HomeMy WebLinkAboutPermit Septic Tank 1979-5-10
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DEPARTI1ENT OF ENV I RONr~ENTAL 11ANAGEl~ENT
PSB, 125 EAST 8TH AVENUE
EUGENE, OREGON 97401
~
Job Address
.lC- !~l~~#~t~ r
Ai:~~'~!1~y.m.~!r~
4J7~j{)fW) ~_. City . tLL{j
IIBJ~. 17-:03-33.1.\ t//:;llC ll'l...
~pplication for. .~C:Lu-'" ~l~~.&, drO-.l..frL'S;l~j"l..J
Structures .now on the property 0 J '1 r_~KU
f~tiR;'';;;4Jii~~~p.mp~tty{ &1~H~H~,;;,.h.J r/ C..iNi~:iM: /-/:t.Mq~tti~jJ. C/:~ijilhK
Affidavit: . I. ~n) 'l~~:ii{;;feH Irl/ , hereby certify. that this information is true and accurate.
If this application is for .an agricultural building it will be used fo,rpurposesall.owed by the State Building Code and
Lane County Code Chapter 10 (zoning) and for'no other purpose. I have the following legal interest in the property:
. ./ owner. of record; 'c;ontract 'purchaser; lessee; holder of an exclusive option to purchase;
./ duly author~zed to ac. t for. the owner. who is knowledgeable of this appl icati~..: .'. .
Signature/Address '~'.. 'Lt..lLj)0V'-. ~jv\'...;; ~ \0 ~. ~~. ~ - ~d, (zip) CZJ747 7
Telephone 74<t1-0E;~ or . . 'Date '-"ltJ....
When permit i.s.rea~notifY.: C/ AP;licant r/ Own~r. C/.Jontractor... .!!1::. C/ mail C/ phone
Owner -^^R.~. Viflal lv'V'\Q;V\.....~2..:i. a. G:;~ - pkLc.o(ziP)0U1, Phone
Contractor "-J\ A- . . . . (ziP,)- ~ Phone
Contractor's OSR# Plumbing by
~:S~~:~:~:~:l :~~~~I~.J -4.
SI test holes ready
DO NOt WRITE BELOW THIS LINE
'P of emp 1 oyees~!~:ijn1t.i
$1$( () Ex i sti ng,
() Proposed,
%~~
BP # ~ ."':' -:-:.a. ,
SI #
Et:i~
tQd~ ~~A!tne~~
// 4 ./~- ~~
.~4~/~~~/
I~I:~I~~II- .
,'tt"".''i/
. )i.O'h{
tOilf
Valuation Fee
$ c::?. -5":
$
$
~
//'$.
--
To~al. Va,luation: $ $
~a!#mm. -: -- .j.'~i~j~i~i~I~!:~ ~ ::~~ ~
~~~.~~/ 4% ",t, '",oh"" "bt"" :
. l "\ J l Plans check fee $
Wa ter Supp 1y1 )0. YE.., t' . ..,..,.--- Change of Occupancy . $
Proposed X1S lng V ... . _-?r- 6"
.fr'~ ~~~~ rcL.~.~ft/~~~~A
PERMIT PROCESSING .zo.ne. ";1[//# Part. # V //1-- Parcel # ~ Parcel ~c~~
Minimum setbacks:. . <t;.front . : '; <to stcle ' . ;Ant. ; rear
'.com~ents.: UA~~/~) ;/;:r~--~. ..~~.. ~/~. ~f'.-I
TObetY~errriit _" /- .: ~. /
. BY.:. /r-:4~-,~~ Date~/(:J-.7Cj
~e C~ficaUon
Group
Fire Zone
CP&I' Type.
. .To .be typed on permIt
~'For plans information call(ar~nspec.tor) .
~ Di~ections to site. ~
_.~,. By
Date
Phone.
e
. C/ SIFO
Pl ans to: cpir
WPC
set(s)
set"{s)
Date
Required
Hold Slip
to PCC
Date
Completed
Da te to .
PCC
~ ;:::o,og
t:. / Pub 1 i c Wqrks
~/ Elevation C/ n/a
C/ Address
C/ Facility Permit
.' () Environl)lental Healttl
.
.
51/1
~
. . . .
. . FOR rNFOR~1ATION about progress of. your ap?lication call:
. G74 - In.. .
Permit' Control Center
687-HELP (687-4357)
.,. ~.. . ..
