HomeMy WebLinkAboutPermit Septic Tank 1991-7-16
~- , T:e:1\,~
'L!lJ!Cunty " .EtV..ILJ
-
. VB B/S?~ .
A UTHORIZA TION ,FORM
r:: ----~- - -- ---
='E::1~~~n' 0
..
L.hd Managamant Olvlalon 125 E. 8th Avo. Eugono, OR 97401
;;J. OCJ g -? /
~--- .- - -----:-:------~ ~
f
REQUEST
FOR:
REPAIR SEPTIC SYSTEM
IADDRESSING
DATI .
Q "'AUD
0."']
LM eGO'
~ TOW/GHlP 17 RANGE 03 aECnOH 2 L:. .'j.~OH YOU LOT 124 au.mvlSlOM f PARnnON
LO'1'b~ l"o'OELROS E STR EET, S P R I NGF I ELD, OR EGON
LOT I PMen aLOCK
BTRUCTURED HOW ON PKOPIil'lTY
EXISTING SINGLE FAMILY DWELLING
PROPOSED WI BEPllC INSTALLED
PRIVATE USE
Oli.8CRlPTlON 01' PROPOSED WORK
REPAIR EXISTING SEPTIC SYSTEM
D1RIiCTlo.tl'QTfl &lTI "'011 COUATHOUUl C
l-l'J' LEFT ON ~TH ST., LEFT
WATER"STAI.I.liO
NO. f1' STORIED
MO. 011 BIPLOTUB
CONBTRUCTIDN COSTfYALUB
NO. 01' HDROOMB
ON HARLOV! ROAD,
RIGHT ON 17TH ST., LEFT ON
16TH ST., RIGHT ON DELROSE STREET
APPIJCANT N.....E . ADDRESS
BRAVADO CONST.,
PHONI
746-5554
7L!7-3964
SM1E
O'NttERB NAME . ADDRESS
STEVE BALDERSTON,
COiiiifACTOR NAME
BRAVADO CONST.,
) MAIL PERMIT TO:
IJRAVADO CONST.,
)101""1
I hava carafully read
BILL BOYD
SAME AS THE JOB ADRESS
ABOVE
08~ ~~'1Ss
PHON I
PHONi:
P.O. BOX #45S,
PLEASANT HILL, OREGON
97L~55
ADDREBS
\ PRM"NAUE
BOTH sides of this eppllcatlon and hereby certify tha~~ }'J1or'"t1o~s true and correct
"\-..131'// 13/fy 'D /~ff.~ ..Z-tT7--'i~
~~ ~q:=AD :::A::l~?U:..L '!( Your [.lI~;lo?I~ct!oi1 fa ~:!cccti - O~.-.~.~~~:~F~II-O~Jl~~ ~Oi1_~!tr~~-c ~,::=;}
, PLANNING/ZONING
tJA
lONa
',P.7
1.10"1. Lon
MINIMUM
SETBACKS
.'ROHTI,.C)T.L.....
l;Il.81Dl" _.
tMTlRlOR .
.RIAft
RIPARIAN
C:OIUllNT81
NO PLANNING ACTION REQUIRED.
U,-G-B SPR INGF I ELO.
''''.''0 ",R OG E R HOLLIS
riA~
7/3/91
I SANITATION
,=Hf
-.TAHK8lZI
,ro' ."'~9q!--:::~:,~0~Y:~. ~~;IO '"'.,,, 7'...J' ~fl
,l . ~ . 0 Ttla8YITDI "PPIA'" TO II'WORlUNQ
UN. n. 0.... MAX. TRH 0 "'~NT, tF SYSTEM 'AIL8, yOU
.11, ,'~-r;-.;1- ,MUST APPLY FOR" RaPAI" PI" '"fT
o Lt! "'..... E~..;...{ :C }-!. a HOOIl; TO P18T1NO 8""01
~.:~:t:l'r;1,
v '
NUl BP., IHST.RlCISS'O
/?">J , ~Q .;.A ,.', I~ '31":-
co ".. '~ d,r
J.LPI_ r- ""1 A.A~"""""'" _~~
,F' , ;;
,d. jJ ,-" ?-'
A4<i".R" I~~-
) BUILDING
,.
A~,
A
A.~
, I
""
GROUP
us.
