HomeMy WebLinkAboutPermit Septic Tank 1974-6-28
,.
EL /~~~If T /_R03s 3.<: TAX LOT
/~ ( Cl "'us TRACT
\ ~ SrcL He K-f'Y/z ,e HOl1cJr-
APPLICANT /
/ o~7- 7/ NJ\ME Ihr kv ///e/1/v
ADDRESS / / /
BUILDING SITE EVALUATION
"- ,
I
1
() BUilding Permit Application No
() Site Inspection
() Pre-Permit Investigation
/'
PHONE
DATE
6'-/7- 7V
Zoning Ordinance Comp1 lance
(Zone )
SubdiVIsion Ordinance Compl lance
NOT
app I ,cab I e
() ()
( )
( )
( )
( )
NO
YES NAME
DATE
LANE COUNTY PLANNING DEPARTMENT
[
3
4
Required Access
( )
( )
( )
( )
)
)
2
BUilding Site (Area. Width.
Frontage. Setback)
Other (see comments)
~J
~i) ~~~N~
d- -/..5-75/
5
COMMENTS
BUILDING INSPECTION SECTION NOT NO YES NAME DATE
app I I cab I e (-y"/ L ~~._ .,~J
6 Plans Subm I tted ( ) ( ) "~ -...2-/-7;/
7 Soli Stability (footings) ( ) ( ) (...y/
8 Flood Plain (..y/ ( ) ( )
9 o the r (see Convnents) ( ) ( ) ( )
//COMMENTS
\,
'"
SANITATION SECTION NOT NO YES NAME DATE
apD I I cab I e
10 Sewage Disposal 9f~ ( ) ( )
11 Usable Area ( ) \ ( ) ( ) or iJ J(JvUrvL
12 Water Supply ( ) ( ) ( ) (jfi {I~,
13 Ot he r (see Comments) (I) ( ) ( ) In -;)6'-?f
COMMENTS
- ..., .~.. '..~ ....
. -......-..---..-,.
TO APPLI CANT
Your
1o-'t6/1i tr
gf
( )
( )
( )
BUildIng PermIt / Site Inspection
Can be app roved I
Cannot be approved at thiS time as Indicated on Item NO above
Questions and further Information on Items I through 5 contact the Lane-
COUNTY PLANNING DEPARTMENT Questions and further InformatIon on Items 6
through 13 contact the Lane County BUlldlnq and Sanitation DIVIsion
WII I be held In thiS office until you can resolve the problems Indicated
Is being returned
Your bUilding permit application fee IS beIng returned under separate cover
LANE COUNTY PLANNING DIVISION
135 S~xth Avenue East, Eugene, Oregon 97401
Phone (503) 687-4186
LANE COUNTY ENVIRONMENTAL MANAGEMENT
135 S~xth Avenue East, Eugene, Oregon 97401
Phone (503) 687-4065
C55-28
1>
.\
LANE CO"
BUILDING ir.-'
TV BUILDING PERMIT OR MOBILE
"
f
PROPERTY OWNER
W'~LE\ j t r-
CONTRACTOR
HCf:~Y J \1 :~
PROPERTY LOCATION - INCLUDE
i ?; ~ /L~ ijN ,\\. ~
! PROPERTY LEGAL DESCRIPTION - METES BOUNDS
'; f~. t,'1n t4d':t:..\ '! r M~!',J,fl ~ 07
> '
j TV"';I':>
11;:3
l" .it
MH'I
MAILING ADDRESS
Al..f.i3J S. L '/1 s.;~,"l If :1f If:: LO, ;l~
MAILING ADDRESS
'"')J(. HC9 r r.')\"'.. C ;~,r..~ f:'J tl~..
JME USE PERMIT
PERMIT NO
~On'I"J!'
PHONE
~JI,'" -" t(.
. 'HJ I""""
PHONE
(1;':; ~ 11 "".,
,+ U> r 1 r j;
!" <If"
\.l'f ~,~
POST OFFICE
B (jf,.l;;" '/Q
RP,NG E
~ 'I
03
SECTION
';,Il~
J'1lo:J-
TAX LOT NO
CODE
APPL
NAME
&
MAILING
ADDRESS
H
^~ hE"ikW
CENSUS TRACT
";\ t_,~.,
)~~l>lr ';J:::iJ
EXISTING STRUCTURES ON PROPERTY
HOMt "-.{'~N;'" t,
LEGAL ACCESS TO PROPERTY
/I., I..r~ .\\ill
~~~ to f"v~ HO~,~.(I\, ~f.i
E~f~ V'\H~f}l O~
fnJar:v):'
" ,
PROPERTY SIZE - FT
WIDTH
DEPTH
AREA
FOR MOBILE HOME PERMITS ONLY
No of Bedrooms
.. .. -. .. -----...--
STRUCTURES TO BE BUILT THIS PERMIT
tof, ;;...:i Du nc, Fj(~...PJ.1,H')1I }z" \'{)!},~ SMf)~.~
Connect to EXisting Sewage System ",]
TYPE CONSTRUCTION SQ FT ~ BDRMS
(~-N 2 ~ c) C ~l
,..
