HomeMy WebLinkAboutPermit Septic Tank 1985-10-3
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Lane County Authorization for~
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FOR OFFICE USE ONLY
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S~BDIVISION/PA~TITION (if applicable) I r~T/PARCEL /1 BLOCK
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OESCRi.PTioN ii' PR'::'OSED WO~ BE SPECIFIC~". . I )'EClARED $ VA~UE
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= OF BEDROOMS -:::;::> -I ~ OF ~~o~y It OF EH:..,LJYECS [\-JATER SUPPLY /.. . R Proposed
, ...... --; /'1//4- N/PdE . #'f#Z77.A'Clv./ . ,Existing
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CONF~~^7/0SR # . /' / ~ ~ 7L7::;.-- r' _ T9"'P)!ONE NUMBER
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PROpOSED USE OF PROPERTY
~Residential D Industrial
o Conunercial 0 Public.
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I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION FOR PERMIT. cu,d do hereLy certify that all information hereon is true and correct, and that I
have the followi.nq leqal interest in the propc:ty.Oowner of record; ~tr'H:t, pllcchascr;Dauthorized agent' .
[ f:.:rther certify that any and all work perfo~d shall be done in accutdanCl;l with tht;l Ordinances of Lane County and the Laws of the State of Oregon
pertaining to the work described herein, and that. NO OCCUPANCY will be made of ar.}' structure without the permission of the Building Division. I fur-
ther certify that rcqiatration with the Bu,ilder's Board is in full forCIl 1md effect dS required by ORS 701.055, that if "exempt the basis for exemption
~:c::~~~~~;~;'oYees who arJ~ 0:;:; 7~ ~ u:: this p,ojoet. ;v~~: h~
- NAME (please print) /"' SIGNATURE I DA'PE
READ THIS SECTION CAREFULLY. YOUR/~HORIZATION ~AS BEEN BASED ON THE FOLLOWING CONDITIONS~
o PLANNING/ZONING: Zone V'/ ~ Partition It Parcel It Parcel Size
C / C. t .
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Date, /#'h/Rr-~
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B. P. It Installation Record Issued? 0 Yes 0 No
Gallon Lineal Feet Maximum Depth I
~7~~s~[).c:;. ~i~kf~~--~t::--/81J, ~ .
U Date(} /D-'I"~ (/ _~
Minimum Setbacks:
CO~"ENTS, ~~
J(SANITATION: S.
1\ Installation
Specifications:
CQMNENTS :~.J () ~
=A~_
1. #
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o ~ EXAMINATION, Type
Group
Use
COMr-lENTS :
/0$
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~~~'vED BY BGILDI~;OFF~/DESlGNEE (per ORS 456.805(1)) 1'1 ~~ D~TE
LANE COUNTY DEPARTM~ OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION C14-25R~
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SETIl.-'CKS A~D OTHeR CC::OITlO::S OF APPRQV,\L ~tuST BE STRICTLY OBSERVED. VIOLATION CA~ RESULT "IN REVQ-
C;'':''IO:-3 Of ,illS r>r:RmT, enAnD:; U~O=:R PROVISIONS OF L'\t>E COU:':1Y'3 INFRACTION ORDI:;.r\NCE, ANO/OR OTHER
REMEDIES ALLOWED BY LAW.
Io,'HEN READY FOR I~SPr:CTION, CAL:' 6a7-~Ol)5. A ~lINH1U:'1 OF AT LEAST 2~ HOURS "OVAI:::::E NOTICE FOR INSPEC~
TIOCl Kt:Ql:t:::;;:-:; ;.;:';~T BE GiJ::;.:. Hu'lc the lo11owing info::-::Jation ready: permit number. job address, type
of inspeCt~~~, when it will be ready, your name and phone nu~ber, and any special ~i[cctions to site.
BUI~~ING DIVISION:
REQUIRED INSPECTIONS:
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1. Founddtion Inspection: To be made after trenches are excavated and forms erected and when all
materIals lor the toundation arc delivered on the job. Where concrete from a central mixing ~
plant (commonly termed ~transit mixed~l is to be used, materials need not be on the job.
2. Concrete Slab or Under-?loor Inspection: To be made after all in-slab or under-floor building
serV1=e equIpment, conou1t, plp1ng accessories, and other ancillary equipment items are in
place but befor~ any concrete is poured or floor sheathing installed, including the subflaor.
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3. Framinq' Insulation -Inspections: To be made after the roof, all framing, fire blocking, and
oraclng are 1n place and all p1pes, fireplaces, chimneys, and vents are complete and all rough
electOical and plumbing are approved. All wall insulation and vapor barrier arc in place.
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Lath and/or GVDsum Board Inspection: To be made after all lathing and ~ypsum board, ;.nterior
ana-eitCrIOr;-rs-rn place but before any plastering is applied and before gypsum board joints
and fasteners are taped-and f~nished.
4.
S. Final Insoection: TO be made after the building is complete and before occupancy.
APPROVAL REQUIRED. ~o work shall. be. done on any part of the building or structure beyond the point
indicated in each successive inspection without first obtaining the approval of the building official.
