.605 to 454.745 and this rule.
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From: Interior property lines 10'
Edge of road right-of-way 10'
Building foundation 5'
Wells or other water sources 50'
DRAINFIELD
10'
10'
10'
100'
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OWNER OF PROPERTY (If not same a. above)
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OWNERS ADDRESS (If not ..me .. above)
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MAIL PERMIT TO:
NA~ ((h~k:lk
14uu..i! if L L.I~ 1/ lA.~i 1/ eSfJ).p
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Existing Buildings or
Improvem~ts on \
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c:J Garage
c:J Mobile. Home
c:J Shed
~PTIC INSTALLED
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c:J No
Water Distric
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For Mobile Home
Placement Only
Brand
Year
Size
No. of Bedrms
License #
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Allowed Use
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Land Management Div. staff can}
not be held responsible for \?
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LMD 149. 2192 incomplete information :;:H'H"H HH, """ H'.,.,.,.,.,',',','.'.'.'. 'H",
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M14-68 02/92
Water
Sewer/Septic
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NEW BLDG TYPE USE R BDRMS 0 UNITS 00i STORIES ~BLDGS 00i PHONE 726 9213
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