New System 0:
.---- ---
VALUATION
t i-l
SEWAGE DISPOSAL
PUBLIC n
BUILDING
WASTE DISPOSAL
PLUMBING
PLAN REVIEW
PARK TRAILER
SEPTIC TANK n OTHER[l
<~ {1\.)
$- ::-
FEES
PLUMBING INSTALLED BY
OWNER D OTHER NAME
WATER SUPPLY
PUBLIC rJ _JJ OTHER
,WITH DIST BOX GAL
MIN SEPTIC TANK CAPACITY
=p~
t- :J.~J,
$_, ~" :"n~
COUNTY BUILDING & SANITATION SPECIFICAT!ONS
DRAIN FielD REQUIRED
TOT AL
'r';,
lIN FT TRENCH WIDTH FT
OR SQ FT
11 It)r -'y' Olil~ 0\, r; J pr'A. I ~ 'I l~, 1;:;) O~' i, u '~I.l/ n ''(",(" r 1-:;\.. Ie'T~ 'f no ,I>- E't. I r- 14 t\l," ~IV'"'' 4[' f.H d h \
.:}TE'<.1 N.~} I.f~.l i"iJ~'Jt'rt~.JII-o :tVl.:~ttr.;;~.;i.C (~r.r r}.r1:J!~ fE,:.:aU1." A;o:.~A ~{ji=' D.F~h.~e"It...i~J
! \
ITYPE OF STRUCTURE
:~ ,.i ~\J
OCCUPANCY
)
ZONE
PUBLIC UTIL EASEMENT
BLDG SETBACKS FT FROM CTR OF ROAD RIGHT OF WAY
~O' 1 ~~
FRONT J SIDE INT SIDE EXT
.-. -
AUTHORIZED SIGNATURE - DATE
1 t } "/J ( fi.'X:;)f BY'.... C.. HA!'\6A'XH
REAR
USE CLASSIFICATION
I flU;:;
f~~
lC\f~iV t ~''''ilJ t 1 iW ij ~i
DATE
(c.,:.~i...J 71.i .H
BLDG PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANARY
BUILDING - GREEN
SANITATION - GOlDENROD
t
Call 687 4065 to schedule all required inspections All construc
tlon shall comply With Uniform Building Code DE Q standards
IMPORTANT for subsurface sewage disposal and county regulations coverrng
plumbing All buildings require a certifIcate of occupancy before
being occupied
(See Details on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG AT SITE)
LANE COUNTY DEPT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX 135 EAST 6th EUGENE OREGON 97401
FORM = CIS 13
J. ~ . .
'_' \1
. " '-
,I
~!TE INSPECTION
ApPROVED / .I
DISAPPROVED /
REMAR,KS
FOUNDATION INSPECTION
ApPROVED /
/ DISAPPROVED /
REMARKS
FRAMING INSPECTION
ApPROVED /
/ DISAPPROVED /
REMARKS
LATH'OR,SHEETROCK INSPECTION
ApPROVED /
/ DISAPPROVED /
REMARK S
FINAL INSPECTI~
ApPROVED ~/ DISAPPROVED
,
REMARK S
If
CERTIFICATE OF OCCUPANCY
READY TO ISSUE /
I DATE
INSPECTOR
/ DATE t
INSPECTOR
/ DATE
I NS.PECTOR
!. .."'_.
/ DAT'E
.. INSPECTOR
"
.".
/
'l ~c; - 7/(
INSPECTOR
/
DATE
I NOT READY TO ISSUE / _,,; DATE
REMARKS
/ ,II/) f17 t2~' ~,
___-fA ~ \Iv"'\;'! "
__J'_ .AI
/()~7~1f 11~ 20~~_~
"..
c?
INSPECTOR
'.
