HomeMy WebLinkAboutPermit Building 1976-10-18
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CONSTRUCTION [] MOBILE HOME L>]- PLAN REVIEW [] CHANGE OF OCCUPANCY [ ]
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LANE COUNTY PERMIT FOR:,,':
/"1/7
PERMIT NO. S.5?j"7t,
DOwner
ADDRESS
CITY
ZIP C:ODE
PHONE
O.S. Reg. #
Tw~
" ..,. Range -,,>11 Section ..::r ~ Tax Lot
/.~. rP~ Code
Census Tract
Subdivision
Lot
Bloc~
Acreage /11'." r" Width
Access to Property (Road Name):
rc:::. ., "_ ~
- ,
~-~
-
.B-h~
<57C;
Depth
Existing Structures on Property:
A/~_
Directions to Property - Address: ~., ~ ,"f/.? _/...... p."...~ E.;.--- h_ _.
/~J_ _~_;:/ /.:. 7'J'~,,:- ,//::- i./__./., ~__ ~>~"L_
STRUCTURE (# BEDROOMS) SQ. FT.
P~-k ~A/"/_ /._~_ .9~/~ ~? /1./)
-,., - -... . / - , ,; ;"..,.
p/
/.
VALUATION
""'T',,::-___//
t"!'" ^ ~
SEWAGE DISPOSAL: ? 6' &. /"iJ
PUBLIC l J SEPTIC TANK 1M OTHER l
BUILDING
PLUMBIN"
3% SURCHARGF
MOBILE HOMF
WASTE DISPOSAl
PLAN REVIEW
~.,., -
PLUMBING INSTALLED BY:
OWNER [] OTHER l) NAMF
WATER SUPPL Y: PROPOSED [ J
EXISTING [J
,-:IF'>
/1,(
f>l' PUB L1C
[ J COMMUNITY - NAME:
[ ] PRIVATE WELL
[ ] OTHER - SPECIFY'
/R... /....
.-9 ~
TOTAL
@ / 352
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY:
GALS.j I'M r) MIN. DRAINFIELD "J () ()
, ,
!" "'_.'" ~~..:.L _ ~"....t I .../":.4..,,......
-,......,_1<\11 ;,'1..' J'.~,......- I.lJt'~lC-
L1N. FT.
MAX. TRENCH DEPTH
t+1 ,... // P,",.I"'. " r I? 0, ..', .f?
INCHES
1/ "'.. A
l.nr d 7,',J.AJ
( . .
TYPE OF CONSTRUCTION
GROUP
FIRE ZON~
STAY 100' FROM ALL WELLS
USE CLASSIF.
SETBACKS - FT. FROM CTR. OF r!W:
FRONT <{""n SIDE EXT.
FT. FROM PROP, LINE:
SIDE INT. .... REAR
c;-
ZON~
'2::"'~ n
BLDG. PERMIT - WHITE
OFFICE COpy - WHITE IMPORTANT'.
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOLDENROD
/ ISSUANCE DATE:
'o-.-f/ Jt.._ t:-;--;;.~ _ /eJ// :9' /~_
" '-,...I - I' ''/ , -
Call 687.4065 to schedule all required construction inspections. Call 687-4061 to schedule all required
septic system inspections. All construction shall comply with the State Buidling Code, D.E.Q. standards
for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate 01
occupancy before being occupied.
AUTHORIZED SIGNATURES:
Isl (r-:;"/..fX ~, _~
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(See Details on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG, AT SITE)
C55.13
LANE COUNTY, DEPT. OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
1'- ..
SEWAGE DISPOSAL SYSTEM RECO. ' "
to signature and submit bot opies with application. .
PERMIT NO. /I1P S0I9- 7/'..
PROPERTY ADDRESS JUit ~ j'tuJ' ~ {tixi
G-A/'A 'fJ.- F Arv.^ R n .
Water Supply
Publ ic Other-List W;;:'/- t-
Gal. Capacity /5 tJ 0
INSTALLER:
Complete
PRAED
top part o~rm
Septic Tank:
Ft. from well Steel D
I D () -r
Inside Dimensions: Ft.
Lenqth Width Diameter Depth
OWNER /1')
NAME (J.~ ~~ bL=:2~.-.-..L
(1- I" hi /J Feet from
MAILING /X"/..~I1~__//f._..~~, WEll /00""-
, , -." 'I.'.' ,..",...
ADDRESS 0 / /. .4.d/ ~. Lot L i.ne
~~ ~~ ~ f?Y..?.? Front
Length of IPnes-Ft7/lTrench I Total Sq. I Ft, Between
Ha02/Db3. 4, 5. 6. Width2. Ft, L./{J () Lines 10
'lot Plan (see instructions):
INSTALLER'S NAME
T /3-1) SO P-rEL. E:AJ"
No, Living Units Bedrooms Baths
II>
"
1't
I
~
"-
~
I"
{~i'lll" ~,
1$ \\V, ,"Z)
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l'3
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Date NOV. Ib- 71,
Basement
Yes No
Concrete ~o, Compartments
Tile Disposal Field:
Distribution Box: Yes ~ No
Other Distribution-Type
~
Foundation
Side Rear
IFille~ IFiller Depth (Filler Below
Tvoe / '3- Above Ti le.2 in.ITi Ie 6 in,
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RE,CEIVED
~ .---..-.,-
NOV 1 'l1976
~g CQUNTY
~VIff@NMgnAb MGMT.
_.J ....
Gt:Jt
S i_qnature!r#~AI f ~;:(Tj/,.-.-.
CERTIFICATE OF SATISFACTORY COMPLETION ' , 11 ~O J-
For Sanitarian Use Only: .. Date: /1---t-7
I n accordance wi th 1973 Oregon Laws Chapter 835. Sect i on 2,14 thi s cert i f i cate is issued
as evidence of satisfactory completion of a subsurface sewage disposal system at the above
loca~~~.
Approved: System Installation conforms to current standards
c==J Disapproved: Does not conform to current stan~ards
Remarks:
C55-11
"
4
5-;!nitarian's
LANE COUNTY
STATE OF OREGON DEPARTMENT OF ENVIR'ONMENTi\L QUALITY ..
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