C:OMMunal
)
FEES DUE: $ APPROVED BY: ~~.a...- _ DATE 7 -/r;. ~9/
~'"~--" - _0_- ~-_....:.'~ . - -~ --- ..._".~~ --. -"~:. - .'.~.-"~ff- -... - - _:~---- ~~~~~~=:~_-:-,-.---...d
~EPTIC pefm%~L~{~~o~NJ:/;:~o::a/s~:Lf~;~~f O;f~~:;[~:"~f~ c~~1~1~~~~::~;~~:7;S!",caon=- afe _cuf'!nJ
..n;
~
.
.
VIOLATIONS
SETBACKS AND 01HER _".-" ......~ OF APl'ROV AL MUST BE snucn. Y OBSERVED. VIOLATION CANRBSULT IN REVOCATION OPnn5 PERMIT. ~
CITATIONS MAYBE lSSUBD UNDER. nm PROVISIONS OF LANE. COUNJ'Y'S INPRACllON ORDINANCB AND/OR onmR. REMEDIES AU.OWHD BY LAW.
.
A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS
Have the following infonnation ready when you call: 687-4065
Permit number - Job address - Type of inspection required When it will be ready
Your name and phone numoor - Any special directions to the site
PUBLIC OmcIAL RIGHT TO TRESPASS ON PRIVATE PROPERTY OKS DS.OIO
POWER TO BNmR UPON LAND. nm COMMISSION, AND ANY OF ITS MEMBERS, OPPlCERS AND EMPLOYES, IN nIB PHRPORMANCB OP1HBIR PUNCllONS, MAY
BNrER UPON ANY LAND AND MAXHBXAMINATlONS AND SURVEYS AND PLAai AND MAINTAIN nm NBCBSSARY MONUMENTS AND MARKERS nmRBON.
REQUIRED INSPECTIONS
FOUNDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in piece.
UNDERGROUND PIPING INSPECTION: To be made after all underground piping has been installed. prior to any backfill.
CONCRETE SLAB OR UNDER-FLOOR INSPECTION: To be made after all in-slab or under-II"".." building service equipment, conduit, piping
accessories and other ancillary equipment items are in place but before any concrete is placed or floor sheathing installed. including the suhfloor.
ROUGH MECHANICAL INSPECTION: To be made after all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPECTION: To be made after all plumbing rough-in is in place, prior to being covered,
FRAMING INSPECTION: To be made after the all framing, flte blocking. bracing and roof are in pIece and all pipes, chimneys and vents ore complete
and the rough electrical, plumbing, and mechanical inspections have been made and approved.
INSULATION INSPECTION: To be made after all insulation and vapor barriers are in place, prior to covering.
LATH AND/OR GYPSUM BOARD INSPECTION: To be made after all lathing and gypsum board, interior and exterior, is in pIece but before any
plastering is applied or before gypsum boord joints and fastene" are taped and finished.
ADDITIONAL INSPECTIONS MAY BE REQUIRED, such as but not limited to;
BLOCK WALL: To be made after reinforcing is in pIece, but before any grout is poured. The inspection is required for each bond beam pour. There
will be no approval until the plumbing and electrical inspections have been made and approved.
FINAL MECHANICAL INSPECTION: To be made just prior to the structure or remodeled area being occupied and prior to operating anyequipmenl
HNAL PLUMBING INSPECTION: To be made just prior to the building. structure or remodeled orea being occupied
FINAL BUILDING INSPECTION: To be made after fInish grading and the building, structure or remodeled orea is completed and ready for oo:upancy.
MOBILE/MANUFACTURED HOMES: An inspection is required after the mobile home is connected to an approved sewer or septic
system. prior to covering sewer or water lines, for setback requirements, blocking, tiedowns and plumbing connections.
Footings and piers to comply with State f01mdation requirements for mobile homes or as recommended by the manufacturer.
Minimum finished lloor elevation shall be certified when required by Floodplain Management
Tiedowns, if required. shall be installed and ready for inspection within 30 days after occupancy. Tiedowns shall be installed per enclosure.
APPROVAL REQUIRED
No work shall be done on any part of the building or structure beyond the point indicated in each successive inspection without nrst 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.
APPROVED PLANS MUST BE ON TIlE JOB SITE AT ALL TIMES DURING WORKING HOURS.
