HomeMy WebLinkAboutBuilding Plans 1989-11-8
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VICINITY MAP
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MUST BE IN BLACK INK fo,m c55-11
Permit No. 7 07 - 7'1 Twnshp. J 7 Range ~""l, _ Section ::> ~ , '!!L Tax Lot /"J L-
Standard System 0 Alternative System 0 (Specify Type) ~ ... ~l ir
Job location (Street Address) ~ ~ 'i'"D "'., """ " "Sr- ,.1' . ('l ,/,~
SupdivisionlPartition " Parcel lot Block
DETAIL SYSTEM PLOf PLAN AS CONSTRUCTED
Scale I "= ~.
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USE BLACK INK ONLY
FOR INSTAllER'S USE: Trench Depth Gravel Depth Below Tile
Tank Capacity ~.,."...,., Manufacturer '" /I'R ....~", _
Measured Distance from Well to Tank c;r oJ From Drainfield Total length of Lines J ~
COMPLETE THE FOllOWING IF A PUM~ WAS USED ON THIS INSTALLATION:
I (installer's name) certify that a (Mfg.) (Model No.) Pump
and Mercury Float Switch (Mfg. and No.) have been installed with this sewage installation.
Signature Date
FOR SANITARIAN'S U..sr; ON~Y: ystemApproved _ 0 Sy~m Disapprove41 0 NeedA-ACorrection
COMME~:.....I ~ . ,:toh..?;" / -!:!'.J...&f.~ ./~ r- ~
~AA..r.e.v, "h;'~"" .IM-....J-r;itf}.("P;~_J'~-L~~ AJV..J'n-r-. "
o ~ystem..Q.orrected Date
System Capacity if.f7} gal./day Signature _ ~ ... ~ ~I Date / / -? ~rf'
INSTALLATION RECORD & CERTIFICATE OF SATISFAClORY COMPLETION When signedby the County Sanit",ian. this.certificate is evi-
dence as per ORS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location.
To request inspection, return all three (3) copies of this form to: Lane County Environmental Health Services. located in the basement of the
Public Service Building, 125 E. 8th Avenue, Eugene, OR 97401.
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