Such approv~l shall be given only after an inspection shall have been made of each successive step
in the cons_truction as indicated by each of the inspections required. .
NOTE: All building pe;mits require"inspections for the work authori~ed, such as but not limited to:
A. Block Wall: TO be mace after reinforcing is in place, but before any grout is poured. This
rnspect10n is required for each bond beam pour. There will be no approval until the plumbing
and electrical inspections have been made and approved.
B. Wood Stove: To be made after completion of masonry (if applicable) and when installation is
compl~ Installation shall be in accordance with an approved, nationally recognized testing
agency and the manufacturer's installation instructions.
C. Mobile Home: An inspection is required after the mobile home is connected to an approved
sewor-or-ieptic system for setback requirements, blocking, footing connection, tiedowns,
skirting, and plumbing connections.
1. Footings and piers to comply with State foundation requirements for mobile homes or as
recommended by the manufacturer.
2. Mobile home minimum finish floor elevab~on~shall be certified when required by a flood-
plain management letter:
3. ~:obile home tiedowns, when required, and Skirting shall be installed and ready for inspec-
tion within at least 30 days after occupancy. Tiedowns and skirting shall be installed
per enclosure.
D. Swimmin9 Pool: Below grade when steel is in place and before concrete is poured. Above grade
wnen pool-rs-installcd.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS.. THIS PERMIT WILL EXPIRE
IF WORK DOES NOT BEGIN WITHIN ISO DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR ~lORE THAN"lSO DAYS.
SUSPENSION OR REVOCATION 11AY OCCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
ANYONE PROCEEDING PAST THE POIl;T or REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
SUBSURfACEANb ALTERNATIVE ~ DISPosAL SYSTEMS:
1. Permits shall be effective for one year from the date of issuance.
2. Upon completing the construction for which a permit has been issued, the permit holder shall
notify the Lane County Department of Planning and Community Development by submitting the
installation record form. The Department shall inspect the construction to determine if it
complies with the rules contained in this division. If the construction does comply with such
rules, the Department Shall issue a certificate of satisfactory completion to the permiti ~oldor.
If the construction does not comply with such rules, the Department shall notify the permit
holder and Shall require satisfactory completion before issuing the certificate. Failure to
meet the requirements for satisfactory completion within a reasonable time constitutes a vio-
.lation of ORS 454.605 to 454.745 and this rule.
Setbacks - Subsurface
Fro:!l:
S~waqe Disposal
Septic Tank
10'
10'
5'
50'
Dril.infield
10'
10'
10'
100'
Interior property lines
Edge of road rlGilt-of-way
Builtiinq foundation
Wells, other wil.tcr sources
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r I-o~ FHA lo~V\ - <~faas& f!x.pe&te!
. ACTI~Y INFORMATION .HEET
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COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
klne county
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Steohetv T lo..uclv
I PERSON MAKING REQUEST
~":3'lq6" ~e-4"V:-l"YllJd-
. MAILING ADDRESS
~ - CJ~ATE
fo 8:3 - 38'C:.o
BUSINESS TELEPHONE #
97494
ZIP CODE
~F9-/07 /
HOME TELEPHONE #
-__GJauL_J_eY"l~Y
PROPERTY OWNER
.~2" 3 RQ.klC:l~wOo.rJ
MAl LING(}\DDRESS
~Dr:[OBQeJA OR <)'L
I CITQ) STATE ZIP CODE
72G,-D394-
BUSINESS TELEPHONE # HOME TELEPHONE #
2 PROPERTY ADDRESS
(IF DIFFERENT FROM MAILING ADDRESS)
3 MAP & PARCEL NUMBER
(REQUIRED INFORMATION)
(from tax maps in Department of Assessment and Taxation:
or from tax statement)
17 o 3 22- /703.22/319'1OD
(LA to pJ~ tOWNSH I p' RANGE SECTI ON TAX LOT(S) OR PARCEL # ZONING
If o~ __?-_~, 3 /'1'100
TOWNSHIP RANGE ~c\" liON TAX LOT(S) OR PARCEL # ZONING
tOWNSHIP SECTION TAX LOT(S) OR PARCEL # ZONING : .
RANGE
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4 SUBDIVISION (if applicable) LOT
5 REQUEST (state exactly what you plan to do) ~ptlc. V7-'.J1i..er,)
PPI'1r11M.:J f" rr~n r..... ()P- ()Ynrp~)
() -' I <1
ACRES
BLOCK
+tv- I..oo..n -
6 DIRECTIONS TO SITE: -BcitUvlO_ E~':)Y11ht.Q.lLGu.me.. h1nM , r'Wd- M'L
Rt:i\p, ~\1IJ\()Qd .
** FOR STAFF USE ONLY ** NUMBER
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V>
ZONE/LAND USE:
BY: DATE:
DATE
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TIME IN:
OUT:
LAND MANAGEMENT DIVISION / 125 E. 8th ^VE., EUGENE, OR 97401 / 687-4061
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