TIllS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WTI1IIN 180 DAYS, OR IF WORK IS >Ju"nu OR ABANDONED FOR MORE TIlAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF TIllS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYON& paOCEEDING PAST THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RIS1{.
Your signature on the front of this form verifIes the following: I HAVE CAREFULLY EXAMINED TIllS COMPLETED APPLICATION, and do
hereby certify that all information hereon is true and correct. and that I have a legal interest in the r....'r-..J as owner of record or authorized agent. I
further certify that any and all work performed shall be done in accordance with the Ordinances of Lane County and the laws of the State of Oregon per-
taining to the work described herein. I further certify that ifl am not the owner of the Y"~r-.~i, my registration with the Builders Board is in full force
and effect as required by ORS 701.055, and that if exempt the basis for the exemption is noted hereon, and that only subcontractors and employees who
ore in compliance with ORS 701.005 will be used on the job.
SUBSURFACE & ALTERNATIVE SEW AGE DISPOSAL SYSTEMS:
When subsurface construction is complete, the permit holder shall notify the County Land Management Division by submitting the installation record
fonn. An inspection will be made by a qualified sanitarian. If construction complies with all rules a certificate of completion will be issued to the permit
holder. If construction does not comply with rules, the permit holder will be notified, and all corrections shall be made before a certificate of completion
will be issued. Failure to meet satisfactory completion within the a1loned time constitutes a violation of ORS 454.605 to 454,745 and this rule.
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From: Interior property lines 10'
Edge of road right-of-way 10'
Building foundation 5'
Wells or other water sources 50'
DRAIN FIELD
10'
10'
10'
100'
~
"
.
Please complete all lines inside white boxes, if possible.
't'UUH "AMI;;
~1T.
P. 0. Box 459
~~
?-/ -9/
UAIt:
?~b s-ssr
t""ON!:
JUUK AUUHt;::;::O
CITY
5rerH
ZIP
Zf7 316 Y
ZIP
'3S-z.rJ ,~
CUNIHACIOH
Uc.:enM .
.
MAP, PARCEL NUMBER
(Found on tax map. In the A.....m.nt . T.utioR Dept.)
lfw2p f:n~ ~l't l~'! :'7:':1
Town.hlp n;;;g;- Secllon 1/4 Seelion T.. Lot
Townatup "lr."rig;- liie<:Uon 1/4 :;>ectlon I.. LOI
,
.
SITE ADDRESS
:;::;-~ J' ~
.
MAIL PERMIT TO:
~~II~P..Il!~
P. O. Box 459
I flJeasant Hill, DR 97455
f1AMI:
AUUHt;;;;;;,;
1,;11'
ZIP
,
.;:.
.
.
land Management Dlv. staff can
not be held responsible for
evaluations or recommendations
based on falsol Inaccurate or
Incomplete Information
,:'~
Existing Buildings or
Improvements on
Property
~ouse
c:J Barn "
c:J Garaga
c:J Mobile. Homa
c:J Shed
SEPTIC INSTALLED
c:J Yes
c:J No
Water District
,I
Directions to site
from Courthous~
/IJS -r &;.
/9'G TL
J-k,!d<..v '/ r<.. (]'X
/7J:.. T L ~
"I Ie tJ^-I / b K
7" "-' ON "!>.p(roSf.
dlJ
dAJ
,
.
ZIP
,
.,
For Mobile Home
Placement Only
Brand
Year
Size
No. of T1p.outs
No. of Bedrms
License #
~:' .
.
............. "
'!J
jo~:
, '] - n..
.1 \i:r'l '.:':~I
,:~ -r:.:,:
:..~ .1)
..-
:
i
.
,
.
.
.
,
,
,
''';:.~:'.''
,'..:::....-:;:........,
.:~.....:.......:
; -.
,
,
...
'j
-"
.
:
.~...
. -
.
.
I .i.
1.";
, .1,-
- "
:':,
. .
. .
..'t.:.
..
"
BLUE RIVER
RANGER ST/\TION
F S ROAD 15
)'
,
-
'f'
;'
~. 73Q/cIers~ .
/tfl Veilda~
oil"
SEWAGE DISPOSAL
PLOT PLAN APPftOUED
A permit is required
prior to startin~ construction.
