HomeMy WebLinkAboutPermit Septic Tank 1974-4-17
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INSPECTION ~ S.i'. # ~-37;Y
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REQUEST FOR SITE
For Office ~
Use Only /~ f2L...<7-0pr' A/..efJ Yes L:I-.-4;J No
Received by Code' C.T. Number SpeciifPermit Area UrbanMinq Area
THIS IS A PRELIMINARY REPORT WHIC~D SINOT INSURE THE ISSUANCE OF A FUTURE BUILDING PERMIT.
PLANS OR EXPENDITURES MADE IN RELI CE UPON THIS REPORT ARE AT YOUR OWN RISK.
PLEASE PRINT
If Subdivlsian - Name: ~~~of~~6'.V'/$~;~ Lat #
17 ~ ~MJ:Jl.L,-",,-t.- N w,rhl!!.'- Yes V- No
Township Range Sectian ~at No.. Ow r of Praperty Owner's Consent
k/~"'~r", ~~"h~~"""'S No.. of Sites J $ 5~~:
c--- . r ../ /Ai,
/~~~ M//"A""~"'~,I'.e S~ No.. af Acres ~ $
~;"::;;~'. L:',1r Total $ SS'<e.:.
3"'~.. %/W X :L Z(lh~ ;.LJ l2'~~:~k
Tefephane # Signature of Appl icant Date' Owner' Seller
Black #
Proposed Use / -.I' Appl icant1s Interest Buyer . . Realtar
af Praperty: $/1'/.4.. ~~./j( in Praperty: Other (Specify): d,tlZh_~
~ ##N'bn A4'r~~.IV #".17~.
Pr~perty Size Leg~Access - Roa~ame Existing Structures an Property
'Is Property Within O.ne Mile af City?
Yes What City?
No. ~
Proposed ~~er Supp I y ./
Publ ic /' District: ~""''''I~ iAz~,..
Spring Well Other {Specify~
Property Location (Directions):.d ~~ tj,;-~.r ;:?"" ~,,/~ ~.dN~
kJ .' 21' tl';.A ~~~~ dd-.t41~,1 .~.'
LId ~~ ~r~ ...$;~v/S~~
When ~ 1 T~s t Ho I es Be Ready?
MARK TEST HOLES WITH OUR FLAGS'
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(Date)
Location of Te" Hole, on P,ope,ty' ~// ~ IV~ .s;,h/-#'/~h
~~:~ed::~~~:r~::property Sh;~n~,'ocat1~ ~an~'k' ;nd ,elation,hip ~te~ole' to
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MAKE CHECK PAYABLE TO: HEALTH AND SANITATION
MAIL TO: LANE COUNTY BUILDING AND SANITATION DIVISION, 135 E. 6 th Ave., Eugene, Oregon 97401
C55-55
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PCl'Y'ceA #/ 0 K ~.~ g ():; )h area. bO / ~~
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BUILDIN~ SITE EVALUATION
Js}1f
() Building Permit Appl ication No.
() Site Inspection 7f/-39yt
() Pre-Permit Investigation
LANE COUNTY PLANNING DEPARTMENT NOT NO
app I icab Ie
1. Zoning Ordinance Compliance ( ) ( )
(Zone RI )
2. Subdivision Ordinance Comp~ iance ( ) ( )
3. Required Access ( ) ( )
4. Building Site (Area, Width, ( ) ( )
Frontage, Setback)
5. Other (see comments) ( ) ( )
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T /7R O:5s 2LJtf.,AX LOT 101
CENSUS TRACT
APPLlCANTj /_
Nll,ME u..J-Pfffr/7 EnQl~'f'.p~
ADDRESS V
PHONE
DATE '-I-F7-, l/
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YES
DATE
NAME
( )
( )
( )
( )
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COMMENTS: (/J'1~~ ~k~~~~'I-~'~/AY7'~ ~..-"'~.d///~."L-._,
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NOT
app I i.cab I e
6. Plans Submitted (f) () ()
7. Soil Stabil ity (footings) (1) () ()
8 . Flood P I a i n () () ( J)
9. Other (see ;!Comments~ /J Il () () (I)
COMMENTS:. !fi~ ,/~~~,/#iU J4 tZ/~~4n-,
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BUILDING INSPECTION SECTION
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NO YES
NAME
DATE
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Permit # '7 L/ - 3?!:(
FIELD INSPECTION SHEET
Completed By Sanitarian
Location: sect2lJt,l T. F1 R.~ Tax Lot or Acct. No. Par t c:> {! /6 J
Are public sewers available or nearby? (Distance)
f\Jb
N/f)
Are there zoning or environmental considerations?
Size of property:
~3 I~-
Are other systems in area malfunctioning? Nil
Is there room for future expansion? Ye.-S
Surface feature considerations: (Explain)
Slope: 0 - &-O')'::t:>
Flood plain:
Plants:
Rocks:
Low area:
Drainage way:
Streams:
Water supply and utilities:
Coriununity water:
'pri vate water:
Water lines:
Gas lines:
Wells on adjacent properties:
I?C{J-~ b{)~ -ffi (j
Location:
PaV'c~l1F1
#1 Test Hole
A" -WJ~~ I..
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TEST HOLE RESULTS
Pd/'C<<'-( 1'= '1-
#2 Test Hole
#3 Test Hole
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i' 0"
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~6() I ~4~J~q--l! 0"
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Soil Classification (If KnO~) :
Is c~rtain drain requir~d?
REMARKS:
Interim Form #6