41
~,
"""
.... .,,,
tU11-'. ~ ~
PERMIT T~~,E_ CB~~~NG~lf~INf:'~~EM~:~R CJ :~B:~~ ~( ~SE. AP:~~c;;'~Ni:rf; I~V
PROPERTY OWNER . MAILING ADDRESS ~? ../J PHONE
_LV ~Jlo/)-1flLt_~5~ O'~ --a ,,- 7t/b-7t)tJ~
CONTRACTOR .cI- \ MAILING ADDRESS , /, J I ^ , ,.,. ~;. __ '. PHONE
'dtL,{L ~ _', 'JL'//D~':-'(~J/~._; -- .'.' 6tf'1o~/'//3
PROPERTY LOCATION - INCLUDE ST OFFICE" ,., .~ -.- " ,-",,--
~. ~
PROPERTY LEGAL DESCRIPTION? ~ /LA ,A
~! - BLOCK - SUBDIV rDRl) HQ'a
TWP RANGE SEC
~;~mKf!.l7z/E "J?1a.n()/2."
-- TAX LOT # CODE
,-
/ /J/ 0 METES & BOUNDS 0 YES
A..({)Tcf OL. -/ -- ATTACHED 0 NO
dNSUS TRACT
3'-/-~
~7 _,__, D3
AP:L~~:NT _~~/})
AND
MAILING
ADDRESS
0.3",
'., .~
DESCRIBE EXISTING STRUCTURES ON PROPERTY IF ANY
.. liD)?ti2'- Cia ro<;fL
LEGAL :L}LSL;~E4LJ~ NW;~~ ~ )
PROPERTY SIZE-WIDTH DEPTH AREA-
r .-
, r
FOR MOBILE HOME PERMIT ONLY
Number of Bedrooms
-- -----
STRUCTURES TO BEIUILT JHIS PERMIT
S h.tJfJ L1tu!b q
-P- _' V
('-LJ~ YJ1p
Connect f6 EXisting Sewage Syste D or New System Req 0
TYPE CONSTRUCTION /' 1 S FT c:.:--. # BEDROOMS VALUATION
~lI}/)ER \'JJtIJ,,{)j (/,2)1. J? d IC!,'-Vt-t <j~;:t
"'L. ~. /'
.'
/
SEWAGE DISPOSAL
PUB~D
SEPTIC TANK 0
"OTHER 0;' ; ~
FEES WATER SUPPLY
PUBLIc-;:D "
PLUMBING FEES
.. _ FIXTURES
CASH 0 SE~ER' "
CHECK [l....-etlNNECTION FEE
PUBLIC WATER
CONNECTION FEE
OTHER
l'
" I
/
PLUMBING INSTALLED BY
I
" OW~ER 0" OTHER 0 NAME
" " ~LANS FURNISHED FACILITY PERMIT
'~ ~?~S~~~~U~E ;~L~~I ' YES 0 NO Qt DATE
/--"-. 4U[A-~L~'~/ b-/?-7f
/ ::-_"F~E:dt7~:J /" ~- ( ;:7 f
I PERM'~ .J.L, --=~"'.... ,,'A I', t/
/ ~',.. -L. r-b/Jlfi1:J:' //'1 (Y,/]-7
I . .",. / c.../O -/
BLDG
WASTE DIS
PLUMBING
PLAN REVIEW
PARK TRLR
$ ,C)D..(')
TOTAL
.'1- dO
WITH DIST BOX GAL
COUNTY '_BUILDING & :?ANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED./.
I -
L1N FT TRENCH WIDTH FT
OR SQUARE FEET
MIN SEPTIC TANK CAPACITY
-~~
Ik Ad-_~--'~<~_~I~ ~/ (f~MY'--__ /
~'__I-' fi ~~~'l __ ;:.~- ,&/;r;~.1/__ :/A.,A_A~L;~/'l'J-rl' --'/1,,/ ~~:,
/ VI) cf: ~-' /; ~t y ;r-' - ~ (! t:'p -- ~ v
aJO~'~ ' ci ',~~/J - -, .Jl:;-~, )~~:.~=: U~
TYPE OF STRU-CJURE r~OC PANCY 0,,' ZONE t/ REAR YARD
o-Al. . " j
BLDG SETBACKS - FT FROM STR / USE CLASSIFICATION
FRONT Fc:/ SIDE INT S- _~,IDE EXT_ ,_ ,_ ~!,-R 7/ ;PUt"
It/JitA /~_{~O;;A~ If; _ ".6'- ~~ "D~;lkw_~d~:/?~?V
D''''''O~ P,ope,'y _l_~~ ____ _-=-_____ _ __' ____
PUBLIC UTIL EASEMENT
.io,
COpy 1 - OFFICE
~COPY 2 - JOURNAL
COPY 3 - AUDIT
~ Form == (55 12
~,. ..~-
"
------