HomeMy WebLinkAboutBuilding Miscellaneous 1974-4-4
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6i73
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REQUEST FOR SITE INSPECTION~
# 7// - 2 3s
s. I.
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For Off i ce
Use Only
,.;?~77
Rece i ved by
Code
...-Pl"v'-
C.T. Number Soecial Permit Area
Yes No-<
UrbanizinQ Area
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE BUILDING PERMIT.
PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK.
PLEASE PRINT
If Subdivision - Name: 2. Md A r1 r1.., 1/'0 \\l /0 l)({/ R05 Eo Lot # 7 Block #
17 -.-2 2tJ Yes /' No
Township Range Section Tax Lot No. Owner of Property Owner's Consent
-il~
Ie
"w
L60l\{ K,f\} ~ r-: TT No. of Sites
Name
1ft, [!, 0 061 R 0 So E No. of Acres
Mail ing Address
<:; 012.. , 1\/ "- F I G./d.,O R ~ '
79-1--3"2--f? ':?X~~-LrYl/~'?-t1..
Telephone # ,ignature of Appl icant Date
/
$ /5. 00
$
$ Ie:;, ()()
Total
Cash
~heck
Owner Seller
V>~
~
~
Proposed Use Applicant's Interest Buyer ~ Realtor
of Property: j? 65, de "ITI..tll..1:J.()M~in Property: Other (Specify):
_?tJ \{ 11.5'
Property Size
pel J<O~e, fi uP..
Legal Access - Road Name
l\1l'\ r.V ~
Existing Structures on Property
Is Property Within One Mile of City?
Ves ....J::::::::.. What City? fZE/'<:.' N<t.l'16Id
No
Proposed Water Supply
Publ ic ~ District:
Spring _ Well
1?A-II\.\ho,~?
Other (Specify):
Property Locat ion (0 i rect ions): 0 F F (-{/I Y D 6 IJ I;> R I ~ 4t<!. "" N I G. T "-
re, C;; H T I') 1\\ J)(; ( Ro S 6.
When Will Test Holes Be Ready?
MARK TEST HOLES WITH OUR FLAGS
.'
'?- ~o - 74-
(Date)
Location of Test Holes on Property: RA-<'-K 6 F PI:?...o P€. R. TY
Draw diagram of property showing location of any landmarks and relationship of test holes to
these landmarks:
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MAKE CHECK PAYABLE TO: HEALTH AND SANITATION
MAIL TO: LANE COUNTY 8UILDING AND SANITATION DIVISION, 135 E. 6 th Ave., Eugene, Oregon 97401
CS5-55
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~A-<L n\~c.t.s si~'<2...~i<JQ\dQ'td...s
)-Qr &: bS " .
APPROVED
NOT APPROVED
Engineered Site Modification Feasibility:
Possible
Not Recommended
4
'.
,
REASON FOR NON-APPROVAL
STATUTORY AUTHORITY
ORS 431.130 and 447.020
OAR 41-020 Par. I
Insufficient lot size for
TndTvidual sewage disposal and
water supply.
OAR 41-030 Par. I
____ Heavy impervious non-
absorptive soil.
OAR 41-020 Par. I
Water Table above minimum
state standards.
Other
G C)~~
V Author ized Signature
~~f)/7>i
Date
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Permit #7Y-~MS
FIELD INSPECTION SHEET
Completed By Sanitarian
Location: sect.~ T.ll- R.~ Tax Lot or Acct. No:A AA r~ D", \ \::)? S E'
t~~ l ~f()~k ~
Are public sewers available or nearby? (Distance)
II';).
N\.~ J
Are there zoning or environmental considerations?
Size of property: 10 Y. \ \ S-
Are other systems in area malfunctioning? !\-\ 0
Is there room for future expansion?
Surface feature 9,onsiderations:
Slope: U
Flood plain:
Plants:
Rocks:
Low area:
Drainage way:
Streams:
(Explain)
Water suppl~ and utilitie;;..: , 'I ,_ I I t-- 11\ . -I--
ConunUn1ty water: K 0I1Y\ C/JJIJ./ A a\ G-/ .f..-.);!;' \
Private water: Location:
Water lines:
Gas lines:
Wells on adjacent properties:
TEST HOLE RESULTS
#1 Test Hole
0" "2[; ST 1-+'1 L-oa.. "'--
2r;-"36 S- (~ L-
0"
#2 Test Hole
S q -...-..
#3 Test Hole
0"
Soil Classification (If Known):
Is curtain drain required?
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REMARKS:
Interim Form #6
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BU~LDING'SITE EVALUATION
tij:"IH
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() Building Permit Appl ication No.
~ Site Inspection / lJ - ).. s 5
() Pre-Permit Investigation
T {i*)"3 S 2. LTAX LOT
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;,(".1. De J. RCIi:-€- L." 16- h
APPLICANT: 1--' -LL.
