HomeMy WebLinkAboutPermit Septic Tank 1992-9-17 (2)
I'
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.
.
I have carefully read BOTH sides of this appllcatlo~ .--!!7reby ~lfY tl}# -l!I Information
KEITH BEDORTHA ./17 /~ ~~
PRNTNAM&: r-r-~
,
Is true and correct
;i-9-9 L
...
$
.D:<..;.:......,,>....
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!.
"
Ii II'
11--1
,
--
:<
~
-t(.
N
,
~
11
,
1-
~
till
-.;.
6-
, I
i
>
II
~
- \
~
II
-
I
.
'.
\
I~
.
\~
L
"
:-
6
~D~e~
r
.
. 0;(~
V",~/rJ'.
f:)< ,t; y....... ~
sc.pt:c. T~k
tJocJS e.
.l-1?7- 92-
;;mA:l1E DISPOSAL
PL011?U\1\l APPI10.;:J
J....,.-~~" .c;.,.......~
~A;.. ';"J1L"9i- ,.,.
B~i . ...
l/lIwironmental Health Sel'/ices
125 East 8th Avenue
Eugene, Oregon 97401
/1p0'
i' ~ '-1J A tI' d ~1;Vtj '9
.. .
.'
~'
.~,
. .
.......,. ...iBEQi1Esi;)l1~_:i'~sslsf~NQE'..
.... 't~;;~) M'Hi!g!ii:i!~iiii~1'~~~;~tH(~y!;!~H~!h!; OR 97401
....'...:,:;.~. . .: .,..;.:.;,:.:,,:;,. -.::::\::::: '::';::::::::::::,:::'..:..;;:':=':::::::::::'::):::::::}(;::::;:'::);:::
. . ,"w'" . ..,..
,
Please complete all lines Inside white
r:e/-r;J is edo.-7 YKl
boxes, if possible.
9-9-77
UAI~
7L//--~~-..
rl"l"'''{--'
?7L/'i57
ZIP -
\PNAMk
,~\,~ Q~... Is::' k
1yV4-(/~
CITY
R ;:L[ f J.. (IJ (:V-r
OWNER OF PROPERTY (It not ume .. .11'0..)
2-7.0
L), -(('f'
C>--
PHONE
4. 7 P 1'J~/U,up' Z; ::r,...v,;""" (1. a.
OWNERS ADDRES8 (11 not ..me .. abon)
16 e 10-.1 U -<2. C~A>c:7 1"0 r/V~
1N::JIALLk{,~UILUI:H I L;UNIHAIYIOH
.
<72.'77."
ZIP
BilC, vg
Lice';.. -.
,.
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
lownsnlp ~ lMCuon ,,.. tlM:UGn ,.. LOl
. .
,
SITE ADDRESS -10
o<c>3~
a KJA7r' n...14'> 1f',.J
'SPv./~J,/f.:,o IJ
r
.
. .
.
MAIL PERMIT TO:
Rr?d 6-v '1-1/ A
:iJi~
".,/[;.0' 13e> k
1.A)/9-(T-e.--...
CIJY"
{J8,oS 'f
('!o
IvvC'
.z "Zo
u,-II~ ~
9 '7l( gg,-
ZlO
STAFF EV AL UATIONi: "-." :.::". ',:;.':://,:\:,: -.,:';:.,;:. ';"0'::::'::'-:::"'_ '::':""...
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'.'.... ........,.",<"..,...,..,. ... ...
"-",""',-,',',",'
+ ~~~.
lend Management Div. steff cen ..
not be held responsible lor
evaluations or recommendations
besed on lalse, ineccurate or
lMO 149- 2192 Incomplete
,
:-:::-::':''"'
,....:...)...\..,.--,-:... ./::-., {(..
....... ...................IZ.^.0
.............:....:.:.-..:-:.,-...-:..,...-:.:.,-,.:._,:.:.:,:.....:.,:...:'....,~:;v.,. .
