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HomeMy WebLinkAboutPermit Building 1990-7-11 ~L, II _On.03 ~!~,/.I / fCOiO' ,;" ' LANE COUNTY li:~-{N'SPECTION REluKD ,or ,"",,\t,' UGj; '~.,..," 5P e..... ~~Nr ~Eq z PHONE NUMBER #PLUMBING FI~RES i<EMC)OEI...- OWNEJR'S~NAME ~- ^ ~/\B Uti "-1 O'~", f:;~ 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" , !1,,{fA. J /7) 5""7 a~'--6.~V/~47<~ , I I 4/1 A~.\ ,DESr2~t0 L.f\J . SITE ADDRESS / REAR /' ( 'l-JV/Jld) '- I II / 6JbEN6 FOOTING /FOUNDATION INSPECTION OR MOBILE HOME SET UP INSPECTION Approvedh Correction Disapproved II Date Inspector 1// 11 I 'v I~. , 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 ./ FRAMING INSPp(TION Approved f/ Correc t ion Disapproved INSULATION / )IAPOR BARRIER INSPECTION .I\pproved 1/ Correcti on Di sapproved II / LATH / GYPSUryBOARD INSPECTION I~ Approved ~ Correction Disapprovedl II FINAL PLUMBING/fNSPECTION Approved ~ Correction Di sapprovedll II Inspector J /601 - 9-:,/ PERMIT NUMBER I?;( Date ?-It,-,f/ Inspector ffi Da te <;1'-- (1-- P/J nspector Date 9- /9- $lLInspector Dateg- '21-- Y/Inspector , ~/ O1Ar/ / t7~ . - ~~ Date--1-lL -!Za.Inspector ~~ FINAL WASTE DISPOSAL SYSTEM INSPECTION , Approved '~Correction Disapprovedp' Date t111q1<if( Inspector ~M I FINAL INSPECTI-PN BUILDING / MOBILE I!HOME Approved v/ Correction ____~isapprove~1 Date7-/I-~a)nsp_ector_ CERTIFICATE OF OCCUPANCY Approved Correction II Disapproveq II Form C74-197 ~ TEMPORARY CERTIFICATE OF OCCUPANCY Date Inspector ,-^-~~, , "t-fy. . '. . T~JI}-()3 -33.dJ :It= 10(') (j/ . VICINITY MJ,-P ./ :1-~ ft ~JeJt~6") (., ,.:( 1-1 ~ ~LU I t- <l: .!'f) 0 r'l G I lv> .~ ill ~ CJ t;;;..J LU ~~~ ~~* ~ \~ ~N 9 '~ ~\\ '" >- C en ',~ ~I'l,v{ ~~~ ti.;~ ~ ~ ':) ~ <t ~ ~ ~ ~ ~ l:J I) ~'~ ~~~ ~ Q.: C' ~~-~.,~.. ~~~ ,. ~~, ~ \ ~ , ~~,~ ~, .- . ~ c::; ~ ~ '}(\~ fY) E ' j~ m ~, \ ~ ~ ~ ~ m ~. '-J ~\Yt ~% 0. 0- <( (J) C'. Job Location (Street, mile post) L) / --; Subdivision. ~ ~t/vYu? .~ ~ Lot Block_ ----. . - ... FOR SANITARIAN'S USE ONLY: ~System Approved o System Disapproved D Needs Correction COMMENTS: 2o-fy..' y '~.t-uJ . ~ /JA-. f, Date:~-.2..'" ? fi Signature: ."?~ , C FOR INSTALLER'S USE: Trench Depth .-x..' Filler Depth Below Tile Tank Capacity ? Manufacturer? Measured distance to well from tank. /105' :-.... ;::\: ~ 6) ~ " , from drainfielrl 1')5 ) . I I "', PLOT PLAN .r ..... 'V '0/ ~ ~~ If .. r- 'J') 7T - Hol..l S. -1' ~ I ~ ~ " ~ \J V) \! ~ '~ ._. .~_L_ I I~ " Scale: -.---. -/ .~, ~ r.; r--. ,,~y~ ~ f,Y'-f 'f f'V . \ -'-.pt"; ". --"-",-;- ~ .- f. ,; ,'~ (i.i, ::' .: \..:. I~, ,; './ '"' -'/ . ' ,_ "i t .-/ . I - --- 19 -I WatQr p. 19 ih -2; C OHUf' , ',) On ""_.;, ., - "On f '-~~ Laile', C,' ,';. ,,)1), / ~v,.." ':;,/ . 0 ~"'j' y/ 01 ~.. ---- 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. 15' ~ 75' , ~ 75' , '] ~t' I ..1- of,. ~r.rttL ~f' . . ==.-::~a:",-t:::~::::::=----=_____,..__~=!~..::::~.1. '. '5' ". Return this form to: Permit Processing Section, Department of Environmental Management, Pllhlir C:",r\l;"o Rllilrl;nn 1 '"It;: C__. n.L.. ^ ...,......... ~.LvICINITY . MAP '-:f"(\ .-~ - (S Q r:...... pV'-- ' , J I, QI NllST BE IN BL~K 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 #, - _r-((i~J6'~-BLUD. Xi, . ~-6fL6 ~~. . V. R.bf.i~ ~~ k)SW 'Ii/...," t) ._~)(/t', ~. ..' . ~ ~;e~~ . CX!Sf"rNt;, .' t ~ V ,8/~9' QM~I\IFr~-": ' ~9- Iii-'1L.-.Ps-81 ~~J.lll2~J', ,~- V ~~ ~ ~,,~ ~~..&jjL~ .. ~/L-b rt~ _ ,_ .l.LI. ~". Y InstallerM;'t'e~~ ~ho!:f 'do ';!~//IJ" Telephone ...J 1-1 :J. '107 License No. :1 </-S 3 f( Bonding Company DitTA S1Jl...E..r (DA~ Date-'1d'b~/ , If Installed By Owner- Date (Signature of Owner) Applicant's Name & Address ':SA ( 1\( C":A \, R (~~ h\ \ q 1\ \\\f) GQSJ~ ~ (::" () G-f.t(\ fJI n 11- q'tl.(O\ ..1 '" : 7>; -f." (n c.. form c55-11 Section33. I. J Tax Lot -1fJO ~ 1\,., '__'" "--,,.0-',~,1 I.J../. ('7 ',~ lorn I,t , --- -<. / . ~ . f' ",r:~i'~fb '-v~ . " ., ~ ' \. \ '- . ~~ " ~_~a ~ \.-~ '.' I-----"'" Ih ~ OCT23" 'J981;P'" I :' , -\ . ". 5 '._" \ ,,~ tOJD \ _\ ~. -:. ....~.,;u il \\j\, \,' ',~ '",''' '.'I~ DIVISI,ON IJ- \ / >-, L.,:~;:eiliJNTY q' " . ". ..d'-- , " ','" ...... ''-'.'~.lT~ ",,,t ;:. ... HtJt~e 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 ~ . n , " /Ait~' ./j.lf~ ~ ~ ~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, '