NAME f\ 11'1 Yj t' / / .
ADDRESS
PHONE
DATE
, < -( f1-7 ~I
DATE
LANE COUNTY PLANNING DEPARTMENT NOT NO
appl icable
I. Zoning Ordinance Compl iance ( ) ( )
(ZoneLl'r;-r) ( ) ( )
2. Subdivision Ordinance Compl iance
3. Requ i red Access ( ) ( )
4. Building Site (Area, Width, ( ) ( )
Frontage, Setback)
5. Ot her (see comments) ( ) ( )
COMMENTS:
YES
NAME
("'-;;::::A7-"""
\,Y)' r;J
(,.y-
( q--'
(~ ~~-~~--
. ,
( )
;/>-';"1-7V
/
BUILDING INSPECTION SECTION NOT NO YES NAME DATE
appl"cable
6. Plans Subm i tted ( ) ( ) ( )
7. Soil Stabil ity (footings) ) ( ) ( )
8. Flood Plain ) ( ) ( )
9. Other (see Comments) ) ( ) ( ) fl2IM/~L:. 4-3-'11/
- -
COMMENTS: ?
SANITATION SECTION NOT NO * j QF~Qk,fZ!J;;;1JIf
~pp I icab Ie ( )
10. Sewage Disposal ( )
( ) ( ) ~...~ 7'
II. Usable Area (l
12. Water Supply ( ) ( ) ( )
13. Other (see Comments) ( , ( ) ( )
COMMENTS:
TO APPLICANT:
Your
~-4 gf fr
Building Permit / Site Inspection:
Can be approved.
Cannot be approved at this time as indicated on item NO. above.
Questions and further information on items 1 through 5 contact the Lane-
COUNTY PLANNING DEPARTMENT. Questions and further information on items 6
through 13 contact the Lane County BuildinQ and Sanitation Division.
Will be held in this office until you can resolve the problems indicated.
Is being returned.
Your building permit application fee is being returned under separate cover.
( )
( )
( )
LANE COUNTY PLANNING DEPARTMENT
135 Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342-1311 EXT. 231
C55-28
LANE COUNTY BUILDING & SANITATION DIVISION
135 Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342-1311 EXT. 411
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1-/ ,. "#r:f;t-r::-;>-; I: --<, I j nLC7 ADD TO DELROSE Li 7 I:l:l 6
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!( I NtH.""TT I ~nM .code
" Surname Range Section Tax Lot
Receipt No.
I Date
':\-19-74
REQUEST FOR SITE INSPECTION
Census TraCt
I Owner
\ Owners Consent
Yes lilt No
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 LEON I{ I NNETT 1 $ 1<;,00
and No. Sites
Address 1680 n~L Ro~r. $
No. Acres
Spnlf'-:~r.'I~1 n & O~r:'"AnN TorAL $ 1<; no
I Proposed Use of Property
PC"ClI n1FtolT I AI UnMI:'
- Road Name I Special Permit Area I Urbanizing Area
A\I~ Yes No vv Yes Nov\!
I Is Property Within One Mile of a City?
What City? c;"... I N"~ I ~I n Yes vv No
other
Specify
Applicants Interest in Property
Telephone No.
7h(;"~:>~
Property Size
70X11<;
Existing Structures
RIl'W'C'Q
Legal Access
n~1 i:?nc:s:-
NOMr'
Proposed Water Supply
Public Xl( District
Spring
Well
Property Location: (Directions) OP~ HAYn~N RR,nnr O~ 16TH AlnHT nw n~l ~^ql:'
APPROVED XX
(See Below)
orHER
Nor APPROVED
SITE MEETS STATE STANOARDS FOR SOS.
Engineered Site Modification Feasibility:
Possible Not Recommended:
REASON FOR NON-APPROVAL
STATUTORY AUTHORITY
ORS. 431.130 and 447.020
pAR 4l-D20 Par. 1
I Insufficient lot size
Ifor individual sewage disposal
and water supplY.
OAR 4l-D30Par. 1
Heavy impervious non-
~bsorptive soil.
OAR 41-D20 Par. 1
Water table above
minimum State Standards.
other
BEFORE CONSTRUCTION IS STARTED bring this form to the Building and Sanitation
Division and make application for a building permit. If the property is a portion
only of a tax lot, a metes and bounds description of the parcel must be furnished.
Exact specifications for the sewage disposal system will appe~r on the building
permit. Two sets of the building plans and plot1Plan, wi~l\be r.equired.
LANE COUNTY DEPT. OF ENVIRONMENTAL MANAGEMENT ~ ~ ~~
135 EAST SIXTH AVENUE, EUGENE, OREJON 97401 j' Authorized Signature
11-11-74
Date
C55-32