HomeMy WebLinkAboutPermit Septic Tank 1984-6-27 (2)
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r. Authorization for:
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LOT/PARCEL - BLOCK
FOR OFFICE USE ONLY
APP1~cation/'-;~O_ CJ/../
Perm~t # /~~ /'- ~ '~
o Two Copies of Plans
DThree Copies of Plot Plans
DMech/Plumbing Checklist
o Legal Interest Document
Dplan Check Info Sheet
TOW;';SHIP / 7
S~BDIVISION/PARTITION
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'STR C?~ PROPERTY .d ~ / - / .- /~', ~
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--:i~St:R~ON'9F PftOPO~ED ~~E/'~FIC - - -/ , ,_ - - ) - " DE;C~ ;; VALUE
kZ/#~& . ~~/~Z~~ 'di~ ~4"?// -- - //
Ai OF ~OOMS '7i? II OF S~~~,,/ /J . # OF EMP)?l?h \..', WATER SUPPLY ~ / v ::J~posed
41 \.?, ~/ ~ /7)~ /r;' /' 7~~vP-~~ &xisting
O;,"N S NAME AND ADDRESS ':! 1// .~) / /., , ./? ' ./ ~ / I TELEPHONE NUMBER
,~h' -' ~~ff% ~~~/ ~ ~~~__" ~?/'--;.9..J~
~RAC 'SN^::.~A~D~-/~ ,,-- " - (J ~~~~R
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C "'t'=:,Rl-l~ BEMAILEIJ..TO~? AND AD~p I TE~EPHON, MBER
y/d'#Y/ /~/ ~/~L7 " ~~~
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I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATI FOR PERMIT, and do hereby certify that all information hereon is t~ and correct, and that I
have the following legal interest in the property: owner of record; []contract purchaser; []authorized agent with evidence of authority attached.
I f~rther certify that any and all work performe sh 1 be done in accordance with the Ordinances of Lane County and the Laws of the State of Oregon
pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I fur-
ther certify that registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption
is noted hereon, and that only subcontractors and employees who are in mpliance with ORS 701.05 will be used on this project. I HAVE READ AND
'~o_rn'~g#~~ -y (1, ,,_,-,_~<j
'CJA, NAME (please print) SIGNATURE DATE
PROPOSED USE OF PROPERTY
gReside.ntial 0 Industrial
o Commercial D Public.
READ THIS SECTION CAREFULLY. YO?R~~ RIZATION HAS BEEN BASED ON THE FOLLOWING
o PLANNING/ZONING: Zone W/4--;:.rtition II Parcel II
Hinimum seL~ CL, ~ ' , ~ C~.# _ _ p;f2rior ~
COMHENTS: 7UJ ~~/~4 /~~ ~~d~
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\'l {,I 6:-~ 7--~~, ~ ,
Date: I" ~
D
CONDITIONS!. ,/,)/
Parcel s~ze/t/$-
/
rear
o FLOODPLAIN:
In flood hazard area? 0 No 0 Yes, SEE ATTACHED SHEET.
Date:
~ANITATION: S.
1\ -Installation
Specifications:
('l
"
I. # B. P. # Installation Record Issued? 0 Yes 0 No
Gallon Lineal Feet Maximum Depth
Tank of Drainfield of Trenches
_P~;f-- Jlt~~-~ k~L7
- < '., Date: 7-;::J~"1 .J.:J.
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o PLANS EXAMINATION: Type
Group
Use
COMHENTS:
Date:
n
TOTAL VALUATION $
CONSTRUCTION AUTHORIZED BY THIS PERMIT
~'Pt; ~ Fixed Fee/ Floodplain Fee $$
~ ~ Sq. Ft. Unit Cost Subsurface Fees
of /2~~ ,~~/ _ Building E'ee $
h/~' -/ / 1<18ch/Plmbg Fee $
~~W~ ::::: ~::::a::: : S f'O
// ~ ./ ) DEQ Surcharge $ _.,.~
('/( ~~ TOTAL FE~ $$ ~~ - -
/ -"'"
~tJ ~~~__/2.. r 7-:;>-//
~ PERMIT APPROVED BY B,~G OFFICIAL~SIGNEE (per ORS 456.805(1)) -- D~TEI'
LANE COUNTY DE~TMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061, C 14-25
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
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SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVO-
CATION OF THIS PERMIT, CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OTHER
REMEDIES ALLOWED BY LAW.
WHEN READY FOR INSPECTION, CALL 687-4065. A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE FOR INSPEC-
TION REQUESTS MUST BE GIVEN. Have the following information ready: permit number, job address, type
of inspection, when it will be ready, your name and phone number, and any special directions to site.
BUILDING DIVISION:
REQUIRED INSPECTIONS:
1. Foundation Inspection: To be made after trenches are excavated and forms erected and when all
materials for the foundation are delivered on the job; Where concrete from a central mixing
plant (commonly termed "transit mixed") is to be used, materials need not be on the job.
