HomeMy WebLinkAboutPermit Septic Tank 1984-5-22
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I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION FO~ERMIT, an rcby certify that all information hereon is true and correct, and that I
have the following legal interest in the property: (:]owner of recor contract purchaser;~authorized agent with evidence of authority attached.
I f~rther certify that 4ny and all work performed shall be done in accordance with the Ordi~s of Lane County and the Laws of the State of Oregon
portaining to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I fur-
thor certify t.hat 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
i!l noted hereon, and that only subcontractors and employees who are in compliance with ORB 701.055 will be used on this project. I HAVE READ AND
CHECKED THIS APPLICATION THOROUGHLY.
_0F'E~ &AS"II/l Y'K
. --- ~AME (please print)
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for:
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FOR OFFICE USE ONLY
Application/ / ~,,~ _~/'~
Perm1t # /d 7'{; 7
o Two Copies of Plans
DThree Copies of Plot Plans
. UMech/Plumbing Checklist
DLegal Interest Document
o Plan Check Info Sheet
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READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION HAS BEEN BASED ON THE FOLLOWING CONDITIONS!
[] PLANNING/ZONING:
Zone
parti tion .,.
Parcel #
Parcel Size
::::::S~e~eL~m-q CL'~~~L6'~' rear
. , ~ (7 6~A. ~
"- ~~-".p~~
n
Date:
[] FLOODPLAIN:
In flood hazard area? 0 No 0 Yes, SEE ATTACHED SHEET.
Date :
let SANITATION: S. 1. ~ B. P. ~
~ Installation Gallon
Specifications: Tank
eOMHENTS: ~/ ~ .$'../lS
_::I~,,;, 7~'~ (J
Installation Record Issued? 0 Yes 0 No
Lineal Feet Maximum Depth
:;;::ie~/~.~r~nc~_
Date: s-.2,l~rl ~
[] ~ EXAMINATION: Type
Group
Use
COMHENTS:
Date:
n
TOTAL VALUATION $
CONSTRUCTION AUTHORIZED BY ~ PERMIT
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Sq. Ft.
Fixed Feej Floodplain Fee $
Uni t Cost Subsurface Fees $
Building F;'ee $
H.ch/P 1mbg Fee $
Plans Check Fee $
State Surcharge $
DEQ Surcharge $
TOTAL FEE $$
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t" '-1'~~~ ~~~-;;~~~R~~~~;e~~~D~~I~;;;~~;;K~~~6D8~~~~GEMENT DIVISION, 687-4061~AT" Ie 14-25
125 EAST 8TH AVENUE, EUGENE, OREGON 97401 '1 f.;. <.{ rAJ6
SEE REVERSE FOR INSPECTION INFORMATION (I-05~.7 '3r
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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 tor the foundation are delivered on the job. Where concrete from a central mixing
plant (commonly termed "transit mixed") is to be used, materials ne~d not be p" the job.
2. Concrete Slab ~ 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. Framins- ~ 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 ~re approved. Al~ wall insulation and vapor barrier are in place.
4. Lath and/~ Gy~sum Board Ins?ection: To be made after all lathing and gypsum board, interior
ana-exter~or, ~s ~n place-OUt 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 req~ire inspections for the work authorized, such as but not limited to:
A. Block Wall: To be made at'ter reinforcing is in place, but before any grout is poured. This
inspect~on 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. Swimminq Pool: Below grade when steel is in place and before concrete is poured. Above grade
when pool-rs-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 OeCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
A~YONE 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 permi tf 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 Sewaqe Disposal
Septic Tank
From: Interior property lines 10 I
Edge of road right-of-way 10'
Building foundation 5'
Wells, other water sources 50'
Drainfield
10'
10'
10 '
100'
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Subdivision
Lot
Plan
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L.ANE COUNTY DEPT ENV MGT I"TCEIPT '::'134604 I)('HE O~521.\
APPL.ICANT ELLISON. ROBERT ADDR 1490 DELRDSE. SPRINGFIELD, OREGON
. TU' 1703243201600 SUBDIV . LOT Ill.. I<
., NEW I<LDG TYPE USE I~ BDI'(MS 3 UNITS 001 STORICS: ':'BL.DGS 001 F'HDNE 746 38;'~..
· OWNEf( NrlE ADDI'( 'I
CODE APPL. NO ACTION DESCRIPTION SQ FT UNIT COST VAL.UATION FEE 0d~~
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NO" FIXTUF\ES:
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CONNECHms:
MECH,iN I Cr'lL. FEE
STi'\!'E SUI~CI'IAI'(GE
F'LAN CHECK FEE
1 :>.00 EACH -..
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COMPLETION DATE:
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ACTIVITY INFORMATION
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COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
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<S-I4tl' ---:B. "'<'\.5 h "'-~tj( 70 6 ev'f /J. <f CJo#ot "'L ;r: t:: -; ) ,. .5 'Ov.. ~
, -.J PERSON MAKIN\1 REQUEST PROPERTY OWNER
, L/ 3 0 W\..o i..vL <-0 l< ~ t v rR ' I L{ 7 0 j) e.. \ v 0 5 ~
MAILING ADDRESS MAILING ADDRESS
SR";"'4.~;d~ ~ Q7Y77 SfJv;'"'-1-f-,-~ (/1-<. 97Y77
I..JJTY STATE ZIP CODE . CUX STATE ZIP CODE
_?)/~_~//'_7t__ '/OJ;.'6-QaOj 7'--/6-Je37 7~6-3tYS7
BUSINESS TELEPHONE # HOME TELEPHONE # BUSINESS TELEPHONE # HOME TELEPHONE #
2, PROPERTY ADDRESS j -4 7 () 7) P / KJ 5-e
(IF DIFFERENT FROM MAILING ADDRESS)
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3 MAP & PARCEL NUMBER
(REOUIRED INFORMATION)
(from tax maps in Department of Assessment and Taxation
or from tax statement)
TOWNSHIP 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:
ACRES
5 REQUEST (state exactly what you plan to do)
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LOT BLOCK
N'eJ S''-&j7 f,'c- ; 1.-,...5 fC!-U../-'-J">--...
4 SUBDIVISION (if applicable)
6 DIRECTIONS TO SITE:
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** FOR STAFF USE ONLY **
NUMBER
DATE
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ZONE/LAND USE:
BY: DATE:
TI ME IN: OUT:
LANO MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 / 687-4061