..~ kJ. O. _!'pE; ART{I~~:: O::iN ~I::N:::T ~~ E :::,\~Ei'E NT
~/(;;..6->~~ '.. EUGENE. OREGON 97401
/ddress 4p 7 n,l)"rfiiH';'f')'lf) 1 f'JJvt.f}.:, ' . City ,,'tt.l <;(
mshlp, Range, Section, Tax Lot \'1-03 - ,2l~~ \. -4!- loC U
6t,dlVision IGt ~) J Block
~PPlication for ~.C.K)Q~.~.: '.ex I ~tL'V"I-..,"" dr~. o~...ij ,
Structures now on the 'property vrrra 0:"\0 ., U('(H.~V- Y ()
Proposed use of property: /y/rRebdential. . C/ Co~me'rcial. /!)/ Industrial () Publ ic
Affidavit: I, l~ PiJ J, TL l.r;-I: Jft!/;:; /Ai , hereby certify that this information is true and accurate.
v ' ~ '0 ~ Y7 '( P 1 e a s e p r; n t ) , ."~rJ
If this application is for an agricultural building it will be used for purposes allowed by the State Building Code and
Lane County Code Chapter 10 (zoning) and for no other purpose. I have the following legal interest in the property:
~ owner of record; contract purchaser; lessee; holder of an exclusive option to purchase;
. ./ duly authorized to act for the owner, who is knowledgeable of this application.
Signature/Address '\.(0...\/\. t .I'H IU''J...},O/V\. .~ l() 0 (,.,9d-h PIner/}
T~lephone ""411L(')~1 t:z or D~te-n-
When permit is ready notify: /-/ Appl icant /-7.ciwn~r /-/ Contractor Ql: I-I mail
Owner 1.. ,A jq~"". S l.~(lJ ,~vv..rlN\ . d2...5. ~. Co~tti n\tlfn (zip)~"1""1
. ,. . (
t\. ) A (zip)
,~
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. 1
LC- _73;;;_~o:,p71
Assigned Numbers
~~~r1 (zip) 07-4\77
g u ~
C/ phone
Phone
Contractor
Phone
Contractor's OSR#
Plumbing by
DO NOT WRITE BELOW THIS LINE
If Commercial: # of stories
Residential: # of bedrooms 4-
.
SI test holes ready
# of employees
# of units
SDS: () Existing,
C/ Proposed,
BP #
SI #
~ /~4fi'1t~
t~"(~~
"Fee
Code
/.J /;:?' Description ~,
.,r:;;;.-......i _,~v~ ~ .&1
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'.- / :~... - ... ~ </(/~. . ~.:.-./..
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,. ,-;. k....;;:;i~/./ /,1 ... ../,.,4 ,~/~..- /
,-,.. //~.' ".~7-
.' .J,.'
Sq. Ft. or
# of Sites
Unit
Co"t
,. "-..
Valuation
Fee
",j,.t~
~
$ .. ..;;.'~ <-(-
~-
. ~
$
$
$
,..
Parcel #
$
each $
each $
$
$
$
$
." TO~AL. /.. . $ ~jo?S; ~
41" 7'- .. . > P/ Ii' P b/JJ
/"l.,.q""'->:, /;n /L- , _ _,~ f: ~.,.~, A~ r:' I
~ "... .- ~....~- -- ---.. ~.. ,~ _."
4;';. tf . .g:;f!(>,c/f ,,~ ~
fiWUr Parcel Slze v . l '1 m/';/'~JL?'t?..I
I' - -=.
;/int. ; rear .
Subtotal
Total Valuation: $
Plumbing fixtures at $
Sewer/water conn. at $
"~
....
.-.
6J.'V~:da~h"'... .
('~~#' ~
C/ Check # ~ , ~/
Received by >/:!!::.....e....//~'
,. -v~~---: ,
I Q )I} P t
Water .Supply
- --'"-'-
Proposed Existing
Year Installed.4 . ,
~ P.-. ;U~ f /' -"" ;..JJ<'.7..d" ~ I-4'f~.
., ~-
\/
4% State surcharge
Plans check fee
Change of Occupancy
PERMIT PROCESSING
Minimum setbacks:
Zone 71//,4-
't, front /
Part.
"'7~
# j)/ //7-.
; 't, s id~
.7: A ........A
4.-?-
....