2. 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 poured or floor sheathing installed, including the subfloor.
3. Framing & Insulation Inspections: To be made after the roof, all framing, fire blocking, and
bracing are in place and all pipes, fireplaces, chimneys, and vents are complete and all rough
electrical and plumbing are approved. All wall insulation and vapor barrier are in place.
4. Lath and/~ ~~sum Board Inspection: To be made after all lathing and gypsum board, interior
and exter~or, ~s in place but before any plastering is applied and before gypsum board joints
and fasteners are taped and finished.
5. Final Inspection: To be made after the building is complete and before occupancy.
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 approval 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.
NOTE: All building permits require inspections for the work authorized, such as but not limited to:
A. Block Wall: To be made after reinforcing is in place, but before any grout is poured. This
inspection is required for each bond beam pour. There will be no approval until the plumbing
and electrical inspections have been made and approved.
B. Wood Stove: To be made after completion of masonry (if applicable) and when installation is
complete. Installation shall be in accordance with an approved, nationally recognized testing
agency and the manufacturer's installation instructions.
C. Mobile Home: An inspection is required after the mobile home is connected to an approved
sewer or septic system for setback requirements, blocking, footing connection, tiedowns,
skirting, and plumbing connections.
1. Footings and piers to comply with State foundation requirements for mobile homes or as
recommended by the manufacturer.
2. Mobile home minimum finish floor elevation shall be certified when required by a flood-
plain management letter.
3. Mobile home tiedowns, when required, and skirting shall be installed and ready for inspec-
tion within at least 30 days after occupancy. Tiedowns and skirting shall be installed
per enclosure.
D. Swimming Pool: Below grade when steel is in place and before concrete is poured. Above grade
when pool is installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMIT WILL EXPIRE
IF WORK DOES NOT BEGIN WITHIN 180 DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
, .
INFORMATION.
ANYONE PROCEEDING PAST THE POINT or REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
1. Permits shall be effective for one year from the date of issuance.
2. Upon completing the construction for which a ,permit has been issued, the permit holder shall
notify the Lane County Department of Planning and Community Development by submitting the
installation record form. The Department shall inspect the construction to determine if it
complies with the rules contained in this division. If the construction does comply with such
rules, the Department shall issue a certificate of satisfactory completion to the permitl'holder.
If the construction does not comply with such rules, the Department shall notify the permit
holder and shall require satisfactory completion before issuing the certificate. Failure to
meet the requirements for satisfactory completion within a reasonable time constitutes a vio-
lation of ORS 454.605 to 454.745 and this rule.
Setbacks - Subsurface Sewage Disposal
Septic Tank
From: Interior property lines 10'
Edge of road right-of-way 10'
Building foundation 5'
Wells, other water sources 50'
Drainfield
10'
10'
10'
100'
.
.
~TIVITY INFORMA~N SHEET
laone county
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'COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
."
.
. JAMES A. G ~E.EN .0'
, l' ....... SAME
. PERSON MAKING REQUEST PROPERTY OWNER
=
l3Qo Co , H.>/'JWOOf) f\~."
. MAILING ADDRESS MAILING ADDRESS
-
S PRl N c;.r:: I E\J:) OR. q,l{11
CITY STATE ZIP CODE - STATE
CITY ZIP CODE
Co ~ 1. 5 \ S~ (41 - 0 8t 8
BUSINESS TELEPHONE # HOME TELEPHONE #
2, PROPERTY ADDRESS s/~
(IF DIFFERENT FROM MAILING ADDRESS)
BUSINESS TELEPHONE #
HOME TELEPHONE #
3 MAP & PARCEL NUMBER
(REQUIRED INFORMATION)
\1
TOWNSHIP
(from tax maps in Department of Assessment and Taxation
or from tax statement)
. '/'1 l/tb
03 ~( "3>") Olqoo'
RANGE SECTION TAX LOT(S) OR PARCEL # ZONING
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL #
ZONING
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL #
ZONING
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4 SUBDIVISION (if applicable) MGNl..O PA~K.
5 REQUEST (state exactly what you plan to do) ~~
LOT
I d CXiv\
ACRES
rZ... BLOCK S
v..ev 1'eIiJ
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; 6 DIRECTIONS TO SITE:(F~Of-1 EU(;EJJE) CE.N~NIAL .JUST \:::l"Efl.... \-5
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AND Eft. s O,J l.N - "11J Itt-J
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Il(Ci~T.
** FOR STAFF USE ONLY **
NUMBER
DATE
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ZONE/LAND USE:
BY: DA T E :
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TIME IN: OUT:
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LAND MANAGEMENT DIVISION / 125 E. 8th ^VE.. EUGENE, OR 97401 / 687-4061
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