HomeMy WebLinkAboutBuilding Miscellaneous 1975-9-29
~~~4 " . .EQUEST FOR SITE FEASIBILITY .Y. ~-..S.I.#
I'For'Offiee~ ~
Use Only ~ ,
eived bv 'Code
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THIS IS A PRELIMINARY REPORT WHICH OOES NOT INSURE THE ISSUANCE OF A FUTURE BUILDING PERMIT.
PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK.
7S- 7~7
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C.T. Number S~eeial Permit
Area
L.--
Yes No
Urbanizina Area
)/
Township
If Subdivision _ Name: \Ip"," D . c11Jt"S,E
3 /.:J'-l32.# /f/JfjaGbc~ ('
Range Section Tax Lot No. Owner of
P R I N T
-i
2/11 () 3
Lot # / Bloek #
"3a..d:s~ (' V" '(' L. _ .I-
Name
Jh10 ,) t'A t. Ah--ee +-
Mail ing Address
,C; >Lf \.,j OR..e ":I ""_
1'-. 0 r;)
,,-\I.,-L\~r"""I X ~",.Q._D~~ ""'N~
Telephone # Signature of AppJ icant Date
1!~.nL. + Yes ><
P~ Owneris
No. of Sites :5 (0)....'0
No
Consent
'"
V>
Total
Cash
Check
$
$02;26-
Owner ~ Seller
-i
r-
""
No. of Aeres
Proposed Use \
of Property: .\0",\lJ hovv,..<;. m...,
1410 '1)0 \ I- S' <.<'
Property Size Legal Aceess
Appl ieant's Interest Buyer
in Property: Other (Specify):
Realtor
fl,).p t1 u....P
- Road Name
1'\0"1.''',
Existing Struetures on Property
Is Property Within One Mile of Ci,ty?
Yes f-- What City? ::::".,..(.. l ,-\
No - ,
Proposed Water Supply "
Public V District: ~o..",\oo~-:> WGt...--\er
Spring r Well Ot}1er (Specify):
b,'sit' c. +-
I
I
<'j2., v', ....l n Q
J
(Direetions):
~..,,~,.,t
~"I~oc;#
tJ.J 0 _......,.. p
,
.h.IL
W"'J.d~.
Property Location
I
When Will Test Holes Be Ready? ~~AJ
MARK TEST HOLES WITH OUR FLAGS (Date)
Loeation of Test Holes on Property:
Draw diagram of property showing loeation of any landmarks and relationship of test holes to
these landmarks:
(
,
I
I
,
.
0/
MAKE CHECK PAYABLE TO: ENVIRONMENTAL MANAGEMENT
MAIL TO: ' LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT.
C55-55
Phoo e &4065
135 E, 6th Ave" ~~ Ore,
APPROVED 3 J.J;;
'\
"-V
NOT APPROVEO
~ ~ ff ~ ~ ~ ~ ~ ,.oz(J ~n..tJ
y~ ~ !f~~~/J,
~~
~~~rized Signature
,;t.:; >>/?,s-
v Date
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e.:'
..pectiori # 7~707
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EVALUATION ' "
FOR DETERMINING, SITE SUI~ILITY
FOR riEV~LOpMiNT UTiLiZING
SUBSURFACE SE~E DISPOSAL METHODS
LOCATION:
TWP.
/7
d
RANGE
z'Iv-,y'
t),) SEC.
tfdk), :t
~
J-. I TAX.}OT f
2/ Jl--<; lJp..a '
Are public sewers available or nearby? (Distance)
Are there zoning or environmental considerations?
'60 Cf) 1!. fiT
, '(! v
Are other systems in area known to be, malfunctioning?
~.
-Ri+
Size of property:
Amount useable areq
----!)
o--tI'
Is there room for future expansion?
u..-e.- .
t;
SURFACE FEATURE CONSIDERATIONS:
Slope: (1'/100')
(Explain)
, (%)"
../.~/f
. .
II
Flood plain:
Plants:
Rocks:
~,
~
{".
Cut bank or slope:
(/~
~
~
~
;..---v
Low area.:
Drainageway:
Streams :
(SKETCH IN PLOT PLAN)
I
_ Administrative Rules Require -
IF SITE MEETS STANDARDS FILL OUT:
Type of structure and approximate sewage flow:
Multi-family
COllllllercial
,GPD
GPD
NOTE: Soil absorbtion area in square feet
Area necessary for sewage disposal systems
_ Your property found to be Deficient -
Single Family
Industrial
Institutiona'
/005# It~~.
