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HomeMy WebLinkAboutPermit Land Drainage Alteration 1999-3-11 ',,;' .' j - . - - ..~. . . ,~ity of Spl'ingfield . This Side To 8e Filled Out by Applicant '" 't'/:,':It1'~~'.1;'~" =~...':" ~ This per'mit is required for any site activity in the flood p:a~-and everywhere"slte ~~erati~~ consists of " -... . fifty (60) cubic yards of material or more and/or if a drainage~~y Is effected, within City limits and r- - ~ ~ UJ c.. Z o - ~. UJ ~ <( UJ CJ -< Z - ~ o o z <( O' z :5 Date of Application '3 . II . qq Permit Expiration Date: .. '/t? II. ' cjl:j Property Owner ,--;5dhvt f.rnd.7L mrnd Phone: 77.(r 0/17.7' Address: ----rik; Ed, ~Id. City ')~~~tate:~ZiP_ Site Address: 5 3,CfO /l1a./~ :s.T ' '~'-.Sprlngfield, Oregon o UGB Tax Map No: /70 Z- -:z., -=s 3/ Journal number applicable Land Use Application Tax Lot: ~~3 o E1 EJ --A ~ "4 FILL. Quantity Supplier GRADING, Quantity EXCAVATION, Quantity Supplier: , Address , Source Location , Material -:t::Y;f?u I Destination: Project Supervisor ' , Phone ~' ",.,.~.,,~~, ~--~~ . i~ 'I; . "~" ; " . SITE PLA Requirea ata:Quantity of material, Property lines and descriptions, Tax map and lot number. Site address, Existing contour lines. Proposed contour"lInes. Existing drelnage ways, Prollosed drainage ways, Significant trees and follalle, Ground cover. son types.. Buildings. Septic systems, Sewers, Areas subject to flooding, Utilities, Areas subject to land slides, Proposed site improvements. , .,,' o o ~ o o CROSS SECTIONS. SOILS & GEOLOGY PLAN, DRAINAGE, POLLUTION AND EROSION CONTROL PLAN REPLANTING PLAN ADDITIONAL INFORMATION, ,. COMPAN-Y NAME: (.J6nn 17 ~S-t ~f(Oc'~/lJfS) . PHONE PROJECT SUPERVISO~ ADDRESS: COMPANY NAME: PROJECT SUPERVISOR: ADDRESS: -- CITY STATE . PHONE CITY STATE CONTRACTOR NAME: $.+f 1:-/ V W1l(}1fjr UiiiJ? Dv /JfCK F..~r:riVf1 'T/On PROJECT SUPERVISOR: .-no. P/'-'IM J4't~r' PHONE "7,,1./1 7ZJt.l1 " , Registration Number: /0/ A .0) ',ExpiratlonOate: '7..:2 ~ . q"'f ADDRESS: .-S-~ 3~ 'D~/s.. ')p.71-57 ,CITY: ~.P-Ij." STATE: OIC. ,ZIP: ;if 7t71V OFFICE PHONE 7<14 ~C/) . FAX$i' 3Z.~'r_ MOBILE PHONE: -5'1.0 Z,1A ~ , EMERGENCY PHONE: "74 (p.9;8 z,q I understand that J. or my succe8sors may have future plans for my property which may be anticipated or unanticipated at this time. I understsnd that such Mure plans may require permits snd developement approvals ,from the CItY of Springfield. I understend thst notwithstanding sny approval of this land and Drainage A1terstlon Parmlt"lLDAPlithat at ,the time of application of future permits or approvals the City may review and reconsider all actions which I or .my IUCce8aors have undertaken parauent to this LOAP. I understand that the City may 8S 8 condition of any ~_approY81, require the undoing, changing, or modification of any actions which I have undenaken as a result of the ctty"s approval of thle LDAP. " . . By signature, I state end agree, that I have carefully examined the completed application and do hereby certify that all Information herein is true end correct, and I further certify that any and all work performed shall b8 done In" accordance with the Ordlnsnces of the City of Springfield, applicable City Standsrd specifications and,O"wfngli; 'and the laws of the StatB of Orag,?" pertaining to the .work described .h8r8ir~. I further certify that only COr:rtr8ctO~ and em..:., ,.... who are In compliance wlth