HomeMy WebLinkAboutSpecial Inspection Septic Tank 1968-4-11
RECEIPT No. 40916
.
TWP. 17 RANGE 03 SEC. 26.11
TAX LOT NO. 3000 CODE-
REQUEST FOR SITE INSPECTION DATE 4 - 10 - 68 r
MA I LING ADORESS 2160 DEBRA OR I VE TEL. No. 747-8331
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HOLES ARE IN
BY TOMI INSrN r. 11
SPRINGfiELD. OREGON
OWNER Of PROPERTY
CONSENT Of OwNER?
EXISTING STRUCTURES
ABOVE
VE:t
ON PROPERTY
SIZE Of PROP. 55 X 142
Is PROPERTY CONTIGUOUS TO
NONE
LEGAL ACCESS?
ANY CITY LIMIT?
DEBRA DRIVE
SOURCE OF WATER SUPPLY: PUBLIC~ SPRING
WELL: DR I LLED
DRIVEN
DUG
DESCRIPTION OF SITE (DIRECTIONS, LANDMARKS, HOUSE OR BOX NO., If ANY): NORTH or 2150 DEBRA
DRIVE. LOT 2, BLK. 4, HAYDEN PARK.
PROPOSED USE OF SITE (E.G., NUMBER or DWELLINGS, COMMERCIAL OR INDUSTRIAL USE, SUBDIVISION):
nVJ.f11 I~r.:
~ URBANIZING AREA.
~ SPECIAL PERMIT AREA.
FEE:
No. or SITES...L- $ 5.00
No. or ACRES
TOTAL- '5.00
~"/o~
RESULTS or
INVESTIGATION: Tw- r.O R. ~ ') .Yec. a." .11/ niL LoT A./tf. 3ao(J
is 11pj!:' J>J. I <fir- <YI'- "i'f.G (~'I/ /< '^
~lA.-feel.d <S(i.We~'<. ~~fuwz_
)
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THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE or A rUTURE BUILDING
PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK:
BEFORE CONSTRUCTION IS STARTED BRING THIS rORM TO THE BUILDING AND SANITATION DIVISION AND
MAKE APPLICATION rOR A BUILDING PERMIT. Ir THE PROPERTY IS A PORTION ONLY or A TAX LOT, A
METES AND BOUNDS DESCRIPTION or THE PARCEL MUST BE rURNISHED. EXACT SPECIFICATIONS rOR THE
SEWAGE DISPOSAL SYSTEM WILL APPEAR ON THE BUILDING PERMIT. Two Sr.TS or THE BUILDING PLANS
AND PLOT PLAN WILL BE REQUIRED.
DIVI~I~:~ /:) rf)
r/fP~
,r~'--' SAN I TAR I AN
t(-//-6Y
DATE
THIS REPORT IS NOT COMPLETE WITHOUT THE SIGNATURES OF THE BUILDING INSPECTOR AND SANITARIAN.
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