. ....... ...............---. ,---"'''. ...
1'114-68 02/92
..-, ....".... ...
....... ".. ..'",'
-"', ."-"
.. .. ...
..~......
. .
. . . . ..
....:-.........:: ..
.,...., '-', ~
. , .
. . "':'UII) l....foQEllENTOIVIU:Jt
~':' 1-
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
12.. ,:., /c,@-o<V
;..f
,
,
.
Directions to site from
nearest main Intersection
f{j Ov- "j J.... 0 N
b fJ-rn e l--F1or /?> (( t>
+~O ""'" Jd IOrl JBN
l$'v, Jet '" ~_ rn,' (-<.
6,u ;<'~'qh-f:
.
7?C/7"7
ZIP .
~. "1-
For Mobile Home
Placement Only
Brand
Year
Size
No. of Bedrms
license #
,
..... Distance from Mobile ~
Home to:
Water
SewerlSeptic
,
e . . e-
. .
. l'i,1t ,,I jl
. .
.\
. .m
c
. .~
a
~
. w
.~
w
Hf~ n l[ , I!
, w
j"t " .~
. .
. .f
.
~
s
. i
.~
0
i'll,', ' , ~
, '.,.
w
. .~
. .
. ~1!'prICANT CLINE, RALPH LANE COUNTY D~blREY.~3~GtA~rC~M;~ RB..?9~?-~tNG'~~H~D ?92i~:
TLI 1703224105700 SUBDIV . LOT BLK
'.
, 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:
;'! II BP , i, I. ':.-
. BP A..
BP
BP
. BP ..
PL
. MECH
SUR
PCK
. SDS
'" ,I ~ SDEQ
.
<i::FIX/BATH:
SWR: FT. WTR:
MECHANICAL FEE
ST A TE SURCHAF~GE
PLAN CHECK FEE
FT. F(AIN:
FT
.
5%
2~5/.
LC 298792 SDSR
FEE SDSR
..
75.00 .
10.00
,"( .
.
.
CATG:, PLN
SEQU:
. TAKEN BY RLH
RA
SDS ELE PCK
1
EST. COMPLETION DATE
ISS
")
~
I SI
OTR
DEPOSIT **
85.00
.,,'
CK 8
,
~
.li
iF
a
ei'
.
e
. ~
l. .\ "
,
."
..
~m .'
.
.
.
.
fIHH~
.
.
.
.
mu
.
.\' .. I f
..,....,, ,
Ii;,' if
,
.."~'.'
.... ".
'...-.':';,'
...
. .
'.. .,'
.'
\
. \
.
H~aH
.
.
.
/
.
mN
.
/
.
/
.
.
HHIlH
.
.
.' .
/
.
~1:;'l'tICANT Ct..INE. HALPH L...\NE COUNTY DXI)~F,E~~3~Gt~(..,JH~C~~~~ R~. :;~9~?~r.N(J)9.~ID ~~9?iF
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::
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST WiLl/AnON FEE ',:Q.tl'I~S
BP U U
BP .
E<F-
EW
BF' .
.
mri
.
.
,
,r"FIX/Br.ITH:
SWR: FT. WTR:
i'1ECH(~NICAL FEE:
STt-ln: SURCHAr,GE
PLAN CHE:Ck FEE
FT..
RAIN:
FT
.
I'L
MECH
SU/(
PCI<
SDS
SD!:::l,
~>%
.
2~5%
.
,111111.
un,'.,
.
- .'
75.00
'" 0' ·
I"'. . '" Huun
HHil
e
LC 298792 SDSI:(
FEE
SDSI,
.
CATG: F:'LN
SEG)U:
TAkEN BY RLH
F(A
SDS
EL.E PCI<
ISS
I
SI
OTf(
EST~
COMPL.ETION DATE
DEF'osn )(.*
B~>. 00
.';
ell, I
;.~
.
.
.
.