DATI' 7 -I ~ -q 1
BY J><J ~~
, ~
EllIinlnmemal Healtb Servigt's
125 East 8th Avenue
[ugelltl,Oregln 91401
-
-----
\
--- _.~ ^,"",
---- ~? --- ~....
\ , -- ~i6fiM- 1 ,.----_ ~tA~I~ f<~rttJ
\ ( .;. If:: , ~,.O
-"':.. , I a' ~\ . I -(~ ttP
~ --:- t.;J, i" ,p D~BJ~f1
I" '\J Dl
i\ l~ ( I 7
'~
~
pros poses:>
~.>..---
-
-----
'D [LJ(o~~
~\
~
.
.
l ba!
.
.
.
.
!Ill
.
.
.
.
lIli
.
.
.-'
.'
.
,
.
.
:' ,
.
/,
, W
e!rJ
r-
.D
~
~
"
e~
'\ M
'. '\1
.~
.
,
.
.!
.
1 I,
ii'
.
.
W: 3 LANE COUNTY DEPT ENV MGT RECEIPT I 200891 DATE 070391
APPLICANT BALDERSTON, STEVE ADDR 1691 DELROSE ST., SPRINGFIELD, OREGco.\!
. TU' 1703243400124 SUBDIV LOT BLI( ..
NEW BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES 'BLDGS 001 PHONE 746 5554
OWNER NME BALDERSTON, STEVE ADDR 1691 DEUWSE ST., SPRINGFIELD. OREG~
. CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DA'~
Iii BP H'
BP ^."
. BP ~;
BP u
BP .c
. ~
~
PL
MECH
. SUF~
PCK
SDS
.
SDEQ
I I"~ ,
..
CATG:
. SEQU:
TAKEN
.
..
IFIX/BATH:
LC 200B91 SDSR
FEE
PLN RA
BY RLH
SWR: FT. WTR:
MECHANICAL FEE
STATE SURCHAF(GE
PLAN ,CHECK FEE
SDS ELE PCK ISS
1 2
EST. COMPLETION DATE
FT. RAIN:
~>%
25/.:
/
SI OTR
DEPOSIT *If
FT
.
.1
w
b
;
.~
..
,:,~
, fl
.~
75.00
10.00
85.00 CI(" ~
o
.
r
.~
~
o
~
.~
~
. !
>i
/ t
. ,.' ,/t
,
um .
"",
'.
.
.
.
.
am
.
:a.-',",
'. .
-::_7
,'.
\
..- 1
!'
.
.
, a~8
\' .
.
"
-\
, ,e
\
\
,
',e,
m,
.'\
.
.
.j
nHe
.
."\;
, ,
,\
\
"
.
\
<
, .r.:
-;--..
. ~ -'. -.
",7
..
r,
.
HOMH
.-
,
;;j '!"-
."
k
,-
,
,
:.._---------------------------------
.
.
/
W: 3 . L.ANE COUNTY .'DEPT ENV MGT RECEIPT ~ 2~0891 DATE' 07039;
. APPLIC,ANT EcAL.DEI~STOW,' STEVE: A!)Dr~ 1691 DEL.ROSE ST., SF "'I NG,FIEL.)}, OREG'.''''
TL.' 17.3243400124 S~DIV' L.OT 'I BLK
, .
NEW BLDG TYPE USE R BDRMS 0 UNITS 001 'S,TORIES IBLDGS 001 'HONE 746 5554
. OWNEr" NME BALDEf(sTON. STEVE ADDR 1691 DELROSE ST., SPRINGFIELD. OREGf:J."
CODE\ APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DA,y
, I ~J'
1~>>9 ~~ ' 6:8
.~ .
BP
BP
. .
PL.
. MECH
SUR ,
PCK
SDS
. SDEQ
mw'
.
I.t.FIX/BATH:
SWR: FT. WTR: FT.
MECHANICAL FEE
STATE SURCHARGE '\ . 5%
PLA~~EC~~E,;~\-.._ 25%
,'" \ ( . '\
RAIN:
-
i'
FT'
.
75.00 .
j0.00
~i1~
.
rj
85.00 CI(.
... .
.
L.C 200891 SDSR
/FEE
/
CATG: PLN
SEQU:
. TAI(EN BY F(I,.I..I
RA
SDS ELE PCK ISS / SI OTR
1 2
EST. COMPLETION DATE DEPOSIT ..
.
"-
.
lo.
/
I