HomeMy WebLinkAboutBuilding Plans 1991-11-18
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VICINITY MAP
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MUST BE IN BLAC~ INK
Permit NO.~.'2 '9 /t? - 9~wnshP. /'if Range L Sllction (J(o
Standard System I)("Alternative Systllm 0 (Specijy Type) ./ R "-r"" '" /
Job location (Stilet Address) /0 Vl/ '-Z:U? JJ H4 ~ 1'/-f:P!'.
SupdivisionlPartition # . Parcel lot.
form c55-11
13 Tax Lot <J?/80
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'Block
DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED
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USE BLACK INK ONLY
FOR INSTALLER'):; USE: Trench Depth Gravel Depth Below Tile
Tank Capacity /~ Manufacturer .
Measured Distance from Well to Tank t! 17<1 From Drainfield_lu~--- Total length of Lines-1Y,~
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's ame) certify that a (Mfg.) (Model No.) Pump
and Mer Float Switch ~:lH1~0.)./ have been installed with this sewage installation.
Signat ~~~ Date /(/r;/7/
FOR .sANITARIAN'S USE ONLY:
COMMENTS'
M System Approved
o System Disapproved
o Needs Correction
System Capacity 'i4R")
[J System Corrected
gal./day Signaturp ~ :..&--~...
Date
Date .I /-11-7/
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When ~ned by the County Sanitarian. this certificate is evi-
dence as per OAS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location.
To request inspection. return all three (3) copies 01 this form to: Lane County Environmental Health Services. located in the basement of the
Public Service Building, 125 E. 8th Avenue, Eugene, OR 97401.