~ ~
//--;-:;-,.... / d'/J_ //~ ~JrL-::;()-/
,tY' ....,~c.w-~.. /v.-. ~ ....,.......--, ., - - /
By _ /~ /#./.#' Da te . ~/ /J.- ?tt:p
WATER POLLUTION CONTROL . .,. ~~. . < /' ' "/.- ~ ~ .-.' .
[""",,;,, }f"";,,tl,," ~.v B...~_7~~. j\: of dSj!!lf'J'dl,l~g. depth of t"och"'.-
~' -. 1 To be typed on permit ! - _ ~ ~ ~ .~~~:~.....--J,4
f ~! tJ/V2Q..-. /(;fl>r?J. In ~ ~J ~ ~ (tJO!-t--'
. /7 ,/} /J . '- I 'v, .,. (J <
, .{/h4vy<<
:;? .
Comments .J,; ,;"'A/',.U'// I
. V. ...7'-..'.."'.-....
To be typed onypermit
"
.~
Directions to site
( ) Telephone
~.
BY~~
---- -. -,,,,,,,,-
Date _S-.~7!
CIS I Fa
/~I ep& I
CI wpe
CI Pl anni ng
CI Pub 1 i c Works
CI Elevation /-/ n/a
CI Address
C/ Facility Permit
CI Environmental Health
r lorl~ LU: Lr'6:1
wpe
set( s)
set(s)
Date
Required
FOR INFOm~TION about progress of your application call:
Hold Slip
'0 pee
Permit Control Cen te'-
U,.1i:e
COIT1p 1 e ted
687-HELP
Da te to
pee
(687 -4357)
aneco!Jnty
Water Pollutiun Control Division
Environmental Manaqement Department
125 East 8th Avenue
Eugene, Or~qon97401
LOCATION: Twp.l7 Ranqp 03 Section~3.J.1 Tax Lot # / ~
(Complete the following~ if apolicable)
Subdivision Name: Lot # Block #
)(
, system located on this property has ever failed by discharqing sewage upon
the ground surface or into public waters. by clogging or backing up, or in
any other manner. ..
I have no information that the existing subsurface sewage disposal
I have information that the existing subsurface sewage disposal sys-
tem located on this propert.y has failed in the past by discharging sewage
upon the ground surface or into public waters, by clogging or backing up, or
in some other manner, and that:
The system has not been repaired.
The system has been repaired and has operated continuously
since the repair without other failures.
Date(s) repaired
I have had personal knowledge of the performance of the existing
subsurface sewage disposal ~ystem located on this prooerty for
years and _ months. '
The existing sewage disposal system consists of:
a) Septic tank has a gallon capacity.
b) Number of drainlines
c) Length of drainlines
d) Distribution box? Yes No
. .
The existing septic ~ystem was installed
under Lane County Building Permit #
This system last served a dwelling having bedrooms (include all
rooms which could be used as a bedroom, though actually used for other
purposes such as for a den or a sewing room) OR, if for commercial use, this
system last se~ved an establishment having. employees, and gallons/
day sewage flow. This system was last used on (Date).
(Date) ~
In case of an addition, the new portion will be
existing drainfield.
APPLICANT:~ ;~.-d~./'L.
, .PROPERTY 15WNER: j- -IY.es r- ... No
DATE: s;-- /O-/~'7 .
. /
feet away from the
C74-156
WATER POLLUTION rr,NTROL DIVISION /
125 EAST 8TH AVENUE PUBLIC SERVICE BUILDING
ENVIRONMENTAL,MANAGEMENT DEPARTMENT
,ENE, OREGON 97401 / (503) 687-4061
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TAXLOT 17033311001
LOT BlK
001 NO STORIES NO BLDGS 001
UNIT COST VALUATION FEE D
LANE COUNTY DEPT ENV MGT RECEIPT
APPLICANT LIlEGREN KEN DATE 051079
SUBDIVISION
NEW BlDG TYPE USE R NO BDRMS 04 NO UNITS
CODE APPL NO ACTION DESCRIPTION SQ FT
BP
BP
BP
BF'
BP
ElF'
Pl NO. FIXTURES:
MECH
SUI~
PCI<
SOS lC 132379 SDSR
SIFO
cpr
WPC
.'""
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NO. CONNECTOf~S:
MECHANICAl. FEE
STATE SURCHARGE
PLAN CHECK FEE:
PLAN
ELEV ADDR FP
COMPLETED !{Y
::~
4.00 EACH::"
4%
~) i::
25.00
ENVH
TOTAL FEE**
25.00 CI'
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