HomeMy WebLinkAboutPermit Septic Tank 1992-9-17 (2)
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d';l?7-9Z
REQUEST
FOR:
REPAIR EXISTING SEPTIC SYSTEM
~ TOWNSHIPl? flANGlE03 SECTlOH22 .lJ':TTlOH T.u:LO~700 .~ClYISlOH/PAllnT1OM
'~cS55.DG'AME FARM ROAD, S PR I N G FIELD, OR EGON
LOT I PARCEL -.OCK
STRUCTURES NOW 0t0I !"ROPOTT
EXISTING SINGLE
PROPOSED USE llUlle ..STALLi:O
PRIVATE USE
FAMILY DWELLING
WATER "STALLED
NO. OF .TONEllI
NO. OF EMPLOYEES
COHSTlIUCTlON CCtlTNA1.U1
gESCRlPTlON Of' PI'IOf'08ED WORt{ NO. 01' aEDROOMS
REPAIR EXISTING SEPTIC SYSTEM ~
l)lllECTlOHS TO SITE ""0M COURTHOUSE
NORTH ON GAME FARM ROAD FROM HAYDEN BRIDGE, 1/2 MILE ON THE RIGHT.
APPUCANT N.....E . ADDRESS
'HDH' 746 - 80 3 5
KEITH BEDORTHA,
OWNERS NAME. AODRESS
RALPH CLI NE, 47
FORTUNA E., IRVINE, CALIF.
3 liS ~;C~.. .
PHON.
NONE GIVEN
CONTRACTOR N....E
BEDORTHA CONST.
~ MAIL PERMIT TO:
BEDORTHA CONST.,
PHON I
P.O. BOX 220, WALTERVILLE, OREGON
97489
n
, N....E ..OOIlES.
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I have carefully read BOTH sides of this appllcatlo~ .--!!7reby ~lfY tl}# -l!I Information
KEITH BEDORTHA ./17 /~ ~~
PRNTNAM&: r-r-~
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Is true and correct
;i-9-9 L
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DATE
CALL FOR INSPECTIONS (SEE BACK OF FORM FOR INSTRUCTIONS) 687-4065
SEPTIC permits ara good lor ana yaar. ALL olhar parmlts axpira aflar 180 days unlass inspactlons ara curran!.
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;;mA:l1E DISPOSAL
PL011?U\1\l APPI10.;:J
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l/lIwironmental Health Sel'/ices
125 East 8th Avenue
Eugene, Oregon 97401
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9-9-77
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MAP, PARCEL NUMBER
(Found on tax m.,a In the ...........nt . r....1on D.pL)
{02n1P ~~ ~ ~14~I~n ~?f:~
To....,.hlp ~ SeeUon 114 SeeUon Ta Lot
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Inl~~;"ati~.~ .Req~e~i.'c)~;y, ..; ;ie~~1~1en;1~~i'yt~'e~ii;';l~r&.'BloC;k
:/\COMMENTS,/j./(Fot'L:'O.W~':UP'::?:': :': ./:.::::'. :::":.-.:.::.::...
TRS Verili9d c::lYes \{Not::J+....... """""{"',..,;,"')'.,{, ...... .... .
Allowed Use =Yes./Nol:::::l'.'.... ........,.",<"..,...,..,. ... ...
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lend Management Div. steff cen ..
not be held responsible lor
evaluations or recommendations
besed on lalse, ineccurate or
lMO 149- 2192 Incomplete
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Existing Buildings or
Improvements on
Property
~.House
c::l Barn
c:J Garage
c::l Mobile. Home
c::l Shed
SEPTIC INSTAllED
--E:9-Yes
c:J No
Water District
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Directions to site from
nearest main Intersection
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For Mobile Home
Placement Only
Brand
Year
Size
No. of Bedrms
license #
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..... Distance from Mobile ~
Home to:
Water
SewerlSeptic
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. ~1!'prICANT CLINE, RALPH LANE COUNTY D~blREY.~3~GtA~rC~M;~ RB..?9~?-~tNG'~~H~D ?92i~:
TLI 1703224105700 SUBDIV . LOT BLK
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, NEW BLDG TYPE USE R.BDRMS 0 UNITS 001 STORIES, IBLDG~ 001 PHONE 746 8035
. OWNE~ NME CLINE, RALPH ADDF~ 2833 GAME FARM RD.., SPRINGFIELD, (.~
'"~ CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DAY:
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TLO 1703224105700 SUBDIV LOT BLK
NEW BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES IBLDGS 001 PHONE 746 8035
OWNER NME CLINE, RAL.PH MDR 2833 GAME FARM F:D., SPfn NGF'IELD, fe::
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