HomeMy WebLinkAboutPermit Building 1990-7-11
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PHONE NUMBER
#PLUMBING FI~RES
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OWNEJR'S~NAME ~- ^ ~/\B
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CO}frRAS~I~ N~E
SET BACK REQUIREMENTS I
CL, FRONT CL, SIDE INTERIOR
WORK AUTI:toRIZED BY PERMIT !i
ADD ~TMeOa^1 BeoecoM.Ii I (\.ITS,~IOf2-
DI RECTIONS TO SITE " f" ,
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SITE ADDRESS /
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FOOTING /FOUNDATION INSPECTION OR MOBILE HOME SET UP INSPECTION
Approvedh Correction Disapproved II Date Inspector
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CONCRETE SLAB / UNDER-FLOOR INSPECTION
l\pproved V Correction Disapproved II DateY-/Io_F- Inspector
UNDER SLAB / PLUMBING GROUNDWORK INSPECTION
Approved Correction Disapproved II Date
ROUGH PLUMBING INSPECTION
Approved ~ Correction
II
Di sapproved II
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FRAMING INSPp(TION
Approved f/ Correc t ion
Disapproved
INSULATION / )IAPOR BARRIER INSPECTION
.I\pproved 1/ Correcti on Di sapproved II
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LATH / GYPSUryBOARD INSPECTION I~
Approved ~ Correction Disapprovedl
II
FINAL PLUMBING/fNSPECTION
Approved ~ Correction
Di sapprovedll
II
Inspector
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PERMIT NUMBER
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Date ?-It,-,f/ Inspector ffi
Da te <;1'-- (1-- P/J nspector
Date 9- /9- $lLInspector
Dateg- '21-- Y/Inspector
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FINAL WASTE DISPOSAL SYSTEM INSPECTION ,
Approved '~Correction Disapprovedp' Date t111q1<if( Inspector ~M
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FINAL INSPECTI-PN BUILDING / MOBILE I!HOME
Approved v/ Correction ____~isapprove~1 Date7-/I-~a)nsp_ector_
CERTIFICATE OF OCCUPANCY
Approved Correction
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Disapproveq
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Form C74-197
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TEMPORARY CERTIFICATE OF OCCUPANCY
Date Inspector
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FOR SANITARIAN'S USE ONLY: ~System Approved o System Disapproved D Needs Correction
COMMENTS:
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FOR INSTALLER'S USE: Trench Depth .-x..' Filler Depth Below Tile
Tank Capacity ? Manufacturer?
Measured distance to well from tank. /105'
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INSTALLATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION
When signed by the County Sanitarian; this certificate is evidence as per ORS 454.665 of sat.
isfactory completion of a subsurface sewage disposal system at the above location.
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Return this form to: Permit Processing Section, Department of Environmental Management,
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Permit No. SO ~ Ul Twnshp, --L.::j- Range J;L: j
Standard System 0 Alternative srr:t /J. (SReC~ T)'pe)
Job Location (Street Address) c... - f...-f]JI-,a... SQ(\J
Subdivision / Partition #,
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License No. :1 </-S 3 f(
Bonding Company DitTA S1Jl...E..r
(DA~ Date-'1d'b~/
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If Installed By Owner-
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(Signature of Owner)
Applicant's Name & Address
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form c55-11
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USE BLACK INK ONLY.
FOR INSTALLER'S USE: Trench Depth Gravel Depth Below Tilp
Tank Capacity /')-00 G Ifl...-_ Manufacturer W;/liAMr:71'E C~,;v ,5 rpA/E
Measured Distance from Well to Tank . From Drainfi~ld / /"---fr Total Length of Lines
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:. .
I (installer's nameIA.t'.s-. .<<",..,a/Net;. ,certify ~hat ~ (Mfg) HyDRo MA-r/& (Model No.)DSP,H-.M.LPump
and Mercury Float Switch (Mfg. and No.) ,t 7.,. 0, I-(!!i/<€ I ~t1A17'Hoi.- have been installed with this sewage installation. '
Signature~~J (& vI~/~ ??!' Date (1')<< h-, /ftfl
FOR SANITARIA~'S USE ONLY: ;s(System A ~r ' d 0 System Disapprov,e~ . 0 r:,l"eeds Correction
COMMENTS: (!)UIl1.I.l.{PJ/I...fLd...1&:J417l.jj.e.r- 'iJ.. "~ '...nAfP ~ '::'~. 'n .-J
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~tib~;,~., .. '--"7/.II@ System Correct~d DatP\ A C/
System Capacity ~al.fday Signature ~.~ Date.4N)/'O/~8'/
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this certificate is
evidence as per ORS 454.665 'of satisfactory completion of a subsurface sewage disposal system at the above location.
Return thiS form to: Building and Sanitation DIV., Dept. of EnVironmental Management, located In the basement of the
Public Service Building. 125 E. 8th Avenue, Eugene 97401, '