(i f/
ARE ALTERNATIVE SITE LOCATION. DESIGN OR MODIFICATION AVAILABLE. DESCRIBE:
f.-
NAM~0It~
, -.!.-
. DATE OF FIELD EVALUATION"
;Z~~7~
V
GPD
GPD
r,PD
.
BU 1 LD ~NW S 11'! EVALUAT ION. .
() B~ILDING PERMIT APPLICATION NO.
(~ITE INSPECTION
~>
1S-- 7:; 7
PLANNING DIVISION
Not
Appl icable
R,~( )
" ( )
( )
( )
( )
I. Zoning Ordinance Compliance: Zone
2. Subdivision Ordinance Compliance
3. Required Access
4. Building Site (Area, Width, Frontage)
5. Other (see comments)
COMMENTS:
130 ()
TA7.. R ~3sc/lI TAX LOTJJ.:~
S~N: Vlu2t2A f)I>t...I..e.
LOT~ Up~:-~ .3
APPL I CANT "'-'tneJ. \ " \
DATE
No Yes
()W6.
( ) (I)
( ) ( )
( ) ( )
( ) ( )
CK'D BY: ~,I r~7~
Setbacks from cll of rod' :
Front '~
5 i.nA ~vt""...;..::o. '
Setbacks from
Side
Rear
interior rs:
r
PLANNING DIVISION ACTfoICPIONDING: Y~ST-,- NO("} APPLlCATlONH
BUILDING INSPECTION DIVISION
Not
Applicable
( )
( )
( )
( )
7. Plans Submitted
8. Soil Stability (footings)
9. Flood Plain
10. Other (see comments)
COMMENTS:
WATER POLUTION CONTROL
Not
Applicable
( )
( )
11. Meets Department of Environmental
Quality Standards.
12. Other (see comments)
COMMENTS:
No Yes
()n
( ) ( )
( ) ( )
( ) ( )
CK'D BY:
DATE
rd~l
() P
J
CK'D
By();1f?;r;'5d 7~
j
DATE
TO APPLI CANT:
~o~Building I Site Inspection:
~X) Can be approved.
?ct' () Cannot be approved at this time as Indicated on item NO. above.
tn~~ Questions and further information on items I through 6 contact the LANE-
-/ t?~ COUNTY PLANNING DIVISION. Questions and further information on items 7
'~ through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION.
( ) Will be held in this office until you can resolve the problems indicated.
( ) Is being returned.
( ) Your building r;>ermit aJ?pl ica!.lE.!:'_fe~s being,x~tur:Q,@.d under seoarate cover.
~EPARTMENT OF ENVIRONMENTAL HANA(;~Mt.NI
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANNING DIVISION PHONE: 687-4186
C55-28
":.-
..
.
.
Surname
Twp. Range Section Tax Lot
Code
Census Tract
Receipt No.
I Date
I Owner
Owners Consent
Yes No
REQUEST FOR SITE FEASIBILITY STUDY
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
ARE AT YOUR OWN RISK:
Name
and
Addrpcc
$
No, Sites
$
No. Acres
TOTAL $
Telephone No,
Appl ieants Interest in Property I Proposed Use of Property
Proposed Water Supply
Publ ic District
Sprinq
Name Ispecial Permit Area
Yes No '
Is Property Within One Mile
What C i tv?
Other
Specifv
I Urbanizing
Yes No
of a City?
Yes No
Area
Property Size
Legal Access - Road
Existing Structures
Well
Propertv Loeation: (Direetions)
APPROVED NOT APPROVED
BEFORE CONSTRUCTION IS STARTED bring this form to the Department of Environmental
Management and make appl ieation for a building permit, If the property is a por-
tion only of a tax lot, a metes and bounds description of the parcel must be fur-
nished. Exact specifications for the sewage disposal system will appear on the
building permit. Two sets of building plans and a plot plan will be required,
LANE COUNTY DEPT. OF ENVIRONMENTAL MANAGEMENT
135 EAST SIXTH AVENUE, EUGENE, OREGON 97401
Authorized Signature
C55-32
Date