ORS 701.055 will be used on thiS proJect. . '.. The City may inspect the work lite described in this permit at any time during a one year 'period foi'owlng the receipt by the City of notice of completion of the described work and specify. at the City's lole del. _':.:..J# any additional reltoration work required to return the site to a standard acceptable to the City. The permittee will be nottfied In writing of any work requlrad and will have thirty (30) days from the date of the notice to complete the wor~ Work not cOmpleted at the end of the thirty dsys will be performed by the City and the com will be billed to the permittee." ' I further agree to ensure that all required inspections are requested at the proper tlme~ thiit'ptOJect' address. I. readable from . the atreet, and tha appr~et of plana will remain on the site at all tlm.. during conltrUctlon, . '.' . Slgnsture ~~['t~_. ' 0, ste '/.:3. / /. ~ cJour~ flr\[O. Iqqq ~O:?-CCb5 D~: ..~.15tiqBd;#: Vcfj-~vr~~ #-Y!-7--o0~O ~ - ~ LJ.J Cl. Z o - ~ ~ LJ.J ~ <( LJ.J LJ <( Z - ~ o o z <( o z ::5' D f DRAINAGE, rJ Storm, 1:1 Di~c.r' 1:1 Culvert, 1:1 Natural WETLANDS, Description Nt>M . FLOOD PLAIN, Zone: (~ , FEMA Community Panel No.: 4/?!i12 OW 2 A FLOOOWAY, FEMA Community Panel No.: , Date: PLAN CHECK FEES: UP TO 100 CUBIC YARDS 10J TO 1.000 CUBIC YARDS 1,001 TO 10,000 CUBIC YARDS 10,000 TO 100,000 CUBIC YARDS 100,001 TO 200,000 200,001 CUBIC YARDS OR MORE GRADING PERMIT FEES: UP TO 100 CUBIC YARDS 101 TO 1,000 CUBIC YARDS 1,001 TO 10,000 CUBIC YARDS 10,000 TO 100,060 CUBIC YARDS 100,001 TO 200,000 $20.00 $30.00 $40.00 $40.00 For the first 10,000 cubic yards, plus $20.00 for each additional 10,000 cubic yards or fraction thereof. $220.00 For the first 100,001 cubic yards, plus .20.00 for each eddltlonlll0,OOO cublo v.rdl or f,.otIon ther.ot, $340 For the first 200,001 cubic yards, plua $6.00 for Bach additional 10,000 cubic yards or fraction thereof. $30.00 $30.00 For the first 100 cubic yards, plus $14.00 for each additional 100 cubic yards or fraction thereof. $ 156.00 For the first 1,000 cubic yards, plus $12.00 for each additional 1.000 cubic yards or fraction thereof. $264.00 For the first 10,000 cubic yards, plus $54.00 for each additional 10,000 cubic yards or fraction thereof. $750.00 For the first 100,001 cubic yards, plus $30.00 for each addittonall0,OOO cubic yards or fraction thereof. .~/ .-... / ~ t!A-( Estimated Volume: 41"'-''''~'fI#III:~ Plan Check Fee: $:3CJ, c:D Received By: / 1-/ f~ iJO Grading Permit fee: ,17"1 ~r, - Received by: ~ .'7J! . I Receipt No: ~J/SI17 Receipt No: 3~451 Date: ~-/2-Cj '1 O)(~_m GRAUf dAlLy;.. P/l(//Vb. 15 /'e':/J7/ . ", d4U:~./7' <#fL...~~~J ,AlLA???/;;''- ~(Old ~~ ~ p .' l}tI ,b!f] Wf'J~, .JdJ :r ~.{:;;)f ,/J~:;~1 i J Hi~hJl- 8f' IA~_'A S1t \I . oate:3J IS /97: I / . )::g Date: Date: Plannin~ Engineering VI C, 1.-: Building: Maintenance: Date: Date: }\ '<-\.\ \~, Date: Date Permit Number Issued by: Date: .8aQ.u;r~~ !:lnal InSpAl":tinns' Planning: 1/6/1998 Date Building: EnGineering: Date DRte Maintenance: o o (J Date: Land and Drainage activity as outlined in this permit has been completed In accordance with the provisions oTthis permit. Land and Drainage ac.tivitv as outlined in this permit has not been completed in accordance With the pr.OVISlonS ot tn,S permit. Land and Drainage activity was performed prior to application for. this permit. A!icepted by: " Date: I